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1.
Am J Sports Med ; 49(11): 2955-2959, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34347536

RESUMO

BACKGROUND: In managing pediatric knee conditions, an accurate bone age assessment is often critical for diagnostic, prognostic, and treatment purposes. Historically, the Greulich and Pyle atlas (hand atlas) has been the gold standard bone age assessment tool. In 2013, a shorthand bone age assessment tool based on this atlas (hand shorthand) was devised as a simpler and more efficient alternative. Recently, a knee magnetic resonance imaging (MRI) bone age atlas (MRI atlas) was created to circumvent the need for a left-hand radiograph. PURPOSE: To create a shorthand version of the knee MRI atlas. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: A shorthand bone age assessment method was created utilizing the previously published MRI atlas, which utilizes several criteria that are visualized across a series of images. The MRI shorthand draws on characteristic criteria for each age that are best observed on a single MRI scan. For validation, we performed a retrospective assessment of skeletally immature patients. One reader performed the bone age assessment using the MRI atlas and the MRI shorthand on 200 patients. Then, 4 readers performed the bone age assessment with the hand atlas, hand shorthand, MRI atlas, and MRI shorthand on a subset of 22 patients in a blinded fashion. All 22 patients had a knee MRI scan and a left-hand radiograph within 4 weeks of each other. Interobserver and intraobserver reliability, as well as variability among observers, were evaluated. RESULTS: A total of 200 patients with a mean age of 13.5 years (range, 9.08-17.98 years) were included in this study. Also, 22 patients with a mean age of 13.3 years (range, 9.0-15.6 years) had a knee MRI scan and a left-hand radiograph within 4 weeks. The intraobserver and interobserver reliability of all 4 assessment tools were acceptable (intraclass correlation coefficient [ICC] ≥ 0.8; P < .001). When comparing the MRI shorthand with the MRI atlas, there was excellent agreement (ICC = 0.989), whereas the hand shorthand compared with the hand atlas had good agreement (ICC = 0.765). The MRI shorthand also had perfect agreement in 50% of readings among all 4 readers, and 95% of readings had agreement within 1 year, whereas the hand shorthand had perfect agreement in 32% of readings and 77% agreement within 1 year. CONCLUSION: The MRI shorthand is a simple and efficient means of assessing the skeletal maturity of adolescent patients with a knee MRI scan. This bone age assessment technique had interobserver and intraobserver reliability equivalent to or better than the standard method of utilizing a left-hand radiograph.


Assuntos
Taquigrafia , Adolescente , Determinação da Idade pelo Esqueleto , Criança , Estudos de Coortes , Humanos , Lactente , Imageamento por Ressonância Magnética , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos
2.
Skeletal Radiol ; 49(9): 1449-1457, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32328674

RESUMO

Greulich and Pyle (GP) is one of the most common methods to determine bone age from hand radiographs. In recent years, new methods were developed to increase the efficiency in bone age analysis like the shorthand bone age (SBA) and automated artificial intelligence algorithms. OBJECTIVE: The aim of this study is to evaluate the accuracy and reliability of these two methods and examine if the reduction in analysis time compromises their efficacy. METHODS: Two hundred thirteen males and 213 females had their bone age determined by two separate raters using the SBA and GP methods. Three weeks later, the two raters repeated the analysis of the radiographs. The raters timed themselves using an online stopwatch. De-identified radiographs were securely uploaded to an automated algorithm developed by a group of radiologists in Toronto. The gold standard was determined to be the radiology report attached to each radiograph, written by experienced radiologists using GP. RESULTS: Intraclass correlation between each method and the gold standard fell within the range of 0.8-0.9, highlighting significant agreement. Most of the comparisons showed a statistically significant difference between the new methods and the gold standard; however, it may not be clinically significant as it ranges between 0.25 and 0.5 years. A bone age is considered clinically abnormal if it falls outside 2 standard deviations of the chronological age; standard deviations are calculated and provided in GP atlas. CONCLUSION: The shorthand bone age method and the automated algorithm produced values that are in agreement with the gold standard while reducing analysis time.


Assuntos
Inteligência Artificial , Taquigrafia , Determinação da Idade pelo Esqueleto , Feminino , Humanos , Masculino , Radiografia , Reprodutibilidade dos Testes
3.
Am Surg ; 84(7): 1169-1174, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30064582

RESUMO

Multiple studies have shown the detrimental effect of miscommunication during transitions of care. The aim of this study is to determine whether a certain method of "sign-out" can improve information transmission and thereby reduce medical errors. Surgical interns underwent a 90-minute training session before starting residency in five previously verified methods of sign-out. They were randomly assigned to six groups (five methods and a control group). They were then given seven simulated patient charts with varying levels of medical complexity. They were then instructed to "sign-out" the patients to randomly selected colleagues. The control group did not use any of the previously taught methods and passed on information in a manner of their choosing. None of the methods consistently results in excellent transitions of care. Patient information values ranged from 26 to 40 (depending on complexity). Major points were consistently missed by all methods, but this may have been a component of the time constraint placed on this study. The "SIGNOUT?" method resulted in superior data transmission when compared with the control group (P = 0.0401). The only method that seemed to be significantly inferior was the "9Ds" method (P = 0.0610). The "SIGNOUT?" method leads to the largest amount of relevant information transmitted to the incoming team. There was no statistically significant difference among the other methods. Improvement in "sign-out" modalities and training may improve transmission of relevant patient information, but larger studies are needed to verify the data seen in this small, single-site study.


