ABSTRACT
Determining outcomes and predictors of mortality following discharge from tuberculosis (TB) hospitalization is crucial to establish health policies. The objective of this study was to analyze outcomes and, secondarily, predictors of mortality following discharge from TB hospitalization. This was a prospective cohort study of patients diagnosed with TB (all forms) discharged from the hospital who began treatment during hospitalization. Out of 169 subjects included, 38 died during the 13-months of follow-up, within a median of 3 months (95%CI: 1.49-4.51). In the multivariate analysis, the variables independently associated with death were age (HR=1.04, 95%CI: 1.01-1.06, P=0.001), presence of sputum production (HR=2.18, 95%CI: 1.09-4.34, P=0.027), and Charlson Comorbidity Index (HR=1.19, 95%CI: 1.04-1.36, P=0.015). In conclusion, post-discharge mortality in subjects hospitalized for TB was 22.5%, with mean survival of 4.6 months. The mortality was higher in older subjects, in those who reported sputum production, and in those with a high comorbidity index.
ABSTRACT
Objetivos: Mensurar los niveles de radiación de fuga y dispersión emanada a través de los blindajes y estructuras plomadas del tubo de rayos X de la unidad dental portátil NOMAD, controlando la retrodispersión con el uso del escudo protector de acrílico plomado adaptado en el extremo final del tubo localizador plomado. Se midieron las tasas de exposición dispersadas mediante un detector tipo Geiger-Müller y una cámara de ionización con respuesta en el rango de energías aportadas en diagnóstico por imágenes para la medición de la exposición directa y determinación posterior de las dosis. Se utilizó un fantomas diseñado para diagnóstico odontológico, sopesando la radiación en diferentes angulaciones de operación del equipo NOMAD, simulando los gestos posturales de odontólogos, radiólogos y sujetos a identificar. Se controlaron las tasas de exposición para determinar los valores de las dosis aportadas en las zonas significativas corporales más radiosensibles del operador del equipo. Se obtuvo como resultado que la retrodispersión en el cristalino del ojo del operador fue significativamente menor cuando el fantomas estaba acostado, mientras que a nivel de gónadas resultó más baja con el cuerpo sentado. La tasa de dosis máxima de radiación dispersa que impactó en los operadores fue de 350.8 micro Sieverts por hora (uSv/h) en la zona de gónadas, por cada radiografía tomada sin el uso del delantal de goma plomada, reduciéndose a 4.38 micro Sieverts por hora (uSv/h) al utilizarlo (AU)
Subject(s)
Humans , Male , Female , Radiography, Dental/methods , Technology, Dental , Dental Equipment , Forensic Dentistry , Patients , Argentina , Radiation Dosage , Radiation Protection , Scattering, Radiation , Diagnostic Imaging/methods , Victims Identification , Radiation Exposure Control , Equipment DesignABSTRACT
The stated objective of the COVID-19 lockdown was to allow time to prepare healthcare facilities. Preparation must include administrative and environmental measures, which when combined with personal protective equipment, minimise the risk of the spread of infection to patients and healthcare workers (HCWs) in facilities, allowing HCWs to safely provide essential services during the pandemic and limit the indirect effects of COVID-19 caused by healthcare disruption. We present our model for facility preparation based on colour-coded zones, social distancing, hand hygiene, rapid triage and separate management of symptomatic patients, and attention to infection transmission prevention between HCWs in communal staff areas. This model specifically addresses the challenges in preparing a facility for COVID-19 in a low-resource setting and in rural areas. In addition, we include links to resources to allow workers in low-resource settings to prepare their facilities adequately
Subject(s)
COVID-19 , Cross Infection , Health Care Facilities, Manpower, and Services , Health Personnel , Pandemics , South AfricaABSTRACT
Abstract Climate is one of the main factors that affect plant behavior. The phenology of Guarea macrophylla Vahl, which is a small tree used for reforestation of degraded areas, was monitored for 18 months in a riparian forest at the Schmidt Stream, Campo Bom, in the state of Rio Grande do Sul, southern Brazil. Vegetative (leaf fall and leaf flushing) and reproductive events were observed, with the latter divided into flowering (flower buds and anthesis) and fruiting (unripe, ripening and ripe fruit). Phenological events were related to temperature, photoperiod and precipitation and their seasonality was verified by circular statistical analysis. Vegetative phenophases were continuous; they were not related to climate factors and presented low intensity, emphasizing the perennial aspect of the species. Flowering occurred during spring and summer. Both flower buds and anthesis were related to temperature and photoperiod. Fruiting was constant and went through all stages of development. Unripe fruits developed during the months with the lowest photoperiod and ripen more intensely in winter, on colder days. Ripe fruit became available for dispersal in spring, in times of longer photoperiod and higher temperatures. Except for leaf fall, all other phenological events showed seasonality in their manifestation. The one-month difference between the onsets of the flowering phases observed in this study indicated that local climate changes induced the early occurrence of this phenophase.
