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OBJECTIVE: To describe the adherence to the sepsis protocol by obstetric nurses in the obstetric triage of a high-risk maternity reference center. METHODS: This was a quantitative, documental, and retrospective study involving 105 pregnant women treated in obstetric triage under sepsis criteria. Data were collected through electronic medical records using structured forms and were organized into tables employing descriptive statistics. This research adhered to ethical principles concerning human studies. RESULTS: Of the checklists for initiating the SEPSIS protocol by obstetric nurses, 105 were identified. Regarding the protocol steps performed, lactate was collected in 97.1% of cases and blood cultures in 98.1%, antibiotic therapy was administered in 94.3%, and hydration was carried out in 51.4% of the cases. CONCLUSION: The initiation of the sepsis protocol for all women meeting the criteria was confirmed. However, the steps were not fully implemented as recommended by the institutional protocol, and the recommended broad-spectrum antibiotic was not administered.
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Fidelidade a Diretrizes , Sepse , Humanos , Feminino , Estudos Retrospectivos , Gravidez , Sepse/tratamento farmacológico , Adulto , Fidelidade a Diretrizes/estatística & dados numéricos , Fidelidade a Diretrizes/normas , Triagem/métodos , Triagem/normas , Triagem/éticaRESUMO
Amelogenesis imperfecta (AI) is a genetic disease characterized by poor formation of tooth enamel. AI occurs due to mutations, especially in AMEL, ENAM, KLK4, MMP20, and FAM83H, associated with changes in matrix proteins, matrix proteases, cell-matrix adhesion proteins, and transport proteins of enamel. Due to the wide variety of phenotypes, the diagnosis of AI is complex, requiring a genetic test to characterize it better. Thus, there is a demand for developing low-cost, noninvasive, and accurate platforms for AI diagnostics. This case-control pilot study aimed to test salivary vibrational modes obtained in attenuated total reflection fourier-transformed infrared (ATR-FTIR) together with machine learning algorithms: linear discriminant analysis (LDA), random forest, and support vector machine (SVM) could be used to discriminate AI from control subjects due to changes in salivary components. The best-performing SVM algorithm discriminates AI better than matched-control subjects with a sensitivity of 100%, specificity of 79%, and accuracy of 88%. The five main vibrational modes with higher feature importance in the Shapley Additive Explanations (SHAP) were 1010 cm-1, 1013 cm-1, 1002 cm-1, 1004 cm-1, and 1011 cm-1 in these best-performing SVM algorithms, suggesting these vibrational modes as a pre-validated salivary infrared spectral area as a potential biomarker for AI screening. In summary, ATR-FTIR spectroscopy and machine learning algorithms can be used on saliva samples to discriminate AI and are further explored as a screening tool.
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Amelogênese Imperfeita , Aprendizado de Máquina , Saliva , Humanos , Amelogênese Imperfeita/diagnóstico , Amelogênese Imperfeita/genética , Amelogênese Imperfeita/metabolismo , Saliva/metabolismo , Saliva/química , Espectroscopia de Infravermelho com Transformada de Fourier/métodos , Feminino , Estudos de Casos e Controles , Masculino , Algoritmos , Adulto , Máquina de Vetores de Suporte , Projetos Piloto , Análise Discriminante , Biomarcadores , Triagem/métodos , Adolescente , Adulto JovemRESUMO
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Testes Respiratórios , Tosse , Sensibilidade e Especificidade , Tuberculose Pulmonar , Humanos , Masculino , Feminino , Tosse/diagnóstico , Tosse/etiologia , Pessoa de Meia-Idade , Peru , Adulto , Estudos Prospectivos , Tuberculose Pulmonar/diagnóstico , Fatores de Risco , Triagem , Idoso , Hospitalização , Adulto Jovem , Escarro/microbiologiaRESUMO
Background: The quantification of self-triage effectiveness, guided by mobile applications, in urgent direct-to-consumer telemedicine (TM) encounters requires further investigation. The objective of this study was to evaluate the outcomes of referral guidance provided by a symptom-based self-management mobile application decision algorithm in the context of remote urgent care assessments. Methods: An observational retrospective single-center study was conducted from May 2022 to December 2023. The inclusion criteria encompassed individuals aged >18 years old, and those spontaneously seeking virtual emergency care through the EINSTEIN CONECTA application. Patients experiencing connectivity issues, preventing completion of the encounter, were excluded. The primary outcomes included the rate of patient concurrence with the algorithm's recommendation for seeking in-person emergency care and the referral rate to face-to-face assessment among cases evaluated through TM. The application's algorithm employs scientific evidence based on symptoms to recommend referrals to emergency departments (EDs). Results: Out of 88,834 patients connected to the TM Center, self-triage obviated the need for virtual physician assessment in 53,302 (60%) encounters. A total of 35,532 patients were remotely evaluated by 316 on-duty physicians, resulting in 1,125 ICD-coded diagnoses. Among these, 21,722 (61.1%) were initially advised by self-triage to visit the ED, with subsequent medical assessment leading to in-person referrals in 6,354 (29.3%) of the evaluations. Of the 13,810 patients recommended to continue with virtual care post-self-triage, 157 (1.1%) were referred for in-person assessment. Conclusions: Self-triage effectively reduced the need for physician encounters in approximately three-fifths of TM consultations. Despite being based on scientific evidence, symptom-based referral algorithms demonstrated high sensitivity but poor correlation with physician decision-making.
