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1.
Female Pelvic Med Reconstr Surg ; 27(8): 493-496, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34261108

RESUMO

OBJECTIVES: Colocated services in a team-based integrated practice unit (IPU) optimize care of pelvic floor disorders. Our goal was to compare ancillary service utilization in a multidisciplinary IPU between patients covered by a bundled payment model (BPM) versus a traditional fee-for-service model (FFSM). METHODS: Medical records of women attending an IPU for pelvic floor disorders with colocated services, including nutrition, social work, psychiatry, physical therapy, and subspecialty care between October 2017 and December 2018, were included in this retrospective chart review. All patients were offered treatment with ancillary services according to standardized care pathways. Data extracted included patient demographics, pelvic floor disorder diagnoses, baseline severity measures, payment model, and ancillary services used. Univariate and multivariate logistic regression identified variables predicting higher uptake of ancillary services. RESULTS: A total of 575 women with pelvic floor disorders presented for care during the study period, of which 35.14% attended at least 1 appointment with any ancillary services provider. Ancillary service utilization did not differ between patients in the BPM group and those in the FFSM group (36.22 vs 33.47%; P = 0.489). Social work services were more likely to be used by the BPM compared with the FFSM group (15.95 vs 6.28%; P < 0.001). The diagnosis of fecal incontinence was associated with a higher chance of using any ancillary service (odds ratio, 4.91; 95% confidence interval, 1.81-13.33; P = 0.002). CONCLUSIONS: One third of patients with pelvic floor disorders receiving care in an IPU used colocated ancillary services. Utilization does not differ between payment models.


Assuntos
Serviços Técnicos Hospitalares/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Pacotes de Assistência ao Paciente/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Distúrbios do Assoalho Pélvico/epidemiologia , Distúrbios do Assoalho Pélvico/terapia , Estudos Retrospectivos , Estados Unidos
2.
Quito; Alvear Delgado, Plinio (Comp.); Arbeláez Rodríguez, Gloria (Comp.); Primera; 2021/05/31. 566 p. ilus, tabs, grafs..
Monografia em Espanhol | LILACS | ID: biblio-1253693

RESUMO

Prólogo. La obra recopiló los hitos históricos, las acciones en gestión y la visión futura de las Unidades Médicas, Administrativas y de Enfermería, en homenaje a los 50 años de función del Hospital de Especialidades Carlos Andrade Marín como ícono de la Seguridad Social del Ecuador, entre el periodo 1970 a diciembre 2020. Cada autor registró el título entrelazado un pensamiento, previo a la cronología de los hechos suscitados en los servicios brindados en beneficio de los pacientes que se atendieron en esta casa de salud. La obra se clasificó en capítulos por Unidades Médicas: Críticas, Clínicas, Quirúrgicas, Administrativas y de Enfermería, se incluyeron tablas, figuras, producción médica, patologías, cambios de técnicas o procedimientos y sustentó su accionar con citas textuales y referen-cias bibliográficas. Además, se narraron mejoras continuas transmitidas de los ilustres y legados maestros, especialistas médicos por varias generaciones, en conjunto con el personal de salud con vocación de servicio, en una reflexión profunda con mensajes vivos de su accionar. En las modalidades de publicación se realizaron aportes de visión nacional e internacional en los ámbitos asistenciales, administrativos, docente, de investigación y producción científica de alto nivel del contexto y naturaleza del emblemático hospital. Finalmente, se agradece a los funcionarios y ex trabajadores que colaboraron durante el proceso de construcción de la obra, así como a ex colaboradores que motivaron aportes de experiencias y la apreciación personal.


Prologue. The work compiled the historical milestones, management actions and future vision of the Medical, Administrative and Nursing Units, in tribute to the 50 years of function of the Carlos Andrade Marin Specialty Hospital as an icon of the Social Security of Ecuador, between 1970 and December 2020. Each author recorded the title intertwined with a thought, prior to the chronology of the events that took place in the services provided for the benefit of patients who were treated in this health center. The work was classified in chapters by Medical Units: Critical, Clinical, Surgical, Administrative and Nursing, and included tables, figures, medical production, pathologies, changes in techniques or procedures, and supported his actions with textual quotations and bibliographical references. In addition, continuous improvements were narrated and transmitted from the illustrious and legacy masters, medical specialists for several generations, together with the health personnel with vocation of service, in a deep reflection with living messages of their actions. In the publication modalities, contributions of national and international vision were made in the care, administrative, teaching, research and scientific production of high level of the context and nature of the emblematic hospital. Finally, we would like to thank the employees and former workers who collaborated during the construction process, as well as former collaborators who contributed with their experiences and personal appreciation.


Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , História do Século XXI , Adulto Jovem , Pesquisa , Cirurgia Geral , Cirurgia Plástica , Cirurgia Torácica , Urologia , Administração de Serviços de Saúde , Unidade Hospitalar de Ginecologia e Obstetrícia , Serviços Hospitalares , Bancos de Sangue , Cardiologia , Registros Hospitalares , Saúde Mental , Saúde Materno-Infantil , Serviço Hospitalar de Oncologia , Infecções por Coronavirus , Transplantes , Cuidados Críticos , Centro de Operações de Emergência , Dermatologia , Equador , Medicina de Emergência , Endocrinologia , Assistência Hospitalar , Hemodinâmica , História , Administração Hospitalar , Hospitais Especializados , Serviços Técnicos Hospitalares , Unidades de Terapia Intensiva , Medicina Interna , Obesidade
4.
Am J Trop Med Hyg ; 104(2): 695-699, 2020 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-33236704

RESUMO

Providing medical care for participants in clinical trials in resource-limited settings can be challenging and costly. Evaluation and treatment of a young man who developed cervical lymphadenopathy during a malaria vaccine trial in Equatorial Guinea required concerted efforts of a multinational, multidisciplinary team. Once a diagnosis of diffuse large B-cell lymphoma was made, the patient was taken to India to receive immunochemotherapy. This case demonstrates how high-quality medical care was provided for a serious illness that occurred during a trial that was conducted in a setting in which positron emission tomography for diagnostic staging, an oncologist for supervision of treatment, and an optimal therapeutic intervention were not available. Clinical researchers should anticipate the occurrence of medical conditions among study subjects, clearly delineate the extent to which health care will be provided, and set aside funds commensurate with those commitments.


Assuntos
Serviços Técnicos Hospitalares , Linfoma Difuso de Grandes Células B/diagnóstico , Vacinas Antimaláricas/administração & dosagem , Malária/prevenção & controle , Adulto , Ensaios Clínicos Fase I como Assunto , Guiné Equatorial/epidemiologia , Humanos , Índia , Linfoma Difuso de Grandes Células B/terapia , Malária/epidemiologia , Masculino , Centros de Atenção Terciária
6.
Cytopathology ; 31(6): 564-571, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32535975

RESUMO

INTRODUCTION: The Papanicolaou Society of Cytopathology (PSC) system of reporting pancreatobiliary cytology is a standardised reporting nomenclature that uses a six-tiered scheme of diagnostic categories utilising routine microscopy and ancillary tests such as biochemical and molecular analysis of cyst fluids and immunochemistry. The objective of this study was to determine the applicability of the PSC system on endoscopic ultrasound-guided fine needle aspiration cytology samples reported at the cytopathology laboratory, Mubarak Al Kabeer Hospital, in Kuwait with special emphasis on situations with limited availability of ancillary tests. METHODS: In total, 132 cases of endoscopic ultrasound-guided fine needle aspiration cytology samples from pancreatic lesions were categorised according to PSC system guidelines after examining the glass slides and reviewing the clinical, imaging and ancillary test findings. These review diagnoses were compared with the diagnoses rendered during initial reporting. Correlation with histopathology reports was done wherever available. RESULTS: In 23 (17.42%) of 132 cases, re-categorisation was necessary between initial and reviewed diagnoses. In 16 cases, re-categorisations were because of non-analogous categories between initial and reviewed diagnosis. In the remaining seven, they were due to identification of newer cytomorphological and imaging findings or because of issues arising from unavailability of sufficient material for ancillary investigations. CONCLUSION: All cases could be categorised using the PSC system with a moderate number of re-categorisations between initial and reviewed diagnoses. In certain circumstances, limited availability of ancillary tests, resulted in non-diagnostic categories whereas in other such circumstances, diagnostic categories could be assigned with certain conceptual modifications to the PSC guidelines.


