5 research outputs found
Retinoblastoma in children older than 5 years of age
No full textBackground Retinoblastoma is a malignant tumor of the embryonic neural retina. About 80% of cases are diagnosed before age 4, with a median age at diagnosis of 2 years. Objective. To determine characteristics and prognosis of retinoblastoma in children older than 5 years. Procedures. From 1986 to 2002, medical records of 16 patients out of 453 cases referred to Hospital do Uncer AC Camargo, São Paulo, Brazil. Results. Median age at diagnosis was 73.7 months (range 65-144) and there was an equal gender distribution. Fifteen patients presented with unilateral disease. the mean time between first symptoms and diagnosis was 9.6 months (range 0-48). Most cases were diagnosed in advanced stages and 15 eyes were enucleated. Eleven patients presented with intraocular tumor (1 Reese II and 10 Reese V) and five presented with extraocular disease (one CCG II and four CCG III). Twelve patients are still alive with a median follow-up of 92 months (range 65-199). Conclusions. Because of its low incidence at this age, diagnosis of retinoblastoma is usually delayed due to low level of suspicion. Therefore, it is important that physicians are aware of this disease in orderto perform an earlier diagnosis, and decrease treatment-related morbidity.Hosp Canc AC Camargo, Dept Pediat Oncol, BR-01509900 São Paulo, BrazilHosp Canc AC Camargo, Hosp Canc Registry, BR-01509900 São Paulo, BrazilHosp Canc AC Camargo, Dept Radiat Oncol, BR-01509900 São Paulo, BrazilHosp Canc AC Camargo, Dept Ophthalmol, BR-01509900 São Paulo, BrazilHosp Canc AC Camargo, Dept Pathol, BR-01509900 São Paulo, BrazilWeb of Scienc
Design of a multifaceted strategy based on automated text messaging in patients with recent heart failure admission
No full textObjetivos: Avaliar uma estratégia de telemonitoramento baseada em mensagens de texto automatizadas e suporte telefônico após hospitalização por insuficiência cardíaca (IC). Métodos e resultados: O estudo MESSAGE-HF é um estudo prospectivo multicêntrico, randomizado, de abrangência nacional, envolvendo pacientes de 30 clínicas em todas as regiões do Brasil. Pacientes com IC com fração de ejeção do ventrículo esquerdo reduzida (<40%) e acesso a telefones celulares são elegíveis após uma hospitalização por IC aguda descompensada. Os pacientes que atendem aos critérios de elegibilidade passam por uma avaliação inicial de viabilidade de mensagens de texto e são randomizados para cuidados habituais ou intervenção de telemonitoramento. Todos os pacientes recebem um livreto de IC com informações básicas e recomendações sobre autocuidado. Os pacientes do grupo de intervenção recebem quatro mensagens de texto curtas diariamente (educativas e de feedback) durante os primeiros 30 dias do protocolo para otimizar o autocuidado; as mensagens de texto de feedback dos pacientes podem desencadear ajustes diuréticos ou um telefonema da equipe de saúde. Após 30 dias, a frequência das mensagens de texto pode ser ajustada. Os pacientes são acompanhados após 30, 90 e 180 dias, com status final apurado em 365 dias por telefone. Nosso desfecho primário é a alteração nos níveis do peptídeo natriurético cerebral N-terminal (NT-proBNP) após 180 dias. Os endpoints secundários incluem alterações no NT-proBNP após 30 dias; escalas de qualidade de vida relacionada à saúde, autocuidado na IC e conhecimento após 30 e 180 dias; e um desfecho composto de hospitalização por IC e morte cardiovascular, avaliado por um comitê cego e independente. Conclusões: O estudo MESSAGE-HF está avaliando uma estratégia educacional e de promoção do autocuidado envolvendo um sistema de telemonitoramento simples, intensivo e personalizado. Se comprovadamente eficaz, pode ser aplicado a uma população mais ampla em todo o mundo.Aims: To evaluate a telemonitoring strategy based on automated text messaging and telephone support after heart failure(HF) hospitalization. Methods and results: The MESSAGE-HF study is a prospective multicentre, randomized, nationwide trial enrolling patients from 30 clinics in all regions of Brazil. HF patients with reduced left ventricular ejection fraction (<40%) and access to mobile phones are eligible after an acute