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Algoritmos , Aplicativos Móveis , Encaminhamento e Consulta , Telemedicina , Triagem , Humanos , Triagem/métodos , Estudos Retrospectivos , Feminino , Masculino , Encaminhamento e Consulta/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto , Idoso , Serviço Hospitalar de Emergência/estatística & dados numéricosRESUMO
INTRODUCTION: Direct transport from the scene of injury to a trauma centre reduces saves lives. In Ontario, paramedics use the field trauma triage standard (FTTS) to determine if a patient meets trauma bypass criteria. Recent studies have questioned the efficacy of the FTTS in identifying severely injured patients. The objective of this study was to determine the predictive performance of the FTTS on the need for trauma center care in patients who were transported to a trauma center. METHODS: This was a single-center health records study of patients transported by ambulance directly to a level 1 trauma center. Hospital based trauma center need and injury severity score-based need were defined. Bivariate associations with one or more FTTS criteria were tested using the Wilcoxon two-sample test for continuous variables, and the Chi-square or Fisher's exact test for categorical indicators. The sensitivity and specificity of each category of the FTTS were calculated. RESULTS: There were 1427 patients included in the study, with 76% men, mean age of 40, and 76% had a blunt mechanism. The overall sensitivity and specificity of the FTTS was 90.9% and 20.8% for hospital-based need and 91.6% and 20.3 for injury severity need. The most sensitive variable for hospital-based need was physiologic criteria (53.7). Mechanism of injury was the most sensitive criteria for injury severity need (54.8). Physiological criteria had the highest association with hospital-based and injury severity need (adjusted odds ratios 7.5 [95% CI 5.8-9.8] and 5.1 [95% CI 3.9-6.7]). CONCLUSIONS: The FTTS has fair performance in identifying the need for hospital-based and injury severity need. Systolic blood pressure less than 90 mmHg, Glasgow Coma Scale (motor) less than 6, and falls greater than 6 m were most predictive of trauma center need. Improving prehospital trauma triage is critical to ensure timely transport to a trauma centre.
RéSUMé: INTRODUCTION: Le transport direct de la scène de la blessure à un centre de traumatologie permet de sauver des vies. En Ontario, les ambulanciers paramédicaux utilisent la norme de triage des traumatismes sur le terrain (FTTS) pour déterminer si un patient répond aux critères de pontage traumatique. Des études récentes ont remis en question l'efficacité du FTTS dans l'identification des patients gravement blessés. L'objectif de cette étude était de déterminer la performance prédictive du FTTS sur le besoin de soins en centre de traumatologie chez les patients qui ont été transportés dans un centre de traumatologie. MéTHODES: Il s'agissait d'une étude des dossiers médicaux d'un seul centre portant sur des patients transportés par ambulance directement à un centre de traumatologie de niveau 1. Les besoins des centres de traumatologie hospitaliers et les besoins basés sur le score de gravité des blessures ont été définis. Les associations bivariées avec un ou plusieurs critères FTTS ont été testées à l'aide du test à deux échantillons de Wilcoxon pour les variables continues et du test de Fisher pour les indicateurs catégoriels. La sensibilité et la spécificité de chaque catégorie du FTTS ont été calculées. RéSULTATS: Il y avait 1427 patients inclus dans l'étude, avec 76% d'hommes, âge moyen de 40, et 76% avaient un mécanisme émoussé. La sensibilité et la spécificité globales du FTTS étaient de 90,9 % et de 20,8 % pour les besoins hospitaliers et de 91,6 % et de 20,3 % pour les besoins de gravité des blessures. La variable la plus sensible pour les besoins hospitaliers était les critères physiologiques (53,7). Le mécanisme de blessure était le critère le plus sensible pour le besoin de gravité de la blessure (54,8). Les critères physiologiques étaient les plus associés aux besoins hospitaliers et aux besoins en matière de gravité des blessures (rapports de cotes ajustés de 7,5 [IC à 95 % 5,8-9,8] et 5,1 [IC à 95 % 3,9-6,7]). CONCLUSION: Le FTTS a un rendement équitable pour ce qui est de déterminer le besoin de soins hospitaliers et de gravité des blessures. La pression artérielle systolique inférieure à 90mmHg, l'échelle de coma de Glasgow (moteur) inférieure à 6 et les chutes supérieures à 6m étaient les plus prédictives des besoins du centre de traumatologie. L'amélioration du triage des traumatismes avant l'hospitalisation est essentielle pour assurer un transport rapide vers un centre de traumatologie.