Assuntos
Competência Clínica/normas , Cirurgia Geral/normas , Internato e Residência/organização & administração , Erros Médicos/prevenção & controle , Transferência da Responsabilidade pelo Paciente , Centros Médicos Acadêmicos/organização & administração , Adulto , Estudos de Casos e Controles , Feminino , Cirurgia Geral/educação , Humanos , Masculino , Gravidade do Paciente , Transferência da Responsabilidade pelo Paciente/normas , Segurança do Paciente/normas , Philadelphia , Taquigrafia
4.
J Surg Res ; 211: 163-171, 2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28501113

RESUMO

BACKGROUND: The handoff of medical information from one provider to another can be inefficient and error prone, potentially undermining patient safety. Although several tools for structuring handoffs exist, none provide a brief, standardized framework for ensuring that patient acuity is efficiently and reliably communicated. We aim to introduce and perform initial testing of the Clinical Acuity Shorthand System (CLASS) (Copyright 2015, Duke University. All rights reserved.) for surgery, a patient classification tool intended to facilitate efficient communication of key patient information during handoffs. MATERIALS AND METHODS: Surgical trainees at a single center were asked to perform an exercise involving application of CLASS to 10 theoretical patient scenarios and to then complete a brief survey. Responses were scored based on similarity to target answers. Performance was evaluated overall and between groups of trainees. Time required to complete the exercise was also determined and perceived utility of the system was assessed based on survey responses. RESULTS: The study task was completed by 17 participants. Mean time to task completion was 10.3 ± 8.4 min. Accuracy was not decreased, and was in fact superior, in junior trainees. Most respondents indicated that such a system would be feasible and could prevent medical errors. CONCLUSIONS: CLASS is a novel system that can be learned quickly and implemented readily by trainees and can be used to convey patient information concisely and with acceptable fidelity regardless of level of training. Further study examining application of this system on clinical surgical services is warranted.


Assuntos
Relações Interprofissionais , Erros Médicos/prevenção & controle , Gravidade do Paciente , Transferência da Responsabilidade pelo Paciente/organização & administração , Taquigrafia , Adulto , Idoso , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Segurança do Paciente
5.
Brain Behav ; 5(5): e00333, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25874166

RESUMO

INTRODUCTION: Stenography, or shorthand, is a unique set of skills that involves intensive training which is nearly life-long and orchestrating various brain functional modules, including auditory, linguistic, cognitive, mnemonic, and motor. Stenography provides cognitive neuroscientists with a unique opportunity to investigate the neural mechanisms underlying the neural plasticity that enables such a high degree of expertise. However, shorthand is quickly being replaced with voice recognition technology. We took this nearly final opportunity to scan the brains of the last alive shorthand experts of the Japanese language. METHODS: Thirteen right-handed stenographers and fourteen right-handed controls participated in the functional magnetic resonance imaging (fMRI) study. RESULTS: The fMRI data revealed plastic reorganization of the neural circuits around the putamen. The acquisition of expert skills was accompanied by structural and functional changes in the area. The posterior putamen is known as the execution center of acquired sensorimotor skills. Compared to nonexperts, the posterior putamen in stenographers had high covariation with the cerebellum and midbrain.The stenographers' brain developed different neural circuits from those of the nonexpert brain. CONCLUSIONS: The current data illustrate the vigorous plasticity in the putamen and in its connectivity to other relevant areas in the expert brain. This is a case of vigorous neural plastic reorganization in response to massive overtraining, which is rare especially considering that it occurred in adulthood.


Assuntos
Idioma , Plasticidade Neuronal/fisiologia , Putamen/fisiologia , Taquigrafia , Adulto , Mapeamento Encefálico/métodos , Estudos de Casos e Controles , Feminino , Humanos , Japão/etnologia , Imageamento por Ressonância Magnética/métodos , Masculino , Vias Neurais/fisiologia , Adulto Jovem
6.
Intern Med J ; 45(4): 423-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25827509

