Biochemical markers for prediction of the first half pregnancy losses: a review.

Objective: 26% of all pregnancies end in miscarriage, and up to 10% of clinically diagnosed pregnancies, and recurrent pregnancy loss is 5% among couples of childbearing ages. Although there are several known causes of pregnancy loss in the first half, including recurrent pregnancy loss, including parental chromosomal abnormalities, uterine malformations, endocrinological disorders, and immunological abnormalities, about half of the cases of pregnancy loss in its first half remain unexplained. Methods: The review includes observational controlled studies (case-control or cohort, longitudinal studies, reviews, meta-analyses), which include the study of biochemical factors for predicting pregnancy losses in the first half, in singlet pregnancy. The Newcastle-Ottawa Scale (NOS) was used to assess the research quality. Results: Finally, 27 studies were included in the review, which has 134904 examined patients. The results of the review include estimates of ß-human chorionic gonadotropin, progesterone, pregnancy-associated protein - A, angiogenic vascular factors, estradiol, α-fetoprotein, homocysteine and CA-125 as a predictors or markers of the first half pregnancy losses. Conclusion: It may be concluded that to date, research data indicate the unavailability of any reliable biochemical marker for predicting pregnancy losses in its first half and require either a combination of them or comparison with clinical evidence. A fairly new model shall be considered for the assessment of α-fetoprotein in vaginal blood, which may have great prospects in predicting spontaneous miscarriages.

Missed opportunities in the prevention and diagnosis of pediatric tuberculosis: a scoping review

Abstract Objectives: Identify potential barriers, delays, and missed opportunities in the prevention and diagnosis of childhood TB. Methods: Scoping review according to the PRISMA extension. The definitions considered for the selection followed the acronym PCC where the population (P) is children under 18years of age with TB disease, the concept (C) refers to missed opportunities for prevention and diagnosis, and context (C) is defined as a diagnosis of TB disease. The authors searched systematically in the databases; VHL/Lilacs, Medline via PubMed, Cochrane, Scopus, and Web of Science, without date or language limitation. Results: Seven studies were included. In developed countries, with low disease burden, the main shortcoming is the delay in diagnosing bacilliferous adults in contact with young children. This problem is concentrated in the portion of the population with socioeconomic vulnerability. In underdeveloped countries, with a high burden of disease, the biggest challenge is tracking children who come into contact with bacilliferous patients. Conclusions: There are still many missed opportunities in the prevention and diagnosis of childhood TB. The positive legacy of the COVID-19 pandemic should be taken advantage of and the encouragement of scientific development in the management of infectious diseases should be taken.

Custos sociais da DPOC: o impacto sobre os anos de vida saudável e a perda de produtividade no Brasil entre os anos de 2017 e 2022 / Social costs of COPD: The impact on healthy life years and productivity loss in Brazil from 2017 to 2022

Objetivo: Estimar as perdas de produtividade causadas pela doença pulmonar obstrutiva crônica (DPOC) na população brasileira. Métodos: O estudo utilizou dados obtidos do Datasus, IBGE, indicadores previdenciários, óbitos e aposentadorias precoces por DPOC no Brasil de 2017 a 2022. Para estimar o impacto da DPOC, foram utilizados: anos de vida saudável perdidos (DALYs) e anos de vida ajustados por produtividade (PALYs), assim como as métricas de perda de produtividade salarial (PPS) e perda de produtividade nacionalizada (PPN), que avalia a perda em função do PIB. Resultados: Mais de 196 milhões de dias de trabalho foram perdidos devido à DPOC. As principais fontes são: óbitos precoces (95.264.088), afastamentos permanentes (67.314.232) e aposentadoria precoce (30.304.490). Diárias hospitalares (3.221.591) têm uma contribuição minoritária. O valor total de DALYs observado no período do estudo foi de 2.819.332,63 anos de vida saudável perdidos causados pela DPOC; um total de 14.997.166 PALYs foi perdido por conta da DPOC ou um valor anual equivalente de R$ 230,7 bilhões. Considerando a PPS, estimamos que a DPOC acarretou perdas de produtividade associadas à reposição da mão de obra de R$ 1,38 bilhão anual e, em relação à PPN, de R$ 8,28 bilhões por ano. Conclusões: Afastamentos de pacientes com DPOC podem acarretar maiores dispêndios com pagamentos de benefícios previdenciários. Este estudo atualiza e amplia correlações entre dados socioepidemiológicos, custos de saúde e previdenciários da DPOC no Brasil. Considerando todas as perdas, a DPOC pode causar perdas de R$ 240 bilhões por ano.

