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2.
Doc Ophthalmol ; 140(1): 5-12, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31902035

RESUMO

The International Society for the Clinical Electrophysiology of Vision (ISCEV) standard for full-field electroretinography (ERG) describes a minimum set of tests, but encourages the use of additional protocols for clinical ERG testing. This extended protocol describes recording methods and derivations that will allow analysis of rod-driven components of the dark-adapted (DA) strong flash ERG a-wave, more closely related to rod phototransduction than ISCEV standard DA ERGs. The method involves recording ERGs to a flash strength equivalent to 30 cd s m2 under conditions of dark adaptation and additionally to the same stimulus following light adaptation (LA) and in the presence of a standard photopic background luminance of 30 cd m-2. The isolated rod-driven ERG a-wave is derived by subtracting the LA response from the DA ERG. The method is likely to be of value in the characterization of retinal disorders which affect rod quantal catch, diseases that affect the dynamics of any component of the activation phase of rod phototransduction, or those affecting total numbers of rod photoreceptors.


Assuntos
Protocolos Clínicos/normas , Eletrorretinografia , Estimulação Luminosa , Células Fotorreceptoras Retinianas Bastonetes/fisiologia , Sociedades Médicas/normas , Visão Ocular/fisiologia , Adaptação à Escuridão/fisiologia , Eletrofisiologia/normas , Humanos , Internacionalidade , Luz
3.
Distrito Federal; s.n; 2020. 32 p.
Não convencional em Português | LILACS, Coleciona SUS | ID: biblio-1050437

RESUMO

Em 22 de janeiro de 2020, foi ativado o Centro de Operações de Emergências em Saúde Pública para o novo Coronavírus (COE ­ nCoV), estratégia prevista no Plano Nacional de Resposta às Emergências em Saúde Pública do Ministério da Saúde. O novo Coronavírus (2019-nCoV) é um vírus identificado como a causa de um surto de doença respiratória detectado pela primeira vez em Wuhan, China. Desde 2005, o Sistema Único de Saúde (SUS) está aprimorando suas capacidades de responder às emergências por síndromes respiratórias, dispondo de planos, protocolos, procedimentos e guias para identificação, monitoramento e resposta às emergências em saúde pública...


Assuntos
Humanos , Protocolos Clínicos/normas , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia
4.
Z Evid Fortbild Qual Gesundhwes ; 147-148: 34-44, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31732386

RESUMO

BACKGROUND: Evidence-based and formally consensus-based clinical practice guidelines (S3-CPGs) are a valuable source for the development of quality indicators (QIs) in Germany. While deriving QIs from guideline recommendations is a mandatory part of the development of S3-CPGs within the National Program for Disease Management Guidelines (DMGP) and the German Guideline Program in Oncology (GGPO), there is no such obligation in the guideline program of the Association of the Scientific Medical Societies in Germany (AWMF) (MS program). Despite that, several S3-CPGs in the MS program have been published with QIs in the last years while some DMGP and one GGPO S3 guidelines have failed to meet this requirement. From the perspective of the guideline authors of all three mentioned programs, the present qualitative study examined why S3-CPGs do or do not contain QIs and explored the factors perceived by authors as either facilitating or hampering in the QI development process. METHODS: Semi-structured interviews were conducted with authors of 22 S3-CPGs, 11 of which represented guidelines containing QIs and 11 of which represented guidelines without QIs. Authors of guidelines containing QIs (n=11) were asked about the perceived decisive reasons for formulating QIs and about facilitators and barriers during the QI development process. Authors of guidelines without QIs (n=11) gave reasons for not formulating QIs. Interviews were analyzed using structuring qualitative content analysis. RESULTS: Within the MS program, not formulating QIs was mainly attributed to the lack of a mandatory requirement and to insufficient funding of guideline projects. Amongst DMGP authors, a low priority of QI development prevailed, which was, for example, due to already existing QIs or to their lacking implementation. In the GGPO guideline examined, not formulating QIs was due to the guideline topic (prevention) - for this topic, there was a lack of suitable evidence and data sources. If QIs were developed, the most important facilitating factor in the development process, across all programs, was the methodological support provided by the guideline program. Important hampering factors included the additional time required for QI development and concerns regarding the implementation of many potential QIs, especially due to a lack of data availability. DISCUSSION: For regular development of QIs within S3-CPG projects, the incorporation of such a requirement in the guideline program is a necessary, but not a sufficient, condition. Other pivotal factors include systematic methodological support, adequate financial and staff resources and the perceived meaningfulness and relevance of guideline-based QI development, measured in terms of the actual implementation of already existing QIs. CONCLUSION: The study reveals starting points for measures to strengthen the consideration of QI development in German S3-CPG projects, especially within the MS program. Without substantial structural changes, especially of the resources of guideline groups, and without an overall concept covering the entire process from QI development to QI implementation, guideline-based QI development will remain heavily dependent on the (self-)motivation of guideline groups.