RESUMO

BACKGROUND: Shorthand is commonplace in clinical notation. While many abbreviations are standard and widely accepted, an increasing number are non-standard and/or unrecognisable. AIM: We sought to describe the frequency of inappropriate and ambiguous shorthand in discharge summaries. METHODS: Eighty electronic discharge summaries from the four General Medical Units at the Royal Melbourne Hospital were randomly extracted from the hospital's electronic records. Extraction was stratified by the four units and by the four quarters between July 2012 and June 2013. All abbreviations were assigned into one of four categories according to appropriateness: 1. 'Universally accepted and understood even without context'; 2. 'Understood when in context'; 3. 'Understood but inappropriate and/or ambiguous'; and 4. 'Unknown'. These categories were determined by the authors, which included junior and senior medical staff. RESULTS: The 80 discharge summaries contained 840 different abbreviations used on 6269 occasions. Of all words, 20.1% were abbreviations. Of the 6269 occasions of shorthand, 6.8% were categorised as 'Understood but inappropriate and/or ambiguous' or 'Unknown' (category 3 or 4), equating to 1.4% of all words, and an average of 5.4 words per discharge summary. CONCLUSION: Abbreviations are common in electronic discharge summaries, occurring at a frequency of one in five words. While the majority of shorthand used seems to be appropriate, the use of inappropriate, ambiguous or unknown shorthand is still frequent. This has implications for safe and effective patient care and highlights the need for better awareness and education regarding use of shorthand in clinical notation.


Assuntos
Registros Eletrônicos de Saúde/normas , Alta do Paciente/normas , Taquigrafia , Registros Eletrônicos de Saúde/tendências , Humanos , Alta do Paciente/tendências
7.
São Paulo; s.n; 2005. 155, A-44 p.
Tese em Português | LILACS | ID: lil-406961

RESUMO

Objetivo: analisar a organização do trabalho no desenvolvimento das Lesões por Esforços Repetitivos/ Distúrbios Osteomoleculares Relacionados ao Trabalho - LER/DORT, em taquígrafos de ambos os sexos, de duas Casas Parlamentares na região metropolitana de São Paulo. Método: estudo qualitativo; os instrumentos de coleta utilizados foram: entrevista individual, observação do trabalho e questionário de saúde e trabalho, composto de questões de identificação, estilo de vida, dados ocupacionais e de morbidade e o Questionário Nórdico de Sintomas Osteomusculares. Resultados: Identificaram-se fatores biomecânicos como prováveis causas de LER/DORT, tais como: manutenção de postura estática e movimentos repetitivos de digitação / manuseio de gravador; e aspectos da organização do trabalho, como por exemplo: divisão de tarefas por ciclos de tempo, pessoal reduzido, horários e pausas irregulares. Os taquígrafos relataram: exigências física, cognitiva, sensorial e psicológica do treinamento/ trabalho, pressão temporal, receio de errar, sobrecarga de trabalho nos períodos de pico e desgaste motivado pela disponibilidade integral de horários. Os trabalhadores identificaram como causas de LER/DORT: as dimensões temporal, ambiental e da ação do trabalho, bem como aspectos individuais e condições fora do trabalho. Conclusões: (a) A taquigrafia parlamentar caracteriza-se pela fragmentação das tarefas, ritmo imposto e prazos rígidos, semelhante a uma linha de montagem; (b) aspectos da organização do trabalho podem influenciar a sobrecarga biomecânica e o aumento no tempo de exposição ao risco para LER/DORT entre taquígrafos; (c) para serem eficazes, medidas preventivas devem considerar os aspectos biomecânicos, bem como as características da organização do trabalho e a participação dos trabalhadores.


Assuntos
Transtornos Traumáticos Cumulativos , Taquigrafia , Saúde do Trabalhador , Condições de Trabalho
9.
Lancet ; 336(8730): 1588-9, 1990.
Artigo em Inglês | MEDLINE | ID: mdl-1979407
10.
Arch Neurol ; 42(4): 400-2, 1985 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-3985817

RESUMO

A proficient stenographer who had had cerebral metastases suffered from pure alexia for normal print but could still read stenography with ease. It is suggested that especially the visuospatial properties of stenography made possible "alternative" reading, most likely via the right hemisphere.


Assuntos
Dislexia Adquirida/psicologia , Percepção de Forma , Lateralidade Funcional , Leitura , Taquigrafia , Idoso , Dislexia Adquirida/fisiopatologia , Hemianopsia/fisiopatologia , Humanos , Testes de Linguagem , Masculino , Córtex Visual/fisiopatologia , Redação
14.
Nature ; 227(5263): 1090, 1970 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-5451098
15.
JPO J Pract Orthod ; 2(10): 524-6, 1968 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-5247616
16.
Science ; 151(3706): 77-8, 1966 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-5908964

RESUMO

A system of symbols for the amino acid residues of proteins and peptides is proposed. The symbols convey immediate meaning in chemical terms and therefore allow rapid recognition of the distribution and frequency of occurrence of the various functional groups. The system is readily adaptable to description of new amino acids and amino acid modifications.


Assuntos
Sequência de Aminoácidos , Terminologia como Assunto , Taquigrafia
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