Assuntos
Citodiagnóstico , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços Técnicos Hospitalares/normas , Criança , Feminino , Humanos , Kuweit/epidemiologia , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/patologia , Teste de Papanicolaou/métodos
7.
J Am Soc Cytopathol ; 9(2): 67-75, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31543473

RESUMO

INTRODUCTION: Data on the performance of cytotechnologists in assessing specimen adequacy of needle core biopsies (NCB) is scant and their role in specimen triaging for ancillary studies have not been well established. MATERIALS AND METHODS: We retrospectively analyzed rapid onsite evaluation (ROSE) performed exclusively by cytotechnologists on 248 NCB and fine-needle aspiration (FNA) specimens. Overall adequacy and accuracy rates were determined by comparing to final diagnosis. We also reviewed the process of specimen allocation for ancillary testing to determine whether specimens were appropriately triaged at the time of ROSE. RESULTS: Of the 248 cases, 222 (89.5%) were touch imprint and 26 (10.5%) were FNA smears. The overall adequacy rate was 73.4% (182 of 248). Concordance for "adequate" interpretation by ROSE with unequivocal malignant or benign diagnoses on final interpretation was 95.6%. The sensitivity, specificity, and accuracy of ROSE for a final "positive for malignancy" were 89.2% (95% CI 83.04% to 93.69%), 43.24% (95% CI 31.77% to 55.28%), and 73.87% (95% CI 67.57% to 55.28%), respectively. Cases with "positive for malignancy" on final diagnosis were "adequate" by ROSE in 89.1% (132 of 148) and "inadequate" in 10.8% (16 of 148), P < 0.0001. Ancillary tests were performed in 168 of 248 (67.7%); the majority were immunohistochemical stains for determining tumor subtype. Predictive biomarkers were performed successfully in 100% of metastatic breast cancers. CONCLUSIONS: Cytotechnologists performed at a high level of competency in providing ROSE and allocating specimens for ancillary testing, which were performed successfully in the majority of cases. Implementation of a standardized protocol for tissue management/prioritization is of paramount importance to maximize tissue preservation and minimize wastage.


Assuntos
Confiabilidade dos Dados , Laboratórios Hospitalares/normas , Pessoal de Laboratório Médico/psicologia , Neoplasias/diagnóstico , Manejo de Espécimes/métodos , Serviços Técnicos Hospitalares , Biomarcadores Tumorais , Biópsia por Agulha Fina/psicologia , Biópsia por Agulha Fina/normas , Biópsia com Agulha de Grande Calibre/psicologia , Biópsia com Agulha de Grande Calibre/normas , Osso e Ossos/patologia , Feminino , Hospitais Universitários , Humanos , Pulmão/patologia , Masculino , Neoplasias/patologia , Estudos Retrospectivos , Triagem/métodos
8.
Saúde Soc ; 29(2): e190730, 2020.
Artigo em Português | LILACS | ID: biblio-1101921

RESUMO

Resumo O crescente fluxo de imigração venezuelana provocou discussões acerca da inserção dessa comunidade no território brasileiro. Atualmente, o sistema de saúde roraimense tem o desafio de efetivar a universalização do acesso à saúde ao imigrante. Logo, este estudo objetiva conhecer as repercussões desse fenômeno sob a ótica de profissionais de saúde. Para isso, trata-se de um estudo qualitativo com abordagem exploratória que analisou a percepção dos técnicos de enfermagem do maior hospital de Roraima sobre os reflexos da imigração nos serviços de saúde e na qualidade da assistência. A análise das entrevistas semiestruturadas foi pautada na técnica de avaliação de conteúdo, sendo elencadas categorias. Por meio de análise da categoria de entraves na assistência de saúde, observaram-se problemas estruturais, como as fragilidades de infraestrutura e a carência de profissionais técnicos, resultando na sobrecarga de trabalho, e étnicos-culturais, como a barreira linguística, que representa um fator limitante para a realização de um atendimento de saúde com qualidade, além da maior fragilidade na condição de saúde dos imigrantes. Os achados deste trabalho podem auxiliar o estado de Roraima a refletir criticamente acerca do emprego correto dos investimentos na saúde, para garantir eficácia, dignidade e humanidade aos imigrantes, bem como aos brasileiros.


