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1.
PLoS Negl Trop Dis ; 13(8): e0007144, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31430283

RESUMO

The objective of this study was to assess the validity of the new dengue classification proposed by the World Health Organization (WHO) in 2009 and to develop pragmatic guidelines for case triage and management. This retrospective study involved 357 laboratory-confirmed cases of dengue infection diagnosed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia over a 4-year period from 2014 to 2017. The sensitivity of the new classification for identifying severe cases was limited (65%) but higher than the old one (30%). It had a higher sensitivity for identifying patients who needed advanced healthcare compared to the old one (72% versus 32%, respectively). We propose adding decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification. This modification improves sensitivity from 72% to 98% for identifying patients who need advanced healthcare without altering specificity (97%). It also improves sensitivity in predicting severe outcomes from 32% to 88%. In conclusion, the new classification had a low sensitivity for identifying patients needing advanced care and for predicting morbidity and mortality. We propose to include decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification to improve the sensitivity of predicting cases requiring advanced care.


Assuntos
Dengue/classificação , Dengue/diagnóstico , Organização Mundial da Saúde , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica , Medicina Clínica/métodos , Medicina Clínica/normas , Dengue/fisiopatologia , Feminino , Hemorragia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Arábia Saudita , Sensibilidade e Especificidade , Dengue Grave/classificação , Dengue Grave/diagnóstico , Índice de Gravidade de Doença , Trombocitopenia , Adulto Jovem
3.
Biochem Med (Zagreb) ; 29(2): 020502, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31223256

RESUMO

The post-analytical phase is the final phase of the total testing process and involves evaluation of laboratory test results; release of test results in a timely manner to appropriate individuals, particularly critical results; and modification, annotation or revocation of results as necessary to support clinical decision-making. Here we present a series of recommendations for post-analytical best practices, tailored to medical biochemistry laboratories in Croatia, which are intended to ensure alignment with national and international norms and guidelines. Implementation of the national recommendations is illustrated through several examples.


Assuntos
Pesquisa Biomédica/normas , Medicina Clínica/normas , Ciência de Laboratório Médico/normas , Humanos
4.
Am J Bioeth ; 19(6): 7-18, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31135322

RESUMO

Innovative practice occurs when a clinician provides something new, untested, or nonstandard to a patient in the course of clinical care, rather than as part of a research study. Commentators have noted that patients engaged in innovative practice are at significant risk of suffering harm, exploitation, or autonomy violations. By creating a pathway for harmful or nonbeneficial interventions to spread within medical practice without being subjected to rigorous scientific evaluation, innovative practice poses similar risks to the wider community of patients and society as a whole. Given these concerns, how should we control and oversee innovative practice, and in particular, how should we coordinate innovative practice and clinical research? In this article, I argue that an ethical approach overseeing innovative practice must encourage the early transition to rigorous clinical research without delaying or deferring the development of beneficial innovations or violating the autonomy rights of clinicians and their patients.


Assuntos
Medicina Clínica/normas , Ética Médica , Terapias em Estudo/ética , Terapias em Estudo/normas , Difusão de Inovações , Humanos , Direitos do Paciente/normas , Autonomia Pessoal , Autonomia Profissional , Medição de Risco , Responsabilidade Social , Padrão de Cuidado/ética
5.
Artigo em Russo | MEDLINE | ID: mdl-30790500

RESUMO

The article covers the life and the work of Ivan A. Petrovsky, doctor of medicine. His contribution into propaganda in the Russian Empire of the idea of French physician Pierre-Charles-Alexandre Louis (1787-1872) concerning necessity of applying the statistical method in the clinical medicine. At that, the new facts of the biography of P.-Ch.-A. Louis were established. So, it is established that in Russia he was family doctor in the family of Armand-Charles-Emmanuel de Guignard, Comte de Saint-Priest (1782-1863). This discovery permitted to specify the circumstances of life of P.-Ch.-A. Louis in the Russian Empire. The study is also based on the archive materials founded in the Russian State Military History Archive. They are introduced into the scientific circulation for the first time.