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Escala de Gravidade do Ferimento , Centros de Traumatologia , Triagem , Ferimentos e Lesões , Humanos , Triagem/métodos , Triagem/normas , Masculino , Estudos Retrospectivos , Feminino , Adulto , Ontário , Ferimentos e Lesões/terapia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia , Pessoa de Meia-Idade , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/organização & administraçãoRESUMO
In Mozambique, targeted provider-initiated HIV testing and counselling (PITC) is recommended where universal PITC is not feasible, but its effectiveness depends on healthcare providers' training. This study aimed to evaluate the effect of a Ministry of Health training module in targeted PITC on the HIV positivity yield, and identify factors associated with a positive HIV test. We conducted a single-group pre-post study between November 2018 and November 2019 in the triage and emergency departments of four healthcare facilities in Manhiça District, a resource-constrained semi-rural area. It consisted of two two-month phases split by a one-week targeted PITC training module ("observation phases"). The HIV positivity yield of targeted PITC was estimated as the proportion of HIV-positive individuals among those recommended for HIV testing by the provider. Additionally, we extracted aggregated health information system data over the four months preceding and following the observation phases to compare yield in real-world conditions ("routine phases"). Logistic regression analysis from observation phase data was conducted to identify factors associated with a positive HIV test. Among the 7,102 participants in the pre- and post-training observation phases (58.5% and 41.5% respectively), 68% were women, and 96% were recruited at triage. In the routine phases with 33,261 individuals (45.8% pre, 54.2% post), 64% were women, and 84% were seen at triage. While HIV positivity yield between pre- and post-training observation phases was similar (10.9% (269/2470) and 11.1% (207/1865), respectively), we observed an increase in yield in the post-training routine phase for women in triage, rising from 4.8% (74/1553) to 7.3% (61/831) (Yield ratio = 1.54; 95%CI: 1.11-2.14). Age (25-49 years) (OR = 2.43; 95%CI: 1.37-4.33), working in industry/mining (OR = 4.94; 95%CI: 2.17-11.23), unawareness of partner's HIV status (OR = 2.50; 95%CI: 1.91-3.27), and visiting a healer (OR = 1.74; 95%CI: 1.03-2.93) were factors associated with a positive HIV test. Including these factors in the targeted PITC algorithm could have increased new HIV diagnoses by 2.6%. In conclusion, providing refresher training and adapting the current targeted PITC algorithm through further research can help reach undiagnosed PLHIV, treat all, and ultimately eliminate HIV, especially in resource-limited rural areas.
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Humanos , Masculino , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Aconselhamento , Triagem/métodos , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Serviço Hospitalar de Emergência , Moçambique/epidemiologiaRESUMO
Las intercurrencias dermatológicas agudas son un motivo de consulta frecuente a las centrales de emergencias, y generalmente los médicos de atención primaria se ocupan del primer nivel de atención. Puede ser necesaria una interconsulta con expertos, aunque no siempre estén disponibles. Ante la necesidad de facilitar dicha interacción a distancia, en Julio 2022 se implementó una herramienta de teledermatología en un hospital de alta complejidad en Buenos Aires, Argentina. Este servicio se limitó a días hábiles con horario restringido, permitiendo la comunicación entre médicos del departamento de emergencias y dermatólogos, a través de WhatsApp institucional. El dermatólogo podía verificar datos de salud relacionados al paciente (ej: comorbilidades y medicación crónica) mediante revisión de la historia clínica electrónica, para decidir sobre un plan de acción. Se evaluó la perspectiva de los usuarios a través de un formulario electrónico tras 3 meses de implementación. Los resultados evidenciaron que la mayoría (85%) de los profesionales conocía la herramienta, y el 57% la había usado al menos una vez. Se obtuvo una mediana de 9 puntos (de una escala de Likert del 1 al 10) sobre la recomendación hacia otro profesional. El teletriage dermatológico resultó beneficioso y fue aceptado, tanto por médicos de guardia como por especialistas. Ante las demoras en la atención ambulatoria, ha resultado una alternativa útil para evitar derivaciones innecesarias y/o acelerar aquellas que verdaderamente lo ameritan. Sin embargo, representa una forma de comunicación informal desde el punto de vista de almacenamiento de datos. Será necesario reflexionar sobre estos tópicos pendientes de esta experiencia asistencial como legalidad, seguridad y confidencialidad (AU)
Acute skin conditions are a frequent reason for consultation in emergency departments, and primary care physicians generally handle them. They might require referrals to experts, who are not always readily available. Recognizing the need to facilitate such interactions remotely, a teledermatology triage tool was implemented in July 2022 at a high-complexity hospital in Buenos Aires, Argentina. The service was limited to business days with restricted hours, enabling communication between emergency department physicians and dermatologists through institutional WhatsApp. Dermatologists could access patient-related health data (e.g., comorbidities and chronic medication) through the electronic medical record to determine an appropriate course of action. The perspective of users was evaluated through an electronic questionnaire after three months of application. Results showed that most professionals were aware of the tool (85%), and 57% used it at least once. The median rating for recommending the tool to other professionals was 9 points (on a Likert scale from 1 to 10). Dermatological teletriage proved beneficial and was well-received by emergency physicians and specialists. In the face of delays in outpatient care, it has been a useful alternative to avoid unnecessary referrals and expedite those that are warranted. However, it represents an informal method of communication with regard to data storage. It will be necessary to rethink on improvements in pending topics such as legal limitations, security, and confidentiality of this healthcare experience (AU)
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Humanos , Triagem/métodos , Consulta Remota , Teledermatologia , Dermatologia , Tele-Emergência , Modelos de Assistência à Saúde , Relações InterprofissionaisRESUMO
OBJECTIVE: To evaluate a fast-track triage model in an integrated community specialty clinic to reduce the age of diagnosis for patients with autism spectrum disorder (ASD). STUDY DESIGN: A retrospective chart review was performed for patients seen in an integrated community specialty pediatric practice using a fast-track screening and triage model. The percentage of ASD diagnoses, age at diagnosis, and time from referral to diagnosis were evaluated. The fast-track triage model was compared with national and statewide estimates of median age of first evaluation and diagnosis. RESULTS: From January 1, 2020, through December 31, 2021, 189 children with a mean (SD) age of 32.2 (12.4) months were screened in the integrated community specialty. Of these, 82 (43.4%) children were referred through the fast-track triage for further evaluation in the developmental and behavioral pediatrics (DBP) department, where 62 (75.6%) were given a primary diagnosis of ASD. Average wait time from referral to diagnosis using the fast-track triage model was 6 months. Mean (SD) age at diagnosis was 37.7 (13.5) months. The median age of diagnosis by the fast-track triage model was 33 months compared with the national and state median ages of diagnosis at 49 and 59 months, respectively. CONCLUSIONS: With the known workforce shortage in fellowship-trained developmental behavioral pediatricians, the fast-track triage model is feasible and maintains quality of care while resulting in more timely diagnosis, and reducing burden on DBP by screening out cases who did not require further multidisciplinary DBP evaluation as they were appropriately managed by other areas.
