Einstein-Sao Paulo最新文献

Objective: To conduct an ex-ante cost-benefit analysis of implementing Vendor Neutral Archive technology in the Brazilian Public Health System.

Methods: The cost-benefit analysis involves monetizing the potential costs and benefits of implementing Vendor Neutral Archive in the Brazilian Public Health System, focusing on comparing these values using the return on investment measure.

Results: The aggregate analysis at the Brazilian Public Health System level reveals that the estimated return on investment for the first year after Vendor Neutral Archive implementation is 5.63%, rising to 10.12% after three years. The results indicate a positive correlation between the number of imaging exams conducted and the financial gains for the health institution under analysis. A minimum number of approximately 11,500 exams is required to implement Vendor Neutral Archive technology to generate positive returns in the first year after implementation.

Conclusion: Despite the importance of interpreting results cautiously owing to assumptions and methodological limitations, the findings highlight the strategic significance of Vendor Neutral Archive in enhancing the efficiency and sustainability of the Brazilian Public Health System. Adopting cloud-based medical image storage requires a significant upfront investment but promises substantial benefits. Within the Brazilian Public Health System, the return on this investment can be realized in less than one year, correlated with the volume of imaging exams performed. This underscores the importance of scalability in the healthcare system, where wider adoption of Vendor Neutral Archive results in higher returns.

Background: ■ Vendor Neutral Archive implementation has an return on investment of 5.63% in the first year and 10.12% after three years.

Background: ■ At least 11,500 exams are needed annually for a positive return on investment in the first year after implementation.

Background: ■ Vendor Neutral Archive enhances interoperability and efficiency by standardizing and centralizing image storage.

Background: ■ Scalability is key: higher adoption of Vendor Neutral Archive leads to greater financial and operational benefits.

Background: Vendor Neutral Archive is a centralized, cloud-based solution that enables interoperable storage and management of medical images. Vendor Neutral Archive enhances data accessibility and long-term cost efficiency, supporting a more scalable and sustainable healthcare infrastructure. This study conducts a cost-benefit analysis of implementing Vendor Neutral Archive technology in the Brazilian Public Health System.

Myopericytomas are perivascular myoid neoplasms that rarely exhibit malignant characteristics. They usually arise in the dermis or subcutaneous tissue and exceptionally involve deep soft tissues, with spinal localization being rare. We report the case of a previously healthy 32-year-old pregnant woman who presented with pain in the interscapular region and progressive loss of lower limb strength. Magnetic resonance imaging revealed a solid neoplastic mass at the T3 level, with spinal canal invasion and spinal cord signal abnormalities. The pregnancy was terminated, followed by lesion embolization, decompressive laminectomy, and local radiotherapy. The patient completely recovered from her neurological symptoms. Thoracic spine myopericytomas are rare and have been poorly reported in the literature. No studies have described the aforementioned neoplasm in a pregnant patient. We report this case because of its peculiarity, evolution, and outcome.

Objective: To identify complications following transrectal posterior biopsies in a public Brazilian reference center, and to identify the risk factors associated with complications.

Methods: This is a prospective cohort study that employed a form designed by the Global Prevalence Infections in Urology study. Data from 1,043 consecutive patients who underwent transrectal prostate biopsy at a single Brazilian center were analyzed, including patient characteristics, procedural characteristics, and self-assessed complications at 28 days. Complications were categorized according to the Clavien-Dindo (CD) classification.

Results: Most bleeding complications were mild (CD Grade 1), although 1.5% reported Grades 2-3. Hypertension, younger age, and anticoagulant use were associated with bleeding (all p<0.001). A total of 4.7% reported infections (CD Grade 2: 0.5%, CD Grade 3: 3.6%, and CD Grade 4 [sepsis]: 0.6%), with risk factors being indwelling catheter use, recent urinary tract infection (p<0.001 for both), and quinolone use (OR= 3.01, 95%CI= 1.15-7.80, p=0.03). Urinary retention was observed in 4.1% (Grade 2), with severe symptoms (p=0.009), prostates >89mL (p=0.001), and prostatic protrusion ≥10mm (p=0.001) being associated with it.

Conclusion: Clinically significant (CD Grades 3-5) adverse effects of transrectal prostate biopsy are rare. Careful pre-procedure evaluation of antimicrobial use, particularly quinolones, along with the assessment of identified risk factors is essential for counseling patients and reducing potential risks.

Background: ■ This prospective cohort study assessed prostate biopsy complications in 1,043 men.

Background: ■ The major outcomes included bleeding (Clavien-Dindo Grades 2-3 = 1.5%), infections (4.7%), and urinary retention (4.1%).

Background: ■ The key risk factors for infection were recent quinolone use, indwelling catheters, and high PSA levels.

Background: ■ Acute urinary retention was linked to untreated lower urinary tract symptoms, prostate volume, intravesical prostatic protrusion, and bladder wall thickness.

Background: This prospective study conducted in a mid-income country evaluated the risk factors associated with complications after transrectal prostate biopsy and highlighted significant correlations with hemorrhagic events, infections, and acute urinary retention.