Assuntos
Recursos em Saúde , Guias de Prática Clínica como Assunto/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Sociedades Médicas , Protocolos Clínicos/normas , Assistência à Saúde/normas , Alemanha , Humanos , Oncologia , Pesquisa Qualitativa
5.
Dis Colon Rectum ; 62(11): 1305-1315, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31567924

RESUMO

BACKGROUND: Delayed initiation of adjuvant chemotherapy negatively impacts long-term survival in patients with colorectal cancer. Colorectal enhanced recovery protocols result in decreased complications and length of stay; however, the impact of enhanced recovery on the timing of adjuvant chemotherapy remains unknown. OBJECTIVE: This study aimed to identify factors associated with on-time delivery of adjuvant chemotherapy after colorectal cancer surgery, hypothesizing that implementation of an enhanced recovery protocol would result in more patients receiving on-time chemotherapy. DESIGN: This was a retrospective cohort study comparing the rate of on-time adjuvant chemotherapy delivery after colorectal cancer resection before and after implementation of an enhanced recovery protocol. SETTINGS: The study was conducted at a large academic medical center. PATIENTS: All of the patients who underwent nonemergent colorectal cancer resections for curative intent from January 2010 to June 2017, excluding patients who had no indication for adjuvant chemotherapy, had received preoperative systemic chemotherapy, or did not have medical oncology records available were included. MAIN OUTCOME MEASURES: Patients before and enhanced recovery were compared, with the rate of on-time adjuvant chemotherapy delivery as the primary outcome. Adjuvant chemotherapy delivery was considered on time if initiated ≤8 weeks postoperatively, and treatment was considered delayed or omitted if initiated >8 weeks postoperatively (delayed) or never received (omitted). Multivariable logistic regression identified predictors of on-time chemotherapy delivery. RESULTS: A total of 363 patients met inclusion criteria, with 189 patients (52.1%) undergoing surgery after enhanced recovery implementation. Groups differed in laparoscopic approach and median procedure duration, both of which were higher after enhanced recovery. Significantly more patients received on-time chemotherapy after enhanced recovery implementation (p = 0.007). Enhanced recovery was an independent predictor of on-time adjuvant chemotherapy (p = 0.014). LIMITATIONS: The study was limited by its retrospective and nonrandomized before-and-after design. CONCLUSIONS: Enhanced recovery was associated with receiving on-time adjuvant chemotherapy. As prompt initiation of adjuvant chemotherapy improves survival in colorectal cancer, future investigation of long-term oncologic outcomes is necessary to evaluate the potential impact of enhanced recovery on survival. See Video Abstract at http://links.lww.com/DCR/B21. LA IMPLEMENTACIÓN DE UN PROTOCOLO DE RECUPERACIÓN ACELERADA SE ASOCIA CON EL INICIO A TIEMPO DE QUIMIOTERAPIA ADYUVANTE EN CÁNCER COLORRECTAL:: El inicio tardío de la quimioterapia adyuvante afecta negativamente la supervivencia a largo plazo en pacientes con cáncer colorrectal. Los protocolos de recuperación acelerada colorrectales dan lugar a una disminución de las complicaciones y la duración de estancia hospitalaria; sin embargo, el impacto de la recuperación acelerada en el momento de inicio de quimioterapia adyuvante sigue siendo desconocido.Este estudio tuvo como objetivo identificar los factores asociados con la administración a tiempo de la quimioterapia adyuvante después de la cirugía de cáncer colorrectal, con la hipótesis de que la implementación de un protocolo de recuperación acelerada daría lugar a que más pacientes reciban quimioterapia a tiempo.Estudio de cohorte retrospectivo que compara la tasa de administración de quimioterapia adyuvante a tiempo después de la resección del cáncer colorrectal antes y después de la implementación de un protocolo de recuperación acelerada.Centro médico académico grande.Todos los pacientes que se sometieron a resecciones de cáncer colorrectal no emergentes con intención curativa desde enero de 2010 hasta junio de 2017, excluyendo a los pacientes que no tenían indicación de quimioterapia adyuvante, que recibieron quimioterapia sistémica preoperatoria o no tenían registros médicos de oncología disponibles.Los pacientes se compararon antes y después de la implementación de la recuperación acelerada, con la tasa de administración de quimioterapia adyuvante a tiempo como el resultado primario. La administración de quimioterapia adyuvante se consideró a tiempo si se inició ≤8 semanas después de la operación, y el tratamiento se consideró retrasado / omitido si se inició> 8 semanas después de la operación (retrasado) o nunca fue recibido (omitido). La regresión logística multivariable identificó predictores de administración de quimioterapia a tiempo.363 pacientes cumplieron con los criterios de inclusión, con 189 (52.1%) pacientes sometidos a cirugía después de la implementación de recuperación acelerada. Los grupos difirieron en el abordaje laparoscópico y la duración media del procedimiento; ambos factores fueron mayores después de la recuperación acelerada. Significativamente más pacientes recibieron quimioterapia a tiempo después de la implementación de recuperación acelerada (p = 0.007). La recuperación acelerada fue un factor predictivo independiente de quimioterapia adyuvante a tiempo (p = 0.014).Diseño retrospectivo, tipo ¨antes y después¨ no aleatorizado.La recuperación acelerada se asoció con la recepción de quimioterapia adyuvante a tiempo. Debido a que el inicio rápido de la quimioterapia adyuvante mejora la supervivencia en el cáncer colorrectal, en el futuro será necesario investigar los resultados oncológicos a largo plazo para evaluar el impacto potencial de la recuperación acelerada en la supervivencia. Vea el Resumen en Video en http://links.lww.com/DCR/B21.