Assuntos
Medicina Clínica , Qualidade da Assistência à Saúde , Medicina Clínica/história , Medicina Clínica/normas , História do Século XIX , Humanos , Federação Russa
6.
BMC Health Serv Res ; 18(1): 964, 2018 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-30545370

RESUMO

BACKGROUND: Men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) infection and sexually transmitted infection (STI) in China. Inadequate clinical services and poor clinical competency among physicians are major barriers to improving the sexual health of MSM. This study aims to understand physician clinical competency in providing MSM health services in China. METHODS: We conducted an online cross-sectional survey among Chinese physicians who have seen male patients for STI complaints in the past year. We obtained information on individual demographics, clinical practice, attitudes toward MSM, and interest in contributing to MSM clinical services. We defined an MSM-competent physician as one who asked male patients about sexual orientation, sexual practices, and recommended HIV/ STI testing during a clinic visit. We conducted multivariable logistic regression to identify factors associated with MSM competency. RESULTS: In total, 501 physicians completed the survey. The most common subspecialties were dermatovenereology (33.1%), urology (30.1%), and general medicine (14.4%). Roughly half (n = 267, 53.3%) reported seeing MSM in the past 12 months. Among physicians who saw MSM in the past 12 months, 60.3% (n = 161) met criteria as MSM-competent physicians, and most (n = 234, 87.6%) MSM-competent physicians reported positive or neutral attitudes towards MSM. Over 60% of all physicians were willing to participate in activities for improving MSM services, such as training and being on a list of physicians willing to serve MSM. MSM-competent physicians showed no sociodemographic differences compared with non MSM-competent physicians. MSM-competent physicians were more willing to have their medical institution named on a public clinic list capable of serving MSM (aOR: 1.70, 95%CI: 1.01-2.86) and being on a public physician list capable of serving MSM (aOR: 1.77, 95%CI: 1.03-3.03). CONCLUSIONS: MSM-competent physicians included a broad range of individuals that practiced in diverse clinical settings. Most physicians were interested in improving and expanding MSM clinical services, despite having neutral attitudes toward same-sex behavior. Future interventions should focus on developing MSM clinical competency and expanding services that meet the needs of MSM.


Assuntos
Competência Clínica/normas , Médicos/normas , Doenças Sexualmente Transmissíveis/terapia , Adulto , Idoso , Atitude do Pessoal de Saúde , China , Medicina Clínica/normas , Medicina Clínica/estatística & dados numéricos , Estudos Transversais , Assistência à Saúde/normas , Feminino , Infecções por HIV/psicologia , Infecções por HIV/terapia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Sexologia/normas , Sexologia/estatística & dados numéricos , Comportamento Sexual , Saúde Sexual/normas , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/psicologia , Inquéritos e Questionários , Urologia/normas , Urologia/estatística & dados numéricos , Venereologia/normas , Venereologia/estatística & dados numéricos , Adulto Jovem
8.
J Microbiol Immunol Infect ; 51(6): 740-748, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28734676

RESUMO

BACKGROUND/PURPOSE: Dengue clinically dynamically changes over time; the World Health Organization (WHO) dengue classification framework proposed 3 dengue clinical phases-febrile (days 1-3), critical (days 4-6) and recovery (days ≥7) phases. This study aimed to better understand clinical and laboratory characteristics in adults (≥18 years) suffering dengue in different clinical phases at their hospital presentations. METHODS: A retrospective analysis of adults suffering dengue between 2008 and 2014. RESULTS: Of the 669 included dengue adults, 146 (21.8%) were elderly (≥65 years), and 27 (4%) suffered severe dengue. When compared with those in febrile phase, significantly higher incidence of ascites, mucosal bleeding, and/or gastrointestinal bleeding; lower white blood cell (WBC) and platelet counts; higher hematocrit, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were found in critical phase. When compared with their younger counterparts, elderly at febrile phase had significantly lower frequencies of bone pain, myalgia, headache and rash; higher frequencies of vomiting, pleural effusion and mucosal bleeding; higher WBC count, AST and ALT levels, and lower platelet count; in critical phase, elderly had significantly higher frequencies of pleural effusion, mucosal bleeding and gum bleeding. Four (0.6%) patients experienced severe dengue in recovery phase. Significantly higher proportions of elderly developed severe dengue in both febrile and critical phases as compared with younger adults. CONCLUSIONS: Elderly had lower frequency of classical dengue symptoms, yet were at higher risk of development of severe dengue during their early dengue course. A small number of patients developed severe dengue at the WHO-proposed recovery phase.