Teachers have the significant potential to facilitate alterations in the teaching-learning process that can positively affect student outcomes. In the healthcare field, exposure to effective teachers is associated with enhanced clinical performance and student knowledge. The literature explores several characteristics that increase the possibility of obtaining better outcomes when developed by teachers. These features are described from the perspectives of students, managers, and teachers. However, when considering teacher development programs, it is necessary to translate these characteristics, skills, and personality traits into competencies for training and enhancement. Therefore, in this review, we propose eight primary competencies that encompass the majority of these previously described characteristics: knowledge, communication skills, empathy, ability to facilitate engagement, preparation, organization, ability to assess learning progress, self-reflection, and continuous enhancement. All of these are trainable. However, teacher training is a complex and continuous process. Understanding these competencies is crucial for designing effective teacher development programs that offer measurable outcomes, reinforce teaching adherence, optimize enhancement timelines, and reduce institutional costs. This review discusses each of the eight competencies, their interrelationships, and their effects on healthcare education, offering a foundation for teachers and managers to facilitate educational excellence.

Objective: The purpose of this systematic review with meta-analysis was to compare the short-term (≤1 month) effects of remote ischemic conditioning versus sham remote ischemic conditioning on vascular function in patients with cardiovascular diseases.

Methods: A systematic review was conducted to identify relevant studies through six healthcare science databases up to March 2025. Arterial stiffness and endothelial function were defined as the primary outcome. Meta-analyses were performed using a random-effect model. Also, GRADE Pro software was used to evaluate the quality of evidence.

Results: A total of 7 randomized clinical trials with 603 patients with cardiovascular diseases were included in the systematic review. Also, we included 5 studies in the meta-analysis. Compared with sham remote ischemic conditioning or control, short-term remote ischemic conditioning resulted in enhanced endothelial function (MD=4.22% [95%CI=1.75; 6.69]; p=0.0008; I2=0%) without any changes in arterial stiffness, (MD=-0.05 m/s [95%CI =-0.77, 0.67]; p=0.89; I2=89%).

Conclusion: This systematic review and meta-analysis found that short-term remote ischemic conditioning was associated with improvements in endothelial function compared with sham remote ischemic conditioning or control in cardiovascular patients, without any impact on arterial stiffness.

Prospero database registration: ID CRD42021234702.

Objective: To evaluate whether the total tumor diameter (sum of the largest diameters of all foci) predicts tumor aggressiveness at initial presentation and treatment response at 1-year follow-up in patients with multifocal papillary thyroid microcarcinoma.

Methods: A retrospective analysis was conducted on 475 patients with differentiated thyroid carcinoma. Fifty-two patients with multifocal papillary thyroid microcarcinoma were included. The primary variable was total tumor diameter, and outcomes included initial tumor aggressiveness, evaluated according to the American Joint Committee on Cancer (AJCC; stages I or II), risk of recurrence according to the American Thyroid Association (low or not low), and response to therapy at 1 year (excellent or not).

Results: AJCC stage II disease was significantly associated with age ≥55 years, lymph node dissection, angiolymphatic invasion, extrathyroidal extension, lymph node metastasis, number of metastatic lymph nodes, non-low risk of recurrence, first stimulated thyroglobulin, and response to therapy at 1-year. Non-low risk of recurrence were associated with Bethesda V/VI cytology, lymph node dissection, angiolymphatic and tumor capsule invasion, extrathyroidal extension, lymph node metastasis, number of metastatic lymph nodes, first stimulated thyroglobulin, and radioiodine dose. Non-excellent response at 1-year follow-up were associated with preoperative thyroid-stimulating hormone levels, lymph node metastasis, number of metastatic lymph nodes, and first stimulated thyroglobulin. Multivariate analysis revealed that only the number of metastatic lymph nodes independently predicted AJCC stage.

Conclusion: Total tumor diameter was not associated with initial tumor aggressiveness or treatment response at 1-year follow-up in patients with multifocal papillary thyroid microcarcinoma.

Background: ■ In multifocal papillary thyroid microcarcinomas.

Background: ■ The total tumor diameter was not associated with aggressiveness or initial evolution.

Background: ■ Other factors are associated with disease outcomes.

Background: ■ The number of metastatic lymph nodes is an independent predictor of American Joint Committee on Cancer stage.

Background: This study demonstrated that in multifocal papillary thyroid microcarcinomas, the sum of the largest diameters of all tumor foci was not associated with tumor aggressiveness or response to therapy at 1-year follow-up. Conversely, the total number of metastatic lymph nodes was an independent predictor of American Joint Committee on Cancer staging.

