Comparative evaluation of underlying causes of death processed by the Automated Classification of Medical Entities and the Underlying Cause of Death Selection Systems

INTRODUCTION: The correct identification of the underlying cause of death and its precise assignment to a code from the International Classification of Diseases are important issues to achieve accurate and universally comparable mortality statistics These factors, among other ones, led to the development of computer software programs in order to automatically identify the underlying cause of death. OBJECTIVE: This work was conceived to compare the underlying causes of death processed respectively by the Automated Classification of Medical Entities (ACME) and the "Sistema de Sele����o de Causa B��sica de Morte" (SCB) programs. MATERIAL AND METHOD: The comparative evaluation of the underlying causes of death processed respectively by ACME and SCB systems was performed using the input data file for the ACME system that included deaths which occurred in the State of S. Paulo from June to December 1993, totalling 129,104 records of the corresponding death certificates. The differences between underlying causes selected by ACME and SCB systems verified in the month of June, when considered as SCB errors, were used to correct and improve SCB processing logic and its decision tables. RESULTS: The processing of the underlying causes of death by the ACME and SCB systems resulted in 3,278 differences, that were analysed and ascribed to lack of answer to dialogue boxes during processing, to deaths due to human immunodeficiency virus [HIV] disease for which there was no specific provision in any of the systems, to coding and/or keying errors and to actual problems. The detailed analysis of these latter disclosed that the majority of the underlying causes of death processed by the SCB system were correct and that different interpretations were given to the mortality coding rules by each system, that some particular problems could not be explained with the available documentation and that a smaller proportion of problems were identified as SCB errors. CONCLUSION: These results, disclosing a very low and insignificant number of actual problems, guarantees the use of the version of the SCB system for the Ninth Revision of the International Classification of Diseases and assures the continuity of the work which is being undertaken for the Tenth Revision version.

Optimiza����o dos protocolos de reconstru����o em imagens TC de AVC isqu��mico agudo: projecto

Mestrado de Radia����es aplicadas ��s Tecnologias da Sa��de. ��rea de especializa����o: Imagem Digital com Radia����o X.

Evaluation of the improvements on pharmacy technicians' work practices after implementation of operational procedures

Several antineoplasic drugs have been demonstrated to be carcinogenic or to have mutagenic and teratogenic effects. The greatest protection is achieved with the implementation of administrative and engineering controls and safety procedures. Objective: to evaluate the improvements on pharmacy technicians' work practices, after the implementation of operational procedures related to individual protection, biologic safety cabinet disinfection and cytotoxic drug preparation. Method: case-study in a hospital pharmacy undergoing a certification process. Six pharmacy technicians were observed during their daily activities. Characterization of the work practices was made using a checklist based on ISOPP and PIC guidelines. The variables studied concerning cleaning/disinfection procedures, personal protective equipment and procedures for preparing cytotoxic drugs. The same work practices were evaluated after four months of operational procedures implementation. Concordance between work practices and guidelines was considered to be a quality indicator (guidelines concordance practices number/total number of practices x 100). Results: improvements were observed after operational procedures implementation. An improvement of 6,25% in personal protective equipment practice was achieved by changing second pair of gloves every thirty minutes. The major progress, 10%, was obtained in disinfection procedure, where 80% of tasks are now realized according to guidelines.By now, we hot an improvement of only 1% at drug preparation procedure by placing one cytotoxic drug at a time inside the biological safety cabinet. Then, 85% of practices are according to guidelines. Conclusion: before operational procedures implementation 80,3% of practices were according to the guidelines, while now is 84,4%. This indicates that is necessary to review the procedures frequently in the benefit to reduce the risks associated with handling cytotoxic drugs and maintenance of drug specifications.

An intelligent tutoring approach to support students and technicians in electrical installation design

Designing electric installation projects, demands not only academic knowledge, but also other types of knowledge not easily acquired through traditional instructional methodologies. A lot of additional empirical knowledge is missing and so the academic instruction must be completed with different kinds of knowledge, such as real-life practical examples and simulations. On the other hand, the practical knowledge detained by the most experienced designers is not formalized in such a way that is easily transmitted. In order to overcome these difficulties present in the engineers formation, we are developing an Intelligent Tutoring System (ITS), for training and support concerning the development of electrical installation projects to be used by electrical engineers, technicians and students.

