ATD: a multiplatform for semiautomatic 3-D detection of kidneys and their pathology in real time

This research presents a novel multi-functional system for medical Imaging-enabled Assistive Diagnosis (IAD). Although the IAD demonstrator has focused on abdominal images and supports the clinical diagnosis of kidneys using CT/MRI imaging, it can be adapted to work on image delineation, annotation and 3D real-size volumetric modelling of other organ structures such as the brain, spine, etc. The IAD provides advanced real-time 3D visualisation and measurements with fully automated functionalities as developed in two stages. In the first stage, via the clinically driven user interface, specialist clinicians use CT/MRI imaging datasets to accurately delineate and annotate the kidneys and their possible abnormalities, thus creating ���3D Golden Standard Models���. Based on these models, in the second stage, clinical support staff i.e. medical technicians interactively define model-based rules and parameters for the integrated ���Automatic Recognition Framework��� to achieve results which are closest to that of the clinicians. These specific rules and parameters are stored in ���Templates��� and can later be used by any clinician to automatically identify organ structures i.e. kidneys and their possible abnormalities. The system also supports the transmission of these ���Templates��� to another expert for a second opinion. A 3D model of the body, the organs and their possible pathology with real metrics is also integrated. The automatic functionality was tested on eleven MRI datasets (comprising of 286 images) and the 3D models were validated by comparing them with the metrics from the corresponding ���3D Golden Standard Models���. The system provides metrics for the evaluation of the results, in terms of Accuracy, Precision, Sensitivity, Specificity and Dice Similarity Coefficient (DSC) so as to enable benchmarking of its performance. The first IAD prototype has produced promising results as its performance accuracy based on the most widely deployed evaluation metric, DSC, yields 97% for the recognition of kidneys and 96% for their abnormalities; whilst across all the above evaluation metrics its performance ranges between 96% and 100%. Further development of the IAD system is in progress to extend and evaluate its clinical diagnostic support capability through development and integration of additional algorithms to offer fully computer-aided identification of other organs and their abnormalities based on CT/MRI/Ultra-sound Imaging.

Nurses��� perceptions of climate and environmental issues : a qualitative study

Aim: The aim of this study was to explore nurses' perceptions of climate and environmental issues and examine how nurses perceive their role in contributing to the process of sustainable development.�� Background: Climate change and its implications for human health represent an increasingly important issue for the healthcare sector. According to the International Council of Nurses Code of Ethics, nurses have a responsibility to be involved and support climate change mitigation and adaptation to protect human health.�� Design: This is a descriptive, explorative qualitative study.�� Methods: Nurses (n=18) were recruited from hospitals, primary care and emergency medical services; eight participated in semi-structured, in-depth individual interviews and 10 participated in two focus groups. Data were collected from April-October 2013 in Sweden; interviews were transcribed verbatim and analysed using content analysis.�� Results: Two main themes were identified from the interviews: (i) an incongruence between climate and environmental issues and nurses' daily work; and (ii) public health work is regarded as a health co-benefit of climate change mitigation. While being green is not the primary task in a lifesaving, hectic and economically challenging context, nurses' perceived their profession as entailing responsibility, opportunities and a sense of individual commitment to influence the environment in a positive direction.�� Conclusions: This study argues there is a need for increased awareness of issues and methods that are crucial for the healthcare sector to respond to climate change. Efforts to develop interventions should explore how nurses should be able to contribute to the healthcare sector's preparedness for and contributions to sustainable development.