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Transtorno do Espectro Autista , Triagem , Humanos , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Estudos Retrospectivos , Pré-Escolar , Masculino , Feminino , Triagem/métodos , Lactente , Encaminhamento e Consulta/estatística & dados numéricos , Criança , Fatores de Tempo , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviços de Saúde Comunitária/organização & administraçãoRESUMO
Although stroke prevention and treatment strategies have significantly advanced in recent years, implementation of these care elements in resource-limited settings can be challenging, since the burden of stroke is higher and access to stroke care is lower. Barriers to stroke care in resource-limited settings include insufficient prevention, reduced awareness of stroke symptoms, limited prehospital care and lack of triage systems, limited access to comprehensive stroke centers, inadequate personnel education, lack of staff and resources, as well as limited access to neuroimaging, thrombolytics, mechanical thrombectomy, neurosurgical care, and rehabilitation. Here, we suggest strategies to improve stroke care in these settings, including public health campaigns, protocols for prehospital notification, organized flow to specialized stroke centers, development of dedicated stroke units, and utilization of telemedicine and telerehabilitation. We also highlight the role of international organizations and governments in reducing the global burden of stroke.
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Região de Recursos Limitados , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/terapia , Triagem/métodos , Fibrinolíticos/uso terapêuticoRESUMO
OBJECTIVES: To investigate the agreement and accuracy of triage blood pressure (BP) in a real-world clinic setting, compared with the reference standard. STUDY DESIGN: Paired triage and standardized BP measurements from patients 4 through 21 years old evaluated in an obesity-related hypertension clinic were obtained via chart-review. Triage BPs were measured by a medical assistant or nurse, often by automated device. Triplicate manual BPs were obtained by the clinic physician. Bland-Altman analyses determined mean differences between paired triage and mean standardized BPs. GEE-based multivariable relative risk (RR) regression determined the RR of triage BP overestimation by ≥ 5 mmHg. Overall agreement, sensitivity, specificity, positive predictive value, and negative predictive value of triage BP measurements identifying hypertensive BP were determined. RESULTS: One hundred thirty participants with 347 clinic encounters were included. Mean age was 13.3 years (SD 3.94), 76% were Black, and 58% were male. Overall mean systolic and diastolic BP difference was 8.7 mmHg (95% limits on agreement: -16.66, 34.07) and 4.1 mmHg (95% limits on agreement: -18.56, 26.68), respectively. Triage systolic BP was more likely overestimated by ≥ 5 mmHg when a large adult (RR = 1.49; 95% CI: 1.00, 2.21) or thigh cuff (RR = 1.94; 95% CI: 1.08, 3.51) was required compared with when a child/adult cuff was required. Overall agreement in identifying hypertensive BP was 57.6%. Sensitivity (52.6%), specificity (63.4%), positive predictive value (60.8%), and negative predictive value (55.3%) were low across all cuffs. CONCLUSIONS: There was poor agreement between usual triage and standardized BP measurements, with potential for significant clinical implications. CLINICAL TRIAL REGISTRATION: ReNEW Clinic Cohort Study (ReNEW), NCT03816462, https://clinicaltrials.gov/ct2/show/NCT03816462.
