Causes and characteristics of uveitis cases at a reference university hospital in Rio de Janeiro, Brazil / Causas e características das uveítes em hospital universitário de referência no Rio de Janeiro, Brasil

ABSTRACT Purpose: The aim of this study was to describe the epidemiological profile of uveitis cases treated at University Hospital Clementino Fraga Filho and to identify the presentation pattern of intraocular inflammation on the basis of clinical, anatomical, etiological, and demographic criteria. Methods: A retrospective study was conducted using data from the medical records of 408 patients with active disease who attended the ophthalmology service between March and October 2018. Age, sex, visual acuity at the time of diagnosis, anatomical and etiological diagnoses, the clinical aspect, and the main symptoms reported during anamnesis were described. Results: Of the 408 patients in the study, 52% were male and 48% were female. The patients' mean age was 42 years, and most (84%) were between 19 and 64 years old. Anterior uveitis was observed in 37.75% of the patients; posterior uveitis, in 49.75%; panuveitis, in 4.66%; and intermediate uveitis, in 3.43%. Only 18 patients (4.41%) presented with scleritis. Of the 390 patients with anatomical classifications, 76% had known etiologies, with the most prevalent diagnoses being toxoplasmosis (35.4%), followed by juvenile idiopathic arthritis (6.4%), ankylosing spondylitis (5.9%), and syphilis (4.9%). Infectious uveitis corresponded to 49.7% of the patients, while 26.6% of the cases were of noninfectious origin. Anterior uveitis had the highest number of cases classified as idiopathic (49.4%). In the cases of posterior uveitis, the etiology was established 94% of the time. The most frequent symptoms were ocular pain (71.8%) and blurring vision (56.8%). Conclusions: The present study confirmed the historical importance of infectious uveitis in our population, especially ocular toxoplasmosis. Uveitis appears to have no predilection for sex but mainly affects young people of working age, thus generating social and economic consequences. Despite the evolution of diagnostic methods, idiopathic uveitis remains one of the major etiologies. Epidemiological studies point to different presentation patterns of uveitis in different populations, but these may reflect the distinct characteristics of each institution.

RESUMO Objetivo: Descrever o perfil epidemiológico das uveítes atendidas no Hospital Universitário Clementino Fraga Filho - UFRJ. Identificando o padrão de apresentação da inflamação intraocular a partir de critérios clínicos, anatômicos, etiológicos e demográficos. Métodos: Estudo retrospectivo, com base em prontuários de 408 pacientes com doença ativa, atendidos no serviço de oftalmologia no período de março a outubro de 2018. Foram descritos a idade, sexo, acuidade visual no momento do diagnóstico, diagnóstico anatômico e etiológico, aspecto clínico, além dos principais sintomas relatados durante a anamnese. Resultados: Dos 408 pacientes do estudo, 52% eram do sexo masculino e 48% do feminino. A idade média dos pacientes foi de 42 anos, a maioria (84%) entre 19 e 64 anos. Uveíte anterior foi observada em 37,75% dos pacientes, uveíte posterior em 49,75%, panuveíte em 4,66% e uveíte intermediária em 3,43%; apenas 18 pacientes (4,41%) apresentaram diagnóstico de esclerite. Dos 390 pacientes com classificação anatômica, a etiologia foi determinada em 76% deles, com os diagnósticos mais prevalentes sendo Toxoplasmose (35,4%), artrite idiopática juvenil (6,4%), espondilite anquilosante (5,9%) e sífilis (4,9%). ) A uveíte infecciosa correspondeu a 49,7% desses pacientes, enquanto 26,6% eram de origem não infecciosa. A uveíte anterior teve o maior número de casos classificados como idiopáticos (49,4%), enquanto a uveíte posterior teve a etiologia estabelecida em 94% das vezes. Os sintomas mais frequentes foram dor ocular (71,8%) e visão embaçada (56,8%). Conclusões: O presente estudo confirmou a importância histórica da uveíte infecciosa em nossa população, principalmente a toxoplasmose ocular. As uveítes parecem não ter predileção por sexo, mas afetam principalmente jovens em idade ativa, gerando consequências sociais e econômicas. Apesar da evolução nos métodos diagnósticos, a uveíte idiopática continua sendo uma das principais causas. Estudos epidemiológicos apontam para diferentes padrões de uveíte nas populações, estes podem refletir características particulares de cada instituição.