Assuntos
Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante/métodos , Colectomia/reabilitação , Neoplasias Colorretais , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica/efeitos dos fármacos , Sobreviventes/estatística & dados numéricos , Tempo para o Tratamento , Protocolos Clínicos/normas , Colectomia/métodos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/reabilitação , Neoplasias Colorretais/terapia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tempo para o Tratamento/normas , Tempo para o Tratamento/estatística & dados numéricos , Estados Unidos/epidemiologia
6.
J Stroke Cerebrovasc Dis ; 28(12): 104423, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31606319

RESUMO

BACKGROUND: The Mission Protocol was implemented in 2017 to expedite stroke evaluation and reduce door-to-needle (DTN) times at Zuckerberg San Francisco General Hospital. The key system changes were team-based evaluation of suspected stroke patients at ambulance entrance by an Emergency Department (ED) physician, ED nurse, and neurologist and immediate emergency medical service (EMS) provider transport of patients to CT. METHODS: Patients were eligible for a Mission Protocol prehospital stroke activation if an EMS provider found a positive Cincinnati Prehospital Stroke Scale and a last known normal time within 6 hours. We retrospectively compared treatment metrics between the first year of Mission Protocol patients and patients from the year prior also brought in via ambulance with suspected stroke and a last known normal time within 6 hours. Median Door to CT and DTN times were compared using 2 sample Wilcoxon rank-sum (Mann-Whitney) tests. RESULTS: There were 236 patients in the Mission Protocol group and 112 in the comparison group. The Mission Protocol was associated with a 10 minutes faster median door to CT time (P < .00001), a 6 minutes faster median DTN time (P = .0046), a 22% increase in the proportion of patients treated within 45 minutes of arrival (84% versus 62%), and a 12% increase in the proportion of patients treated within 60 minutes (92% versus 80%). There were 8 stroke mimics treated in the Mission Protocol cohort compared to 2 in the comparison cohort. Symptomatic intracranial hemorrhage occurred in one Mission Protocol patient with an ischemic stroke. CONCLUSIONS: The EMS direct to CT based Mission Protocol was associated with faster median door to CT and DTN times. There was a 22% increase in the proportion of thrombolysis patients treated within 45 minutes or less. More stroke mimic patients received thrombolysis but symptomatic intracranial hemorrhage only occurred in 1 ischemic stroke patient.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Protocolos Clínicos/normas , Serviços Médicos de Emergência/normas , Fibrinolíticos/administração & dosagem , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/normas , Tempo para o Tratamento/normas , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/normas , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X/normas , Resultado do Tratamento
7.
Eur J Radiol ; 120: 108662, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31539790