Resumo O clima é um dos principais fatores que condicionam o comportamento das plantas. A fenologia de Guarea macrophylla Vahl, arvoreta utilizada no reflorestamento de áreas degradadas, foi acompanhada durante 18 meses, em mata ciliar do arroio Schmidt, Campo Bom, RS, Brasil. Foram observados os eventos vegetativos (queda foliar e brotamento) e reprodutivos, separados em floração (botão floral e antese) e frutificação (frutos imaturos, maturando e maduros). Os eventos fenológicos foram relacionados à temperatura, ao fotoperíodo e à precipitação e a sua sazonalidade foi verificada por meio da análise estatística circular. As fenofases vegetativas foram contínuas, não se relacionaram com os fatores climáticos e apresentaram baixa intensidade, ressaltando a característica perene da espécie. A floração ocorreu durante a primavera e o verão e tanto botão floral quanto antese relacionaram-se com temperatura e fotoperíodo. A frutificação foi constante e passou por todos os estádios de desenvolvimento. Os frutos imaturos desenvolveram-se em meses com o menor fotoperíodo e maturaram mais intensamente no inverno, em dias de menor temperatura. Os frutos maduros tornaram-se disponíveis para os dispersores na primavera, em períodos com maior fotoperíodo e temperatura. Com exceção da queda foliar, todos os outros eventos fenológicos apresentaram sazonalidade em sua manifestação. O adiantamento de um mês entre as florações observadas no presente estudo indicou que as alterações climáticas locais de temperatura induziram a ocorrência antecipada dessa fenofase.
Subject(s)
Forests , Conservation of Natural Resources , Meliaceae/physiology , Temperature , Climate Change , Brazil , Photoperiod , Fruit/physiologyABSTRACT
Abstract Climate is one of the main factors that affect plant behavior. The phenology of Guarea macrophylla Vahl, which is a small tree used for reforestation of degraded areas, was monitored for 18 months in a riparian forest at the Schmidt Stream, Campo Bom, in the state of Rio Grande do Sul, southern Brazil. Vegetative (leaf fall and leaf flushing) and reproductive events were observed, with the latter divided into flowering (flower buds and anthesis) and fruiting (unripe, ripening and ripe fruit). Phenological events were related to temperature, photoperiod and precipitation and their seasonality was verified by circular statistical analysis. Vegetative phenophases were continuous; they were not related to climate factors and presented low intensity, emphasizing the perennial aspect of the species. Flowering occurred during spring and summer. Both flower buds and anthesis were related to temperature and photoperiod. Fruiting was constant and went through all stages of development. Unripe fruits developed during the months with the lowest photoperiod and ripen more intensely in winter, on colder days. Ripe fruit became available for dispersal in spring, in times of longer photoperiod and higher temperatures. Except for leaf fall, all other phenological events showed seasonality in their manifestation. The one-month difference between the onsets of the flowering phases observed in this study indicated that local climate changes induced the early occurrence of this phenophase.
Resumo O clima é um dos principais fatores que condicionam o comportamento das plantas. A fenologia de Guarea macrophylla Vahl, arvoreta utilizada no reflorestamento de áreas degradadas, foi acompanhada durante 18 meses, em mata ciliar do arroio Schmidt, Campo Bom, RS, Brasil. Foram observados os eventos vegetativos (queda foliar e brotamento) e reprodutivos, separados em floração (botão floral e antese) e frutificação (frutos imaturos, maturando e maduros). Os eventos fenológicos foram relacionados à temperatura, ao fotoperíodo e à precipitação e a sua sazonalidade foi verificada por meio da análise estatística circular. As fenofases vegetativas foram contínuas, não se relacionaram com os fatores climáticos e apresentaram baixa intensidade, ressaltando a característica perene da espécie. A floração ocorreu durante a primavera e o verão e tanto botão floral quanto antese relacionaram-se com temperatura e fotoperíodo. A frutificação foi constante e passou por todos os estádios de desenvolvimento. Os frutos imaturos desenvolveram-se em meses com o menor fotoperíodo e maturaram mais intensamente no inverno, em dias de menor temperatura. Os frutos maduros tornaram-se disponíveis para os dispersores na primavera, em períodos com maior fotoperíodo e temperatura. Com exceção da queda foliar, todos os outros eventos fenológicos apresentaram sazonalidade em sua manifestação. O adiantamento de um mês entre as florações observadas no presente estudo indicou que as alterações climáticas locais de temperatura induziram a ocorrência antecipada dessa fenofase.