Objective: To estimate productivity losses due to workdays lost caused by chronic obstructive pulmonary disease (COPD) in the Brazilian population. Methods: The study used data from DATASUS, IBGE, social security indicators, deaths, and early retirements due to COPD in Brazil from 2017 to 2022. To estimate the impact of COPD, the following were used: Disability-Adjusted Life Years (DALYs) and Productivity-Adjusted Life Years (PALYs), as well as metrics for wage productivity loss (PPS) and nationalized productivity loss (PPN), which evaluates the loss in relation to GDP. Results: More than 196 million workdays were lost due to COPD. The main sources are premature deaths (95,264,088), permanent absences (67,314,232), and early retirement (30,304,490). Hospitalization days (3,221,591) had a minor contribution. The total DALYs observed during the study period was 2,819,332.63 years of healthy life lost due to COPD; a total of 14,997,166 PALYs were lost due to COPD, equivalent to an annual value of R$ 230.7 billion. Considering PPS, we estimate that COPD resulted in productivity losses associated with workforce replacement of R$ 1.38 billion annually; and in relation to PPN, R$ 8.28 billion per year. Conclusions: Absences in COPD patients can lead to higher expenditures on social security benefit payments. This is the first study to correlate socioepidemiological data, health, and social security costs of COPD in Brazil. Considering all losses, COPD can cause losses of R$ 240 billion per year.

Chronic Pain and Joint Hypermobility: A Brief Diagnostic Review for Clinicians and the Potential Application of Infrared Thermography in Screening Hypermobile Inflamed Joints.

Joint hypermobility syndromes, particularly chronic pain associated with this condition, including Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD), present diagnostic challenges due to their multifactorial origins and remain poorly understood from biomechanical and genomic-molecular perspectives. Recent diagnostic guidelines have differentiated hEDS, HSD, and benign joint hypermobility, providing a more objective diagnostic framework. However, incorrect diagnoses and underdiagnoses persist, leading to prolonged journeys for affected individuals. Musculoskeletal manifestations, chronic pain, dysautonomia, and gastrointestinal symptoms illustrate the multifactorial impact of these conditions, affecting both the physical and emotional well-being of affected individuals. Infrared thermography (IRT) emerges as a promising tool for joint assessment, especially in detecting inflammatory processes. Thermal distribution patterns offer valuable insights into joint dysfunctions, although the direct correlation between pain and inflammation remains challenging. The prevalence of neuropathies among hypermobile individuals accentuates the discordance between pain perception and thermographic findings, further complicating diagnosis and management. Despite its potential, the clinical integration of IRT faces challenges, with conflicting evidence hindering its adoption. However, studies demonstrate objective temperature disparities between healthy and diseased joints, especially under dynamic thermography, suggesting its potential utility in clinical practice. Future research focused on refining diagnostic criteria and elucidating the underlying mechanisms of hypermobility syndromes will be essential to improve diagnostic accuracy and enhance patient care in this complex and multidimensional context.

Missed opportunities in the prevention and diagnosis of pediatric tuberculosis: a scoping review.

OBJECTIVES: Identify potential barriers, delays, and missed opportunities in the prevention and diagnosis of childhood TB. METHODS: Scoping review according to the PRISMA extension. The definitions considered for the selection followed the acronym PCC where the population (P) is children under 18 years of age with TB disease, the concept (C) refers to missed opportunities for prevention and diagnosis, and context (C) is defined as a diagnosis of TB disease. The authors searched systematically in the databases; VHL/Lilacs, Medline via PubMed, Cochrane, Scopus, and Web of Science, without date or language limitation. RESULTS: Seven studies were included. In developed countries, with low disease burden, the main shortcoming is the delay in diagnosing bacilliferous adults in contact with young children. This problem is concentrated in the portion of the population with socioeconomic vulnerability. In underdeveloped countries, with a high burden of disease, the biggest challenge is tracking children who come into contact with bacilliferous patients. CONCLUSIONS: There are still many missed opportunities in the prevention and diagnosis of childhood TB. The positive legacy of the COVID-19 pandemic should be taken advantage of and the encouragement of scientific development in the management of infectious diseases should be taken.

Decision analysis framework for predicting no-shows to appointments using machine learning algorithms.