Assuntos
Medicina Clínica/métodos , Dengue Grave/epidemiologia , Adulto , Fatores Etários , Idoso , Medicina Clínica/normas , Dengue/epidemiologia , Dengue/patologia , Dengue/fisiopatologia , Feminino , Hospitais , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Dengue Grave/patologia , Dengue Grave/fisiopatologia , Índice de Gravidade de Doença , Taiwan/epidemiologia , Organização Mundial da Saúde , Adulto Jovem
9.
Clin Chem Lab Med ; 55(12): 1849-1856, 2017 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-29031018

RESUMO

Measurements in clinical laboratories produce results needed in the diagnosis and monitoring of patients. These results are always characterized by some uncertainty. What quality is needed and what measurement errors can be tolerated without jeopardizing patient safety should therefore be defined and specified for each analyte having clinical use. When these specifications are defined, the total examination process will be "fit for purpose" and the laboratory professionals should then set up rules to control the measuring systems to ensure they perform within specifications. The laboratory community has used different models to set performance specifications (PS). Recently, it was felt that there was a need to revisit different models and, at the same time, to emphasize the presuppositions for using the different models. Therefore, in 2014 the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) organized a Strategic Conference in Milan. It was felt that there was a need for more detailed discussions on, for instance, PS for EQAS, which measurands should use which models to set PS and how to set PS for the extra-analytical phases. There was also a need to critically evaluate the quality of data on biological variation studies and further discussing the use of the total error (TE) concept. Consequently, EFLM established five Task Finish Groups (TFGs) to address each of these topics. The TFGs are finishing their activity on 2017 and the content of this paper includes deliverables from these groups.


Assuntos
Técnicas de Laboratório Clínico/normas , Medicina Clínica/normas , Laboratórios/normas , Humanos , Controle de Qualidade
10.
Dtsch Med Wochenschr ; 142(18): 1390-1395, 2017 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-28902385

RESUMO

Standard operating procedures (SOP) in hospital care have the potential to improve treatment quality and transparency. However, after arriving at the decision to generate a SOP for the own hospital or ward, the upcoming question is often, how to start?The present article tries to give some interdisciplinary guidance about reasonable structures and contents of SOPs that could be understood as a basic matrix for individual work.


Assuntos
Medicina Clínica , Medicina Clínica/métodos , Medicina Clínica/normas , Departamentos Hospitalares , Humanos , Equipe de Assistência ao Paciente , Guias de Prática Clínica como Assunto
11.
Saúde Soc ; 26(3): 626-637, Jul.-Set. 2017.
Artigo em Português | LILACS | ID: biblio-903880

RESUMO

Resumo Este artigo objetiva apresentar uma crítica ao modelo biomédico de saúde predominante nas ciências médicas, a partir do conceito de normatividade vital, proposto por Georges Canguilhem. Na introdução apresentamos, a partir de um breve histórico do conceito de saúde, a normalização como o primado fundamental do modelo biomédico. Na primeira parte, discutimos o problema da determinação do normal e do patológico, da saúde e da doença, no pensamento de Canguilhem, buscando situar esses conceitos em função de valores individuais, questionando a existência de um processo normativo em biologia. Na segunda parte, pretende-se demonstrar que a normatividade vital defendida por Canguilhem é uma ferramenta conceitual fundamental para o entendimento da lógica de produção biológica. Esta lógica de produção não toma a norma como critério de valoração das formas de vida possíveis. Não são as individualidades biológicas que se adéquam ou se afastam das normas, mas, ao contrário, é a individualidade biológica enquanto potência de criação de novas formas que produz o processo de sua normatividade. Por fim, destacamos o impacto crítico do conceito de saúde entendido como uma abertura ao risco, enfatizando essa dimensão da saúde como a capacidade de enfrentar novas situações de vida.


