Pub Date : 2024-11-04eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024RC0524
Américo Gusmão Amorim, Olival Cirilo Lucena da Fonseca Neto, Raimundo Hugo Matias Furtado, Laécio Leitão Batista, Ludmilla Rodrigues Oliveira Costa, Igor Montenegro Galvão
Major liver resections require extensive margins. Occasionally, insufficient parenchyma is available after surgery to maintain liver function. In such cases, vascular embolization in the affected lobe is necessary to induce contralateral lobe hypertrophy. We present a case of embolization of the right portal and hepatic veins prior to intrahepatic cholangiocarcinoma resection. Embolization was performed because of insufficient residual parenchyma on imaging studies. The patient recovered well with no signs of liver failure, and remains in remission at 3 years postoperatively. Knowledge of the use of this technique in association with surgical resection can reduce postoperative complications and allow the removal of larger tumors than those previously considered borderline.
{"title":"Simultaneous embolization of the right portal and hepatic veins before intrahepatic cholangiocarcinoma resection.","authors":"Américo Gusmão Amorim, Olival Cirilo Lucena da Fonseca Neto, Raimundo Hugo Matias Furtado, Laécio Leitão Batista, Ludmilla Rodrigues Oliveira Costa, Igor Montenegro Galvão","doi":"10.31744/einstein_journal/2024RC0524","DOIUrl":"10.31744/einstein_journal/2024RC0524","url":null,"abstract":"<p><p>Major liver resections require extensive margins. Occasionally, insufficient parenchyma is available after surgery to maintain liver function. In such cases, vascular embolization in the affected lobe is necessary to induce contralateral lobe hypertrophy. We present a case of embolization of the right portal and hepatic veins prior to intrahepatic cholangiocarcinoma resection. Embolization was performed because of insufficient residual parenchyma on imaging studies. The patient recovered well with no signs of liver failure, and remains in remission at 3 years postoperatively. Knowledge of the use of this technique in association with surgical resection can reduce postoperative complications and allow the removal of larger tumors than those previously considered borderline.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eRC0524"},"PeriodicalIF":1.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024CE1251
Hinpetch Daungsupawong, Viroj Wiwanitkit
{"title":"Comment to: Lessons from the pandemic and the value of a structured system of ultrasonographic findings in the diagnosis of COVID-19 pulmonary manifestations.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.31744/einstein_journal/2024CE1251","DOIUrl":"10.31744/einstein_journal/2024CE1251","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eCE1251"},"PeriodicalIF":1.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0583
Jusciele Brogin Moreli, Natália Ferrari, Ana Maria Cirino Ruocco, Mariana Gomes de Oliveira Santos, Aline Rodrigues Lorenzon, Carla Patrícia Carlos, Marilza Vieira Cunha Rudge, Iracema de Mattos Paranhos Calderon
Objective: This study was conducted to investigate the distribution of placental villous vessels in pregnant women with different degrees of hyperglycemia.
Methods: A cross-sectional study was performed using placental samples from 30 pregnant women without diabetes (n=10), with gestational diabetes mellitus (n=10), and with previous diabetes (type 1 and type 2 diabetes; n=10). Maternal glycemic control was evaluated using the glycemic mean and glycated hemoglobin levels. Placental samples were obtained during elective cesarean sections and processed for villous vessel analysis using immunohistochemistry for Von Willebrand factor. Vessels within 10μm of the villus margin were classified as peripheral, and vessels at a distance greater than 10μm were classified as central. The number, area, and perimeter of all vessels were evaluated, and the relationship between vessel area and total area of placental villus was calculated.
Results: Pregnant women with gestational diabetes mellitus and those with previous diabetes had higher glycated hemoglobin levels. The number of vessels was reduced in the villi of the previous Diabetes Group owing to peripheral reduction. Additionally, the area, perimeter, and percentage of peripheral blood were lower in the previous Diabetes Group than in the Non-Diabetic Group.
Conclusion: Maternal glycemic levels can modify placental capillary distribution.