Research on evaluation system of emergency disposal plan for power plant incidents

This paper starts with the analysis of the unusual inherence mechanism, from two aspects: accumulating and human error. We put forward twelve factors affected the decision of the emergency treatment plan in practice and summarized the evaluation index system combining with literature data. Then we screened out eighteen representative indicators by used the FDM expert questionnaire in the first phase. Hereafter, we calculated the weight of evaluation index and sorted them by the FAHP expert questionnaire, and came up with the frame of the evaluation rule by combined with the experience. In the end, the evaluation principles are concluded.

Emergency energy resource management in SmartGrids

Energy resources management can play a very relevant role in future power systems in a SmartGrid context, with intensive penetration of distributed generation and storage systems. This paper deals with the importance of resource management in incident situations. The paper presents DemSi, an energy resources management simulator that has been developed by the authors to simulate electrical distribution networks with high distributed generation penetration, storage in network points and customers with demand response contracts. DemSi is used to undertake simulations for an incident scenario, evidencing the advantages of adequately using flexible contracts, storage, and reserve in order to limit incident consequences.

Peculiarities of the professional education and qualification appraisal of assistants of pharmacists in Lithuania

Following the alterations and additions to the pharmaceutical law of Lithuanian Republic the pharmaceutical activity in Lithuanian pharmacies is carried out by pharmacy specialists ��� pharmacists and pharmacy assistants (pharmacy technicians). The ability of pharmacy specialists to adapt, to improve and to develop their competencies is one of the success preconditions for Lithuanian health care pharmacy sector. Work aim: to investigate the changes among the specialists employed in pharmacies and pharmacy sector as well as to highlight the necessity to develop the qualification of pharmacy assistants (pharmacy technicians) according to the modern pharmaceutical legal basis in Lithuania. In 2008���2011 the research in Lithuanian pharmacy sector was performed which identified the changes in the numbers of pharmacies and their staff: the number of pharmacies decreased, while the number of pharmacists increased and the number of the assistants of pharmacists (pharmacy technicians) decreased. The decrease in the number of the assistants of pharmacists (pharmacy technicians) and the danger of their extinction in the future has been identified. The qualification appraisal for pharmacy assistants (pharmacy technicians) is implemented through the leveling studies at the Pharmacy technique department at the Health care faculty of Kauno Kolegija University of applied sciences and pharmacy study programme at the faculty of Pharmacy of Medical Academy at Lithuanian University of Health Sciences. 75 % of respondents use their own money to pay for the qualification appraisal, and 25 % of respondents get financial support for the qualification appraisal activities from the pharmacy managers.

Tend��ncias dos processos de profissionaliza����o no campo da sa��de

Neste artigo, resultante de uma comunica����o proferida nas III Jornadas de Ci��ncias Sociais e Humanas em Sa��de, abordam-se as din��micas presentes nas rela����es profissionais e as tend��ncias dos processos de profissionaliza����o que ocorrem no campo da sa��de. O trabalho de investiga����o emp��rica, realizado no quadro de um estudo de caso sobre os t��cnicos de cardiopneumologia e o desenvolvimento da reflex��o sobre o tema, constituem o ponto de partida da an��lise sobre o tema que toma como refer��ncia o conjunto dos grupos socioprofissionais deste setor. Ap��s enquadrar os contextos de transforma����o social que t��m ocorrido desde as ��ltimas d��cadas do s��culo XX e a forma como incidiram no campo da sa��de, bem como na recomposi����o dos respetivos grupos socioprofissionais, salientam-se cinco tend��ncias relativas aos processos de profissionaliza����o observadas neste setor, relacionadas com as rela����es de poder e domina����o profissional; os efeitos da delega����o de tarefas e compet��ncias ao n��vel da transfer��ncia de legitimidade entre os grupos socioprofissionais; o grau de autonomia; a variabilidade das situa����es quotidianas ocorridas em diferentes contextos de trabalho que se traduz numa disparidade de tend��ncias muitas vezes contradit��rias e paradoxais entre si; o efeito das altera����es recentes nos cen��rios de inser����o profissional, num contexto de crescente precariedade e desregula����o do mercado de trabalho.