ABSTRACT
This article reports the correlation between different clinical assessors' scoring of learners' clinical competencies in order to exclude any possible extraneous variables with regard to reasons for poor clinical competencies of learners. A university in Gauteng; South Africa provides a learning programme that equips learners with clinical knowledge; skills and values in the assessment; diagnosis; treatment and care of patients presenting at primary health care (PHC) facilities. The researcher observed that; despite additional clinical teaching and guidance; learners still obtained low scores in clinical assessments at completion of the programme. This study sought to determine possible reason(s) for this observation. The objectives were to explore and describe the demographic profile of learners and the correlation between different clinical assessors' scoring of learners. A purposive convenience sample consisted of learners (n = 34) and clinical assessors (n = 6). Data were collected from learners using a self-administered questionnaire and analysed using a nominal and ordinal scale measurement. Data from clinical assessors were collected using a checklist; which was statistically analysed using a software package. The variables were correlated to determine the nature of the relationship between the different clinical assessors' scores on the checklist to ensure inter-rater reliability. Findings showed that there was no significant difference in the mean of the scoring of marks between clinical assessors after correlation (p 0.05). Thus; scoring of marks did not contribute to poor clinical competencies exhibited by learners
Subject(s)
Clinical Competence , Evaluation Studies as Topic , Human Characteristics , Nursing , StudentsABSTRACT
Newly qualified intensive care nurses are forced into positions of authority and responsibility as shift leaders at an early stage and are not given a chance to consolidate their new knowledge with practice. They have to be responsible and accountable not only for their own actions; but also for those of their staff. The purpose of this study was to explore and describe the competencies of the shift leader in the intensive care unit setting to determine whether there is a gap between what is expected of the shift leader and what is happening in reality. A quantitative; descriptive design was used and cluster sampling was implemented. Questionnaires were used to gather data from three clusters; comprising 11 hospitals from a single private hospital group. Of the 251 questionnaires that were handed out to intensive care personnel (including trained and non-trained staff); 98 were returned; resulting in a response rate of 39. An in-depth literature study and submission of questionnaires to experts before being administered to respondents ensured validity and reliability. Results were used to describe a typology of the competencies of the shift leader in the intensive care setting and indicated that respondents classified competencies related to the application of the nursing process in the intensive care unit in all its facets as essential competencies. None were classified as a critical competency and only four were classified as specific competencies. All respondents in the three clusters regarded their shift leaders as competent
Subject(s)
Critical Care , Hospitals , Nursing , Professional CompetenceABSTRACT
Los pacientes sometidos a procedimientos de intervención coronaria percutánea, al igual que en pacientes con enfermedad coronaria, deben recibir en forma indefinida tratamiento con ácido acetilsalicílico (AAS) y Clopidogrel. El desarrollo de nuevos productos a base de Clopidogrel a menores costos ayudan a evitar la discontinuación prematura de la terapia antiplaquetaria; entre estos productos desarrollados tenemos la marca Cravid® de Laboratorios LETI S.A.V. y esta debe comparar su efectividad e inocuidad con el patrón internacional de Clopidogrel marca Plavix® de Laboratorios Sanofi Aventis. Se realizó un estudio: prospectivo, comparativo, cruzado, aleatorizado, en voluntarios sanos. Cada grupo recibió 1 comprimido de Clopidogrel Leti, CLOP-L o Clopidogrel Sanofi, CLOP-S de 75 mg. en una sola dosis al día durante 7 días continuos. Después de un período de lavado de 7 días recibieron el segundo tratamiento. Se midió la agregación plaquetaria al inicio de cada período y a los 7 días de tratamiento mediante agregometría óptica, con un agregómetro Óptico Modelo 490-2D marca Cronolog, con sistema de autocalibración que trabajó con plasma rico en plaquetas. Lectura 0-100% de paso de luz. En ambos grupos se produjo un descenso importante en la agregabilidad plaquetaria a los 7 días de tratamiento de más del 50 % independiente del reactivo de ADP (Helena y Cronolog) utilizado para agregar (P < 0.05). La relación de las medias e IC del porcentaje de agregación obtenida con las dos diferentes marcas comerciales de ADP se encontraron entre el 80 y 125%, por lo cual se concluye que ambas marcas de Clopidrogrel son bioequivalentes y por lo tanto, son perfectamente intercambiables