{"title":"Influence of maternal hyperglycemia on placental capillary distribution.","authors":"Jusciele Brogin Moreli, Natália Ferrari, Ana Maria Cirino Ruocco, Mariana Gomes de Oliveira Santos, Aline Rodrigues Lorenzon, Carla Patrícia Carlos, Marilza Vieira Cunha Rudge, Iracema de Mattos Paranhos Calderon","doi":"10.31744/einstein_journal/2024AO0583","DOIUrl":"10.31744/einstein_journal/2024AO0583","url":null,"abstract":"<p><strong>Objective: </strong>This study was conducted to investigate the distribution of placental villous vessels in pregnant women with different degrees of hyperglycemia.</p><p><strong>Methods: </strong>A cross-sectional study was performed using placental samples from 30 pregnant women without diabetes (n=10), with gestational diabetes mellitus (n=10), and with previous diabetes (type 1 and type 2 diabetes; n=10). Maternal glycemic control was evaluated using the glycemic mean and glycated hemoglobin levels. Placental samples were obtained during elective cesarean sections and processed for villous vessel analysis using immunohistochemistry for Von Willebrand factor. Vessels within 10μm of the villus margin were classified as peripheral, and vessels at a distance greater than 10μm were classified as central. The number, area, and perimeter of all vessels were evaluated, and the relationship between vessel area and total area of placental villus was calculated.</p><p><strong>Results: </strong>Pregnant women with gestational diabetes mellitus and those with previous diabetes had higher glycated hemoglobin levels. The number of vessels was reduced in the villi of the previous Diabetes Group owing to peripheral reduction. Additionally, the area, perimeter, and percentage of peripheral blood were lower in the previous Diabetes Group than in the Non-Diabetic Group.</p><p><strong>Conclusion: </strong>Maternal glycemic levels can modify placental capillary distribution.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0583"},"PeriodicalIF":1.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0748
Tatianna Pinheiro da Costa Rozzino, Thalita Barreira Modena Cardim, Claudia Regina Laselva, Carolina de Lima Pires, Carolina Muriel Pongillo Mendonça, Milena Siciliano Nascimento
Objective: To assess whether post-discharge telemonitoring reduces hospital readmission in patients participating in the diabetes care program.
Methods: This retrospective cohort study was conducted from June 2021 to December 2022 and included patients who were enrolled in the Diabetes Program under a hyperglycemia treatment protocol and eligible for post-discharge telemonitoring. The variables included age, sex, diagnosis, hospital stay, LACE Score, and readmission rate.
Results: Among 165 patients who underwent telemonitoring, significant differences emerged in hospital readmission rates between those with and without telemonitoring (p=0.015), with a 15.4% lower readmission rate in the telemonitoring group (95%CI= 3.0-27.9%). Subgroup analyses revealed higher readmission rates in men without telemonitoring (15.2% difference; 95%CI= 0.4-30.0%; p=0.045), and in age groups ≤60 and ≥75 years without telemonitoring (24.2% difference; 95%CI= 4.5-43.9%; p=0.016 for ≤60 years; 37.1% difference; 95%CI= 9.9% to 64.2%; p=0.007 for ≥75 years). Additionally, patients with prolonged hospital stays (>7 days) without telemonitoring had higher readmission rates (19.5% difference; 95%CI= 4.5%-34.5%; p=0.011).
Conclusion: This study suggests that post-discharge telemonitoring can effectively lower hospital readmission rates in diabetes management programs, potentially offering improved health outcomes, cost savings, and enhanced healthcare delivery to patients.
{"title":"Elevating care: assessing the impact of telemonitoring on diabetes management at a cutting-edge quaternary hospital.","authors":"Tatianna Pinheiro da Costa Rozzino, Thalita Barreira Modena Cardim, Claudia Regina Laselva, Carolina de Lima Pires, Carolina Muriel Pongillo Mendonça, Milena Siciliano Nascimento","doi":"10.31744/einstein_journal/2024AO0748","DOIUrl":"10.31744/einstein_journal/2024AO0748","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether post-discharge telemonitoring reduces hospital readmission in patients participating in the diabetes care program.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted from June 2021 to December 2022 and included patients who were enrolled in the Diabetes Program under a hyperglycemia treatment protocol and eligible for post-discharge telemonitoring. The variables included age, sex, diagnosis, hospital stay, LACE Score, and readmission rate.</p><p><strong>Results: </strong>Among 165 patients who underwent telemonitoring, significant differences emerged in hospital readmission rates between those with and without telemonitoring (p=0.015), with a 15.4% lower readmission rate in the telemonitoring group (95%CI= 3.0-27.9%). Subgroup analyses revealed higher readmission rates in men without telemonitoring (15.2% difference; 95%CI= 0.4-30.0%; p=0.045), and in age groups ≤60 and ≥75 years without telemonitoring (24.2% difference; 95%CI= 4.5-43.9%; p=0.016 for ≤60 years; 37.1% difference; 95%CI= 9.9% to 64.2%; p=0.007 for ≥75 years). Additionally, patients with prolonged hospital stays (>7 days) without telemonitoring had higher readmission rates (19.5% difference; 95%CI= 4.5%-34.5%; p=0.011).</p><p><strong>Conclusion: </strong>This study suggests that post-discharge telemonitoring can effectively lower hospital readmission rates in diabetes management programs, potentially offering improved health outcomes, cost savings, and enhanced healthcare delivery to patients.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0748"},"PeriodicalIF":1.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0467
Beatriz Nistal-Nuño