RESUMO

PURPOSE: The Prostate Imaging-Reporting and Data System has been developed to standardize prostate MRI in terms of acquisition, interpretation and reporting. It received a major revision in late 2014 (PI-RADSv2). Recently, doubts have been raised on imaging facilities adherence to its acquisition protocol. With this systematic review, we assessed adherence to PI-RADSv2 minimum technical specifications in literature, to achieve a better understanding of issues limiting their diffusion. METHOD: Multiple medical literature databases were extensively searched to retrieve original studies published after January 2016 performing prostate MRI. Information pertaining acquisition protocols and patient enrolment were recorded for analysis. Technical parameters were dichotomized in relation to adherence to the corresponding minimal technical requirements. RESULTS: A total of 150 studies were included for analysis. Only 5% reported every technical parameter specified in the PI-RADSv2 document requirements, none of which completely met guideline specifications. Overall, 19% were in line with PI-RADSv2 for all reported MRI acquisition parameters. The adherence was lowest for T2-weighted frequency in-plane resolution (12%), diffusion-weighted imaging field of view (40%), apparent diffusion coefficient map low b-value (27%) and dynamic contrast-enhanced imaging temporal resolution (43%). Considering its role in image interpretation, it must be highlighted that only 59% of studies reporting diffusion-weighted imaging high b-value follow recommendations. CONCLUSIONS: Adherence to PI-RADSv2 minimum technical standards is heterogeneous in the scientific community. Our findings endorse the need for greater diffusion of PI-RADSv2 guidelines to achieve protocol standardization and support the notion that some requirements might benefit from streamlining to improve clinical applicability.


Assuntos
Neoplasias da Próstata/diagnóstico , Idoso , Protocolos Clínicos/normas , Imagem de Difusão por Ressonância Magnética/métodos , Humanos , Aumento da Imagem/normas , Imagem por Ressonância Magnética/métodos , Masculino , Padrões de Referência , Estudos Retrospectivos
8.
Z Evid Fortbild Qual Gesundhwes ; 146: 15-20, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31473073

RESUMO

BACKGROUND: The bureaucratic and administrative burden for obtaining the obligatory Institutional Review Board (IRB) approval, which confirms the ethical integrity of a scientific project, is high. In order to participate in multicenter studies, most participating centers in Germany require a local second approval. We investigated the variation in the time it took the participating centers of a non-interventional multicenter study to obtain this approval. METHODS: Descriptive investigation of the amount of time it takes to gain an IRB approval for a multicenter observational study on the quality of life of sarcoma patients conducted throughout Germany. Stratified analyses were carried out on the basis of potential predictors of this duration and reasons for requests for revisions by the IRB were identified. RESULTS: 44 applications for ethics approval were submitted to 26 IRBs. To obtain the 25 second approvals took 53.6 days on average (standard deviation 49.8 days, median 34 days). While State Medical Chambers needed an average of 20.3 days for a local second approval, university hospitals needed 72.4 days. 81.3 % of the university IRBs and 33.3% of the IRB of the State Medical Chambers made specific requests. Ten IRBs followed the recommendations of the primary approval without undertaking their own assessment (average 41.3 days), five IRBs examined the application in an abbreviated procedure (51.4 days), and ten examined it thoroughly (67.1 days). CONCLUSION: Submitting ethics approval applications for observational studies in a clinical setting involved considerable effort and long waiting times in 2017 and 2018. Simplified review procedures or a waiver of examination by local IRBs do not necessarily mean shorter processing times. In general, there is a continued need for further progress.


Assuntos
Protocolos Clínicos/normas , Comitês de Ética em Pesquisa , Qualidade de Vida , Ensaios Clínicos como Assunto/normas , Coleta de Dados , Alemanha , Humanos , Estudos Multicêntricos como Assunto/normas
9.
Nat Rev Drug Discov ; 18(10): 797-807, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31462747

RESUMO

Researchers, clinicians, policymakers and patients are increasingly interested in questions about therapeutic interventions that are difficult or costly to answer with traditional, free-standing, parallel-group randomized controlled trials (RCTs). Examples include scenarios in which there is a desire to compare multiple interventions, to generate separate effect estimates across subgroups of patients with distinct but related conditions or clinical features, or to minimize downtime between trials. In response, researchers have proposed new RCT designs such as adaptive platform trials (APTs), which are able to study multiple interventions in a disease or condition in a perpetual manner, with interventions entering and leaving the platform on the basis of a predefined decision algorithm. APTs offer innovations that could reshape clinical trials, and several APTs are now funded in various disease areas. With the aim of facilitating the use of APTs, here we review common features and issues that arise with such trials, and offer recommendations to promote best practices in their design, conduct, oversight and reporting.