BACKGROUND: No-show to medical appointments has significant adverse effects on healthcare systems and their clients. Using machine learning to predict no-shows allows managers to implement strategies such as overbooking and reminders targeting patients most likely to miss appointments, optimizing the use of resources. METHODS: In this study, we proposed a detailed analytical framework for predicting no-shows while addressing imbalanced datasets. The framework includes a novel use of z-fold cross-validation performed twice during the modeling process to improve model robustness and generalization. We also introduce Symbolic Regression (SR) as a classification algorithm and Instance Hardness Threshold (IHT) as a resampling technique and compared their performance with that of other classification algorithms, such as K-Nearest Neighbors (KNN) and Support Vector Machine (SVM), and resampling techniques, such as Random under Sampling (RUS), Synthetic Minority Oversampling Technique (SMOTE) and NearMiss-1. We validated the framework using two attendance datasets from Brazilian hospitals with no-show rates of 6.65% and 19.03%. RESULTS: From the academic perspective, our study is the first to propose using SR and IHT to predict the no-show of patients. Our findings indicate that SR and IHT presented superior performances compared to other techniques, particularly IHT, which excelled when combined with all classification algorithms and led to low variability in performance metrics results. Our results also outperformed sensitivity outcomes reported in the literature, with values above 0.94 for both datasets. CONCLUSION: This is the first study to use SR and IHT methods to predict patient no-shows and the first to propose performing z-fold cross-validation twice. Our study highlights the importance of avoiding relying on few validation runs for imbalanced datasets as it may lead to biased results and inadequate analysis of the generalization and stability of the models obtained during the training stage.

Biochemical markers for prediction of the first half pregnancy losses: a review

Abstract Objective 26% of all pregnancies end in miscarriage, and up to 10% of clinically diagnosed pregnancies, and recurrent pregnancy loss is 5% among couples of childbearing ages. Although there are several known causes of pregnancy loss in the first half, including recurrent pregnancy loss, including parental chromosomal abnormalities, uterine malformations, endocrinological disorders, and immunological abnormalities, about half of the cases of pregnancy loss in its first half remain unexplained. Methods The review includes observational controlled studies (case-control or cohort, longitudinal studies, reviews, meta-analyses), which include the study of biochemical factors for predicting pregnancy losses in the first half, in singlet pregnancy. The Newcastle-Ottawa Scale (NOS) was used to assess the research quality. Results Finally, 27 studies were included in the review, which has 134904 examined patients. The results of the review include estimates of β-human chorionic gonadotropin, progesterone, pregnancy-associated protein - A, angiogenic vascular factors, estradiol, α-fetoprotein, homocysteine and CA-125 as a predictors or markers of the first half pregnancy losses. Conclusion It may be concluded that to date, research data indicate the unavailability of any reliable biochemical marker for predicting pregnancy losses in its first half and require either a combination of them or comparison with clinical evidence. A fairly new model shall be considered for the assessment of α-fetoprotein in vaginal blood, which may have great prospects in predicting spontaneous miscarriages.

Inteligencia artificial en la colonoscopia de tamizaje y la disminución del error.

Artificial Intelligence (AI) has the potential to change many aspects of healthcare practice. Image discrimination and classification has many applications within medicine. Machine learning algorithms and complicated neural networks have been developed to train a computer to differentiate between normal and abnormal areas. Machine learning is a form of AI that allows the platform to improve without being programmed. Computer Assisted Diagnosis (CAD) is based on latency, which is the time between the captured image and when it is displayed on the screen. AI-assisted endoscopy can increase the detection rate by identifying missed lesions. An AI CAD system must be responsive, specific, with easy-to-use interfaces, and provide fast results without substantially prolonging procedures. AI has the potential to help both, trained and trainee endoscopists. Rather than being a substitute for high-quality technique, it should serve as a complement to good practice. AI has been evaluated in three clinical scenarios in colonic neoplasms: the detection of polyps, their characterization (adenomatous vs. non-adenomatous) and the prediction of invasive cancer within a polypoid lesion.