<p><strong>Background: </strong>Beatriz Nistal-Nuño designed a machine learning system type of ensemble learning for patients undergoing cardiac surgery and intensive care unit cardiology patients, based on sequences of cardiovascular physiological measurements and other intensive care unit physiological measurements in addition to static features, which generates a score for prediction of mortality of cardiac intensive care unit patients.</p><p><strong>Background: </strong>■ Gradient Boosting Machine and Random Forest models were built for prediction of mortality at cardiac intensive care units.</p><p><strong>Background: </strong>■ A total of 9,761 intensive care unit stays of patients admitted under a Cardiac Surgery and Cardiac Medical services were studied.</p><p><strong>Background: </strong>■ The AUROC and AUPRC values were significantly superior to seven conventional systems compared.</p><p><strong>Background: </strong>■ The machine learning models' calibration curves were substantially closer to the ideal line.</p><p><strong>Objective: </strong>Logistic Regression has been used traditionally for the development of most predictor tools of intensive care unit mortality. The purpose of this study is to combine shared risk factors between patients undergoing cardiac surgery and intensive care unit cardiology patients to develop a risk score for prediction of mortality in cardiac intensive care unit patients, using machine learning.</p><p><strong>Methods: </strong>Gradient Boosting Machine and Distributed Random Forest models were developed based on 9,761 intensive care unit-stays from the MIMIC-III database. Sequential and static features were collected. The primary endpoint was intensive care unit mortality prediction. Discrimination, calibration, and accuracy statistics were evaluated. The predictive performance of traditional scoring systems was compared.</p><p><strong>Results: </strong>Machine learning models' AUROC and AUPRC were significantly superior to all conventional systems for the primary endpoint (p<0.05), with AUROC of 0.9413 for Gradient Boosting Machine and 0.9311 for Distributed Random Forest. Sensitivity was 0.6421 for Gradient Boosting Machine, 0.6 for Distributed Random Forest, and <0.3 for all conventional systems except for serial SOFA (0.6316). Precision was 0.574 for Gradient Boosting Machine, 0.566 for Distributed Random Forest, and <0.5 for all conventional systems. Diagnostic odds ratio was 58.8144 for Gradient Boosting Machine, 51.2926 for Distributed Random Forest and <34 for all conventional systems. Brier score was 0.025 for Gradient Boosting Machine and 0.028 for Distributed Random Forest, being worse for the traditional systems. Calibration curves of Gradient Boosting Machine and Distributed Random Forest were substantially closer to the ideal line.</p><p><strong>Conclusion: </strong>The machine learning models showed superiority over the traditional scoring systems compared, with Gradient Boosting Machine havi
{"title":"Comparing ensemble learning algorithms and severity of illness scoring systems in cardiac intensive care units: a retrospective study.","authors":"Beatriz Nistal-Nuño","doi":"10.31744/einstein_journal/2024AO0467","DOIUrl":"https://doi.org/10.31744/einstein_journal/2024AO0467","url":null,"abstract":"<p><strong>Background: </strong>Beatriz Nistal-Nuño designed a machine learning system type of ensemble learning for patients undergoing cardiac surgery and intensive care unit cardiology patients, based on sequences of cardiovascular physiological measurements and other intensive care unit physiological measurements in addition to static features, which generates a score for prediction of mortality of cardiac intensive care unit patients.</p><p><strong>Background: </strong>■ Gradient Boosting Machine and Random Forest models were built for prediction of mortality at cardiac intensive care units.</p><p><strong>Background: </strong>■ A total of 9,761 intensive care unit stays of patients admitted under a Cardiac Surgery and Cardiac Medical services were studied.</p><p><strong>Background: </strong>■ The AUROC and AUPRC values were significantly superior to seven conventional systems compared.</p><p><strong>Background: </strong>■ The machine learning models' calibration curves were substantially closer to the ideal line.</p><p><strong>Objective: </strong>Logistic Regression has been used traditionally for the development of most predictor tools of intensive care unit mortality. The purpose of this study is to combine shared risk factors between patients undergoing cardiac surgery and intensive care unit cardiology patients to develop a risk score for prediction of mortality in cardiac intensive care unit patients, using machine learning.</p><p><strong>Methods: </strong>Gradient Boosting Machine and Distributed Random Forest models were developed based on 9,761 intensive care unit-stays from the MIMIC-III database. Sequential and static features were collected. The primary endpoint was intensive care unit mortality prediction. Discrimination, calibration, and accuracy statistics were evaluated. The predictive performance of traditional scoring systems was compared.</p><p><strong>Results: </strong>Machine learning models' AUROC and AUPRC were significantly superior to all conventional systems for the primary endpoint (p<0.05), with AUROC of 0.9413 for Gradient Boosting Machine and 0.9311 for Distributed Random Forest. Sensitivity was 0.6421 for Gradient Boosting Machine, 0.6 for Distributed Random Forest, and <0.3 for all conventional systems except for serial SOFA (0.6316). Precision was 0.574 for Gradient Boosting Machine, 0.566 for Distributed Random Forest, and <0.5 for all conventional systems. Diagnostic odds ratio was 58.8144 for Gradient Boosting Machine, 51.2926 for Distributed Random Forest and <34 for all conventional systems. Brier score was 0.025 for Gradient Boosting Machine and 0.028 for Distributed Random Forest, being worse for the traditional systems. Calibration curves of Gradient Boosting Machine and Distributed Random Forest were substantially closer to the ideal line.</p><p><strong>Conclusion: </strong>The machine learning models showed superiority over the traditional scoring systems compared, with Gradient Boosting Machine havi","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0467"},"PeriodicalIF":1.1,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0693
Luciana Lopes Manfredini, Elisa Rossi Conte, Gislene Padilha Dos Santos, Eliseth Ribeiro Leão, Nelson Hamerschlak
Background: Manfredini et al. demonstrate that the new rating protocol, EMOnco, can triage of cancer patients in acute care settings safely, considering their cancer type, stage and treatment histories and oncological emergencies, enabling the appropriate classification from high-risk patients to non-urgent patients.