Abstract The growing flow of Venezuelan immigration has provoked discussions about the insertion of this community in Brazilian territory. Currently, the health system of Roraima has the challenge of effecting the universalization of access to the immigrant population. Therefore, this study aims to understand the repercussions of this phenomenon from the perspective of health professionals. As such, this is a qualitative study with an exploratory approach that analyzed the perception of nursing technicians of the largest hospital in Roraima about the effects of immigration on health services and quality of care. The analysis of semi-structured interviews was based on the content evaluation technique, and categories were listed. Through the categorical analysis of obstacles in health care, we observed structural problems, such as frailties in infrastructure and lack of technical professionals, resulting in work overload, as well as ethnocultural problems, such as the language barrier, which represents a limiting factor for performing quality health care, in addition to the greater frailty in the health condition of immigrants. The findings of this study may help the state of Roraima to reflect critically on the correct use of investments in health, to ensure efficacy, dignity and humanity to immigrants, as well as Brazilians.


Assuntos
Humanos , Masculino , Feminino , Assistência Integral à Saúde , Participação da Comunidade , Acesso Universal aos Serviços de Saúde , Emigração e Imigração , Serviços Técnicos Hospitalares , Sistemas de Saúde
9.
Cytotherapy ; 21(12): 1234-1245, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31837736

RESUMO

Ancillary materials (AMs) play a critical role in the manufacture of cell and gene therapies, and best practices for their quality management are the subject of ongoing discussion. Given that the final product cannot be sterilized, AM quality becomes increasingly critical to the clinical advancement of cell and gene therapies. Despite a lack of direct legislative direction regarding AM quality, internationally harmonized guidance is available from several industry-standard bodies that describe the principles and application of a risk-based approach to AM qualification and related supply-chain risk management. According to a best-practice risk-based approach, AMs must be adequately qualified to a degree that reflects the level of risk the material presents to patient safety and the drug product's specification. This general approach can be implemented in different ways, and balancing quality with cost of goods is critical to the cost-effective manufacture of advanced therapy medicinal products. In some cases, it may be preferable or necessary to use AMs that are produced in compliance with current Good Manufacturing Practice. However, developers may be able to suppress manufacturing costs without undermining safety or regulatory compliance in the case that a material presents a lower risk profile. Despite a great deal of attention and interest in the quality of AMs in the cell and gene therapy space, there is still a need for greater harmonization to create a shared understanding of what constitutes a risk-based approach to AM production and sourcing. In this article, we propose a staged approach to AM quality that achieves a balance between the competing demands of risk mitigation and cost of goods containment at the various stages of AM quality development. Our novel, heuristic framework for communication among AM suppliers, users and regulators aims to bring down development and manufacturing costs and lessen the workload around regulatory compliance.


Assuntos
Serviços Técnicos Hospitalares/normas , Serviços Técnicos Hospitalares/tendências , Terapia Baseada em Transplante de Células e Tecidos , Terapia Genética , Manufaturas/normas , Guias de Prática Clínica como Assunto , Controle de Qualidade , Serviços Técnicos Hospitalares/economia , Terapia Baseada em Transplante de Células e Tecidos/economia , Terapia Baseada em Transplante de Células e Tecidos/métodos , Terapia Baseada em Transplante de Células e Tecidos/normas , Terapia Baseada em Transplante de Células e Tecidos/tendências , Comércio , Análise Custo-Benefício , Utilização de Equipamentos e Suprimentos/organização & administração , Utilização de Equipamentos e Suprimentos/normas , Terapia Genética/economia , Terapia Genética/métodos , Terapia Genética/normas , Terapia Genética/tendências , Humanos , Manufaturas/economia , Manufaturas/provisão & distribuição , Segurança do Paciente/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Referência , Gestão de Riscos/organização & administração , Gestão de Riscos/normas
10.
Otolaryngol Clin North Am ; 52(5): 937-948, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31400814

RESUMO

The early efforts of pediatric airway surgeons, gastroenterologists, and pulmonologists to optimize surgical outcomes involved evaluating multiple organ systems for diseases negatively affecting surgery. This resulted in coordinated clinics with multiple services, ancillary testing, and endoscopic procedures, known as aerodigestive programs. These programs have nationally increased the value of care, with multidisciplinary experts delivering organized and efficient care to children with complex needs. This article describes the origin and value of aerodigestive programs within the modern health care landscape, serving as a primer for providers and administrators investigating how to facilitate aerodigestive or similar programs.