La inteligencia artificial (IA) tiene el potencial de cambiar muchos aspectos de la práctica sanitaria. La discriminación y la clasificación de imágenes tiene muchas aplicaciones dentro de la medicina. Se han desarrollado algoritmos de aprendizaje automático y redes neuronales complicadas para entrenar a una computadora a diferenciar las áreas normales de las anormales. El aprendizaje automático es una forma de IA que permite que la plataforma mejore sin ser programada. El diagnóstico asistido por computadora (CAD) se basa en latencia, que es el tiempo entre la imagen capturada y cuando es mostrada en la pantalla. La endoscopia asistida por IA puede incrementar la tasa de detección al identificar lesiones obviadas. Un sistema CAD de IA debe ser sensible, específico, con interfaces fáciles de usar, y proporcionar resultados rápidos sin prolongar sustancialmente los procedimientos. La IA tiene el potencial de ayudar tanto a endoscopistas entrenados como a los que están en entrenamiento. En vez de ser un sustituto para una técnica de alta calidad, deberá servir como un complemento de las buenas prácticas. La IA ha sido evaluada en tres escenarios clínicos en las neoplasias colónicas: la detección de pólipos, su caracterización (adenomatosos vs. no adenomatosos) y la predicción de cáncer invasor dentro de una lesión polipoide.

Could trauma laparoscopy be the standard of care for hemodynamically stable patients? A retrospective analysis of 165 cases.

BACKGROUND: Trauma laparoscopy may provide a less invasive alternative to laparotomy by providing accurate diagnosis and minimally invasive management of selected trauma patients. The risk of missing injuries during the laparoscopic evaluation still refrains surgeons from using this approach. Our aim was to evaluate feasibility and safety of trauma laparoscopy in selected patients. METHODS: We performed a retrospective review of hemodynamically trauma patients who underwent laparoscopic management in a tertiary center in Brazil due to abdominal trauma. Patients were identified by searching through the institutional database. We collected demographic and clinical data, focusing on avoidance of exploratory laparotomy, and missed injury rate, morbidity, and length of stay. Categorical data were analyzed using Chi-square, while numerical comparisons were performed using Mann-Whitney and Kruskal-Wallis test. RESULTS: We evaluated 165 cases, of which 9.7% needed conversion to an exploratory laparotomy. One-hundred and twenty-one patients (73%) had at least one intrabdominal injury. Two missed injuries to retroperitoneal organs were identified (1.2%), of which only one was clinically relevant. Three patients died (1.8%), one of which was due to complications from an intestinal injury after conversion. No deaths were related to the laparoscopic approach. CONCLUSION: In selected hemodynamically stable trauma patients, the laparoscopic approach is feasible and safe, and reduces the need for exploratory laparotomy and its associated complications.

Cuidado perdido de enfermería desde la percepción de la supervisión durante la pandemia de COVID-19 / Missed nursing care from the perception of supervision during the COVID-19 pandemic / Cuidados de enfermagem perdidos como percebidos pela supervisão durante a pandemia de COVID-19

El cuidado perdido tiene un impacto negativo en los resultados en salud, los cuales son reconocidos como eventos adversos por los participantes de la investigación.

Missed care has a negative impact on health outcomes, which are recognized as adverse events by research participants.

A falta de cuidados tem um impacto negativo nos resultados da saúde, que são reconhecidos como eventos adversos pelos participantes da pesquisa.

Post-treatment apical periodontitis associated with a missed root canal in a maxillary lateral incisor with two roots: A case report.

Missed canals can be a common cause of persistent intraradicular infection and post-treatment apical periodontitis. This article reports on a rare case of a maxillary lateral incisor with two roots exhibiting symptomatic post-treatment apical periodontitis regardless of a radiographically adequate root canal treatment. The second root, which was only revealed by cone-beam computed tomography, had passed unnoticed during the first treatment, and its missed canal was the most likely cause of symptoms and treatment failure. Reintervention including the proper management of the extra root canal and retreatment of the main canal resulted in the resolution of symptoms and periradicular tissue healing. This case report reinforces the need for three-dimensional radiographic diagnosis to search for the cause of post-treatment disease and guide the decision-making process for proper management.

Assistência de enfermagem em situação de abortamento retido: cenário validado para simulação clínica / Nursing care in situation of retained abortion: scenario validated for clinical simulation / Atención de enfermería en situaciones de aborto retenido: escenario validado para simulación clinica

Objetivo: Descrever a elaboração e validação de um cenário para simulação clínica no ensino de graduação em enfermagem sobre assistência às mulheres em situação de abortamento retido. Métodos: Estudo metodológico de validação desenvolvido em cinco etapas: overview, scenario design, progression, debriefing e assessment, em 2019 em uma Universidade Pública do Distrito Federal, envolvendo doze participantes, cinco deles como juízes. Para verificar a validação calculou-se o Índice de Validade de Conteúdo (IVC) e o coeficiente kappa. Resultados: O cenário propõe uma situação de assistência de enfermagem a um casal em processo de abortamento retido, em atendimento em um Pronto Socorro Ginecológico. A elaboração do cenário partiu do objetivo de aprendizagem "Realizar a assistência de enfermagem à gestante para tratar o quadro de abortamento retido". A partir do preenchimento de uma escala likert, pelos juízes, obteve-se o IVC 0,97 e um Kappa de 0,68, sendo o cenário considerado como validado. Conclusão: O estudo alcançou o objetivo proposto. Espera-se que esse material educativo seja utilizado como recurso pedagógico nas disciplinas sobre saúde da mulher nos cursos de graduação em enfermagem ou em treinamentos de profissionais já atuantes no contexto da saúde da mulher. (AU)