Liderança transformacional na prática dos enfermeiros em um hospital universitário / Liderazgo transformacional en la práctica de enfermería en un hospital universitario / Transformational leadership in nurses' practice in a university hospital

Resumo Objetivo Analisar o exercício da liderança transformacional na prática dos enfermeiros em um hospital universitário. Métodos Estudo de métodos mistos explanatório sequencial. Na etapa quantitativa, com amostra não probabilística por conveniência, aplicou-se um questionário de atitudes frente a estilos de liderança adaptado para a frequência de adoção dos comportamentos de liderança transformacional a 152 enfermeiros do referido hospital. Estes dados passaram por testes estatísticos descritivos e analíticos. Na etapa qualitativa, 25 participantes da primeira etapa foram sorteados e responderam a uma entrevista semiestruturada, analisadas mediante análise temática de conteúdo. Resultados Identificou-se a prática da liderança transformacional de forma frequente entre os enfermeiros. Entretanto, eles apresentam dificuldades para exercer esse modelo de liderança, devido a carência de apoio da instituição que, majoritariamente adota uma liderança verticalizada, pela falta de capacitação para os enfermeiros assistenciais, e fragilidades na comunicação e discussão dos problemas antes das tomadas de decisões. Conclusão A prática da liderança transformacional encontra resistências pelo maior exercícios da liderança verticalizada pelos gestores, entretanto os enfermeiros acreditam que uma liderança com comportamento horizontalizado pode favorecer mudanças estruturais e comportamentais da instituição.

Resumen Objetivo Analizar el ejercicio del liderazgo transformacional en la práctica de enfermería de un hospital universitario. Métodos Estudio de mixtos métodos explicativos secuenciales. En la etapa cuantitativa, con muestra no probabilística por conveniencia, se aplicó cuestionario de actitudes frente a estilos de liderazgo adaptados a la frecuencia de adopción de conductas de liderazgo transformacional en 152 enfermeras del hospital. Datos sometidos a pruebas estadísticas descriptivas y analíticas. En la etapa cualitativa, 25 participantes de la primera etapa fueron sorteados, y respondieron a entrevista semiestructurada, revisada por análisis de contenido temático. Resultados La práctica del liderazgo transformacional fue identificada frecuentemente entre los enfermeros. Sin embargo, presentan dificultades para ejercer este modelo de liderazgo debido a falta de apoyo institucional, que mayoritariamente adopta un liderazgo vertical, por falta de capacitación de los enfermeros de atención y debilidades comunicacionales y de discusión de problemas antes de tomar decisiones. Conclusión La práctica del liderazgo transformacional encuentra resistencia por el mayor ejercicio de liderazgo vertical de los gestores, sin embargo, los enfermeros creen que un liderazgo de tipo horizontal podría favorecer cambios estructurales y conductuales en la institución.

Abstract Objective To analyze the exercise of transformational leadership in nurses' practice in a university hospital. Methods Mixed-method explanatory sequential study. In the quantitative phase, a questionnaire of attitudes towards leadership styles adapted to the frequency of adoption of transformational leadership behaviors was applied to a non-probabilistic convenience sample of 152 nurses from the university hospital. Descriptive and analytical statistical tests were used for data treatment. In the qualitative phase, 25 participants from the first phase were randomly selected (draw) and responded to a semi-structured interview that was analyzed by thematic content analysis. Results The practice of transformational leadership was identified frequently among nurses. However, they had difficulties to exercise this leadership model, because of lack of institutional support, since vertical leadership is the most adopted style, as well as lack of training for care nurses, and weaknesses in communication and discussion of problems before decision making. Conclusion The managers' greater exercise of vertical leadership offers resistance to the transformational leadership practice. However, nurses believe that leadership with horizontal behavior can favor structural and behavioral institutional changes.