Background: ■ EMOnco considers variables related to the cancer history and treatment.
Background: ■ Triages patients in the emergency care in less than three minutes.
Background: ■ Cancer patients need priority care regarding infection, and this protocol consider it.
Background: ■ EMOnco has shown to be a valid and reliable scale for the triage of oncological patients in the emergency room or acute care clinics.
Objective: To validate a risk rating scale for triaging of cancer patients in emergency rooms that can identify individuals needing urgent care or in imminent worsening of the clinical condition.
Methods: This is a health instrument validation study developed in the emergency care ward of a Brazilian hospital, a referral center for cancer and hematological diseases. We built the Emergency Oncology Scale (EMOnco) based on literature review and a Delphi survey with 20 experienced oncologists (physicians and nurses). We validated the scale by assessing its construct validity, interobserver agreement and reliability after applying them in a convenience sample of all consecutive patients with cancer who visited the ward between August 2017 and January 2018. We compared the EMOnco Scores with those from other scales, used by six trained nurses: the Emergency Severity Index, the Manchester Triage System, and the Karnofsky Performance Status. We also recorded socio-demographic and clinical features and the Sequential Organ Failure Assessment (SOFA) results in the intensive care unit.
Results: We included 250 patients with locally advanced or recurrent disease and undergoing chemotherapy. EMOnco screening took 2.24 (± 2.9) minutes in average. The interobserver correlation coefficient was 0.9. EMOnco was highly correlated with Emergency Severity Index (r=0.617) and also correlated with Karnofsky Performance Status (0.420) Manchester Triage System (0.491; p<0.001 for all).
Conclusion: EMOnco in Portuguese considers variables related to the cancer history and treatment and has proven to be a valid and reliable for the risk classification of oncological patients in emergency care services.
{"title":"Construction and validation of the Emergency Oncology Scale (EMOnco), a risk rating protocol for the triage of cancer patients in acute care settings.","authors":"Luciana Lopes Manfredini, Elisa Rossi Conte, Gislene Padilha Dos Santos, Eliseth Ribeiro Leão, Nelson Hamerschlak","doi":"10.31744/einstein_journal/2024AO0693","DOIUrl":"https://doi.org/10.31744/einstein_journal/2024AO0693","url":null,"abstract":"<p><strong>Background: </strong>Manfredini et al. demonstrate that the new rating protocol, EMOnco, can triage of cancer patients in acute care settings safely, considering their cancer type, stage and treatment histories and oncological emergencies, enabling the appropriate classification from high-risk patients to non-urgent patients.</p><p><strong>Background: </strong>■ EMOnco considers variables related to the cancer history and treatment.</p><p><strong>Background: </strong>■ Triages patients in the emergency care in less than three minutes.</p><p><strong>Background: </strong>■ Cancer patients need priority care regarding infection, and this protocol consider it.</p><p><strong>Background: </strong>■ EMOnco has shown to be a valid and reliable scale for the triage of oncological patients in the emergency room or acute care clinics.</p><p><strong>Objective: </strong>To validate a risk rating scale for triaging of cancer patients in emergency rooms that can identify individuals needing urgent care or in imminent worsening of the clinical condition.</p><p><strong>Methods: </strong>This is a health instrument validation study developed in the emergency care ward of a Brazilian hospital, a referral center for cancer and hematological diseases. We built the Emergency Oncology Scale (EMOnco) based on literature review and a Delphi survey with 20 experienced oncologists (physicians and nurses). We validated the scale by assessing its construct validity, interobserver agreement and reliability after applying them in a convenience sample of all consecutive patients with cancer who visited the ward between August 2017 and January 2018. We compared the EMOnco Scores with those from other scales, used by six trained nurses: the Emergency Severity Index, the Manchester Triage System, and the Karnofsky Performance Status. We also recorded socio-demographic and clinical features and the Sequential Organ Failure Assessment (SOFA) results in the intensive care unit.</p><p><strong>Results: </strong>We included 250 patients with locally advanced or recurrent disease and undergoing chemotherapy. EMOnco screening took 2.24 (± 2.9) minutes in average. The interobserver correlation coefficient was 0.9. EMOnco was highly correlated with Emergency Severity Index (r=0.617) and also correlated with Karnofsky Performance Status (0.420) Manchester Triage System (0.491; p<0.001 for all).</p><p><strong>Conclusion: </strong>EMOnco in Portuguese considers variables related to the cancer history and treatment and has proven to be a valid and reliable for the risk classification of oncological patients in emergency care services.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0693"},"PeriodicalIF":1.1,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AE0855
Fernando Gatti de Menezes, Hélio Minoru Samano, Mauro Dirlando Conte de Oliveira, Adriana Leme de Campos da Silva, Carin Ferreira Lopes, Debora da Costa Marques, Amanda Lindsay da Silveira, Giancarlo Colombo, Miguel Cendoroglo Neto
Background: Menezes et al. describe their experience with the diagnosis and management of disruptive medical staff behavior in a private hospital between 2020 and 2022. Surgical medical specialties were found to demonstrate the highest prevalence of such behavior, and continual education of physicians regarding appropriate workplace behavior was found to be the most important management strategy to prevent unsafe work environments and strengthen an appropriate culture of safety.