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Determinação da Pressão Arterial , Hipertensão , Triagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Adulto Jovem , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Hipertensão/diagnóstico , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Triagem/métodosRESUMO
Introducción: La categorización de las urgencias quirúrgicas es una necesidad en razón al continuo desequilibrio entre la oferta y la demanda de servicios quirúrgicos en la mayoría de las instituciones donde se encuentra habilitada la prestación del servicio. Hay abordajes en el tema, con estrategias de priorización de los casos quirúrgicos, que consideran escalas y flujogramas, pero su ausente validez externa y las particularidades de las instituciones y aseguradores, han limitado una generalización de los resultados. Métodos: Se efectúa una conceptualización del triaje de las urgencias quirúrgicas con planteamientos críticos y reflexivos soportados en la evidencia. Se identifican, asimismo, las posibles oportunidades para la investigación. Discusión: Los beneficios potenciales de un triaje quirúrgico en situaciones de urgencia, son extensivos a todos los actores del sistema de salud, disminuyen la posibilidad de desenlaces y repercusiones económicas negativas para las instituciones y los aseguradores. La teoría de las colas ofrece el soporte para un entendimiento del tema y contribuye en las soluciones. Su adopción es escasa como parte de una estrategia local de priorización quirúrgica en un contexto de urgencia. Conclusión:La creación de estrategias que establezcan el triaje para el paciente con una urgencia quirúrgica están influenciadas por la participación continua y efectiva de los actores involucrados en el proceso y en su impacto en los desenlaces clínicos
Introduction: Categorizing surgical emergencies is necessary due to the continued imbalance between the supply and demand of surgical services in most institutions where the service is enabled. There are approaches to the subject, with strategies for prioritizing surgical cases, which consider scales and flowcharts, but their lack of external validity and the particularities of the institutions and insurers have limited the generalization of the results. Methods: A conceptualization of the triage of surgical emergencies is carried out with critical and reflective approaches supported by evidence. Potential research opportunities are also identified. Discussion: The potential benefits of surgical triage in emergent situations are extensive to all health system actors, reducing the possibility of adverse outcomes and economic repercussions for institutions and insurers. Queuing theory offers support for understanding the issue and contributes to solutions. However, its adoption is scarce in an emergency as part of a local surgical prioritization strategy. Conclusion: The creation of strategies that establish triage for the patient with a surgical emergency is influenced by the continuous and effective participation of the actors involved in the process and its impact on clinical outcomes
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Humanos , Triagem , Serviços Médicos de Emergência , Salas Cirúrgicas , Classificação , Cartão de TriagemRESUMO
Abstract This study presents the first preliminary phytochemical screening and investigation of the lipoidal matter of Latania verschaffeltii Lem. leaves, belonging to the Arecaceae family. Gas chromatography coupled with mass spectroscopy (GC/MS) was used to analyze and identify compounds of saponifiable and unsaponifiable content. The preliminary phytochemical screening of total methanolic extract of Latania verschaffeltii Lem. leaves revealed the presence of unsaturated sterols and/or triterpenes, carbohydrates and/or glycosides, flavonoids, tannins, saponins, and phenolic acids in the leaves. However, cardenolides, cyanogenic compounds, alkaloids, and iridoids were not detected. The results of the gas chromatography/mass spectrometry (GC/MS) analysis indicated that the percentage of saturated fatty acids (83.82%) is higher than that of unsaturated fatty acids (9.42%). The predominant methyl ester of a saturated fatty acid detected in the sample was hexadecanoic acid methyl ester, accounting for 41.68% of the total. The composition of the unsaponifiable matter consisted of hydrocarbons (5.66%), fatty alcohols (0.96%), terpenes (85.97%), and sterols (2.18%). The major terpenes observed were phytol (43.62%) and squalene (39.27%).
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Triagem , Folhas de Planta/efeitos adversos , Arecaceae/classificação , Egito/etnologia , Compostos Fitoquímicos/análise , Alcaloides/agonistas , Cromatografia Gasosa-Espectrometria de Massas/métodosRESUMO
OBJECTIVE: Deep learning (DL) has shown promising results for improving mammographic breast cancer diagnosis. However, the impact of artificial intelligence (AI) on the breast cancer screening process has not yet been fully elucidated in terms of potential workload reduction. We aim to assess if AI-based triaging of breast cancer screening mammograms could reduce the radiologist's workload with non-inferior sensitivity. METHODS: PubMed, EMBASE, Cochrane Central, and Web of Science databases were systematically searched for studies that evaluated AI algorithms on computer-aided triage of breast cancer screening mammograms. We extracted data from homogenous studies and performed a proportion meta-analysis with a random-effects model to examine the radiologist's workload reduction (proportion of low-risk mammograms that could be theoretically ruled out from human's assessment) and the software's sensitivity to breast cancer detection. RESULTS: Thirteen studies were selected for full review, and three studies that used the same commercially available DL algorithm were included in the meta-analysis. In the 156,852 examinations included, the threshold of 7 was identified as optimal. With these parameters, radiologist workload decreased by 68.3% (95%CI 0.655-0.711, I² = 98.76%, p < 0.001), while achieving a sensitivity of 93.1% (95%CI 0.882-0.979, I² = 83.86%, p = 0.002) and a specificity of 68.7% (95% CI 0.684-0.723, I² = 97.5%, p < 0.01). CONCLUSIONS: The deployment of DL computer-aided triage of breast cancer screening mammograms reduces the radiology workload while maintaining high sensitivity. Although the implementation of AI remains complex and heterogeneous, it is a promising tool to optimize healthcare resources.