decompensated HF hospitalization. Patients meeting eligibility criteria undergo an initial fea-sibility text messaging assessment and are randomized to usual care or telemonitoring intervention. All patients receive a HFbooklet with basic information and recommendations about self-care. Patients in the intervention group receive four dailyshort text messages (educational and feedback) during the first 30 days of the protocol to optimize self-care; the feedback text messages from patients could trigger diuretic adjustments or a telephone call from the healthcare team. After 30 days, the frequency of text messages can be adjusted. Patients are followed up after 30, 90, and 180 days, with final status ascertained at 365 days by telephone. Our primary endpoint is the change in N-terminal pro-brain natriuretic peptide (NT-proBNP) levelsafter 180 days. Secondary endpoints include changes in NT-proBNP after 30 days; health-related quality of life, HF self-care, and knowledge scales after 30 and 180 days; and a composite outcome of HF hospitalization and cardiovascular death, adjudicated by a blinded and independent committee. Conclusions: The MESSAGE-HF trial is evaluating an educational and self-care promotion strategy involving a simple, intensive, and tailored telemonitoring system. If proven effective, it could be applied to a broader population worldwide
Erro humano na saúde: o caso com medicamentos de alto risco por via intravenosa
Get PDFTese (doutorado) - Universidade Federal de Santa Catarina, Centro Tecnológico, Programa de Pós-Graduação em Engenharia de Produção, Florianópolis, 2015.O presente estudo foi desenvolvido com o objetivo propor diretrizes para impedir ocorrência do erro no preparo, administração e monitoramento de Medicamentos Potencialmente Perigosos (MPPs) por via intravenosa em um Serviço de Emergência Adulto num hospital escola, com ênfase na ergonomia, visando à segurança do paciente e trabalhadores. O estudo é classificado como um estudo de caso de natureza aplicada, com abordagem quantitativa e qualitativa, embasado em pesquisa exploratória de desenho transversal, em razão da intencionalidade da escolha da população. A população investigada constituiu-se de 34 técnicos e 06 auxiliares de enfermagem. Os dados foram levantados em dois momentos. O primeiro, no período de 15 a 21 de novembro de 2013, quando foi aplicado o questionário e o segundo, no período de 15 a 26 de janeiro de 2014, com a observação. Nesta fase, foram observados e identificados os erros ocorridos durante o preparo, a administração e o monitoramento de 23 doses de MPPs com o uso do Checklist. Os dados do questionário indicaram, dentre outros, que dos 40 sujeitos da pesquisa 27 (67,5%) não fizeram a leitura da bula do cloreto de potássio, 32 (80,0%) não fizeram a leitura da bula do sulfato de magnésio e 45,0% (n=18) não fizeram a leitura da bula da glicose. Os resultados da observação permitiram identificar que, dos 54 itens do Checklist, em 43 (79,6%) ocorreram erros. Nenhum dos erros causou impactos para o paciente, um causou dano material e todos foram classificados como violação. Propõe-se, como medidas para impedir a ocorrência dos erros nessa instituição, a elaboração de protocolos de preparo e administração de medicamentos; a promoção de educação continuada e permanente para os profissionais sobre o tema; e a formação de um grupo multiprofissional com a finalidade de discutir e estabelecer estratégias que possam promover a segurança do paciente.Abstract : This study was developed with the objective of offerring guidelines to stop errors in preparing, managing and monitoring Potencially Dangerous Drugs (MPPs) pushed through intravenous via at an Adult Emergency Service, with ergonomic emphasis, aiming pacient?s and workers safety. The study is classified as an apllied nature case study, with qualitative and quantitative approach, based on exploratory research of transversal design, because the choice of the population was intentional. This population was constituted of 34 technicians and 06 nursing helpers. The data was raised in two moments. The first, during november 15th and 21st of 2013, when a questionnaire was applied; the second moment took place during january 15th and 