Background: ■ Disruptive medical staff behavior potentially affects patient care.
Background: ■ Surgical specialties have the highest incidence of disruptive medical staff behavior.
Background: ■ Proper diagnosis and management is key to the mitigating disruptive medical staff behavior.
Objective: To describe the 3-year long experience of addressing disruptive events by medical staff in a private hospital.
Methods: The cross-sectional study that was conducted between 2020 and 2022, involved collection, analysis, and management of suspected cases of disruptive behavior by medical staff.
Results: Relevant information was collected from reports issued by health care leaders (69%), anonymous reports accessed from the health institution's intranet tool "SINAPSE" (19%), the compliance center (5%), customer attendance service (3.7%), the hospital board (2.3%), and the medical practice department (1%). Surgical specialties were responsible for 70.3% of the disruptive incidents, and the average time to outcome was 24.5 days, with most solutions involving guided education of physicians (92.7%).
Conclusion: Management of disruptive behavior by medical staff is essential for the prevention of unsafe work environments and strengthening a culture of safety.
{"title":"Addressing disruptive medical staff behavior: a 3-year experience.","authors":"Fernando Gatti de Menezes, Hélio Minoru Samano, Mauro Dirlando Conte de Oliveira, Adriana Leme de Campos da Silva, Carin Ferreira Lopes, Debora da Costa Marques, Amanda Lindsay da Silveira, Giancarlo Colombo, Miguel Cendoroglo Neto","doi":"10.31744/einstein_journal/2024AE0855","DOIUrl":"https://doi.org/10.31744/einstein_journal/2024AE0855","url":null,"abstract":"<p><strong>Background: </strong>Menezes et al. describe their experience with the diagnosis and management of disruptive medical staff behavior in a private hospital between 2020 and 2022. Surgical medical specialties were found to demonstrate the highest prevalence of such behavior, and continual education of physicians regarding appropriate workplace behavior was found to be the most important management strategy to prevent unsafe work environments and strengthen an appropriate culture of safety.</p><p><strong>Background: </strong>■ Disruptive medical staff behavior potentially affects patient care.</p><p><strong>Background: </strong>■ Surgical specialties have the highest incidence of disruptive medical staff behavior.</p><p><strong>Background: </strong>■ Proper diagnosis and management is key to the mitigating disruptive medical staff behavior.</p><p><strong>Objective: </strong>To describe the 3-year long experience of addressing disruptive events by medical staff in a private hospital.</p><p><strong>Methods: </strong>The cross-sectional study that was conducted between 2020 and 2022, involved collection, analysis, and management of suspected cases of disruptive behavior by medical staff.</p><p><strong>Results: </strong>Relevant information was collected from reports issued by health care leaders (69%), anonymous reports accessed from the health institution's intranet tool \"SINAPSE\" (19%), the compliance center (5%), customer attendance service (3.7%), the hospital board (2.3%), and the medical practice department (1%). Surgical specialties were responsible for 70.3% of the disruptive incidents, and the average time to outcome was 24.5 days, with most solutions involving guided education of physicians (92.7%).</p><p><strong>Conclusion: </strong>Management of disruptive behavior by medical staff is essential for the prevention of unsafe work environments and strengthening a culture of safety.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAE0855"},"PeriodicalIF":1.1,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0760
Marcelo Antonini, Gabriel Duque Pannain, Gabriela Silva Solino de Souza, Odair Ferraro, Andre Mattar, Reginaldo Guedes Coelho Lopes, Juliana Monte Real
<p><strong>Background: </strong>Antonini et al. evaluated gynecologists', obstetricians', and family and community physicians knowledge of breast cancer screening and their adherence to recommendations defined by the BI-RADS™ system. The study demonstrated that inadequate training resulted in insufficient screening and failure to follow the protocols recommended by the BIRADS™ system.</p><p><strong>Background: </strong>■ Variability in screening protocols: only 42.8% of gynecologists and obstetricians follow the 40-74 years protocol, while 76.6% of family physicians follow the 50-69 years protocol.</p><p><strong>Background: </strong>■ High rate of incorrect BIRADS. interpretation: there were 46.3% incorrect responses among gynecologists and obstetricians and 77.9% among family physicians, highlighting significant knowledge gaps.</p><p><strong>Background: </strong>■ Misconception about breast ultrasound: 39.1% of gynecologists and obstetricians and 20.3% of family physicians incorrectly consider ultrasound as a screening method.</p><p><strong>Background: </strong>■ Impact of inadequate training: inadequate training leads to improper screening practices that do not align with the BIRADS. recommended guidelines.</p><p><strong>Objective: </strong>To evaluate the knowledge and practices of gynecologists, obstetricians, and family and community physicians in Brazil regarding breast cancer screening, mammographic findings defined by the BIRADS™ system, and their approach to suspected clinical lesions.