Cyclotech - contribution to solve the Technetium shortage by using low energy medical cyclotrons

This paper presents work in progress, to develop an efficient and economic way to directly produce Technetium 99metastable (99mTc) using low-energy cyclotrons. Its importance is well established and relates with the increased global trouble in delivering 99mTc to Nuclear Medicine Departments relying on this radioisotope. Since the present delivery strategy has clearly demonstrated its intrinsic limits, our group decided to follow a distinct approach that uses the broad distribution of the low energy cyclotrons and the accessibility of Molybdenum 100 (100Mo) as the Target material. This is indeed an important issue to consider, since the system here presented, named CYCLOTECH, it is not based on the use of Highly Enriched (or even Low Enriched) Uranium 235 (235U), so entirely complying with the actual international trends and directives concerning the use of this potential highly critical material. The production technique is based on the nuclear reaction 100Mo (p,2n) 99mTc whose production yields have already been documented. Until this moment two Patent requests have already been submitted (the first at the INPI, in Portugal, and the second at the USPTO, in the USA); others are being prepared for submission on a near future. The object of the CYCLOTECH system is to present 99mTc to Nuclear Medicine radiopharmacists in a routine, reliable and efficient manner that, remaining always flexible, entirely blends with established protocols. To facilitate workflow and Radiation Protection measures, it has been developed a Target Station that can be installed on most of the existing PET cyclotrons and that will tolerate up to 400 ��A of beam by allowing the beam to strike the Target material at an adequately oblique angle. The Target Station permits the remote and automatic loading and discharge of the Targets from a carriage of 10 Target bodies. On other hand, several methods of Target material deposition and Target substrates are presented. The object was to create a cost effective means of depositing and intermediate the target material thickness (25 - 100��m) with a minimum of loss on a substrate that is able to easily transport the heat associated with high beam currents. Finally, the separation techniques presented are a combination of both physical and column chemistry. The object was to extract and deliver 99mTc in the identical form now in use in radiopharmacies worldwide. In addition, the Target material is recovered and can be recycled.

Modelo de data mining para dete����o de embolias pulmonares

Trabalho de Projeto para obten����o do grau de Mestre em Engenharia Inform��tica e de Computadores

Dosimetria das exposi����es em imagiologia cl��nica

A import��ncia da radia����o ionizante na pr��tica m��dica, n��oo s�� como diagn��stico mas tamb��m como terapia, ganhou, no ��ltimo meio s��culo, uma import��ncia fulcral. Devido aos efeitos secund��rios da radia����o ao ser humano, torna-se fundamental definir regras para aumentar a seguran��a de todos os seus utilizadores, surgindo assim a radioprotec����o. Nesse sentido a Comunidade Europeia da Energia At��mica (EURATOM) define directrizes para os pa��ses membros da Comunidade Europeia de forma a poder orient��-los nesse processo. Torna-se assim importante registar e monitorizar os valores de dose de radia����o num exame radiol��gico para o aumento de seguran��a dos pacientes e t��cnicos. O presente trabalho desenvolvido no ��mbito da disciplina anual Disserta����o/Projecto/ Est��gio Profissional do Mestrado em Computa����o e Instrumenta����o M��dica teve como objectivo registar esses valores atrav��s da comunica����o com medidores de doses. A luz do dia-a-dia da Dr. Campos Costa - Consult��rio de Tomogra a Computarizada S.A, �� apresentada nesta tese uma aplica����o computacional capaz de obter os valores de dose de um estudo radiol��gico a um paciente e guard��-los numa base de dados projectada exclusivamente para esse fim. Os resultados obtidos s��o animadores uma vez que provam ser poss��vel automatizar a monitoriza����o desses valores atrav��s de aplica����es com ferramentas capazes de auxiliar os respons��veis por essa monitoriza����o em qualquer centro cl��nico.