The undergoing percutaneous coronary intervention procedures, as in patients with coronary disease should receive treatment indefinitely with acetylsalicylic acid (ASA) and Clopidogrel. Developing new products based on lower costs clopidogrel to help prevent premature discontinuation of antiplatelet therapy, among these products we have developed the brand Cravid® of LETI S,A.V. Laboratories® and this should compare their effectiveness and safety with the international standard Clopidogrel brand Plavix® of Sanofi Aventis Laboratories. We conducted a study: a prospective, comparative, cross-randomized, in healthy volunteers. Each group received 1 tablet of Clopidogrel Leti, CLO-L or Clopidogrel Sanofi-LCLOP-S 75 mg. in a single dose daily for 7 days. Followed for 7 day-washout period before administration of second treatment. Platelet aggregation was measured at the beginning of each period and 7 days of treatment by agregometría optics. With a agregómetro Optical Model 490-2D. In both groups there was a decrease in platelets add to the 7 days of treatment for more than 50% independent of the reagent ADP (Helena and cronolog) used to add (P <0.05). The mean and CI at 90%, obtained with two different trademarks of ADP were between 80 and 125%, which was concluded that both brands are bioequivalent and are therefore perfectly interchangeable
Subject(s)
Female , Coronary Disease , Fibrinolytic Agents , Pharmacology , Platelet Activating Factor , Platelet AggregationABSTRACT
No member of [health] staff should undertake tasks unless they are competent to do so' is stated in the Comprehensive Primary Health Care Service Package for South Africa (Department of Health 2001) document. In South Africa; primary clinical nurses (PCNs); traditionally known as primary health care nurses (PHCNs); function as 'frontline providers' of clinical primary health care (PHC) services within public PHC facilities; which is their extended role. This extended role of registered nurses (set out in section 38A of the Nursing Act 50 of 1978; as amended) demands high clinical competency training by nursing schools and universities. The objectives of the study were to explore and describe the perceptions of both clinical instructors and students; in terms of the reasons for poor clinical competencies. Results established that two main challenges contributed to students' poor clinical competencies: challenges within the PHC clinical field and challenges within the learning programme (University)
Subject(s)
Clinical Competence , Comprehensive Health Care , Primary Health Care , Students , TherapeuticsABSTRACT
This work evaluates a microprocessed cistometry equipment developed by the Biomedical Engineering Div. of the HCPA. The system provides an useful means of quantifying bladders pressures and volume during the filling of bladder...
Subject(s)
Urinary Bladder/physiology , Urinary Bladder Diseases , Urinary IncontinenceABSTRACT
The gastric pressure monitor was developed by the Biomedical Engineering Div. of the HCPA. It helps to evaluate Gastric Yield Pressure (GYP) in a swine model for gastroesophageal reflux (GER). A dual lumen 20 Fr Foley catheter is passed through a gastrostomy into the swine stomach...
Subject(s)
Esophageal Sphincter, Lower , Gastroesophageal Reflux , Polymethyl Methacrylate , SwineABSTRACT
Nódulos de tireóide säo uma condiçäo clínica comum e em seu diagnóstico diferencial inclui-se o câncer de tireóide. Como o câncer de tireóide é raro, é importante conhecer a prevalência de nódulos de tireóide em grupos fortemente pre-dispostos para dimensionar seu impacto e adequar estratégias diagnósticas. OBJETIVOS: O objetivo deste estudo foi verificar a prevalência de nódulos de tireóide diagnosticados por ecografia em mulheres na maturidade. MÉTODOS: Entre agosto de 1996 e dezembro de 1997 foram avaliadas, de forma consecutiva, pacientes do sexo feminino com idade de 40 anos ou mais que realizavam ecografia no Serviço de Radiologia do HCPA...
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Thyroid Neoplasms , Thyroid Nodule , Age Factors , Brazil/epidemiology , Thyroid Neoplasms/epidemiology , Thyroid Nodule/epidemiologyABSTRACT
Los autores presentan una investigacion casuistica sobre la incidencia y predominancia del sulcus lunatus en el cerebro del hombre. Tomando como punto de partida las incongruencias bibliograficas encontradas, se enfoca el trabajo desde un punto de vista estrictamente morfologico y macroscopico. La metodologia empleada consistio en observaciones directas del lobulo occipital, secciones en diferentes planos, mediciones de longitud y diagramacion de los casos examinados. A traves de los resultados obtenidos se arriba a conclusiones de alta significacion con respecto a incidencia, predominancia y bilateralidad. Se senala, ademas, que la diversidad del sulcus lunatus en cuanto a su conformacion anatomica ha obligado a dividir los casos positivos en un grupo con caracteres tipicos y otro con diferentes grados de atipia