26th of 2014, with observation. At this point, the errors occurred during preparation, managing and monitoring of 23 doses of MPPs with the use of checklist. The questionnaire data indicated, along with other facts, that 27 of the 40 people interviewed (67,5%) did not read the potassium chloride bull; 32 (80,0%) did not read the magnesium sulfate bull and 45,0% (18 people) did not read the glucose bull. The results allowed to identify that errors occurred in 43 of the 54 items of the checklist (79,6%). None of the errors caused impacts on the patient; one caused material damage and all errors were classified as violation. Within the major errors identified during preparation of the 23 doses, 23 (100,0%) of the professionals did not verify prescription before iniciating the process; 23 (100,0%) did not verify the expiration date, particle presence and solution turbidity; 23 (100,0%) of the professionals didn?t do the second and third label readings. In the managing section, 23 (100,0%) did not use the tray to transport medication; 23 (100,0%) didn?t wash their hands before iniciating drug administration; 21 (91,3%) did not identify the paciente by their name; 17 (74,0%) didn?t check the drug?s name; the dose was not checked by 23 (100,0%) professionals before it was managed and 11 individuals (47,8%) did not test the venous permeability. Besides, all 23 people didn?t do the pacient?s monitoring. It can be concluded that facts like work conditions of technicians and nursing helpers, overcrowding, reduced number of professionals, work organization, double bond and the extensive working hours, beyond others, are factors that favor the errors incidence in medication, and are present in the SEA of the studied institution. It is proposed, as measures to stop errors incidence in this institution, the elaboration of preparation and managing drugs protocols, the promotion of continued andpermanent education for professionals and the criation of a multiprofissional group with the objective of discussing and establishing strategies to promote pacient?s safety
Characterisation of llama antibody fragments able to act as HIV-1 entry inhibitors
Get PDFHuman immunodeficiency virus type 1 (HIV-1) entry into cells is mediated by
the functional envelope spike, which consists of trimers of gp120 bound to gp41.
Most variants of HIV-1 enter cells through attachment of the envelope spike to
the main cellular receptor CD4, allowing interaction with a co-receptor and
eventually fusion of viral and cellular membranes. Neutralising antibodies inhibit
HIV-1 entry by targeting epitopes on the functional spike. HIV-1 has, however,
evolved several ways to evade recognition by antibodies, including variable
regions, carbohydrates, and conformational masking. As a result, the neutralising
antibody response in HIV-1 infection and post-immunisation is generally narrow,
and only a handful of broadly neutralising monoclonal antibodies have been
reported. In this thesis, the isolation and characterisation of novel, broadly
neutralising antibody fragments derived from llamas is described. Llamas
produce antibodies devoid of light chains, which have their antigen-binding
properties confined to a single fragment, the VHH, and a preference for cleftrecognition.
VHH were isolated from llamas immunised with recombinant gp120
using phage display-based methods. In order increase the chances of isolating
neutralising VHH, a functional selection strategy was employed, involving a
competitive elution with soluble CD4. Three VHH able to neutralise HIV-1
primary isolates of subtype B and C were characterised. These VHH bound to
gp120 with high affinities and competed with soluble CD4 and antibodies to the
CD4-binding site for this binding, indicating that their mechanism of
neutralisation involves interacting with the functional envelope spike prior to
binding to CD4. These results indicate that llama VHH can be potent HIV-1
entry inhibitors. Since VHH are stable and can be produced at a relatively low
cost, they may be considered for HIV-1 microbicide development. Anti-gp120
VHH might also prove useful in defining neutralising and non-neutralising
epitopes on HIV-1 envelope proteins, with implications for HIV-1 vaccine
design