Assuntos
Serviços Técnicos Hospitalares/organização & administração , Gastroenteropatias/terapia , Equipe de Assistência ao Paciente/organização & administração , Doenças Respiratórias/terapia , Criança , Análise Custo-Benefício , Eficiência Organizacional , Humanos , Comunicação Interdisciplinar , Modelos Organizacionais , Desenvolvimento de Programas , Sistema Respiratório/cirurgia
12.
Urology ; 129: 29-34, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30974108

RESUMO

OBJECTIVE: To analyze variation in total healthcare costs for vasectomies performed in the United States, based on procedure setting and use of ancillary pathology services. METHODS: We queried the MarketScan Commercial Claims database using CPT, ICD, and HCPCS codes to identify men who underwent vasectomy between 2009 and 2015, either in the office or ambulatory surgical center (ASC) setting, with or without use of pathology services. All payments for each treatment episode were calculated based on relevant claims. Patient out-of-pocket expenses were defined as the sum of copayments, coinsurance, and deductibles for each claim. Trends in vasectomy use, and differences in procedure costs by practice setting were compared over the study period. RESULTS: 453,492 men underwent a vasectomy between 2009 and 2015. The number of procedures decreased from 76,197 in 2009 to 37,575 in 2015 (P = .002). Average procedural costs increased from $870 in 2009 to $938 in 2015 (P = .001). Overall, 82.6% and 17.4% of procedures were performed in the office vs ASCs, respectively. In-office procedures were associated with lower total healthcare costs ($707 vs $1851) and lower patient out-of-pocket expenses ($173 vs $356) than those performed in ASCs. Vasal segments were submitted for pathologic evaluation in 40% of cases, which increased average payments by 55%. The use of ASCs and ancillary pathology services for vasectomies performed during the study period increased vasectomy-associated costs by $64 million. CONCLUSION: The unnecessary use of ASCs and ancillary pathology services for vasectomy may lead to tens of millions of dollars in potentially avoidable healthcare costs annually.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/economia , Serviços Técnicos Hospitalares/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Vasectomia/economia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
13.
MedEdPORTAL ; 15: 10853, 2019 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-31976363

RESUMO

Introduction: Physicians must be facile in working with a medical interpreter (MI) given the large population of patients with limited English proficiency. Methods: To facilitate residents' assessment of their ability to interact with non-English-speaking patients, we developed a simulation case involving one such patient. The case involved a 31-year-old Spanish-speaking postpartum female who presented with eclamptic seizures. The learner needed to request an MI to assist with obtaining the patient's medical history once her concerned family member (also Spanish speaking) arrived. The major critical actions included appropriate use of MI services, recognition of the risk for eclamptic seizures, proper evaluation and treatment, and appropriate disposition to an obstetrician. The case required a high-fidelity mannequin and simulation operator, nurse simulated participant, Spanish-speaking actor (to play the husband or family member), certified Spanish MI, and faculty evaluator. Results: We implemented this case with 60 emergency medicine residents, ranging from PGY 1 to 3. The learner was assessed by both the faculty observer and MI. Checklists for assessment and debriefing materials were provided. Two of 60 residents did not request an MI. When compared to a prior version of this case that did not include the language barrier, median scores dropped from 12 to 10 out of 24, suggesting that the language barrier created a more challenging case. Discussion: The use of MIs is an integral part of health care practice in the United States, and we present a simulation case that can assess learners' use of MIs.


Assuntos
Serviços Técnicos Hospitalares , Medicina de Emergência/educação , Internato e Residência , Simulação de Paciente , Tradução , Serviços Técnicos Hospitalares/estatística & dados numéricos , Competência Clínica , Barreiras de Comunicação , Competência Cultural , Pesquisa sobre Serviços de Saúde , Hispânico ou Latino , Humanos , Manequins , Educação de Pacientes como Assunto/métodos , Relações Profissional-Paciente , Estados Unidos
15.
Am J Clin Pathol ; 149(6): 499-513, 2018 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-29659673

RESUMO

OBJECTIVES: To evaluate the utility of flow cytometry, karyotype, and a fluorescence in situ hybridization (FISH) panel in screening children for myelodysplastic syndrome (MDS). METHODS: Bone marrow morphology, flow cytometry, karyotype, and FISH reports from 595 bone marrow specimens (246 patients) were analyzed. RESULTS: By morphology, 8.7% of cases demonstrated at least unilineage dysplasia and/or increased blasts. Flow cytometry identified definitive abnormalities in 2.8% of cases, all of which had abnormal morphology. Of the 42 cases (7.2%) with acquired karyotypic abnormalities, 26 had no morphologic dysplasia. With a 98.2% concordance between karyotype and MDS FISH, FISH only identified two additional cases, both with low-level (<4%) abnormalities. Peripheral blood count evaluation only identified the absence of thrombocytopenia to correlate with an absence of abnormal ancillary tests. CONCLUSIONS: The combination of morphologic evaluation and karyotype with judicious use of flow cytometry and MDS FISH is sufficient to detect abnormalities for these indications.