Assuntos
Protocolos Clínicos/normas , Ensaios Clínicos como Assunto/normas , Tomada de Decisões , Projetos de Pesquisa , Humanos
10.
Int J Eat Disord ; 52(9): 1015-1023, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31408212

RESUMO

OBJECTIVE: Although hospitalization is sometimes necessary when treating individuals with anorexia nervosa, the available literature provides limited guidance to inform decisions surrounding optimal components or duration of inpatient treatments. We report observational data comparing outcomes of two inpatient treatments. The first was longer and more strictly structured around a Contingency Management Protocol (CMP) emphasizing external incentives for achieving weight-restoration goals; the second was a shorter Autonomy Support Protocol (ASP) that progressively increased patient autonomy around meal management without external incentives. METHOD: We compared data from 41 patients who participated in the ASP to a historical sample of 41 patients treated using the CMP. At admission, discharge, and post-treatment follow-up, participants completed the Eating Disorder Examination Questionnaire and the Behavior and Symptom Identification Scale-32, and we measured height and weight to compute body mass index. RESULTS: Multilevel modeling analyses that controlled for time in treatment and time in follow-up indicated the two protocols yielded equivalent in-treatment gains and post-treatment loss of gains. DISCUSSION: Our results indicate that shorter inpatient stays emphasizing autonomous control over eating behavior may yield outcomes that are equivalent to those of lengthier, more stringent, and more costly approaches implicating external incentives and controls.


Assuntos
Anorexia Nervosa/terapia , Protocolos Clínicos/normas , Adulto , Feminino , Hospitalização , Humanos , Pacientes Internados , Masculino , Resultado do Tratamento , Adulto Jovem
11.
Br J Surg ; 106(9): 1204-1215, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31268180

RESUMO

BACKGROUND: The UK Medical Research Council ST03 trial compared perioperative epirubicin, cisplatin and capecitabine (ECX) chemotherapy with or without bevacizumab (B) in gastric and oesophagogastric junctional cancer. No difference in survival was noted between the arms of the trial. The present study reviewed the standards and performance of surgery in the context of the protocol-specified surgical criteria. METHODS: Surgical and pathological clinical report forms were reviewed to determine adherence to the surgical protocols, perioperative morbidity and mortality, and final histopathological stage for all patients treated in the study. RESULTS: Of 1063 patients randomized, 895 (84·2 per cent) underwent resection; surgical details were available for 880 (98·3 per cent). Postoperative assessment data were available for 873 patients; complications occurred in 458 (52·5 per cent) overall, of whom 71 (8·1 per cent) developed complications deemed to be life-threatening by the responsible clinician. The most common complications were respiratory (211 patients, 24·2 per cent). The anastomotic leak rate was 118 of 873 (13·5 per cent) overall; among those who underwent oesophagogastrectomy, the rate was higher in the group receiving ECX-B (23·6 per cent versus 9·9 per cent in the ECX group). Pathological assessment data were available for 845 patients. At least 15 nodes were removed in 82·5 per cent of resections and the median lymph node harvest was 24 (i.q.r. 17-34). Twenty-five or more nodes were removed in 49·0 per cent of patients. Histopathologically, the R1 rate was 24·9 per cent (208 of 834 patients). An R1 resection was more common for proximal tumours. CONCLUSION: In the ST03 trial, the performance of surgery met the protocol-stipulated criteria. Registration number: NCT00450203 ( http://www.clinicaltrials.gov).


Assuntos
Adenocarcinoma/cirurgia , Junção Esofagogástrica , Garantia da Qualidade dos Cuidados de Saúde , Neoplasias Gástricas/cirurgia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/administração & dosagem , Bevacizumab/uso terapêutico , Capecitabina/administração & dosagem , Capecitabina/uso terapêutico , Cisplatino/administração & dosagem , Cisplatino/uso terapêutico , Protocolos Clínicos/normas , Terapia Combinada , Epirubicina/administração & dosagem , Epirubicina/uso terapêutico , Junção Esofagogástrica/cirurgia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Gastrectomia/normas , Humanos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Estômago/cirurgia , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/terapia
12.
J Surg Res ; 244: 122-129, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31284141