Antimicrobial susceptibility patterns among bacteria isolated from intensive care units of the largest teaching hospital at the northwest of Iran

ABSTRACT This study was conducted to determine the antimicrobial susceptibility patterns among common pathogens in the intensive care units (ICUs) of a university hospital in northwestern Iran. A retrospective study was done on laboratory records of patients with nosocomial infection who were admitted to five ICUs of Imam Reza Hospital during a 21-month period from March 2010 to January, 2012. A total number of 556 isolates from 328 patients were evaluated. The most common sites of infections included respiratory (51.7%), urinary (24.8%), and blood (10.4%). The most frequently isolated microorganisms were Enterobacter aerogenes (50.6%) followed by Escherichia coli (16.7%) and Pseudomonas aeruginosa (7.5%). Staphylococcus aureus was the most frequent pathogen among gram-positives (39.7%). The rate of methicillin-resistant Staphylococcus aureus (MRSA) was 87.5%. Multidrug-resistant (MDR) gram-negative bacteria were documented in 25.8% of Acinetobacter, 20% of Klebsiella, and 16.6% of Pseudomonas. The most active antimicrobials were vancomycin (93.5%) followed by amikacin (71.5%) and gentamicin (46%). The overall antibiotic susceptibility was as follows: 36% ciprofloxacin, 19% imipenem, 20% trimethoprim-sulfamethoxazole, 20.5% ceftazidime, and 12% ceftriaxone. Due to the high rate of antimicrobial resistance in the ICU setting, more surveillance and control of the use of antimicrobials is needed to combat infections.

Application study on supervision system of hospital-university collaboration in class teaching of nursing undergraduates / 中国实用护理杂志

Objective To evaluate the application effect of supervision system of hospital-university collaboration on class teaching of nursing undergraduates,so as to provide reference to promote the link-up between nursing theory and clinical practices.Methods The supervision group of hospital-university collaboration were formed by selecting 30 excellent clinical instructors from university-affiliated hospitals and 12 nursing teachers,they listened to the teachers in classes randomly and recorded,simultaneously filled in rating forms about the class with students.Supervision meetings were held and targeted strategies were put down regularly,their effects were evaluated through interview and investigation methods.Results Professional teachers accepted their suggestions and took some actions to make a change.The results of rating forms showed that the quality of classroom teaching were improved gradually.Conclusions The supervision system of hospital-university collaboration can enhance the sense of responsibility of teaching,contribute to the integration between the hospital and university.It should be continued as a long-run system.

Ecologia médica: uma reavaliação na realidade brasileira, 2010 / The ecology of medical care 2010: in brazilian's scenarios

Introdução A educação médica sofreu transformações ao longo do século XX. Alguns educadores médicos já reconheceram o problema do modelo centrado na doença e focado em condições não usuais de pacientes hospitalizados e a carência do ensino sobre problemas comuns de saúde. O termo ecologia do cuidado médico é como se conhece a relação entre as pessoas e os cenários de saúde. Esse conceito foi introduzido em 1961 por K. White (e atualizado por Green em 2001), que mostrou graficamente a proporção de pessoas que utilizaram serviços de saúde no período de um mês. Esses resultados influenciaram organizações do sistema de saúde, pesquisa científica e educação médica ao longo dos anos. Objetivos Reavaliar a ecologia médica, agora na população brasileira, identificando, no período de um mês, o número de pessoas que apresentaram sintomas, qual atitude tomaram em relação a eles e comparar as queixas apresentadas com o conteúdo dos livros tradicionais de clínica médica. Métodos Entrevistas telefônicas realizadas por auxiliares de enfermagem a 1.065 participantes consecutivos de uma empresa de convênio médico no período de maio de 2008 a fevereiro de 2009 em São Paulo. Resultados Dos entrevistados, 70% eram mulheres e a idade média foi de 68 anos. No período de 30 dias, em 1.000 pessoas: 398 apresentaram algum sintoma; a maioria (292) procurou consulta ambulatorial; 99 buscaram resolver a queixa no pronto-socorro; 59 foram internadas e 1 foi internada em um hospital universitário. Os sintomas mais encontrados foram: dor em extremidades (10%), mal-estar (10%), lombalgia (8%), cefaleia (6%) e dor articular (6%). Foram 5 livros selecionados; Harrinson, Cecil, Current e Tratado de Clínica Médica AC Lopes e Clinica Médica Milton Arruda e colaboradores, um dos sintomas mais frequentes, como lombalgia, é abordado em 4 a 13 páginas, dor em membros em 0 a 4 páginas e fadiga/mal-estar são discutidos em 2 a 4 páginas dentre todo o conteúdo desses livros. Os sintomas...