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Inteligência Artificial , Neoplasias da Mama , Aprendizado Profundo , Detecção Precoce de Câncer , Mamografia , Triagem , Carga de Trabalho , Humanos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico , Mamografia/métodos , Mamografia/estatística & dados numéricos , Feminino , Carga de Trabalho/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Triagem/métodos , Software , Algoritmos , Sensibilidade e EspecificidadeRESUMO
Este artigo analisa os desafios e estratégias de atuação de psicólogas(os) nos Centros de Referência Especializados de Assistência Social (CREAS) do norte de Minas Gerais durante a pandemia de covid-19. Trata-se de um estudo descritivo, quanti-qualitativo, de corte transversal e com análise de conteúdo e estatística para a interpretação de dados primários e meio de questionário eletrônico, emergiram os seguintes eixos temáticos: (a) Perfil sociodemográfico das(os) trabalhadoras(es); (b) Medidas de prevenção à contaminação para quem? Impactos da pandemia na práxis da psicologia no CREAS; (c) Chegada das demandas no CREAS; e (d) Tenuidade entre as potencialidades e vicissitudes do uso das tecnologias digitais. Observou-se que a inserção das(os) trabalhadoras(es) nos CREAS é marcada por contratos temporários, altas jornadas de trabalho e baixa remuneração. Além disso, com a pandemia de covid-19, têm enfrentado obstáculos como a falta de equipamentos de proteção individual (EPI) e de prevenção ao vírus. A chegada de demandas aos CREAS também foi afetada pela pandemia, como apontam as análises estatísticas dos registros mensais de atendimento dos municípios. As tecnologias digitais se configuraram como a principal estratégia adotada no ambiente de trabalho dos CREAS. Conclui-se que, se por um lado, a pandemia engendrou e acentuou obstáculos para a práxis da psicologia; por outro, a imprevisibilidade desse cenário e a potência da psicologia norte-mineira possibilitaram diversas estratégias para assistir os usuários.(AU)
This article analyses the challenges and strategies over the psychologists activity at the Specialized Reference Centers for Social Assistance (CREAS), from the north of the state of Minas Gerais during the COVID-19 pandemic. It is a descriptive, quantitative-qualitative study on content and statistics analysis for interpretation of primary and secondary data, with 19 psychologists participating. From interviews made with electronic questionnaires, the following theatrical axes emerged: (a) Social demographic profile of workers; (b) Prevention measures over contamination directed to which public? The impacts of the pandemic over the practice of psychology at CREAS; (c) Demand reception at CREAS; and (d) Tenuity between potentialities and vicissitudes of the use of digital technologies. The workers insertion at CREAS is notably marked by transitory working contracts, long labor journeys, and low wages. Furthermore, the COVID-19 pandemic is causing hindrances such as the lack of personal protection equipment (PPE) and virus prevention. The demands received by CREAS were also affected by the pandemic, as shown in the statistics analysis from monthly county treatment records. The digital technologies were the main strategy enforced by the working environment at CREAS. In conclusion, if on the one hand, the pandemic produced and increased obstacles for the practice of Psychology, on the other hand, the unpredictability of this scenery and the capacity of the psychology of the north of Minas Gerais enabled diverse strategies to attend the users.(AU)
Este artículo analiza los desafíos y las estrategias en la actuación de psicólogas(os) en los Centros de Referencia Especializados de Asistencia Social (CREAS) del norte de Minas Gerais (Brasil) durante la pandemia de la COVID-19. Se trata de un estudio descriptivo, cualicuantitativo, de cohorte transversal, con análisis de contenido y estadísticas para la interpretación de datos primarios y secundarios, en el cual participaron 19 psicólogas(os). De las entrevistas en un cuestionario electrónico surgieron los siguientes ejes temáticos: (a) perfil sociodemográfico de los(as) trabajadores(as); (b) medidas de prevención de la contaminación ¿para quién? Impactos de la pandemia en la praxis de la psicología en CREAS; (c) la llegada de demandas a CREAS y; (d) la tenuidad entre las potencialidades y vicisitudes del uso de tecnologías digitales. Se observó que la inserción de las(os) trabajadoras(es) en el CREAS está marcada por contratos laborales temporales, largas jornadas y baja remuneración. Además, con la pandemia de la COVID-19, se han enfrentado a obstáculos como la falta de equipo de protección personal (EPP) y prevención del virus. La llegada de demandas al CREAS también se vio afectada por la pandemia, como lo demuestran los análisis estadísticos de los registros mensuales de atención de los municipios. Las tecnologías digitales se han convertido en la principal estrategia adoptada en el entorno laboral de los CREAS. Se concluye que si, por un lado, la pandemia engendró y acentuó obstáculos a la praxis de la Psicología, por otro, la imprevisibilidad de este escenario y el poder de la Psicología en el norte de Minas Gerais posibilitaron varias estrategias para asistir a los usuarios.