RESUMO

BACKGROUND: The objective of this study was to evaluate clinical outcomes, costs, and clinician and parent satisfaction after implementation of a protocol to discharge patients from the emergency department (ED) after successful reduction of uncomplicated ileocolic intussusception. MATERIALS AND METHODS: In March 2017, an intussusception management protocol was implemented for children presenting with ultrasound findings of ileocolic intussusception. Those meeting inclusion criteria were observed after successful radiological reduction in the ED and discharged after 6 h with resolution of symptoms. Retrospective chart review was completed for cases before and after protocol implementation for clinical outcomes and costs. Clinicians and parents were surveyed to assess overall satisfaction. RESULTS: Charts were reviewed before (42 encounters, 37 patients) and after (30 encounters, 23 patients) protocol implementation. After implementation, admission rates decreased from 95% (40/42) to 23% (7/30; P < 0.001) and antibiotic use was eliminated (91% to 0%, P < 0.001). There was no difference in recurrence rates (17% versus 23%, P = 0.44). Median total length of stay decreased from 18.87 to 9.52 h (P < 0.001), whereas median ED length of stay increased from 4.37 to 9.87 h (P < 0.001). In addition, there was an overall hospital cost saving of over $2000 ($9595 ± 3424 to $7465 ± 3723; P = 0.009) per encounter. Clinicians and parents were overall satisfied with the protocol and parents showed no changes in patient satisfaction with protocol implementation. CONCLUSIONS: An intussusception protocol can facilitate early discharge from the ED and improve patient care without increased risk of recurrence. Additional benefits include decreased hospital- and patient-related costs, elimination of antibiotic use, and parent as well as clinician satisfaction.


Assuntos
Protocolos Clínicos/normas , Implementação de Plano de Saúde , Doenças do Íleo/terapia , Intussuscepção/terapia , Satisfação Pessoal , Pré-Escolar , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Enema , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Doenças do Íleo/economia , Lactente , Recém-Nascido , Intussuscepção/economia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Alta do Paciente/normas , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Estudos Retrospectivos , Prevenção Secundária/economia , Prevenção Secundária/organização & administração , Prevenção Secundária/normas , Inquéritos e Questionários/estatística & dados numéricos
13.
Chem Biol Interact ; 310: 108739, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31288001

RESUMO

Phenol red (PR) is the standard pH indicator in various cell and tissue culture media, as it provides a quick check for the health of the culture. PR has also been used in multiple protocols to detect cellular hydrogen peroxide as well as peroxidase activity from human peroxidase enzymes. The majority of promyelocytic leukemia cell lines (e.g. HL-60 cells) express myeloperoxidase (MPO), which may react with PR, especially as the latter is present in cell culture media at sufficient concentrations (~15 µM) to partake in redox reactions. Moreover, phenolic molecules are often efficient donor substrates for peroxidase enzymes. In this study, we hypothesized that MPO metabolism of PR via MPO-expressing HL-60 cells could result in PR metabolite(s) that could modulate cell viability. We used purified human MPO for UV-visible spectrophotometry, electron paramagnetic resonance (EPR) and LC-MS analyses to investigate PR peroxidation. 2-chloro-5,5-dimethyl-1,3-cyclohexanedione (monochloro-dimedone, MCD) was used to assess the effect of PR on MPO-catalyzed chlorination activity, and we assessed PR uptake by HL-60 cells using LC-MS analysis. Lastly, we investigated the impact of PR metabolism by intracellular MPO on cell viability (ATP, using CellTiter-Glo®), cytotoxicity (using trypan blue), and on reduced and oxidized glutathione (using GSH/GSSG-Glo™). Our results demonstrate that PR undergoes oxidative halogenation via MPO, resulting in its UV-vis spectral changes due to the formation of mono- and di-halogenated products. Moreover, a significant increase in MPO-catalyzed chlorination of MCD and an increase in glutathionyl radical detection (using EPR) were observed in the presence of PR. Our in-vitro studies revealed that PR is readily taken up by HL-60 cells and its metabolism by intracellular MPO leads to a significant decrease in cellular glutathione as well as a significant increase in glutathione disulphide formation. In spite of the latter, PR had no considerable effect on HL-60 cell viability. These results provide evidence that while no overt decrease in cell viability may be observed, PR does impart redox activity, which investigators should be wary of in experimental protocols.


Assuntos
Protocolos Clínicos/normas , Concentração de Íons de Hidrogênio , Peroxidase/metabolismo , Fenolsulfonaftaleína/farmacologia , Células HL-60 , Halogenação , Humanos , Peróxido de Hidrogênio/metabolismo , Leucemia Promielocítica Aguda/enzimologia , Leucemia Promielocítica Aguda/metabolismo , Leucemia Promielocítica Aguda/patologia , Oxirredução , Fenolsulfonaftaleína/química , Fenolsulfonaftaleína/metabolismo , Fenolsulfonaftaleína/farmacocinética , Espectrofotometria
15.
Zhonghua Wai Ke Za Zhi ; 57(7): 513-516, 2019 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-31269613

RESUMO

As the concept of enhanced recovery after surgery (ERAS) have been widely promoted and applied in clinical practice,reasonable nutrition intervention strategy has been paid more and more attention. The whole-process nutrition management strategy has been optimized based on the ERAS concept,which mainly includes key points such as pre-operative nutrition screening and nutrition assessment,perioperative nutrition treatment,and post-discharge nutritional support. With more and more research evidences,the ERAS strategy would be more detailed and complete. Further nutrition-related high-quality researches is necessary to provide evidence support,aiming to establish a standardized,ERAS-optimized,whole-process nutrition management pathway.