Obstru����o intestinal no idoso

RACIONAL: O envelhecimento da popula����o �� realidade sentida na viv��ncia di��ria, levando �� necessidade associada de prover cuidados m��dicos eletivos e de emerg��ncia a um n��mero cada vez maior de idosos. OBJETIVO: Avaliar os aspectos cl��nicos, terap��uticos e evolutivos de pacientes idosos com obstru����o intestinal atendidos no Hospital das Cl��nicas da Faculdade de Medicina de Botucatu - UNESP. M��TODOS: An��lise retrospectiva de pacientes internados no per��odo de janeiro de 2002 a dezembro de 2006. Foram estudados 50 pacientes, 24 homens e 26 mulheres, com idade m��dia de 74,7 �� 7,4 anos, analisando-se a diferencia����o entre obstru����o funcional e org��nica; a freq����ncia das causas obstrutivas; a mortalidade; a incid��ncia dos sinais e sintomas; e correla����o laboratorial. RESULTADOS: O quadro obstrutivo intestinal teve as seguintes causas: brida (38%), c��ncer de colon (24%), h��rnias (12%), impactac��o fecal (12%), carcinomatose (10%) e volvo da sigm��ide (4%). A mortalidade foi de 18% associada �� complica����es infecciosas em todos os pacientes. CONCLUS��ES: a) A distin����o entre a obstru����o intestinal funcional e org��nica oferece dificuldade no idoso; b) o c��ncer do colon constitui-se em importante causa de obstru����o intestinal com quadro obstrutivo j�� na primeira manifesta����o cl��nica desse tumor; c) bridas e h��rnias s��o igualmente importantes na etiologia da obstru����o intestinal; d) os sinais cl��nicos obstrutivos s��o poucos evidentes no idoso e a leucometria �� mais fidedigna para este diagn��stico.

The importance of knowing the home conditions of patients receiving long-term oxygen therapy

Purpose: Long-term oxygen therapy (LTOT) is one of the main treatments for patients with chronic obstructive pulmonary disease. Patients receiving LTOT may have less than optimal home conditions and this may interfere with treatment. The objective of this study was, through home visits, to identify the characteristics of patients receiving LTOT and to develop knowledge regarding the home environments of these patients.Methods: Ninety-seven patients with a mean age of 69 plus or minus 10.5 years were evaluated. This study was a cross-sectional descriptive analysis. Data were collected during an initial home visit, using a questionnaire standardized for the study. The results were analyzed retrospectively.Results: Seventy-five percent of the patients had chronic obstructive pulmonary disease, and 11% were active smokers. The patients' mean pulse oximetry values were 85.9% plus or minus 4.7% on room air and 92% plus or minus 3.9% on the prescribed flow of oxygen. Most of the patients did not use the treatment as prescribed and most used a humidifier. The extension hose had a mean length of 5 plus or minus 3.9 m (range, 1.5-16 m). In the year prior to the visit, 26% of the patients received emergency medical care because of respiratory problems. Few patients reported engaging in leisure activities.Conclusion: The home visit allowed us to identify problems and interventions that could improve the way LTOT is used. The most common interventions related to smoking cessation, concentrator maintenance and cleaning, use of a humidifier, and adjustments of the length of the connector hose. Therefore, the home visit is a very important tool in providing comprehensive care to patients receiving LTOT, especially those who show lack of adequate progress and those who show uncertainty about the treatment method.

An��lise da configura����o de SAMU utilizando m��ltiplas alternativas de localiza����o de ambul��ncias

Conselho Nacional de Desenvolvimento Cient��fico e Tecnol��gico (CNPq)

Experi��ncia interacional homem-processo sa��de doen��a: A sa��de inabal��vel e a materialidade da doen��a

P��s-gradua����o em Sa��de Coletiva - FMB

Avalia����o dos par��metros gasom��tricos dos traumatizados durante o atendimento pr��-hospitalar m��vel

OBJECTIVE: To evaluate gasometric differences of severe trauma patients requiring intubation in prehospital care. METHODS: Patients requiring airway management were submitted to collection of arterial blood samples at the beginning of pre-hospital care and at arrival at the Emergency Room. We analyzed: Glasgow Coma Scale, respiratory rate, arterial pH, arterial partial pressure of CO2 (PaCO2), arterial partial pressure of O2 (PaO2), base excess (BE), hemoglobin O2 saturation (SpO2) and the relation of PaO2 and inspired O2 (PaO2/FiO2). RESULTS: There was statistical significance of the mean differences between the data collected at the site of the accident and at the entrance of the ER as for respiratory rate (p = 0.0181), Glasgow Coma Scale (p = 0.0084), PaO2 (p <0.0001) and SpO2 (p = 0.0018). CONCLUSION: tracheal intubation changes the parameters PaO2 and SpO2. There was no difference in metabolic parameters (pH, bicarbonate and base excess). In the analysis of blood gas parameters between survivors and non-survivors there was statistical difference between PaO2, hemoglobin oxygen saturation and base excess.

Orienta����es de alta: cart��es padronizados ajudam na compreens��o dos pacientes do pronto socorro?