Background Medical education has gone through several transitions during the twentieth century, and medical educators recognize the problems inherent to hospital-centered learning: treating rare conditions and involving medical subspecialties very frequently resulting in lack of continuity care. Today, we talk about fragmentation of medical education for both students and patients. This goes far from meeting the real needs of the general population. The expression medical ecology is a conceptual framework to describe the relationship and utilization of medical care by a given population. Introduced by White in 1961 (updated by Green in 2001), the results of these studies have had great impact and influenced ideas regarding organization of health services, research and education. Objectives To analyze the ecology of medical care in a Brazilian population. First, we have aimed to quantify the number of people who demonstrated symptoms in a previous month and considered seeking health care in any one of the following settings: patient does not seek medical care; a physicians office; office of complementary/alternative medicine professional; emergency department; patients home; hospital and university hospital. We have also compared the prevalence of reported symptoms with number of pages of traditional textbooks that discussed these symptoms. Design and Participants The survey was based on telephone interviews in a health insurance company of São Paulo from may/2008 to feb/2009 Results Patients responding (1.065) included 70% women with a mean age of 68 years old; 398 people felt some symptoms in a month; 292 people were in a consultation; 99 have visited an emergency room; 59 were hospitalized and 1 per thousand was admitted in a university hospital. The most prevalent symptoms were: pain in extremities (10%), fatigue (10%), back pain (8%), headache (6%), and joint pain (6%). They are not discussed enough in medical graduation. 5 books were analyzed: Harrinson...

Establishment of individuation mode of talent cultivation based on talent database / 中华医学科研管理杂志

The talent cultivation and echelon construction are the embodiment of core competition and the source of sustainable development in the hospitaI.In order to expedite the talent cuhivation based on the talent database an individuation mode of talent cuhivation was established in Peking University People's Hospital.Following this mode the individuation cultivation of talents and echelon construction were achieved,consequently,the scientific research team would be expected to form and develop.

Analysis of medical scientific theses of Union Hospital of Tongji Medical College in last 5 years / 中华医学科研管理杂志

The publication of the scientific theses and their management are significant for the development of technology and science in the hospital.Therefore.they play an important role iU the hospital management.The retrospective analysis on the theses that published in the last 5 years and embodied by SCI was conducted using the statistics method and analyzed the first 10 departments in the published theses in this paper.The specialty of our hospital and the shortcoming in the scientific research was concluded from the analysis result.The amount of the theses increased steadily,and the research capability of the key subjects and key departments were promoted.The amount and the quality of the theses reflected an important indicator of the development strategy that means to develop the hospital through science.technology and education.Therefore,these conclusions could offer some valuable information to the manage department of t}le hospital.

Present status analysis of state key discipline construction in Shanghai Jiao Tong University School of Medicine / 中华医学科研管理杂志

In this article some ideas on the discipline construction and development in the school of medicine of Shahghai Jiao Tong University were put forward based on the results analysis of state key discipline application in 2007 and comparison between approval and failure disciplines from team,research,graduates education and lab construction.It will be meaningful for the sustainable development of the school of medicine of Shahghai Jiao Tong University in future.

Current Status of Outpatient Anesthesia in University Hospitals in Korea / 대한마취과학회지

BACKGROUND: Outpatient procedures account for more than half the operations performed in the United States, but the status of outpatient anesthesia in Korea has not been documented yet. The present study was designed to evaluate the current status of outpatient anesthesia in university hospitals in Korea. METHODS: Thirty-nine university hospitals were surveyed by questionnaire in February 1997. Objects were patients underwent outpatient operations under general, intravenous or regional anesthesia except local anesthesia by surgeon from January 1996 to December 1996. RESULTS: One university hospital started outpatient anesthesia in 1980 and now ten of 39 universities (25.6 %) provide the procedures. In 1995 one of 10 university hospitals has opened day- surgery center having 7 operating rooms and the capability of 24 hours overnight stays. The other 9 hospitals use one of in-patient operating rooms for outpatient procedures. The utility rate per year was 3.06 +/- 1.59 % and 11.49 % in 9 university hospitals and day-surgery center respectively during 1996. Outpatients were mainly classified as physical status 1 and 2 by American Society of Anesthesiologists, and 54.0 38.3 % to 70 % of patients were distributed under 15 years of age. Surgical procedures were relatively simple and 10 surgical departments were participated into the field of outpatient anesthesia. Inhalation techniques and intravenous anesthesia were used predominantly. Complications were sore throat, nausea and vomiting, delayed recovery of consciousness, bleeding at the operative site, fever and so on. CONCLUSIONS: I think that outpatient anesthesia in Korea has grown at very slow rate over the last 4 decades and that it is very low utility rate per year compared to United States. So we have to try to get more interests and supports about the outpatient anesthesia setting.