Assuntos
Protocolos Clínicos/normas , Terapia Nutricional/normas , Assistência Perioperatória/normas , Humanos , Avaliação Nutricional , Estado Nutricional , Apoio Nutricional , Cuidados Pré-Operatórios
16.
Emerg Med J ; 36(9): 520-528, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31320332

RESUMO

BACKGROUND: Intubation is an essential, life-saving skill but associated with a high risk for adverse outcomes. Intubation protocols have been implemented to increase success and reduce complications, but the impact of protocol conformance is not known. Our study aimed to determine association between conformance with an intubation process model and outcomes. METHODS: An interdisciplinary expert panel developed a process model of tasks and sequencing deemed necessary for successful intubation. The model was then retrospectively used to review videos of intubations from 1 February, 2014, to 31 January, 2016, in a paediatric emergency department at a time when no process model or protocol was in existence. RESULTS: We evaluated 113 patients, 77 (68%) were successfully intubated on first attempt. Model conformance was associated with a higher likelihood of first attempt success when using direct laryngoscopy (OR 1.09, 95% CI 1.01 to 1.18). The use of video laryngoscopy was associated with an overall higher likelihood of success on first attempt (OR 2.54, 95% CI 1.10 to 5.88). Thirty-seven patients (33%) experienced adverse events. Model conformance was the only factor associated with a lower odds of adverse events (OR 0.94, 95% CI 0.88 to 0.99). CONCLUSIONS: Conformance with a task-based expert-derived process model for emergency intubation was associated with a higher rate of success on first intubation attempt when using direct laryngoscopy and a lower odds of associated adverse events. Further evaluation of the impact of human factors, such as teamwork and decision-making, on intubation process conformance and success and outcomes is needed.


Assuntos
Protocolos Clínicos/normas , Estado Terminal/terapia , Intubação Intratraqueal/normas , Guias de Prática Clínica como Assunto , Ressuscitação/normas , Adolescente , Bradicardia/epidemiologia , Bradicardia/etiologia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Hipóxia/epidemiologia , Hipóxia/etiologia , Lactente , Recém-Nascido , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/instrumentação , Laringoscópios/efeitos adversos , Masculino , Ressuscitação/efeitos adversos , Ressuscitação/instrumentação , Estudos Retrospectivos , Gravação em Vídeo , Adulto Jovem
17.
Khirurgiia (Mosk) ; (7): 58-62, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355816

RESUMO

OBJECTIVE: To assess standardized protocol for fast track recovery after lung cancer surgery. MATERIAL AND METHODS: There were 201 patients. Patients underwent VATS lung resection, VATS lobectomy and various open resections of lungs. Patients had either primary lung cancer or metastatic lung lesion with indications for surgical treatment. Management of patients was divided into 3 periods: preoperative, intraoperative and postoperative. The protocol of fast track recovery was developed considering literature data and own experience. Requirements of this protocol were applied in perioperative management. RESULTS: Application of the protocol was successful in all patients. Minimum number of complications (6%) and length of postoperative hospital-stay of 4 days were observed after VATS resection of lung. VATS lobectomy was followed by complication rate 25% and postoperative hospital-stay of 6 days. In the group of open resections these values were 29% and 7 days.


Assuntos
Protocolos Clínicos/normas , Neoplasias Pulmonares/cirurgia , Assistência Perioperatória/normas , Pneumonectomia , Cuidados Pré-Operatórios/normas , Humanos , Tempo de Internação , Pneumonectomia/métodos , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida
18.
J Neurosci Nurs ; 51(5): 259-265, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31356426