</p><p><strong>Methods: </strong>This was an observational, cross-sectional, descriptive study conducted using an online research questionnaire distributed via email to 9,000 gynecologists and obstetricians and 5,600 family and community and preventive medicine doctors actively practicing in Brazil.</p><p><strong>Results: </strong>Among gynecologists and obstetricians, 42.8% follow the 40-74 years screening, 33.5% follow the 50-69 years screening, and 23.6% do not follow any specific protocol. Among the family and community physicians, 76.6% follow the 50-69 years screening protocol, and 23.4% do not follow any specific protocol. When we evaluated the responses regarding the behaviors of each BIRADS™ classification, 46.3% of responses were wrong among gynecologists and obstetricians, and 77.9% were wrong among community and preventive medicine doctors, exhibiting a significant difference. The role of breast ultrasound in screening was evaluated; 39.1% of gynecologists and obstetricians and 20.3% of community and preventive medicine doctors consider it as a screening method. Among gynecologists and obstetricians who do not follow any screening protocol, 94.7% consider ultrasound as a screening method. Among community and preventive medicine doctors, only 26.5% of physicians who follow the 50-69 years screening method consider it as a screening method.</p><p><strong>Conclusion: </strong>Inadequate training results in gynecologists and obstetricians, and famil
{"title":"Knowledge related to breast cancer screening programs by physicians in Brazil.","authors":"Marcelo Antonini, Gabriel Duque Pannain, Gabriela Silva Solino de Souza, Odair Ferraro, Andre Mattar, Reginaldo Guedes Coelho Lopes, Juliana Monte Real","doi":"10.31744/einstein_journal/2024AO0760","DOIUrl":"10.31744/einstein_journal/2024AO0760","url":null,"abstract":"<p><strong>Background: </strong>Antonini et al. evaluated gynecologists', obstetricians', and family and community physicians knowledge of breast cancer screening and their adherence to recommendations defined by the BI-RADS™ system. The study demonstrated that inadequate training resulted in insufficient screening and failure to follow the protocols recommended by the BIRADS™ system.</p><p><strong>Background: </strong>■ Variability in screening protocols: only 42.8% of gynecologists and obstetricians follow the 40-74 years protocol, while 76.6% of family physicians follow the 50-69 years protocol.</p><p><strong>Background: </strong>■ High rate of incorrect BIRADS. interpretation: there were 46.3% incorrect responses among gynecologists and obstetricians and 77.9% among family physicians, highlighting significant knowledge gaps.</p><p><strong>Background: </strong>■ Misconception about breast ultrasound: 39.1% of gynecologists and obstetricians and 20.3% of family physicians incorrectly consider ultrasound as a screening method.</p><p><strong>Background: </strong>■ Impact of inadequate training: inadequate training leads to improper screening practices that do not align with the BIRADS. recommended guidelines.</p><p><strong>Objective: </strong>To evaluate the knowledge and practices of gynecologists, obstetricians, and family and community physicians in Brazil regarding breast cancer screening, mammographic findings defined by the BIRADS™ system, and their approach to suspected clinical lesions.</p><p><strong>Methods: </strong>This was an observational, cross-sectional, descriptive study conducted using an online research questionnaire distributed via email to 9,000 gynecologists and obstetricians and 5,600 family and community and preventive medicine doctors actively practicing in Brazil.</p><p><strong>Results: </strong>Among gynecologists and obstetricians, 42.8% follow the 40-74 years screening, 33.5% follow the 50-69 years screening, and 23.6% do not follow any specific protocol. Among the family and community physicians, 76.6% follow the 50-69 years screening protocol, and 23.4% do not follow any specific protocol. When we evaluated the responses regarding the behaviors of each BIRADS™ classification, 46.3% of responses were wrong among gynecologists and obstetricians, and 77.9% were wrong among community and preventive medicine doctors, exhibiting a significant difference. The role of breast ultrasound in screening was evaluated; 39.1% of gynecologists and obstetricians and 20.3% of community and preventive medicine doctors consider it as a screening method. Among gynecologists and obstetricians who do not follow any screening protocol, 94.7% consider ultrasound as a screening method. Among community and preventive medicine doctors, only 26.5% of physicians who follow the 50-69 years screening method consider it as a screening method.</p><p><strong>Conclusion: </strong>Inadequate training results in gynecologists and obstetricians, and famil","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0760"},"PeriodicalIF":1.1,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0733
Hadassa Hillary Novaes Pereira Rodrigues, Kathyelli Thaynara Pimenta de Araujo, José Eduardo de Aguilar-Nascimento, Diana Borges Dock-Nascimento
Background: Overlapping sarcopenia and malnutrition may increase the risk of readmission in surgical oncology. Overlapping probable sarcopenia/malnutrition was found in 4.6% of 238 patients and the 30-day unplanned readmission rate was 9.0%. In multivariate analysis, the overlap of probable sarcopenia and malnutrition was a significant predictor for the 30-day unplanned readmission (OR= 8.10, 95%CI= 1.20-0.55; p=0.032).
