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INTRODUCTION: This study aimed to describe and analyze the rate of clot migration of vessel thrombosis to distal segments in patients with acute ischemic stroke (AIS) who received intravenous thrombolysis (IVT) with tenecteplase (TNK) and alteplase (ALT) before mechanical thrombectomy (MT). In addition, we aimed to determine the relationship between thrombus migration and functional prognosis. METHODS: This study followed the STROBE reporting guidelines. We performed a retrospective analysis of a series of patients from November 2017 to April 2023 with an AIS with thrombosis on CT imaging, treated with IVT (TNK or ALT, split into two distinct groups) prior to mechanical thrombectomy. RESULTS: Two hundred and fifty-six patients with large vessel occlusion (LVO) were included. Ninety-six had received TNK. One hundred and sixty had received ALT. Of the 96 TNK patients, 25 experienced either complete recanalization (n = 3) or thrombus migration (n = 22). Of the 160 ALT patients, 20 experienced either complete recanalization (n = 6) or thrombus migration (n = 14). The difference being statistically substantial for the thrombus migration rate (OR = 3.61, 95% confidence interval: 1.63; 7.98). Migration to an irretrievable very distal segment occurred in four (4%) patients with TNK and in three patients (2%) with ALT (p > 0.05). Thrombus migration was not significantly associated to a different functional prognosis, measured through Rankin scale after 3 months (OR = 0.44, 95% confidence interval: 0.17; 1.12). CONCLUSION: The use of TNK over ALT as a fibrinolytic agent is associated with a higher thrombus migration rate. The migration of thrombi to distal segments, which are theoretically less accessible for mechanical thrombectomy, did not result in worse clinical outcomes.
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Introducción: la educación en el trabajo en la especialidad de Medicina General Integral constituye la principal forma de organización de la enseñanza, donde los tutores desempeñan un papel fundamental. Objetivo: caracterizar la educación en el trabajo en la especialidad de Medicina General Integral. Materiales y Métodos: se realizó un estudio pedagógico, y en su ejecución se emplearon métodos teóricos como: la revisión bibliográfica y documental, que abarcó las principales temáticas: el plan de estudio de la especialidad de Medicina General Integral, el perfil profesional y recursos para el aprendizaje. Resultados: se expusieron los resultados del análisis documental efectuado a partir de: la formación del profesional, educación en el trabajo, así como los valores y la ética médica. Conclusiones: la educación en el trabajo constituye el principal artífice de los procesos de formación profesional, educación en el trabajo propiamente dicho, así como valores y ética médica (AU).
Introduction: the education in the work in the specialty of General Medicine constitutes the main form of organization of the teaching, where the tutors play a fundamental part. Objective: to characterize the education in the work in the specialty of Integral General Medicine. Materials and Methods: a pedagogic study was carried out, and in their execution theoretical methods were used as: the bibliographical and documental revision that embraced the main ones thematic: the plan of study of the specialty of General Medicine, the professional profile and resources for the learning. Results: the results of the documental analysis were exposed made starting from: the professional's formation, education in the work, as well as the values and the medical ethics. Conclusions: the education in the work the main author of the processes of professional formation, education in the properly this work constitutes, as well as you value and medical ethics (AU).
Assuntos
Humanos , Masculino , Feminino , Ensino/educação , Ensino/normas , Trabalho/normas , Mentores/educação , Educação Médica/métodos , Educação Médica/normas , Medicina Geral/educação , Medicina Geral/métodos , Medicina Geral/ética , Literatura de Revisão como Assunto , Educação Profissionalizante/métodos , Ética Médica/educação , Capacitação ProfissionalRESUMO
Introducción: la educación en el trabajo en la especialidad de Medicina General Integral constituye la principal forma de organización de la enseñanza, donde los tutores desempeñan un papel fundamental. Objetivo: caracterizar la educación en el trabajo en la especialidad de Medicina General Integral. Materiales y Métodos: se realizó un estudio pedagógico, y en su ejecución se emplearon métodos teóricos como: la revisión bibliográfica y documental, que abarcó las principales temáticas: el plan de estudio de la especialidad de Medicina General Integral, el perfil profesional y recursos para el aprendizaje. Resultados: se expusieron los resultados del análisis documental efectuado a partir de: la formación del profesional, educación en el trabajo, así como los valores y la ética médica. Conclusiones: la educación en el trabajo constituye el principal artífice de los procesos de formación profesional, educación en el trabajo propiamente dicho, así como valores y ética médica (AU).
Introduction: the education in the work in the specialty of General Medicine constitutes the main form of organization of the teaching, where the tutors play a fundamental part. Objective: to characterize the education in the work in the specialty of Integral General Medicine. Materials and Methods: a pedagogic study was carried out, and in their execution theoretical methods were used as: the bibliographical and documental revision that embraced the main ones thematic: the plan of study of the specialty of General Medicine, the professional profile and resources for the learning. Results: the results of the documental analysis were exposed made starting from: the professional's formation, education in the work, as well as the values and the medical ethics. Conclusions: the education in the work the main author of the processes of professional formation, education in the properly this work constitutes, as well as you value and medical ethics (AU).