Hypothyroidism is most frequently caused by Hashimoto's thyroiditis. While thyrotropin receptor antibodies are well-known in Graves' disease-induced hyperthyroidism, their role in hypothyroidism is emerging. We report the case of a 37-year-old woman with facial and periorbital edema, weight gain, and hoarseness suggestive of hypothyroidism. Elevated thyroid stimulating hormone (TSH; 131mIU/L) and decreased free thyroxine (0.2ng/dL, 2.6pmol/L) levels confirmed this diagnosis. Laboratory findings showed dyslipidemia, impaired renal function, elevated creatine phosphokinase levels, and anemia. Despite negative results for thyroid peroxidase (TPO-Ab) and thyroglobulin (TgAb) antibodies, positive thyrotropin receptor antibodies (11IU/L) suggested an autoimmune etiology. Thyroid ultrasound confirmed atrophic thyroiditis. Levothyroxine treatment improved the symptoms and laboratory values. Two months after diagnosis, the patient became pregnant. Anemia relapsed during pregnancy, thyrotropin receptor antibodies levels normalized, and postpartum follow-up revealed stable thyroid function without affecting the newborn thyroid function. This case underscores the diagnostic challenges of negative TPOAb and TgAb hypothyroidism, which is often misdiagnosed as Hashimoto's thyroiditis, and highlights the need for functional discrimination in thyrotropin receptor antibodies assays. Thyrotropin receptor antibodies measurements can help in the differential diagnosis of rapidly evolving hypothyroidism in women with negative TPO-Ab and thyrotropin receptor antibodies levels, especially in women of childbearing age. Further research is essential to understand thyrotropin-binding inhibitory immunoglobulin-mediated hypothyroidism and to develop targeted therapies.

Objective: Post-COVID symptoms are frequent and can be debilitating, particularly in individuals with cancer. However, their impact on this population remains unclear. This study aimed to prospectively assess the symptoms and impairments following COVID-19 hospitalization in patients with cancer, focusing on fatigue, nutritional status, speech and swallowing, anxiety, depression, and posttraumatic stress disorder symptoms.

Methods: This prospective observational cohort study included cancer survivors hospitalized with COVID-19 between June and December 2020. We assessed symptoms and impairments related to fatigue, independence in activities of daily living, speech and swallowing, voice, nutritional risk, anxiety/depression, and posttraumatic stress disorder. The participants were assessed at discharge and after 1, 3, 6 and 12 months.

Results: A total of 51 participants were included in the study. At the time of discharge, 98% had at least one of the following impairments: fatigue (68.6%), anxiety/depressive symptoms (17.7%), voice and speech impairments (19.6%), dysphagia (21.6%), or nutritional risk (45.1%). By one year, impairments persisted in 66% of the sample: fatigue (34.2%), anxiety/depressive symptoms (19.5%), voice and speech impairments (12.2%), and dysphagia (17.1%), with no participants remaining at nutritional risk. The participants reported no significant limitations in their daily living activities.

Conclusion: Cancer survivors hospitalized for COVID-19 presented with high levels of fatigue, nutritional risk, anxiety/depression, and posttraumatic stress disorder symptoms at discharge, with improvements in fatigue and nutrition after one year.

Background: ■ High fatigue and nutritional risk at discharge improved over one year in cancer survivors.

Background: ■ Psychological symptoms, such as anxiety, depression, and posttraumatic stress disorder, remained prevalent for one year.

Background: ■ 66% of patients had lasting symptoms or impairments after 12 months of follow-up.

Background: ■ Nutritional risk was resolved in the following year. A prospective study of 51 cancer survivors hospitalized for COVID-19 revealed high initial levels of fatigue, nutritional risk, anxiety/depression, and posttraumatic stress disorder symptoms, with impairments persisting in 66% of patients after 1 year. Nutritional risk was resolved; however, psychological, and physical symptoms remained prevalent and required continuous care.

Objective: To analyze the impact of a serious immersive virtual reality game on the physiological and behavioral aspects of pain during peripheral venous access or central catheter puncture in children and adolescents with cancer.

Methods: This was a longitudinal intervention study that included 50 children and adolescents undergoing cancer therapy and peripheral venipuncture or venous catheter puncture (totally implanted or central venous catheter) at two independent time points (control and experimental intervention). The intervention consisted of playing a serious immersive virtual reality game with three-dimensional goggles and a Bluetooth controller. The patients were monitored for alterations in physiological (heart rate and oxygen saturation) and behavioral (agitation, crying, and pain assessed using the Faces Pain Scale-Revised and Visual Analogue Scale) parameters. An agreement analysis was conducted by calculating the weighted kappa coefficient; p was obtained using Bowker's symmetry test.

Results: Use of immersive virtual reality significantly reduced heart rate, improved pain control as assessed by the Faces Pain Scale-Revised, and decreased agitation and crying.

Conclusion: Serious immersive virtual reality games reduce pain and distress during repetitive and uncomfortable procedures such as venipuncture and venous catheter puncture in children and adolescents with cancer. This strategy is simple to implement, cost-effective, and should be considered by health care services assisting pediatric patients with cancer.

Background: ■ Immersive virtual reality reduced heart rate, pain, agitation, and crying during pediatric venipuncture.

Background: ■ This technology effectively reduced pain during repeated invasive procedures, including catheter punctures.

Background: ■ The serious game strategy is low-cost, easy to implement, and well-suited for pediatric oncology care.

Background: Various pain management strategies are employed for children undergoing cancer treatment. Silva et al. prospectively evaluated an innovative approach using an immersive serious game for pain control. The intervention significantly reduced pain perception during venipuncture. Herein, we evaluate immersive virtual reality for pain management in pediatric oncology care.