Rational use of blood calcium determinations / Uso racional da dosagem de cálcio no sangue

CONTEXT AND OBJECTIVE: This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo (HCFMUSP). Its aim was to suggest rules for the determination of total and ionized calcium in our intensive care units, emergency department, wards and outpatient services, thus contributing towards improving the quality of medical care and achieving more appropriate use of human and financial resources. DESIGN AND SETTING: Critical analysis on clinical and laboratory data and the pertinent scientific literature, conducted by the study group for rational clinical laboratory use, which is part of the Central Laboratory Division, HCFMUSP. METHODS: The study group reviewed scientific publications, statistics and clinical and laboratory data concerning requests for total and ionized calcium determinations in the settings of intensive care units, emergency department, wards and outpatient services. RESULTS: From this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed. CONCLUSIONS: Use of the proposed flow diagrams may help to limit the numbers of inappropriate requests for ionized and total calcium determinations, with consequent reductions in the number of tests, risks to patients and unnecessary costs. .

CONTEXTO E OBJETIVO: Este trabalho foi motivado pelo recente aumento excessivo de solicitações de dosagem de cálcio no sangue, assim como de exames laboratoriais em geral, no complexo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Seu objetivo foi sugerir regras para a determinação de cálcio total e iônico nas nossas unidades de terapia intensiva, pronto-socorro, enfermarias e ambulatórios e contribuir para a melhoria da qualidade da assistência médica, com utilização mais adequada dos recursos humanos e financeiros. TIPO DO ESTUDO E LOCAL: Análise crítica de dados clínicos, laboratoriais e da literatura médica pertinente, realizada pelo grupo de estudos para o uso racional do laboratório clínico, vinculado à Divisão de Laboratório Central do HCFMUSP. MÉTODOS: O grupo de estudos reviu publicações científicas, estatísticas e dados clínico-laboratoriais relativos às solicitações de cálcio total e iônico nos ambientes das unidades de terapia intensiva, prontos-socorros, enfermarias e ambulatórios. RESULTADOS: A partir dessa análise crítica, foram construídos fluxogramas de decisão clínica que visam orientar a requisição desses testes. CONCLUSÕES: A utilização dos fluxogramas propostos pode ajudar a limitar a solicitação inadequada das dosagens de cálcio total e iônico, com consequente redução do número de exames, de riscos para os pacientes e de custos desnecessários. .

role of internet and telemedicine in modern medical practice

The revolution in the information technology has mede profound and unprecedented changes in the society and in the world of science including medical and health related sciences. With this revolution will come an enormous potential to increase efficiency of clinical, reduce human errors, and improve the quality of medical care. Moreover, electronic medical information will help to democratize medicine. So physicians and health care providers realize that they must adopt these technologies since they are going to be standards of clinical practice very soon and surveys are showing that expanding numbers of physicians and health care providers are accessing the web daily for medical information, consultations, and distant learning. This emerging environment will also have a great influence on patient eduction and will certainly affect physician-patient relationship. Actually the internet is a key influence in changing the balance of knowledge between physicians and the public,empowering patients to become more involved in health care decision-making since more patients are coming to the physicians with information from the internet about illnesses, medical treatment, and the availability of clinical trials. The most important areas are the internet, the world wide web [www] and telemedicine which begins to enter the mainstream of health care. This article focuses light on some of the applications of internet in clinical practice. It also provides some guidelines for the effective use and retrieval of medical information from the internet

A gestão do sistema pericial de saúde do MAER

O sistema pericial de saúde representa um modelo alargado de prestações de serviços, exigindo uma gestão moderna, proativa, com um planejamento cuidadoso de seus recursos. Da mesma forma requer uma unidade de doutrina e a incorporação de seus valores por todas as suas clientelas

Conservative management of post-date pregnancy

This study was conducted to evaluate the management of postdate pregnancy. Ninety-nine patients with a firmly established gestational age of more than 294 days were admitted to the Department of Obstetrics and Gynecology, Assiut University. They had no other complications. They compromised two groups, Group I consisted of 49 patients who were actively managed due to the presence of an abnormal finding suggesting fetal compromise. Group II consisted of 50 patients who were managed conservatively without intervention until the spontaneous onset of labor. The mean age, parity and gestational age were significantly higher in group II. The mean duration of the second stage of labor was longer in group I. Spontaneous vaginal delivery was more in group II, while ventouse extraction was more in group I. The mean birth weight was higher in group I. The mean Apgar score was significantly higher in group II. Meconium aspiration was present in eight babies of group I and in none of group II. Nineteen babies in group I needed admission to the Neonatal Intensive Care Unit, while only five in group II needed so. The incidence of CS was significantly higher among patients more than 30 years. Postdating was more in younger age group. The incidence of vaginal delivery was significantly higher in younger age group while that of CS showed the reverse