Objective: To describe development and validation of a clinical simulated scenario in nursing school concerning the assistance to women who have been through a missed abortion. Methods: Methodological validation study developed in five stages: overview, scenario, scenario design progression, debriefing e assessment, during 2019 at a public University of Distrito Federal, that involved 12 participants, four of whom were the judges. To verify the validation, the Índice de Validade de Conteúdo (IVC) and the Kappa coefficient were calculated. The project was approved by the Ethics in Research Committee. Results: Scenario proposed a situation of nursing assistance to a couple in the process of missed abortion, in a gynaecological emergency room. The development of the scenario started from the learning objective "Giving nursing assistance to the pregnant woman aiming to treat the medical condition of missed abortion". With a Likert scale completion by the judges, the IVC 0,97 and Kappa 0,68 were obtained, which means the scenario was considered valid. Conclusion: The study achieved proposed objective. It`s expected that this educational material be used as pedagogical resource in classes about women health in Nursing graduation course, or in training courses given to professionals who are in practice in women`s heath context. (AU)

Objetivo: Describir elaboración y validación de un escenario de simulación clínica en la educación de pregrado en enfermería sobre asistencia a mujeres en situaciones de aborto retenido. Métodos: Estudio metodológico de validación desarrollado en cinco etapas: panorama general, diseño de escenarios, progresión, debriefing y evaluación, en 2019 en Universidad Pública del Distrito Federal, involucrando doce participantes, cinco como jueces. Para verificar la validación se calculó el Índice de Validez de Contenido (IVC) y el coeficiente Kappa. El proyecto fue aprobado por el Comité de Ética en Investigación. Resultados: El escenario propone una situación de asistencia de enfermería a una pareja en processo de aborto retenido, en atendimiento a Urgencias Ginecológicas. La elaboración del escenario partió del objetivo de aprendizaje "Brindar cuidados de enfermería a gestantes para tratar la situación de aborto retenido". Se obtuvo un IVC de 0,97 y un Kappa de 0,68, considerándose el escenario como validado. Conclusión: El estúdio logró el objetivo propuesto. Se espera que este material ecucativo sea utilizado como recurso pedagógico en las disciplinas sobre salud de la mujer en cursos de pregrado en enfermería o en la formación de profesionales que ya trabajan en el contexto de salud de la mujer. (AU)

Impact of United States 2017 Immigration Policy changes on missed appointments at two Massachusetts Safety-Net Hospitals.

INTRODUCTION: Studies have shown mixed findings regarding the impact of immigration policy changes on immigrants' utilization of primary care. METHODS: We used a difference-in-differences analysis to compare changes in missed primary care appointments over time across two groups: patients who received care in Spanish, Portuguese, or Haitian Creole, and non-Hispanic, white patients who received care in English. RESULTS: After adjustment for age, sex, race, insurance, hospital system, and presence of chronic conditions, immigration policy changes were associated with an absolute increase in the missed appointment prevalence of 0.74 percentage points (95% confidence interval: 0.34, 1.15) among Spanish, Portuguese and Haitian-Creole speakers. We estimated that missed appointments due to immigration policy changes resulted in lost revenue of over $185,000. CONCLUSIONS: We conclude that immigration policy changes were associated with a significant increase in missed appointments among patients who receive medical care in languages other than English.

Sociodemographic and work environment correlates of missed nursing care at highly specialized hospitals in Mexico: A cross-sectional study.