Background: ■ Probable sarcopenia plus malnutrition was significantly associated with unplanned readmission.
Background: ■ Overlap of probable sarcopenia and malnutrition was an independent risk factor for readmission.
Background: ■ Certification of whether the patient is malnourished and/or sarcopenic preoperatively is necessary.
Background: ■ SARC-F and subjective global assessment can effectively and easily assess sarcopenia and malnutrition at admission.
Objective: To assess the 30-day unplanned readmission rate and its association with overlapping probable sarcopenia and malnutrition after major oncological surgery.
Methods: A prospective bicentric observational cohort study performed with adult oncological patients undergoing major surgery. The primary outcome was unplanned readmission within 30 days after discharge and the association with probable sarcopenia and malnutrition. Nutritional status and probable sarcopenia were assessed just prior to surgery. Patients classified using subjective global assessment, as B and C were malnourished. Probable sarcopenia was defined using SARC-F (strength, assistance with walking, rise from a chair, climb stairs, falls) questionnaire ≥4 points and low HGS (handgrip strength) <27kg for males and <16kg for females.
Results: Two hundred and thirty-eight patients (51.7% female) with a median age of 60 years were included. The 30-day readmission rate was 9.0% (n=20). Univariate analysis showed an association of malnutrition (odds ratio (OR) = 4.84; p=0.024) and probable sarcopenia (OR = 4.94; p=0.049) with 30-day readmission. Furthermore, when both conditions were present, the patient was almost nine times more likely to be readmitted (OR = 8.9; p=0.017). Multivariable logistic regression analysis showed that overlapping probable sarcopenia and malnutrition was an independent predictor of 30-day unplanned readmission (OR = 8.10, 95% confidence interval (95%CI) 1.20-0.55; p=0.032).
Conclusion: The 30-day unplanned readmission rate was 9.0%, and the overlap of probable sarcopenia and malnutrition is an independent predictor for the 30-day unplanned readmission after major oncologic surgery.
{"title":"The 30-day readmission rate of patients with an overlap of probable sarcopenia and malnutrition undergoing major oncological surgery.","authors":"Hadassa Hillary Novaes Pereira Rodrigues, Kathyelli Thaynara Pimenta de Araujo, José Eduardo de Aguilar-Nascimento, Diana Borges Dock-Nascimento","doi":"10.31744/einstein_journal/2024AO0733","DOIUrl":"10.31744/einstein_journal/2024AO0733","url":null,"abstract":"<p><strong>Background: </strong>Overlapping sarcopenia and malnutrition may increase the risk of readmission in surgical oncology. Overlapping probable sarcopenia/malnutrition was found in 4.6% of 238 patients and the 30-day unplanned readmission rate was 9.0%. In multivariate analysis, the overlap of probable sarcopenia and malnutrition was a significant predictor for the 30-day unplanned readmission (OR= 8.10, 95%CI= 1.20-0.55; p=0.032).</p><p><strong>Background: </strong>■ Probable sarcopenia plus malnutrition was significantly associated with unplanned readmission.</p><p><strong>Background: </strong>■ Overlap of probable sarcopenia and malnutrition was an independent risk factor for readmission.</p><p><strong>Background: </strong>■ Certification of whether the patient is malnourished and/or sarcopenic preoperatively is necessary.</p><p><strong>Background: </strong>■ SARC-F and subjective global assessment can effectively and easily assess sarcopenia and malnutrition at admission.</p><p><strong>Objective: </strong>To assess the 30-day unplanned readmission rate and its association with overlapping probable sarcopenia and malnutrition after major oncological surgery.</p><p><strong>Methods: </strong>A prospective bicentric observational cohort study performed with adult oncological patients undergoing major surgery. The primary outcome was unplanned readmission within 30 days after discharge and the association with probable sarcopenia and malnutrition. Nutritional status and probable sarcopenia were assessed just prior to surgery. Patients classified using subjective global assessment, as B and C were malnourished. Probable sarcopenia was defined using SARC-F (strength, assistance with walking, rise from a chair, climb stairs, falls) questionnaire ≥4 points and low HGS (handgrip strength) <27kg for males and <16kg for females.</p><p><strong>Results: </strong>Two hundred and thirty-eight patients (51.7% female) with a median age of 60 years were included. The 30-day readmission rate was 9.0% (n=20). Univariate analysis showed an association of malnutrition (odds ratio (OR) = 4.84; p=0.024) and probable sarcopenia (OR = 4.94; p=0.049) with 30-day readmission. Furthermore, when both conditions were present, the patient was almost nine times more likely to be readmitted (OR = 8.9; p=0.017). Multivariable logistic regression analysis showed that overlapping probable sarcopenia and malnutrition was an independent predictor of 30-day unplanned readmission (OR = 8.10, 95% confidence interval (95%CI) 1.20-0.55; p=0.032).</p><p><strong>Conclusion: </strong>The 30-day unplanned readmission rate was 9.0%, and the overlap of probable sarcopenia and malnutrition is an independent predictor for the 30-day unplanned readmission after major oncologic surgery.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0733"},"PeriodicalIF":1.1,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30eCollection Date: 2024-01-01DOI: 10.31744/einstein_journal/2024AO0536