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Psicologia Social , Política Pública , Apoio Social , COVID-19 , Ansiedade , Defesa do Paciente , Equipe de Assistência ao Paciente , Serviço de Acompanhamento de Pacientes , Satisfação Pessoal , População , Pobreza , Preconceito , Psicologia , Qualidade da Assistência à Saúde , Reabilitação , Segurança , Delitos Sexuais , Classe Social , Controle Social Formal , Meio Social , Isolamento Social , Problemas Sociais , Seguridade Social , Fatores Socioeconômicos , Estresse Psicológico , Desemprego , Violência , Características da População , Trabalho Infantil , Políticas, Planejamento e Administração em Saúde , Sistema Único de Saúde , Abuso Sexual na Infância , Riscos Ocupacionais , Atividades Cotidianas , Acidentes de Trabalho , Família , Defesa da Criança e do Adolescente , Características de Residência , Triagem , Exposição Ocupacional , Local de Trabalho , Qualidade, Acesso e Avaliação da Assistência à Saúde , Barreiras de Comunicação , Serviços de Saúde Comunitária , Assistência Integral à Saúde , Transmissão de Doença Infecciosa , Conflito Psicológico , Diversidade Cultural , Vida , Risco à Saúde Humana , Autonomia Pessoal , Denúncia de Irregularidades , Redução do Dano , Violação de Direitos Humanos , Depressão , Economia , Emprego , Equipamentos e Provisões Hospitalares , Violência contra a Mulher , Mercado de Trabalho , Acolhimento , Medidas de Associação, Exposição, Risco ou Desfecho , Ética , Capacitação Profissional , Instituições de Saúde, Recursos Humanos e Serviços , Conflito Familiar , Rede Social , Fadiga de Compaixão , Abuso Físico , Exclusão Digital , Sistemas de Apoio Psicossocial , Estresse Ocupacional , Acesso a Medicamentos Essenciais e Tecnologias em Saúde , Respeito , Solidariedade , Universalização da Saúde , Integração Social , Direito à Saúde , Assistência de Saúde Universal , Empoderamento , Análise de Mediação , Inclusão Social , Abuso Emocional , Estresse Financeiro , Características da Vizinhança , Fatores Sociodemográficos , Enquadramento Interseccional , Vulnerabilidade Social , Cidadania , Diversidade, Equidade, Inclusão , Medida Socioeducativa , Segurança do Emprego , Exaustão Emocional , Pressão do Tempo , Prevenção de Acidentes , Planejamento em Saúde , Política de Saúde , Acessibilidade aos Serviços de Saúde , Habitação , Direitos Humanos , Relações Interpessoais , Atividades de Lazer , Acontecimentos que Mudam a Vida , Máscaras , Serviços de Saúde MentalRESUMO
OBJECTIVE: To verify the determining factors of high priority in the risk classification and the outcomes of the care provided to adult patients with chest pain. METHOD: Retrospective study, conducted at an emergency referral service of a public hospital in the interior of São Paulo State, analyzing the records of care performed in the risk classification in 181 medical records of patients with the symptom of chest pain, between August and November 2020. RESULTS: Individuals were most males 98 (54.1%), with moderate pain 133 (73.5), high priority for care 135 (74.5%) and who sought the service spontaneously 139 (76.8%). Of those classified as high priority, 47 (34.8%) were referred to the emergency room and, of these, 27 (17.0%) remained hospitalized. Female gender (p=0.0198; OR=0.40; CI=0.189-0.866) was independently associated with high priority of care. CONCLUSION: Despite the priority classification, few participants were referred to the emergency room and required hospitalization. Female gender was a protective factor in the risk classification as high priority.
Assuntos
Serviços Médicos de Emergência , Triagem , Adulto , Masculino , Humanos , Feminino , Estudos Retrospectivos , Brasil/epidemiologia , Serviço Hospitalar de Emergência , Dor no Peito/epidemiologia , Dor no Peito/diagnósticoRESUMO
The objective of this paper was to identify the main indicators used to measure the performance in emergency trauma care. A literature review was carried out in the electronic databases: PubMEd, LILACS and Epistemónikos, including publications between January 2011 and December 31, 2021, in Spanish, English and Portuguese. A total of 962 publications were identified. When reviewing the full text, 48 articles were included. The indicators were classified in the dimensions of process and results. 100 different indicators were identified to analyze the performance of emergency trauma care. 71% were process indicators, including service time and triage. In the results dimension 29 indicators were identified; mortality was the indicator most analyzed as well as length of stay. Six indicators on the disability of injured people and 14 indicators related to satisfaction were identified, the most frequent being complaints. Various indicators have been used to assess the performance of emergency trauma care. In the results dimension, the indicators related to satisfaction and disability after injuries have been little explored. Decision-makers and those responsible for emergency care must promote performance evaluation exercises to learn about their current situation using appropriate and sensitive indicators with the available data.
El objetivo del presente trabajo fue identificar los principales indicadores utilizados para medir el desempeño en la atención de emergencias traumatológicas. Se realizó una revisión de la literatura de tipo narrativa en las bases de datos: PubMed, LILACS y Epistemónikos, se incluyeron publicaciones entre enero de 2011 y el 31 diciembre 2021, en español, inglés y portugués. Se identificaron 962 publicaciones. Tras revisar el texto completo, 48 artículos fueron incluidos. Los indicadores se clasificaron en las dimensiones de proceso y resultado. Se identificaron 100 diferentes indicadores para analizar el desempeño de la atención de emergencias traumatológicas. 71% fueron indicadores de proceso, entre ellos el tiempo de atención y el triaje. En la dimensión de resultados se identificaron 29 indicadores; la mortalidad fue el indicador mayormente analizado así como el periodo de estancia hospitalaria. Se identificaron seis indicadores sobre la discapacidad de las personas lesionadas y 14 indicadores relacionados con la satisfacción, el más frecuente fue quejas. Diversos indicadores han sido utilizados para evaluar el desempeño de la atención de emergencias traumatológicas. En la dimensión de resultados, los indicadores relacionados con la satisfacción y discapacidad han sido poco explorados. Los responsables de la atención de emergencias traumatológicas deben impulsar ejercicios de evaluación del desempeño para conocer su situación actual a través de indicadores sensibles y acordes con los datos disponibles.