Assuntos
Contagem de Células Sanguíneas/métodos , Aberrações Cromossômicas , Citometria de Fluxo/métodos , Hibridização in Situ Fluorescente/métodos , Cariotipagem/métodos , Síndromes Mielodisplásicas/diagnóstico , Serviços Técnicos Hospitalares , Medula Óssea/patologia , Criança , Feminino , Humanos , Masculino , Síndromes Mielodisplásicas/genética , Síndromes Mielodisplásicas/patologia , Estudos Retrospectivos
18.
Intern Med J ; 48(4): 408-413, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29236347

RESUMO

BACKGROUND: Temporal artery biopsy is considered the investigation of choice to diagnose definitively giant cell arteritis (GCA) in patients with compatible symptoms. However it is invasive and not completely sensitive. Serum markers, particularly erythrocyte sedimentation rate (ESR), can be supportive, but are not definitive in individual cases. AIMS: To investigate whether indices derived from the full blood count, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with a positive biopsy in patients with suspected GCA. METHODS: The clinical and pathological details of 537 patients undergoing temporal artery biopsy at our institution from 1992 to 2015 were reviewed. RESULTS: In univariate analysis high platelets (odds ratio (OR) 4.44, P < 0.001), NLR (OR 1.81, P = 0.02), PLR (OR 3.25, P < 0.001), C-reactive protein (CRP) (OR 3.00, P < 0.001), ESR (OR 3.62, P < 0.001) and increased age (OR 1.03, P = 0.006) were strongly associated with a positive biopsy. In multivariate modelling only high platelets (P < 0.001) and ESR (P = 0.049) maintained significance. CONCLUSIONS: We conclude that the presence of thrombocytosis and high NLR, PLR, ESR and CRP can all be used clinically to support the diagnosis of GCA prior to biopsy. Of particular note, in multivariate modelling the presence of thrombocytosis is a stronger predictor of a positive temporal artery biopsy than ESR. Therefore, careful consideration of the findings in a full blood count can be used to predict the likelihood of a positive temporal artery biopsy in patients with suspected GCA.


Assuntos
Serviços Técnicos Hospitalares/tendências , Plaquetas/metabolismo , Arterite de Células Gigantes/sangue , Arterite de Células Gigantes/diagnóstico , Linfócitos/metabolismo , Neutrófilos/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Contagem de Células Sanguíneas/métodos , Sedimentação Sanguínea , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Medisan ; 21(9)sep. 2017.
Artigo em Espanhol | CUMED | ID: cum-70122

RESUMO

Teniendo en cuenta el insuficiente desempeño investigativo del tecnólogo de la salud en la solución de problemas, que limitan su actuar profesional, se implementó una estrategia de gestión formativa en la Facultad de Enfermería-Tecnología de la Salud de Santiago de Cuba, en el período 2015-2016, a fin de perfeccionar la formación permanente de la cultura científico-investigativa de estos profesionales, para lo cual se revisaron las hojas de cargo, se realizaron entrevistas a los profesores y se aplicaron encuestas a estudiantes, tecnólogos y pacientes. Se observó el perfeccionamiento del desempeño profesional y la solución dada a los problemas que se presentan en los diferentes servicios donde laboran los tecnólogos de la salud(AU)


Taking into account the scarce investigative performance of the health technologist in the solution of problems that limit his professional performance, a strategy of management training was implemented in the Nursing-Technology Health Faculty of Santiago de Cuba, during 2015-2016, aimed at perfectioning the permanent training of the scientific-investigative culture of these professionals, for which the position papers were reviewed, interviews were carried out to the professors and surveys were applied to students, technologists and patients. The improvement of the professional performance and the solution given to the problems that are presented in the different services where the health technologists work were observed(AU)


Assuntos
Humanos , Masculino , Feminino , Pesquisa/educação , Pesquisadores/educação , Desenvolvimento de Pessoal , Capacitação Profissional , Educação Continuada , Publicações Científicas e Técnicas , Serviços Técnicos Hospitalares
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