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1.
Harefuah ; 158(10): 680-684, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576717

RESUMO

INTRODUCTION: The Israeli Society of Internal Medicine (ISIM) has joined a journey led by the Scientific Council of the Israeli Medical Association (IMA) to improve the residency of physicians in Israel. The process of transformation from time and place-based residency to an outcome-oriented, competencies and assessment-based residency is a multi-step, complex process. We describe the theoretical basis of the need for transformation, examples of specific competencies (basic, relating to all residencies and unique, specific for internal medicine) and their means of assessment. Furthermore, we present several examples of similar processes being conducted worldwide. We describe the process so far and the future anticipated challenges. We foresee the residency transformation resulting in elevated professional excellence amongst internists in Israel. Also, we anticipate that residents' satisfaction will rise and eventually, patients will receive better diagnostic and treatment outcomes in our wards.


Assuntos
Medicina Interna , Internato e Residência , Médicos , Ultrassonografia , Competência Clínica , Humanos , Israel , Sistemas Automatizados de Assistência Junto ao Leito
2.
Ultraschall Med ; 40(5): 560-583, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31597173

RESUMO

E-FAST (Extended-Focused Assessment with Sonography for Trauma) is now a widely utilized and internationally recognized standard exam in trauma care. It is highly accepted by emergency physicians and trauma surgeons alike. Thanks to the popularity of PoCUS (point-of-care ultrasound), it has continued to evolve over the last years and can now improve trauma diagnosis at all stages of the primary ABCDE. This review article summarizes key observations made over recent years and also highlights the extension of FAST into E-FAST in the context of PoCUS and CT developments for modern trauma management. Time has come to learn the lessons from 25 years of FAST and 15 years of E-FAST. We should redefine and position ultrasound in the primary ATLS survey (Advanced Trauma Life Support) on two levels: 1. Basic ATLS with new clinical questions, six additional abdominal image sections and one or more follow-up examinations depending on the clinical situation, and 2. Advanced ATLS with ultrasound applications for the entire trauma ABCDE.


Assuntos
Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia/métodos , Traumatismos Abdominais/diagnóstico por imagem , Humanos
8.
Stud Health Technol Inform ; 266: 115-120, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31397311

RESUMO

Recent research involving representatives from nursing professional organisations found a lack of governance regarding access and use of mobile technology has led to the maintenance of outdated safety and quality strategies. Current organisational policies and guidelines preclude nurses from aligning with the Australian National Safety and Quality in Health Service Standards. Continuance of the mobile technology paradox,where there is theinability of nurses to access and use mobile technology at point of care, hinders the promotion of positive two-way communication between consumers and nurses as the lack of connectivity impedes opportunities for nurses to partner with consumers to promote participation in their own healthcare, develop mutuality of understanding, and improve health and ehealth literacy. Legitimisation ofthe use of mobile technology at point of care is necessaryto supportmeeting consumer expectations, improve the consumer experience and promote participatory health, while contributing to delivery ofcontemporaryhealthcare.


Assuntos
Assistência à Saúde , Sistemas Automatizados de Assistência Junto ao Leito , Austrália , Comunicação , Serviços de Saúde , Humanos
9.
Stud Health Technol Inform ; 264: 1775-1776, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438338

RESUMO

When a critical blood glucose value is detected, then it is necessary to inform, advice, communicate, act and document it in the patient's medical record. We sought to describe the development of an alert system for glycemia values at the point of care integrated with an EHR, both in desktop and mobile devices.


Assuntos
Sistemas Automatizados de Assistência Junto ao Leito , Glicemia , Documentação , Humanos
10.
Stud Health Technol Inform ; 264: 1007-1011, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438076

RESUMO

Even though Adverse Drug Reactions (ADRs) constitute a significant public health issue, there is a lack of Information & Communication Technologies (ICT) tools supporting Pharmacovigilance activities at the point of care. In this paper, we present the rationale of a Web-based platform to address this need. The driving user scenario of the proposed platform refers to a clinician who investigates information for a possible ADR as part of a specific patient treatment. The goal is to facilitate this assessment through appropriate tools for searching various relevant data sources, analysing the acquired data, aggregating the obtained evidence, and offering follow-up ADR monitoring over time in a systematic and user-friendly way. In this regard, we describe the adopted user requirements engineering methodology and illustrate the use of Knowledge Engineering (KE) as the platform's main technical paradigm to enable heterogeneous data integration and handle the complexity of the underlying information processing workflow.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Sistemas Automatizados de Assistência Junto ao Leito , Sistemas de Notificação de Reações Adversas a Medicamentos , Humanos , Armazenamento e Recuperação da Informação , Bases de Conhecimento , Farmacovigilância
11.
Medicine (Baltimore) ; 98(35): e17011, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464959