RESUMO

BACKGROUND: Adhering to an antithrombotic medication regimen is essential to reducing recurrent stroke in adult stroke survivors. The purpose of this study was to evaluate the feasibility and acceptability of the SystemCHANGE (SC) and attention control (AC) intervention in older adult, nonadherent ischemic stroke patients. METHODS: A pilot randomized controlled trial was conducted to determine the feasibility and acceptability of an SC versus AC intervention in older adult, nonadherent stroke survivors in the management of antithrombotic medication. Participants were masked to group assignment. Stroke survivors 50 years or older, taking at least 1 once-a-day antithrombotic medication, were recruited from a Midwest Comprehensive Stroke Center-affiliated neurology office. They were screened electronically using the Medication Event Monitoring System for 2 months to determine baseline medication adherence. Nonadherent stroke survivors (medication adherence < 0.97) were randomized to SC or AC intervention and monitored for 3 months. SC focused on redesigning the interpersonal environmental system and daily routines. The AC group was provided education materials on stroke that consisted of stroke risk factor reduction, stroke facts, rehabilitation, and nutrition with the primary investigator. Participation and intervention experience interviews were evaluated for themes. RESULTS: Thirty participants were recruited: median age was 64 years, 46.7% of them were male, and they took an average of 7.77 (SD, 3.191; range, 3-15) prescribed medications. The number of over-the-counter medications taken (excluding aspirin) on a regular basis averaged 1.9 (SD, 0.8; range, 1-4). Two participants were nonadherent and were randomized to the 2 arms. Both participants had positive feedback and were not inconvenienced by their participation in the study. Neither participant voiced concerns about the intervention, survey demands, time requirement, or completing the surveys on the primary investigator's laptop. CONCLUSION: The SC and AC intervention protocols were feasible and acceptable to the participants in this study. Additional pilot testing is needed to further evaluate the intervention and its effect on medication adherence in this population.


Assuntos
Protocolos Clínicos/normas , Fibrinolíticos/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Acidente Vascular Cerebral/tratamento farmacológico , Sobreviventes/psicologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Projetos Piloto , Acidente Vascular Cerebral/psicologia
19.
Rev Med Chil ; 147(3): 296-304, 2019 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-31344166

RESUMO

BACKGROUND: Organ donation rates for transplantation are low in Chile and there is a paucity of a technical-structured-normalized procurement process. AIM: To design a protocol to standardize the organ procurement process based on the Chilean reality. MATERIAL AND METHODS: After a first phase of bibliographic reviews and analyzing de Chilean legislative and normative frame, a proposal was elaborated in collaboration with five expert coordinators. In the second phase, two Delphi rounds with the local coordinators of the organ procurement centers were carried out. Their responses were analyzed and the stages and criteria to standardize the organ procurement process were determined. RESULTS: The expert defined organ procurement process, validated by local coordinators, comprised nine stages and 36 criteria. The expert opinion coincidence was high and significant (Cronbach's alpha > 0.8, p < 0.01). CONCLUSIONS: The protocol describing the procurement process, constructed and validated by experts, will allow to standardize a clinical protocol contributing to a successful national organ procurement.


Assuntos
Protocolos Clínicos/normas , Obtenção de Tecidos e Órgãos/normas , Chile , Humanos , Inquéritos e Questionários
20.
Glob Health Action ; 12(1): 1621589, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31203791

RESUMO

Background: Anaemia in pregnancy is typically due to iron deficiency (IDA) but remains a complex and pervasive problem, particularly in low resource settings. At clinics on the Myanmar-Thailand border, a protocol was developed to guide treatment by health workers in antenatal care (ANC). Objective: To evaluate the clinical use of a protocol to treat anaemia in pregnancy. Methods: The design was a descriptive retrospective analysis of antenatal data obtained during the use of a standard anaemia treatment protocol. Two consecutive haematocrits (HCT) <30% prompted a change from routine prophylaxis to treatment doses of haematinics. Endpoints were anaemia at delivery (most recent HCT before delivery <30%) and timeliness of treatment initiation. Women whose HCT failed to respond to the treatment were investigated. Results: From August 2007 to July 2012, a median [IQR] of five [4-11] HCT measurements per woman resulted in the treatment of anaemia in 20.7% (2,246/10,886) of pregnancies. Anaemia at delivery was present in 22.8% (511/2,246) of treated women and 1.4% (123/8,640) who remained on prophylaxis. Human error resulted in a failure to start treatment in 97 anaemic women (4.1%, denominator 2,343 (2,246 + 97)). Fluctuation of HCT around the cut-point of 30% was the major problem with the protocol accounting for half of the cases where treatment was delayed greater than 4 weeks. Delay in treatment was associated with a 1.5 fold higher odds of anaemia at delivery (95% CI 1.18, 1.97). Conclusion: There was high compliance to the protocol by the health workers. An important outcome of this evaluation was that the clinical definition of anaemia was changed to diminish missed opportunities for initiating treatment. Reduction of anaemia in pregnancy requires early ANC attendance, prompt treatment at the first HCT <30%, and support for health workers.


Assuntos
Anemia/terapia , Protocolos Clínicos/normas , Guias de Prática Clínica como Assunto , Complicações Hematológicas na Gravidez/terapia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/normas , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Mianmar , Gravidez , Estudos Retrospectivos , Tailândia , Adulto Jovem
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