Assuntos
Humanos , Masculino , Feminino , Ensino/educação , Ensino/normas , Trabalho/normas , Mentores/educação , Educação Médica/métodos , Educação Médica/normas , Medicina Geral/educação , Medicina Geral/métodos , Medicina Geral/ética , Literatura de Revisão como Assunto , Educação Profissionalizante/métodos , Ética Médica/educação , Capacitação ProfissionalRESUMO
OBJECTIVES: To evaluate the effect of radiologist experience on the risk of false-positive results in population-based breast cancer screening programmes. METHODS: We evaluated 1,440,384 single-read screening mammograms, corresponding to 471,112 women aged 45-69 years participating in four Spanish programmes between 1990 and 2006. The mammograms were interpreted by 72 radiologists. RESULTS: The overall percentage of false-positive results was 5.85% and that for false-positives resulting in an invasive procedure was 0.38%. Both the risk of false-positives overall and of false-positives leading to an invasive procedure significantly decreased (p < 0.001) with greater reading volume in the previous year: OR 0.77 and OR 0.78, respectively, for a reading volume 500-1,999 mammograms and OR 0.59 and OR 0.60 for a reading volume of >14,999 mammograms with respect to the reference category (<500). The risk of both categories of false-positives was also significantly reduced (p < 0.001) as radiologists' years of experience increased: OR 0.96 and OR 0.84, respectively, for 1 year's experience and OR 0.72 and OR 0.73, respectively, for more than 4 years' experience with regard to the category of <1 year's experience. CONCLUSION: Radiologist experience is a determining factor in the risk of a false-positive result in breast cancer screening.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico , Mamografia/métodos , Radiologia/métodos , Idoso , Neoplasias da Mama/patologia , Detecção Precoce de Câncer , Reações Falso-Positivas , Feminino , Humanos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Risco , Fatores de TempoRESUMO
Introducción. La detección precoz del déficit auditivo en el periodo neonatal permite instaurarun programa de rehabilitación temprana para mejorar la capacidad de comunicación de los niños afectadospor déficit de audición. Con este objetivo se han iniciado en los sistemas sanitarios de muchospaíses programas poblacionales de cribado de hipoacusia a los recién nacidos.Material y métodos. La población objetivo la constituyen todos los recién nacidos en Galicia. Elprograma fue implantado de forma progresiva desde mayo del 2002 hasta junio del 2008 en todoslos hospitales de la red pública gallega y en algunos hospitales privados. La prueba de cribado consisteen la realización de potenciales evocados auditivos automatizados. Se realiza preferentementeantes del alta hospitalaria. Las unidades de cribado están integradas por personal del propio centro.El personal de enfermería es el encargado de realizar la prueba de cribado de forma habitual en sujornada laboral. Si antes de que el niño abandone el centro se obtiene un resultado positivo de laprueba, tanto unilateral como bilateral, el niño es derivado para confirmación diagnóstica.Resultados. Tanto la cobertura como la participación aumentaron desde un 46 y un 69,11% en2002 a un 89 y un 99,78% respectivamente en 2007, con un total de 80.166 niños cribados en los 6años de funcionamiento. La tasa de derivación global fue de 0,84% y el número de casos diagnosticadosde hipoacusia fue de 64, lo que sitúa la tasa de detección global en 0,80 por mil niños cribados.Conclusiones. La aceptación de la prueba ha sido muy buena, hecho que se refleja en la altaparticipación que alcanzó, el 99% en 2003, manteniéndose en años sucesivos. La tasa de derivaciónobservada 0,84% es relativamente baja, por lo que está siendo motivo de estudio. La tasa dedetección ha ido aumentando con la cobertura del programa, acercándose a la incidencia estimadade hipoacusia neonatal
Early detection of hearing deficit in the neonatal period makes it possible to establish a rehabilitationprogram to enhance the communication capacity of infants born with hearing loss.With this aim,the health care authorities of many countries have implemented population-screening programs aimingthe early detection of neonatal deafness.Material and methods. The target population is made up of all newborn infants in Galicia.Screening was gradually introduced in all the Galician public maternity hospitals and some privateones from May 2002 to June 2008. The screening test was made by performing the automatedauditory brain response, preferentially performed prior to discharge from hospital.The screening unitsare formed by centers own staff.The test is performed by nurses, performing the screening during theusual daily work in the nursery. If a unilateral or bilateral positive result is obtained before dischargefrom the maternity ward, the baby is referred for diagnostic confirmation.Results. Both the coverage and the participation rate increased from 46% and 69.11% in 2002to 89% and 99.78% in 2007, respectively, with 80,166 children screened during 6 years of experience.The global referral rate was 0.84% and the number of cases of deafness diagnosed was 64.Detection rate was 0.80 per one thousand children tested.Conclusions. Acceptance of the test by the parents has been very good, this being reflected inhigh participation that reached 99% in 2003 and has been maintained over successive years.The observedreferral rate of 0.84 % is relatively low, which is the reason for this study. The detection rate hasbeen increasing as the coverage of the program has been growing, approaching the estimated incidenceof neonatal deafness