RESUMO

Aim was to compare the impact of bedside percutaneous dilational tracheostomy (PDT) and open surgical technique (ST) on intracranial pressure (ICP), pulmonary gas exchange and hemodynamics.We retrospectively analyzed data of 92 neurocritical care patients with invasive ICP monitoring during either PDT (43 patients) or ST (49 patients).Peak ICP levels were higher during PDT (22 [17-38] mm Hg vs 19 [13-27] mm Hg, P = .029). Mean oxygen saturation (SpO2) and end-tidal carbon dioxide partial pressure (etCO2) did not differ. Episodes with relevant desaturation (SpO2 < 90%) or hypercapnia (etCO2 > 50 mm Hg) occurred rarely (5/49 during ST vs 3/43 during PDT for SpO2 < 90%; 2/49 during ST vs 5/43 during PDT for hypercapnia). Drops in mean arterial pressure (MAP) below 60 mm Hg were seen more often during PDT (8/43 vs 2/49, P = .026). Mean infusion rate of norepinephrine did not differ (0.52 mg/h during ST vs 0.45 mg/h during PDT). No fatal complications were observed.Tracheostomy can be performed as ST and PDT safely in neurocritical care patients. The impact on ICP, pulmonary gas exchange and hemodynamics remains within an unproblematic range.


Assuntos
Transtornos Cerebrovasculares/terapia , Hemodinâmica/fisiologia , Pressão Intracraniana/fisiologia , Troca Gasosa Pulmonar/fisiologia , Traqueostomia/métodos , Estado Terminal , Dilatação , Feminino , Humanos , Tempo de Internação , Masculino , Oxigênio/sangue , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos
13.
Medicine (Baltimore) ; 98(30): e16349, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348234

RESUMO

INTRODUCTION: Hyoid bone movement can be useful for diagnosing oropharyngeal dysphagia. In most clinical settings, the movement can be evaluated by a video fluoroscopic swallowing study (VFSS) that induces radiation exposure. In contrast with the hyoid bone, the thyroid cartilage is easily seen through the anterior neck surface. We hypothesized that the movement of thyroid cartilage correlates with hyoid bone movement in various axis and can be used as a parameter to evaluate swallowing. The purpose of this study was to investigate whether thyroid cartilage and hyoid bone movement were correlated and to collect basic data to determine if thyroid cartilage can be used as a parameter to evaluate swallowing. METHODS: A total of 25 subjects were included, and the VFSS image with normal swallowing function was collected retrospectively. The VFSS image was analyzed by specially developed semi-automatic software. Laryngeal prominence and anterior-superior margins of the hyoid were automatically extracted during swallowing. Two-point sets of the loci during swallowing were obtained in all VFSS frames. The X-coordinates showed an anterior-posterior axis, and the Y-coordinates showed a superior-inferior axis. Pearson correlation coefficients for each X- and Y-coordinate component were computed. RESULTS: X- and Y-coordinates of the thyroid cartilage and hyoid bones in all subjects showed movement in similar patterns, although each subject's movement differed. Pearson correlation coefficients of X- and Y-coordinate components of all subjects ranged from 0.611 to 0.981, which indicated that thyroid cartilage and hyoid bone movement was strongly correlated in anterior-posterior and superior-inferior axes, respectively. CONCLUSION: We analyzed thyroid cartilage and hyoid bone movement using a specifically developed semi-automatic software and concluded that the movement of thyroid cartilage and hyoid bone was strongly correlated in anterior-posterior and superior-inferior axes, respectively, during swallowing. The present study implies that analysis of thyroid cartilage movement can be used as a parameter for swallowing evaluation.