Rafael Tavares Jomar, Jéssica Thaís Nascimento Marques, Livia Costa de Oliveira, Gelcio Luiz Quintella Mendes, Daianny Arrais de Oliveira da Cunha, Raphael Mendonça Guimarães
Background: Jomar et al. demonstrated that death due to COVID-19 did not affect the time under exclusive palliative care among patients with advanced cancer, even during the first year of the pandemic caused by a hitherto little-known disease.
Background: ◼ Fatality due to COVID-19 does not alter the time under oncological palliative care.
Background: ◼ The retrospective design of this pioneering study allows causal inference.
Background: ◼ Access to oncological palliative care frequently approaches terminality of life.
Objective: This study aimed at investigating the extent to which COVID-19-induced fatalities affect the duration of palliative care among patients with advanced cancer.
Methods: A retrospective cohort study was conducted at the Palliative Care Unit of the Brazilian Instituto Nacional de Câncer in Rio de Janeiro, Brazil, on 1,104 advanced cancer patients who died under exclusive palliative care between March 11, 2020, and March 31, 2021. Wilcoxon rank-sum (Mann-Whitney U) and log-rank tests were performed to examine statistical differences between the medians of time, and the Kaplan-Meier estimator was used to graphically illustrate survival over time under exclusive palliative care contingent upon the underlying causes of death of the two experimental groups (cancer versus COVID-19).
Results: A total of 133 (12.05%) patients succumbed to COVID-19. In both groups, the median time under exclusive palliative care was less than one month. The exclusive palliative care survival curves did not exhibit any statistically significant difference between the groups.
Conclusion: Death due to COVID-19 did not modify the duration of exclusive palliative care among patients with advanced cancer.
{"title":"Fatality from COVID-19 does not affect palliative care duration among patients with advanced cancer: a retrospective cohort study.","authors":"Rafael Tavares Jomar, Jéssica Thaís Nascimento Marques, Livia Costa de Oliveira, Gelcio Luiz Quintella Mendes, Daianny Arrais de Oliveira da Cunha, Raphael Mendonça Guimarães","doi":"10.31744/einstein_journal/2024AO0536","DOIUrl":"10.31744/einstein_journal/2024AO0536","url":null,"abstract":"<p><strong>Background: </strong>Jomar et al. demonstrated that death due to COVID-19 did not affect the time under exclusive palliative care among patients with advanced cancer, even during the first year of the pandemic caused by a hitherto little-known disease.</p><p><strong>Background: </strong>◼ Fatality due to COVID-19 does not alter the time under oncological palliative care.</p><p><strong>Background: </strong>◼ The retrospective design of this pioneering study allows causal inference.</p><p><strong>Background: </strong>◼ Access to oncological palliative care frequently approaches terminality of life.</p><p><strong>Objective: </strong>This study aimed at investigating the extent to which COVID-19-induced fatalities affect the duration of palliative care among patients with advanced cancer.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at the Palliative Care Unit of the Brazilian Instituto Nacional de Câncer in Rio de Janeiro, Brazil, on 1,104 advanced cancer patients who died under exclusive palliative care between March 11, 2020, and March 31, 2021. Wilcoxon rank-sum (Mann-Whitney U) and log-rank tests were performed to examine statistical differences between the medians of time, and the Kaplan-Meier estimator was used to graphically illustrate survival over time under exclusive palliative care contingent upon the underlying causes of death of the two experimental groups (cancer versus COVID-19).</p><p><strong>Results: </strong>A total of 133 (12.05%) patients succumbed to COVID-19. In both groups, the median time under exclusive palliative care was less than one month. The exclusive palliative care survival curves did not exhibit any statistically significant difference between the groups.</p><p><strong>Conclusion: </strong>Death due to COVID-19 did not modify the duration of exclusive palliative care among patients with advanced cancer.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0536"},"PeriodicalIF":1.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号