BACKGROUND: Despite its direct relevance to quality of care, little is known about missed nursing care or its sociodemographic and work environment correlates at highly specialized hospitals in low- and middle-income countries. OBJECTIVE: To analyze the frequency of missed nursing care among Mexican nursing professionals, and to assess its associated sociodemographic and labor-related predictors. DESIGN AND METHODS: A cross-sectional, observational study based on data collected from 315 nursing professionals in 11 highly specialized public hospitals in Mexico. We assessed missed nursing care both as a total figure and according to the four dimensions of the MISSCARE inventory. We estimated its sociodemographic and work-related predictors using fractional logistic analysis. RESULTS: The global score for missed nursing care was 15.21%: 7.94% concerned individual needs, 9.37% discharge planning and patient education, 18.10% basic care, and 1.59% care under continuous assessment. The odds of engaging in missed nursing care increased with age and were higher among women and night-shift workers. In contrast, they decreased among nursing professionals who were satisfied with their jobs, and among those working in suitable environments. CONCLUSIONS: Missed nursing care in highly specialized public hospitals is associated with the sociodemographic characteristics and labor-related conditions -including the work environments- of the nurses. Given its impact on both health-care users and institutions, further research on the subject is urgently needed. It is essential to improve the design, implementation and evaluation of comprehensive strategies aimed at reducing the frequency of missed nursing care and achieving universal health coverage.

The role of autopsy on the diagnosis of missed injuries and on the trauma quality program goal definitions: study of 192 cases / Valor da autópsia no diagnóstico de lesões despercebidas e na definição de metas para programa de qualidade em trauma: estudo de 192 casos

ABSTRACT Objective: to assess the role of autopsy in the diagnosis of missed injuries (MI) and definition of trauma quality program goals. Method: Retrospective analysis of autopsy reports and patient's charts. Injuries present in the autopsy, but not in the chart, were defined as "missed". MI were characterized using Goldman's criteria: Class I, if the diagnosis would have modified the management and outcome; Class II, if it would have modified the management, but not the outcome; Class III, if it would not have modified neither the management nor the outcome. We used Mann-Whitney's U and Pearson's chi square for statistical analysis, considering p<0.05 as significant. Results: We included 192 patients, with mean age of 56.8 years. Blunt trauma accounted for 181 cases, and 28.6% were due to falls from the same level. MI were diagnosed in 39 patients (20.3%). Using Goldman's criteria, MI were categorized as Class I in 3 (1.6%) and Class II in 11 (5.6%). MI were more often diagnosed in the thoracic segment (25 patients, 64.1% of the MI). The variables significantly associated (p<0.05) to MI were: time of hospitalization < 48 h, severe trauma mechanism, and not undergoing surgery or computed tomography. At autopsy, the values of ISS and NISS were higher in patients with MI. Conclusion: the review of the autopsy report allowed diagnosis of MIs, which did not influence outcome in their majority. Many opportunities of improvement in quality of care were identified.

RESUMO Objetivo: Avaliar a utilidade da autópsia no diagnóstico de lesões despercebidas (LD) e no estabelecimento de metas para programa de qualidade em trauma. Método: análise retrospectiva dos laudos de autópsia por trauma entre outubro/2017 e março/2019 provenientes do mesmo hospital. Lesões descritas na autópsia, mas não no prontuário médico, foram consideradas como despercebidas (LD) e classificadas pelos critérios de Goldman: Classe I: mudariam a conduta e alterariam o desfecho; Classe II: mudariam a conduta, mas não o desfecho; Classe III: não mudariam nem a conduta nem o desfecho. As variáveis coletadas foram comparadas entre o grupo com LD e os demais, através de método estatístico orientado por profissional na área. Consideramos p<0,05 como significativo. Resultados: analisamos 192 casos, com média etária de 56,8 anos. O trauma fechado foi o mecanismo em 181 casos, sendo 28,6% por quedas da própria altura. LD foram observadas em 39 casos (20,3%), sendo 3 (1,6%) classe I e 11 (5,6%) classe II. O tórax foi o segmento com maior número de LD (25 casos - 64,1% das LD). Foram associados à presença de LD (p<0,05): tempo de internação menor que 48 horas, mecanismo de trauma grave e a não realização de procedimento cirúrgico ou tomografia. Nos óbitos até 48h, valores de ISS e NISS nas autópsias foram maiores que os da internação. Conclusão: a revisão das autópsias permitiu identificação de LD, na sua maioria sem influência sobre conduta e prognóstico. Mesmo assim, várias oportunidades foram criadas para o programa de qualidade.

Efficacy of a New Protocol of Premixed 70/30 Human Insulin in Haitian Youth with Diabetes.