Assuntos
Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Deglutição/fisiologia , Osso Hioide/diagnóstico por imagem , Cartilagem Tireóidea/diagnóstico por imagem , Algoritmos , Transtornos de Deglutição/diagnóstico por imagem , Feminino , Fluoroscopia , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos
14.
Adv Exp Med Biol ; 1138: 47-56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31313257

RESUMO

Ultrasound uses high frequency sound waves and their rebounding echoes to capture live images of the structures beneath the skin. Thanks to recent technological advances, contemporary ultrasound machines offer excellent image resolution packaged in smaller, highly portable devices, which has allowed ultrasound to expand into new areas, both within the hospital as well as across non-traditional settings. Ultrasound is an incredibly powerful visualization tool in medicine, allowing physicians to safely see and interrogate the most relevant parts of their patient's internal anatomy instantly. Point-of-care ultrasound, a focused ultrasound evaluation performed at the patient's bedside, is now common across medical specialties, encompassing a vast array of diagnostic, procedural and screening applications. The impressive expansion of point-of-care ultrasound has resulted in an increased demand for ultrasound training earlier during medical school. As a non-invasive and non-destructive way to see inside the living body, ultrasound is an ideal tool to teach anatomy. It allows both medical and non-medical students the ability to improve their understanding and retention of anatomical form and function. The widespread and still expanding use of ultrasound in healthcare today, as well as its adoption into the anatomy classroom, is a testament to the power of ultrasound for achieving real-time visualization of the hidden aspects of our bodies.


Assuntos
Anatomia/educação , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Anatomia/métodos , Humanos
15.
Stud Health Technol Inform ; 262: 214-217, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349305

RESUMO

Bedside infotainment technology has been gaining popularity, helping providers to address patient needs and improve hospitalization experience. Such systems have the potential to become valuable tools for medical and nursing personnel, with the integration of patient monitoring features, bolstering efficiency and coordination. Extending their utility beyond conventional monitoring, the incorporation of affective computing capabilities would allow for early detection of potentially dangerous situations, as an individual's emotional state has a direct effect on their health, cognitive status, behaviour and quality of life. Furthermore, the addition of a serious games module would provide additional value for patients with cognitive decline or mobility issues. This work presents a novel bedside infotainment system, equipped with the aforementioned capabilities and designed to address the needs of patients in long-term care facilities, such as recreation and rehabilitation centres.


Assuntos
Inteligência Emocional , Sistemas Automatizados de Assistência Junto ao Leito , Qualidade de Vida , Humanos , Assistência de Longa Duração
16.
BMC Infect Dis ; 19(1): 647, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324229

RESUMO

BACKGROUND: Lassa fever virus has been enlisted as a priority pathogen of epidemic potential by the World Health organization Research and Development (WHO R & D) Blueprint. Diagnostics play a crucial role in epidemic preparedness. This systematic review was conducted to determine the sensitivity and specificity of Lassa fever diagnostic tests for humans. METHODS: We searched OVID Medline, OVID Embase, Scopus and Web of Science for laboratory based and field studies that reported the performance of diagnostic tests for Lassa fever in humans from 1 January 1990 to 25 January 2019. Two reviewers independently screened all the studies and included only studies that involved the evaluation of a Lassa fever diagnostic test and provided data on the sensitivity and specificity. The quality of the studies was assessed using the QUADAS-2 criteria. Data on the study location, study design, type of sample, index test, reference tests and diagnostic performance were extracted from the studies. RESULTS: Out of a total of 1947 records identified, 1245 non-duplicate citations were obtained. Twenty-six (26) full-text articles examined which identified 08 studies meeting pre-defined criteria. Only one study was a field evaluation study. The sensitivity and specificity of the point of care (RDT) against the Nikisins qPCR were 91.2%(95% CI:75.2-97.7) and 86%(95% CI: 71.4-94.2) at temperatures 18-30 °C, while the sensitivity and specificity of the single IgM ELISA assay against standard RT-PCR were 31.1%(95%CI: 25.6-37) and 95.7%(95%CI:92.8-97.7). The sensitivity of the combined ELISA Antigen/IgM assay(against virus isolation), the recombinant IgM/IgG ELISA(against standard RT-PCR), and the IgM/IgG immunoblot(against IFA) were 88%(95%CI:77-95), 25.9%(95%CI:20.8-31.6), and 90.7%(95%CI:84.13-97.27) respectively. The specificity of the combined ELISA Antigen/IgM assay(against virus isolation), the recombinant IgM/IgG ELISA(against standard RT-PCR), and the IgM/IgG immunoblot(against IFA) were 90%(95%CI:88-91), 100%(95%CI:98.2-100), and 96.3%(95%CI:92.2-100) respectively. CONCLUSION: Lassa fever has assays for antigenaemia, IgM, IgG and PCR detection. The RDT reportedly performed well but more data are needed from other countries and at temperatures above 30 °C. Most combined immunoassays perform better than the single IgM. Multiplex and pan-Lassa assays are needed. More well conducted field studies are needed. TRIAL REGISTRATION: Prospero registration number: CRD42018091585 .


