Impact of Routine Fractional Flow Reserve Evaluation During Coronary Angiography on Management Strategy and Clinical Outcome: One-Year Results of the POST-IT.

Penetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome. METHODS AND RESULTS: Nonselected patients undergoing coronary angiography, in which at least 1 lesion was interrogated by FFR, were prospectively enrolled in a multicenter registry. FFR-driven change in management strategy (medical therapy, revascularization, or additional stress imaging) was assessed per-lesion and per-patient, and the agreement between final and initial strategies was recorded. Cardiovascular death, myocardial infarction, or unplanned revascularization (MACE) at 1 year was recorded. A total of 1293 lesions were evaluated in 918 patients (mean FFR, 0.81±0.1). Management plan changed in 406 patients (44.2%) and 584 lesions (45.2%). One-year MACE was 6.9%; patients in whom all lesions were deferred had a lower MACE rate (5.3%) than those with at least 1 lesion revascularized (7.3%) or left untreated despite FFR≤0.80 (13.6%; log-rank P=0.014). At the lesion level, deferral of those with an FFR≤0.80 was associated with a 3.1-fold increase in the hazard of cardiovascular death/myocardial infarction/target lesion revascularization (P=0.012). Independent predictors of target lesion revascularization in the deferred lesions were proximal location of the lesion, B2/C type and FFR. CONCLUSIONS: Routine FFR assessment of coronary lesions safely changes management strategy in almost half of the cases. Also, it accurately identifies patients and lesions with a low likelihood of events, in which revascularization can be safely deferred, as opposed to those at high risk when ischemic lesions are left untreated, thus confirming results from randomized trials.

Errors in preparation and medication management in nursing professionals

The preparation and administration of medications is one of the most common and relevant functions of nurses, demanding great responsibility. Incorrect administration of medication, currently constitutes a serious problem in health services, and is considered one of the main adverse effects suffered by hospitalized patients. Objectives: Identify the major errors in the preparation and administration of medication by nurses in hospitals and know what factors lead to the error occurred in the preparation and administration of medication. Methods: A systematic review of the literature. Deined as inclusion criteria: original scientiic papers, complete, published in the period 2011 to May 2016, the SciELO and LILACS databases, performed in a hospital environment, addressing errors in preparation and administration of medication by nurses and in Portuguese language. After application of the inclusion criteria obtained a sample of 7 articles. Results: The main errors identiied in the pr eparation and administration of medication were wrong dose 71.4%, wrong time 71.4%, 57.2% dilution inadequate, incorrect selection of the patient 42.8% and 42.8% via inadequate. The factors that were most commonly reported by the nursing staff, as the cause of the error was the lack of human appeal 57.2%, inappropriate locations for the preparation of medication 57.2%, the presence of noise and low brightness in preparation location 57, 2%, professionals untrained 42.8%, fatigue and stress 42.8% and inattention 42.8%. Conclusions: The literature shows a high error rate in the preparation and administration of medication for various reasons, making it important that preventive measures of this occurrence are implemented.

Addressing wildfire risk in forest management with a wildfire resistance indicator

Mestrado Mediterranean Forestry and Natural Resources Management - Instituto Superior de Agronomia - UL