INTRODUCTION: Controlling insulin-treated diabetes is challenging in low-resource settings where only Neutral Protamine Hagedorn (NPH), regular (R) and premixed insulin formulations are available, self-monitoring of blood glucose (SMBG) supplies are scarce and food insecurity is common. We examined the impact of a treatment protocol that includes sliding scale-based 70/30 insulin adjustments in Haiti. METHODS: Thirty young patients aged 11-28 years with diabetes treated with premixed 70/30 insulin twice daily were included in the study. The participants performed one or two daily self-monitoring of blood glucose (SMBG) tests and attended our diabetes clinic monthly. They were randomized to two treatment groups, with one group remaining on the 70/30 insulin formulation (group 70 [G70]) and the other group switching to self-mixed NPH + R (group NR [GNR]). Sliding scales for insulin correction doses and meal insulin doses were designed based on the total daily insulin dose (TDD), carbohydrate ratio and insulin sensitivity factor. SMBG tests and insulin were administered before the morning and evening meals. The frequency of visits to the diabetes clinic was increased to biweekly during a 14-week follow-up. RESULTS: Fifteen patients of each group were included in the analysis. Baseline characteristics, increase in total daily dose and number of missed SMBG tests and skipped meals at 14 weeks did not differ between the two groups. Hemoglobin A1c (HbA1c) decreased from 9.5% (interquartile range [IQR] 8.8, 10.5) (80.3 mmol/mol) to 8.0% (IQR 7.1%, 9.0%) (63.9 mmol/mol) in G70 (p = 0.01), and from 10.6% (IQR 8.1,% 13.1)% (92.4 mmol/mol) to 9.0% (IQR 7.6%, 9.6%) (74.9 mmol/mol) in GNR (p = 0.10), with no significant between-group difference in reductions (p = 0.12). No serious acute complications were reported. Stopping the use of sliding scales and resuming monthly visits increased HbA1c to values not significantly different from baseline in both groups after 15 weeks. CONCLUSION: The use of sliding scales adjusted for missed SMBG tests and skipped meals, and frequent clinic visits that focus on patient self-management education significantly improved glycemic control in the patients with youth-onset diabetes in our study treated with premixed 70/30 human insulin in a low-resource setting.

Using Household Surveys to Assess Missed Opportunities for Simultaneous Vaccination: Longitudinal Examples from Colombia and Nigeria.

One important strategy to increase vaccination coverage is to minimize missed opportunities for vaccination. Missed opportunities for simultaneous vaccination (MOSV) occur when a child receives one or more vaccines but not all those for which they are eligible at a given visit. Household surveys that record children's vaccination dates can be used to quantify occurrence of MOSVs and their impact on achievable vaccination coverage. We recently automated some MOSV analyses in the World Health Organization's freely available software: Vaccination Coverage Quality Indicators (VCQI) making it straightforward to study MOSVs for any Demographic & Health Survey (DHS), Multi-Indicator Cluster Survey (MICS), or Expanded Programme on Immunization (EPI) survey. This paper uses VCQI to analyze MOSVs for basic vaccine doses among children aged 12-23 months in four rounds of DHS in Colombia (1995, 2000, 2005, and 2010) and five rounds of DHS in Nigeria (1999, 2003, 2008, 2013, and 2018). Outcomes include percent of vaccination visits MOSVs occurred, percent of children who experienced MOSVs, percent of MOSVs that remained uncorrected (that is, the missed vaccine had still not been received at the time of the survey), and the distribution of time-to-correction for children who received the MOSV dose at a later visit.

Platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in missed abortion

Abstract Objective Missed abortion occurs in ~ 15% of all clinical pregnancies. The pathogenesis is not clearly known. However, defective placentation resulting in maternal systemic inflammatory response is considered responsible for missed abortion. Platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) are increasingly cited parameters of inflammation in the literature. However, no study evaluated the PLR and NLR rates in missed abortions so far. The aim of the present study is to investigate whether complete blood count (CBC) inflammatory parameters such as NLR and PLR are increased in patients with missed abortion. Methods Medical records of 40 pregnant women whose gestation ended in missed abortion at between 6 and14 weeks of gestation and of 40 healthy pregnant women were collected and compared retrospectively. The groups were compared regarding hemoglobin, hematocrit, platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), PLR and NLR. Results Platelet distribution width, NLR and PLR values were higher in the missed abortion group compared with the healthy pregnant women group (rates are p = 0.043; p = 0.038; and p = 0.010, respectively). Hematocrit, MPV, and lymphocyte values were found to be lower in the missed abortion group compared with the healthy pregnant women group (p = 0.027, p = 0.044 and p = 0.025, respectively). Conclusion The PDW, NLR and PLR values of the missed abortion group were reported high; and MPV values were reported low in the present study. These findings may help to speculate a defective placentation in the pathogenesis of missed abortion.