Assuntos
Testes Diagnósticos de Rotina/métodos , Febre Lassa/diagnóstico , Ensaio de Imunoadsorção Enzimática , Humanos , Immunoblotting , Vírus Lassa/genética , Vírus Lassa/patogenicidade , Sistemas Automatizados de Assistência Junto ao Leito , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade
17.
Z Evid Fortbild Qual Gesundhwes ; 144-145: 1-6, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31279645

RESUMO

OBJECTIVE: In hospitals, case management (CM) on hospital wards is essential for maintaining a high level of quality and efficiency of care. The present study examined how CM at the Point of Care (POC) can be optimized and which potentials exist. METHODS: The potentials for optimization of typical case management processes performed on hospital wards were analyzed using a structured interview guide. For this purpose, a field study was performed in 24 German hospital departments of tertiary care. Structured interviews were conducted with homogeneous focus groups. The results were evaluated using an extended Balanced Score Card approach and discussed afterwards with the focus groups. RESULTS: Above all, the process quality and safety of case management as well as ensuring the relevant documentation at the POC appears to offer significant potential for optimization. An essential approach to eventually realize the potential for optimization is the reduction of fragmentation of the micro-processes associated with the case management duties on inpatient wards. This homogenization of these activities ideally requires a new and interdisciplinary acting profession, the clinical case managers. CONCLUSION: The homogenization of the case management activities on hospital wards by clinical case managers has the potential and possibilities to relieve both medical and nursing staff of these activities, while improving the quality and efficiency of care for patients, staff and cross-sectoral healthcare provider at the same time.


Assuntos
Administração de Caso , Pacientes Internados , Sistemas Automatizados de Assistência Junto ao Leito , Análise Custo-Benefício , Alemanha , Pessoal de Saúde , Hospitais Universitários , Humanos
19.
Emerg Med Clin North Am ; 37(3): 409-430, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262412

RESUMO

Resuscitative ultrasound describes point-of-care applications that provide diagnostic information, physiologic monitoring, and procedural guidance in critically ill patients. This article reviews the evaluation of ventricular function, identification of pericardial effusion and tamponade, evaluation of preload and fluid responsiveness, and hemodynamic monitoring, as some of the main applications where this modality can help emergency physicians during resuscitation of critically ill patients.


Assuntos
Ecocardiografia Transesofagiana , Ventrículos do Coração/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Ressuscitação , Velocidade do Fluxo Sanguíneo , Tamponamento Cardíaco/diagnóstico por imagem , Estado Terminal , Medicina de Emergência , Serviço Hospitalar de Emergência , Hemodinâmica , Humanos , Monitorização Fisiológica , Derrame Pericárdico/diagnóstico por imagem , Ultrassonografia , Ultrassonografia Doppler , Veia Cava Inferior/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem
20.
Emerg Med Clin North Am ; 37(3): 493-509, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262417

RESUMO

Although cardiogenic shock is uncommon in the emergency department, it is associated with high mortality. Most cardiogenic shock is caused by ischemia, but nonischemic etiologies are essential to recognize. Clinicians should optimize preload, contractility, and afterload. Volume-responsive patients should be resuscitated in small aliquots, although some patients may require diuresis to improve cardiac output. Vasopressors are important to restore end-organ perfusion, and inotropes improve contractility. Intubation and positive pressure ventilation impact hemodynamics, which, depending on volume status, may be beneficial or deleterious. Knowing indications for mechanical circulatory support is important for timely consultation or transfer as indicated.


Assuntos
Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Algoritmos , Antiarrítmicos/uso terapêutico , Cardiotônicos/uso terapêutico , Cateterismo , Ecocardiografia , Eletrocardiografia , Medicina de Emergência , Cardiopatias/complicações , Cardiopatias/diagnóstico , Cardiopatias/terapia , Humanos , Ácido Láctico/sangue , Anamnese , Monitorização Fisiológica , Peptídeos Natriuréticos/sangue , Exame Físico , Sistemas Automatizados de Assistência Junto ao Leito , Troponina/sangue , Vasoconstritores/uso terapêutico
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