Assuntos
Serviços Médicos de Emergência , Humanos , TriagemRESUMO
The goal of induced or spontaneous labor is childbirth by vaginal delivery. Delivery after 37 weeks is desirable and associated with favorable maternal and newborn outcomes. Delivery facilities should have suitable staff and resources on site for antenatal services and delivery care. FIGO's Prep-for-Labor triage method provides rapid diagnostic tools that help define patients as high or low risk to determine whether transfer to a higher-level center is needed. There is often a disconnect between a facility's designation and its ability to achieve safe deliveries. For preplanned labor induction, the designated clinical facility must have the right set-up and prenatal records available to achieve a successful outcome. However, this is often not the case if a patient arrives in labor or needs an induction and the facility has limited patient information and resources, thus requiring rapid management decisions. The practical guidance checklist in this article defines maternal and/or fetal risk factors and delineates approaches and safe practices for labor induction and management, including when antenatal information is limited to maximize safe delivery practices. Guidelines on using the Bishop score (>6 or <6) to manage labor are presented. Evidence supporting successful safe labor induction at 41-42 weeks of gestation in low-risk cases is described. This practice will increase the rate of spontaneous labor and delivery, minimizing intervention and thereby diverting limited clinical resources to those patients in need. In the right setting, this could lead to around 80% of women delivering spontaneously, which remains a desired goal.
Assuntos
Trabalho de Parto , Triagem , Recém-Nascido , Gravidez , Feminino , Humanos , Parto Obstétrico/métodos , Trabalho de Parto Induzido/métodos , FetoRESUMO
The aim of this study is to analyze the effect of implementing a prioritization triage model for admission to an intensive care unit on the outcome of critically ill patients. Retrospective longitudinal study of adult patients admitted to the Intensive Care Unit (ICU) carried out from January 2013 to December 2017. The primary outcome considered was vital status at hospital discharge. Patients were divided into period 1 (chronological triage) during the years 2013 and 2014 and period 2 (prioritization triage) during the years 2015-2017. A total of 1227 patients in period 1 and 2056 in period 2 were analyzed. Patients admitted in period 2 were older (59.8 years) compared to period 1 (57.3 years; p < 0.001) with less chronic diseases (13.6% vs. 19.2%; p = 0.001), and higher median APACHE II score (21.0 vs. 18.0; p < 0.001)) and TISS 28 score (28.0 vs. 27.0; p < 0.001). In period 2, patients tended to stay in the ICU for a shorter time (8.5 ± 11.8 days) compared to period 1 (9.6 ± 16.0 days; p = 0.060) and had lower mortality at ICU (32.8% vs. 36.9%; p = 0.016) and hospital discharge (44.2% vs. 47.8%; p = 0.041). The change in the triage model from a chronological model to a prioritization model resulted in improvement in the performance of the ICU and reduction in the hospital mortality rate.
Assuntos
Unidades de Terapia Intensiva , Triagem , Adulto , Humanos , Estudos Retrospectivos , Estudos Longitudinais , APACHE , Mortalidade Hospitalar , Tempo de InternaçãoRESUMO
BACKGROUND: Low adherence to triage after positive screening is a widespread problem for cervical cancer screening programs in Low- and Middle-income Countries. Adherence to cytology-based triage can be challenging, especially among women with self-collected tests. SMS-based interventions are accepted by women and can increase screening uptake. The ATICA study was an effectiveness-implementation hybrid type I trial, combining a cluster randomized controlled trial (RCT) with a mixed-methods implementation evaluation involving quantitative and qualitative methods. Although the RCT provided evidence regarding the effectiveness of the SMS-based intervention, less is known about its acceptability, relevance, and usefulness from the women´s perspective. METHODS: We carried out a cross-sectional study based on a structured questionnaire among HPV-positive women who were enrolled in ATICA's intervention group. We measured acceptability, appropriateness, and message content comprehension. Also, we evaluated if the SMS message was considered a cue to encourage women to pick up their HPV test results and promote the triage. RESULTS: We interviewed 370 HPV-positive women. Acceptability of SMS messages among women who had received at least one message was high (97%). We found high levels of agreement in all appropriateness dimensions. More than 77% of women showed high comprehension of the content. Among women who received at least one SMS message, 76% went to the health center to pick up their results. Among those who got their results, 90% reported that the SMS message had influenced them to go. We found no significant differences in acceptability, appropriateness or message comprehension between women who adhered to triage and those who did not adhere after receiving the SMS messages. CONCLUSION: The intervention was highly acceptable, and women reported SMS was an appropriate channel to be informed about HPV test results availability. SMS was also a useful cue to go to the health center to pick up results. The implementation did not encounter barriers associated with the SMS message itself, suggesting the existence of other obstacles to triage adherence. Our results support the RCT findings that scaling up SMS is a highly acceptable intervention to promote cervical screening triage adherence.