OBJECTIVE: To determine whether the addition of discharge standard illustrated cards improves understanding of patients in the emergency room. METHODS: We conducted a prospective, randomized, interventional study with 228 patients discharged from the emergency department. All patients were interviewed and tested for the level of understanding of discharge instructions. Some of them received the intervention, with the standard cards, and another did not, constituting the control group. RESULTS: The average of followed discharge guidelines of the group that received the cards was higher than the control group, with statistical significance (p=0.009). When segregated by age, the group between 16 and 35 years of both sexes had the best average of followed guidelines, statistically, than the average of the control group (p=0.01). The difference between the mean orientations between the control group and the card for patients undergoing procedures was statistically significant (p=0.02); as for the stratification according to the number of procedures, the significance increases when that is equal to 1 (p=0.001) and decreased the more procedures were carried out. CONCLUSION: The introduction of discharge standard orientation cards was associated with improvement in the understanding of patients. Without replacing the verbal directions, which establishes dialogue and doctor-patient bonding, cards appear as auxiliary elements, facilitating understanding and care guidelines.

Diverg��ncias entre hist��rico da consulta e diagn��stico m��dico de agress��es f��sicas registradas nos prontu��rios de uma unidade de urg��ncia e emerg��ncia

There can be several indicators of violence in society. However, in no other health unit such violence acquires visibility as in emergency. This study aimed to examine whether there is divergence between the history of medical consultation and diagnosis of physical aggressions in the emergency unit. A cross-sectional study was conducted in an emergency unit in the city of Ara��atuba, state of S��o Paulo, Brazil, based on medical records, considering data on patients, lesions, history, diagnosis and treatment. Out of 133,537 visits, only 153 were recorded as physical aggressions, and 161 informed violence in the history of the consultation; 59.6% were male, 60.6% were between 20 and 44 years old. Excoriations, pain and injury predominated. There were no associations between state violence in the diagnosis and the characteristics of patients and visits (schedule, routing, gender, age). The conclusion is that in most cases violence reported in the history of the consultation was not mentioned in the diagnosis of injuries. The characteristics of care and patients were not related to the fact that professionals diagnosed the case as violence.

Caracteriza����o do perfil dos pacientes em oxigenoterapia domiciliar em uma cidade do interior do estado de S��o Paulo

P��s-gradua����o em Enfermagem (mestrado profissional) - FMB

Extens��o do modelo hipercubo para an��lise de sistemas de atendimento m��dico emergencial com prioridade na fila

Conselho Nacional de Desenvolvimento Cient��fico e Tecnol��gico (CNPq)

Viol��ncia interpessoal: estudo descritivo dos casos n��o fatais atendidos em uma unidade de urg��ncia e emerg��ncia refer��ncia de sete munic��pios do estado de S��o Paulo, Brasil, 2008 a 2010

Objective: to describe the profile of non-fatal cases related to interpersonal violence treated in an emergency care unit of reference that serves seven municipalities of the state of S��o Paulo, Brazil, from 2008 to 2010. Methods: the study data came from the cases reported from the Epidemiological Vigilance in Pen��polis-SP to the Brazilian Information System for Notifiable Diseases; variables were shown according to the Notification/Investigation Individual Formulary of Domestic, Sexual, and/or other Types of Violences. Results: 109 occurrences were studied; most of the victims were young and female (93.6%); and the aggressors, mostly were men (57.8%), partners or relatives/acquaintances of victims. Physical violence was the main form of aggression (93.6%), principally in the home (67.9%), on Sunday (16.5%), between 6:01pm and 12:00pm (57.8%). Conclusion: the cases reported had a consistent profile of domestic family violence against women, different from other studies about interpersonal violence in large cities and metropolitan regions

As interfaces da conviv��ncia da fam��lia em uma unidade de pronto socorro

The aim was to describe the positive and negative aspects in a family communication at an emergency care unit. This is a descriptive research with a qualitative approach. The sample consisted of 20 family members / caregivers of patients admitted to the emergency room of a university hospital. Data collection was carried out through semi-structured interviews applied during the period of May-June 2011. Data analysis was performed using the methodological framework of the Collective Subject Discourse which resulted in four themes: Lack of information compromising the family/health professional ties; The ideal model of information provided by the professional regarding the condition of the hospitalized relative; Assessment of information provided about hospital routines; and The role of the relative/companion. Therefore, for the patient and his family, communication is presented as a tool on the care given with the function of transmitting safety, respect and guidance. However when it is incomplete, it becomes a potential form of stress and dissatisfaction.