Abstract This article aims to criticize the biomedical health model prevalent in medical sciences, based on the concept of vital normativity proposed by Georges Canguilhem. In the introduction we present, from a brief history of the health concept, normalization as the fundamental primacy of the biomedical model. In the first part, we discuss the problem of determining normal and pathological, health and illness in Canguilhem's thought, seeking to situate these concepts in function of individual values, questioning the existence of a normative process in Biology. In the second part, it aims to demonstrate that the vital normativity advocated by Canguilhem is a fundamental conceptual tool for the understanding of organic production logic. This production logic in Biology does not take the norm as criterion for valuing possible forms of life. Biological individuals do not fit or deviate from the rules, but biological individuality, as a power of generating new ways, produces the normativity process. Finally, we highlight the critical impact of the concept of health understood as an openness to risk, emphasizing this dimension of health as capacity to face new situations of life.


Assuntos
Humanos , Masculino , Feminino , Saúde , Doença , Risco , Medicina , Medicina Clínica/normas
15.
Nanotoxicology ; 11(2): 147-149, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28055261

RESUMO

Nanotechnology has transformed materials engineering. However, despite much excitement in the scientific community, translation of nanotechnology-based developments has suffered from significant translational gaps, particularly in the field of biomedicine. Of the many concepts investigated, very few have entered routine clinical application. Safety concerns and associated socioeconomic uncertainties, together with the lack of incentives for technology transfer, are undoubtedly imposing significant hurdles to effective clinical translation of potentially game-changing developments. Commercialisation aspects are only rarely considered in the early stages and in many cases, the market is not identified early on in the process, hence precluding market-oriented development. However, methodologies and in-depth understanding of mechanistic processes existing in the environmental, health and safety (EHS) community could be leveraged to accelerate translation. Here, we discuss the most important stepping stones for (nano)medicine development along with a number of suggestions to facilitate future translation.


Assuntos
Medicina Clínica , Nanomedicina , Nanotecnologia/métodos , Pesquisa Biomédica , Medicina Clínica/economia , Medicina Clínica/métodos , Medicina Clínica/normas , Saúde Ambiental , Humanos , Nanomedicina/economia , Nanomedicina/métodos , Nanomedicina/normas , Segurança
17.
Semin Dial ; 30(1): 69-79, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27611901

RESUMO

Since the beginning of life of the first multicellular organisms, the preservation of a physiologic milieu for every cell in the organism has been a critical requirement. A particular range of osmolality of the body fluids is essential for the maintenance of cell volume. In humans the stability of electrolyte concentrations and their resulting osmolality in the body fluids is the consequence of complex interactions between cell membrane functions, hormonal control, thirst, and controlled kidney excretion of fluid and solutes. Knowledge of these mechanisms, of the biochemical principles of osmolality, and of the relevant situations occurring in disease is of importance to every physician. This comprehensive review summarizes the major facts on osmolality, its relation to electrolytes and other solutes, and its relevance in physiology and in disease states with a focus on dialysis-related considerations.