Health-related quality of life and working conditions among nursing providers

OBJECTIVE: To evaluate working conditions associated with health-related quality of life (HRQL) among nursing providers. METHODS: Cross-sectional study conducted in a university hospital in the city of S��o Paulo, Southeastern Brazil, during 2004-2005. The study sample comprised 696 registered nurses, nurse technicians and nurse assistants, predominantly females (87.8%), who worked day and/or night shifts. Data on sociodemographic information, working and living conditions, lifestyles, and health symptoms were collected using self-administered questionnaires. The following questionnaires were also used: Job Stress Scale, Effort-Reward Imbalance (ERI) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Ordinal logistic regression analysis using proportional odds model was performed to evaluate each dimension of the SF-36. RESULTS: Around 22% of the sample was found to be have high strain and 8% showed an effort-reward imbalance at work. The dimensions with the lowest mean scores in the SF-36 were vitality, bodily pain and mental health. High-strain job, effort-reward imbalance (ERI>1.01), and being a registered nurse were independently associated with low scores on the role emotional dimension. Those dimensions associated to mental health were the ones most affected by psychosocial factors at work. CONCLUSIONS: Effort-reward imbalance was more associated with health than high-strain (high demand and low control). The study results suggest that the joint analysis of psychosocial factors at work such as effort-reward imbalance and demand-control can provide more insight to the discussion of professional roles, working conditions and HRQL of nursing providers.

Biomonitorization in hospital settings with cytostatics occupational exposure

Exposure in a hospital setting is normally due to the use of several antineoplastic drugs simultaneously. Nevertheless, the effects of such mixtures at the cell level and on human health in general are unpredictable and unique due to differences in practice of hospital oncology departments, in the number of patients, protection devices available, and the experience and safety procedures of medical staff. Health care workers who prepare or administer hazardous drugs or who work in areas where these drugs are used may be exposed to these agents in the air, on work surfaces, contaminated clothing, medical equipment, patient excreta, and other surfaces. These workers include specially pharmacists, pharmacy technicians, and nursing personnel. Exposures may occur through inhalation resulting from aerosolization of powder or liquid during reconstitution and spillage taking place while preparing or administering to patients, through Cytokinesis-block micronucleus test (CBMN) is extensively used in biomonitoring, since it determines several biomarkers of genotoxicity, such as micronuclei (MN), which are biomarkers of chromosomes breakage or loss, nucleoplasmic bridges (NPB), common biomarkers of chromosome rearrangement, poor repair and/or telomeres fusion, and nuclear buds (NBUD), biomarkers of elimination of amplified DNA.

Direct medical costs associated with schizophrenia relapses in health care services in the city of S��o Paulo

OBJECTIVE: To assess direct medical costs associated with schizophrenia relapses in mental health services. METHODS: The study was conducted in three health facilities in the city of S��o Paulo: a public state hospital; a Brazilian National Health System (SUS)-contracted hospital; and a community mental health center. Medical records of 90 patients with schizophrenia who received care in 2006 were reviewed. Information on inpatient expenditures was collected and used for cost estimates. RESULTS: Mean direct medical cost of schizophrenia relapses per patient was US$ 4,083.50 (R$ 8,167.58) in the public state hospital; US$ 2,302.76 (R$ 4,605.46) in the community mental health center; and US$ 1,198.50 (R$ 2,397.74) in the SUS-affiliated hospital. The main component was daily inpatient room rates (87% - 98%). Medication costs varied depending on the use of typical or atypical antipsychotic drugs. Atypical antipsychotic drugs were more often used in the community mental health center. CONCLUSIONS: Costs associated with schizophrenia relapses support investments in antipsychotic drugs and strategies to reduce disease relapse and the need for mental health inpatient services. Treating patients in a community mental health center was associated with medium costs and added the benefit of not depriving these patients from family life.