Relationship between the implementation of primary nursing model and the reduction of missed nursing care.

AIMS: To evaluate and predict the relationship between the implementation of the primary nursing model and the reduction of missed nursing care. BACKGROUND: Primary nursing can provide hospital leaders and nursing staff with guidance in implementing safe, patient-centred care, with responsibility and accountability during the nursing process. The implementation can be measured in terms of missed nursing care. METHODS: A predictive correlational study was used. The study was conducted in four inpatient units at the University Hospital, Northeast, Brazil. Data were collected from 96 nursing professionals, using the MISSCARE instrument at four and seven months after the implementation of the primary nursing model. RESULTS: Missed nursing care was reduced by 78.5%. Job title and staff satisfaction showed significant associations with decreased missed care (p < .05). CONCLUSION: The predictive effect between efficacy in reducing missed nursing care and reasons and efficiency in the management of nursing care, using the primary nursing model, was verified. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing staff and managers should consider adopting a Primary Nursing Model of care to reduce missed nursing care.

El diagnóstico de trastorno del espectro autista (TEA) a temprana edad del niño y sus consecuencias en el encuentro-desencuentro entre los padres y su hijo / Le diagnostique trouble du spectre autistique (TSA), en bas âge et ses consequénces dans la rencontre o la divergence entre les parents et leur enfant / The autism spectrum disorder (ASD) at an early age and its consequences on the encounters and missed encounters between parents and their children / O diagnóstico de transtorno do espectro do autismo (TEA) em terna idade da criança e suas consequências no encontro-desencontro entre os pais e o filho

En los últimos años llegan a mi consulta niñas y niños entre los dos y los nueve años de edad diagnosticados tempranamente con TEA. Dicho diagnóstico es realizado, por otros profesionales, que desde la observación fenomenológica ubican en el niño alguna de las características presente en el cuadro clínico de autismo. A partir de tres viñetas clínicas con padres (de modalidades psíquicas e historias diferentes), reflexionaré qué les sucedió en el desencuentro con su bebé y de qué manera la enunciación de determinado tipo de diagnóstico imposibilitó que ese desencuentro inicial se transforme en un encuentro conjunto madre-hijo y padre-hijo. Cuando ocurre la posibilidad de este encuentro entre los padres y su hijo, el mismo se constituye en el punto de partida de un desarrollo más pleno de la subjetividad del niño(AU)

Ces dernières anneés, ils sont arrivés a mon cabinet des filles et fils entre les deux et les neuf ans qui portent le diagnostic TSA. Ce diagnostic a été fait par des professionels qui, du point de vue de l'observation phenomenologique, ont trouve dans l'enfant quelque charactéristiques du cadre autiste. A partir de trois vignettes cliniques (les parents ont de modalités psichiques et d'histoires differénts) je refléchirai sur la divergence entre eux et leur bébé et comment l'énunciation de ce diagnostic empêche la transformation de cette divergence initial dans une rencontre conjoint merè -fils et perè-fils. Quand cette rencontre entre les parents et leur fils est possible, elle se transforme en partie constituante d'une développement plus pleine de la subjectivité del' enfant(AU)

In recent years I came across consultations of children between two and nine years old who had been previously diagnosed with ASD at an early age. Such diagnose was made by other professionals who, from a phenomenological analysis, place the patient under some features of the clinical picture of autism. Taking into account three clinical vignettes with parents of diverse psychic modalities and stories, I will reflect over the past events that lead to a missed encounter with their babies and in which way the annunciation of a determined diagnose precludes the possibility of that missed encounter to transform into a joint meeting parent-child. When an encounter parent-child occurs, it represents the starting point of a fulfilled development of the child's subjectivity(AU)

Nos últimos anos, meninos e meninas com idades entre dois e nove anos diagnosticados com TEA chegam cedo ao meu consultório. Esse diagnóstico é feito por outros profissionais que, a partir da observação fenomenológica, localizam na criança algumas das características presentes no quadro clínico do autismo. A partir de três vinhetas clínicas com pais (de modalidades psíquicas e histórias diferentes), refletirei sobre o que aconteceu com eles no desencontro com seu bebê e como a enunciação de um certo tipo de diagnóstico torna impossível que esse desencontro inicial se torne um encontro conjunto mãe-filho e pai e filho. Quando a possibilidade desse encontro entre os pais e o filho ocorre, torna-se o ponto de partida para um desenvolvimento pleno da subjetividade da criança(AU)