Assuntos
Pressão Osmótica/fisiologia , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Desequilíbrio Hidroeletrolítico/prevenção & controle , Medicina Clínica/normas , Medicina Clínica/tendências , Soluções para Diálise , Feminino , Humanos , Masculino , Monitorização Fisiológica/métodos , Concentração Osmolar , Segurança do Paciente/estatística & dados numéricos , Medição de Risco , Resultado do Tratamento , Ultrafiltração/efeitos adversos , Ultrafiltração/métodos , Desequilíbrio Hidroeletrolítico/etiologia
19.
J Neurol Sci ; 369: 306-309, 2016 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-27653914

RESUMO

BACKGROUND: Use of TPA to treat patients with acute ischemic stroke was introduced in Assaf Harofeh Medical Center (AHMC) in Israel in November 2007 initially with strict adherence to the inclusion/exclusion criteria of the pivotal NINDS TPA studies published in 1995. The treatment window was expanded in 2010 to 4.5h following the results of ECASS-III. Application of the 2013 AHA/ASA Guidelines resulted in further expanded inclusion and relaxed exclusion criteria. DESIGN/METHODS: A retrospective chart review was conducted of patients who received TPA at AHMC to evaluate the additional impact of applying the 2013 guidelines. Number of patients treated, outcomes at discharge, and safety were compared between two periods: May 2011-January 2013 (the 21months preceding the 2013 Guidelines); and February 2013-October 2014 (the 21months after publication of the 2013 Guidelines). Statistical analysis was done using z-tests for differences between proportions, and t-tests to compare means. RESULTS: 63 patients were treated during the immediate pre-2013 Guideline period (36/year, or approximately 5% of patients with ischemic stroke), and 105 during the post-2013 Guidelines period (60/year, approximately 8.3% of patients with ischemic stroke) (p<0.001). During the two periods, respectively: discharges home were 22(34%) and 55(52%) (p<0.05); facility discharges were 29(46%) and 33(31%); and inter-hospital transfers were 6(9%), and 11(10% of treated patients). Most transfers were for endovascular treatment. Total treatment-related symptomatic bleeds in the two periods, respectively, was: 4(6%) and 4(4%), and the number of in-hospital deaths was 6 (9%) and 6 (6%) (unchanged). CONCLUSIONS: Application of the 2013 AHA/ASA Guidelines resulted in a 64% increase in the number of acute ischemic stroke patients treated with TPA at AHMC with no worsening of aggregate outcomes and no increase in bleeds or deaths.


Assuntos
Isquemia Encefálica/complicações , Medicina Clínica/normas , Fibrinolíticos/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Ativador de Plasminogênio Tecidual/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais/normas , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
20.
Acad Med ; 91(12): 1612-1617, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27254011

RESUMO

The clinician-scientist role is critical to the future of health care, and in 2010, the Carnegie Report on Educating Physicians focused attention on the professional identity of practicing clinicians. Although limited in number, published studies on the topic suggest that professional identity is likely a critical factor that determines career sustainability. In contrast to clinicians with a singular focus on clinical practice, clinician-scientists combine two major disciplines, clinical medicine and scientific research, to bridge discovery and clinical care. Despite its importance to advancing medical practice, the clinician-scientist career faced a variety of threats, which have been identified recently by the 2014 National Institutes of Health Physician Scientist Workforce. Yet, professional identity development in this career pathway is poorly understood. This Perspective focuses on the challenges to the clinician-scientist's professional identity and its development. First, the authors identify the particular challenges that arise from the different cultures of clinical care and science and the implications for clinician-scientist professional identity formation. Next, the authors synthesize insights about professional identity development within a dual-discipline career and apply their analysis to a discussion about the implications for clinician-scientist identity formation. Although not purposely developed to address identity formation, the authors highlight those elements within clinician-scientist training and career development programs that may implicitly support identity development. Finally, the authors highlight a need to identify empirically the elements that compose and determine clinician-scientist professional identity and the processes that shape its formation and sustainability.


Assuntos
Pesquisa Biomédica/educação , Competência Clínica , Medicina Clínica/educação , Educação Médica , Papel do Médico , Pesquisa Biomédica/normas , Pesquisa Biomédica/tendências , Escolha da Profissão , Medicina Clínica/normas , Medicina Clínica/tendências , Educação Médica/normas , Educação Médica/tendências , Humanos , Estados Unidos
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