Identifying the location of fire refuges in wet forest ecosystems

The increasing frequency of large, high-severity fires threatens the survival of old-growth specialist fauna in fire-prone forests. Within topographically diverse montane forests, areas that experience less severe or fewer fires compared with those prevailing in the landscape may present unique resource opportunities enabling old-growth specialist fauna to survive. Statistical landscape models that identify the extent and distribution of potential fire refuges may assist land managers to incorporate these areas into relevant biodiversity conservation strategies. We used a case study in an Australian wet montane forest to establish how predictive fire simulation models can be interpreted as management tools to identify potential fire refuges. We examined the relationship between the probability of fire refuge occurrence as predicted by an existing fire refuge model and fire severity experienced during a large wildfire. We also examined the extent to which local fire severity was influenced by fire severity in the surrounding landscape. We used a combination of statistical approaches, including generalized linear modeling, variogram analysis, and receiver operating characteristics and area under the curve analysis (ROC AUC). We found that the amount of unburned habitat and the factors influencing the retention and location of fire refuges varied with fire conditions. Under extreme fire conditions, the distribution of fire refuges was limited to only extremely sheltered, fire-resistant regions of the landscape. During extreme fire conditions, fire severity patterns were largely determined by stochastic factors that could not be predicted by the model. When fire conditions were moderate, physical landscape properties appeared to mediate fire severity distribution. Our study demonstrates that land managers can employ predictive landscape fire models to identify the broader climatic and spatial domain within which fire refuges are likely to be present. It is essential that within these envelopes, forest is protected from logging, roads, and other developments so that the ecological processes related to the establishment and subsequent use of fire refuges are maintained.

Agent based risk patient management

This paper explores the role of information and communication technologies in managing risk and early discharge patients, and suggests innovative actions in the area of E-Health services. Treatments of chronic illnesses, or treatments of special needs such as cardiovascular diseases, are conducted in long-stay hospitals, and in some cases, in the homes of patients with a follow-up from primary care centre. The evolution of this model is following a clear trend: trying to reduce the time and the number of visits by patients to health centres and derive tasks, so far as possible, toward outpatient care. Also the number of Early Discharge Patients (EDP) is growing, thus permiting a saving in the resources of the care center. The adequacy of agent and mobile technologies is assessed in light of the particular requirements of health care applications. A software system architecture is outlined and discussed. The major contributions are: first, the conceptualization of multiple mobile and desktop devices as part of a single distributed computing system where software agents are being executed and interact from their remote locations. Second, the use of distributed decision making in multiagent systems, as a means to integrate remote evidence and knowledge obtained from data that is being collected and/or processed by distributed devices. The system will be applied to patients with cardiovascular or Chronic Obstructive Pulmonary Diseases (COPD) as well as to ambulatory surgery patients. The proposed system will allow to transmit the patient's location and some information about his/her illness to the hospital or care centre

Toward adaptive management of coastal MPAs: The influence of different conservation targets and costs on the design of no-take areas

There is still much discussion on the most appropriate location, size and shape of marine protected areas (MPAs). These three factors were analyzed for a small coastal MPA, the Luiz Saldanha Marine Park (LSMP), for which a very limited amount of local ecological information was available when implemented in 1998. Marxan was used to provide a number of near-optimal solutions considering different levels of protection for the various conservation features and different costs. These solutions were compared with the existing no-take area of the LSMP. Information on 11 habitat types and distribution models for 3 of the most important species for the local artisanal fisheries was considered. The human activities with the highest economic and ecological impact in the study area (commercial and recreational fishing and scuba diving) were used as costs. The results show that the existing no-take area is actually located in the best area. However, the no-take area offers limited protection to vagile fish and covers a very small proportion of some of the available habitats. An increase in the conservation targets led to an increase in the number of no-take areas. The comparative framework used in this study can be applied elsewhere, providing relevant information to local stakeholders and managers in order to proceed with adaptive management. (C) 2015 Elsevier B.V. All rights reserved.

Animal GRIN database user manual for the management of genetic resources.

Introduction to Animal GRIN; Navigating the Database; Setting Up the Database (Super Users); Create Taxonomy Structure; Set Up Location Structure; Form Descriptions (All Users); Form Descriptions (Super Users); Entering Shipments; E-R Diagram for Incoming Orders; Entering Requests; Reports.

Health information management : What business are we in?

Developments in information technology will drive the change in records management; however, it should be the health information managers who drive the information management change. The role of health information management will be challenged to use information technology to broker a range of requests for information from a variety of users, including he alth consumers. The purposes of this paper are to conceptualise the role of health information management in the context of a technologically driven and managed health care environment, and to demonstrat e how this framework has been used to review and develop the undergraduate program in health information management at the Queensland University of Technology.