947 resultados para Emergency Medical Technicians
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BACKGROUND: Variations in emergency department admissions have been reported to happen as a result of major sports events. The work presented assessed changes in volume and urgency level of visits to a major Emergency Department in Lisbon during and after the city's football derby. MATERIAL AND METHODS: Volume of attendances and patient urgency level, according to the Manchester Triage System, were retrospectively analyzed for the 2008-2011 period. Data regarding 24-hour periods starting 45 minutes before kick-off was collected, along with data from similar periods on the corresponding weekdays in the previous years, to be used as controls. Data samples were organized according to time frame (during and after the match), urgency level, and paired accordingly. RESULTS: A total of 14 relevant periods (7 match and 7 non-match) were analyzed, corresponding to a total of 5861 admissions. During the match time frame, a 20.6% reduction (p = 0.06) in the total number of attendances was found when compared to non-match days. MTS urgency level sub-analysis only showed a statistically significant reduction (26.5%; p = 0.05) in less urgent admissions (triage levels green-blue). Compared to controls, post-match time frames showed a global increase in admissions (5.6%; p = 0.45), significant only when considering less urgent ones (18.9%; p = 0.05). DISCUSSION: A decrease in the total number of emergency department attendances occurred during the matches, followed by a subsequent increase in the following hours. These variations only reached significance among visits triaged green-blue. CONCLUSION: During major sports events an overall decrease in emergency department admissions seems to take place, especially due to a drop in visits associated with less severe conditions.
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OBJECTIVE: Recognizing the potential impact of psychiatric and psychosocial factors on liver transplant patient outcomes is essential to apply special follow-up for more vulnerable patients. The aim of this article was to investigate the psychiatric and psychosocial factors predicted medical outcomes of liver transplanted patients. METHODS: We studied 150 consecutive transplant candidates, attending our outpatient transplantation clinic, including 84 who had been grafted 11 of whom died and 3 retransplanted. RESULTS: We observed that active coping was an important predictor of length of stay after liver transplantation. Neuroticism and social support were important predictors of mortality after liver transplantation. CONCLUSION: It may be useful to identify patients with low scores for active coping and for social support and high scores for neuroticism to design special modes of follow-up to improve their medical outcomes.
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Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA School of Business and Economics
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Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5% of patients and median age was 84years old (IQR 77-90). Comorbidities were present in 69.8% of cases and 48.3% of patients had used healthcare services during the previous 90days. In-hospital mortality rate was 46.6% and median length-of-stay was 9days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n=0; one: n=7 (0%); two: n=18 (38.9%); three: n=26 (38.5%); four: n=30 (53.3%); and five; n=22 (68.2%); and sepsis n=50 (34.0%), severe sepsis n=43 (48.8%) and septic shock n=22 (72.7%). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p=0.001), age75years (p=0.02), and severe sepsis or shock (p=0.03) at the ED. Microbiological testing in 78.4% of cases was positive in 15.4% (n=15): methicillin-resistant Staphylococcus aureus (26.7%), Pseudomonas aeruginosa (20.0%), S. pneumoniae (13.3%), Escherichia coli (13.3%), others (26.7%); the rate of MDR bacteria was 53.3%. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.
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RESUMO - Introduo: Os dispositivos mdicos para diagnstico in vitro (DMDIV) so testes de diagnstico rpido que podem ser realizados em diversos contextos, seja na enfermaria, no departamento de urgncia, no bloco operatrio, no consultrio mdico, centros de enfermagem, farmcias, lares de terceira idade ou at na prpria residncia, uma vez que a sua utilizao no requer formao especializada em tcnicas de laboratrio. Os DMDIV tm inmeras finalidades: triagem de utentes, diagnstico de situaes agudas, monitorizao de frmacos ou acompanhamento de doenas crnicas. Objectivos: conhecer as potenciais implicaes operacionais, clnicas e econmicas da implementao generalizada de DMDIV em instituies de sade da regio de Lisboa e Vale do Tejo, bem como conhecer o nvel de utilizao e opinio sobre DMDIV de mdicos e enfermeiros da regio de sade de Lisboa e Vale do Tejo. Metodologia: foi realizado um estudo observacional, analtico e transversal. Como instrumento de recolha de dados, foi aplicado um questionrio a uma amostra de convenincia constituda por mdicos e enfermeiros a exercer funes em instituies hospitalares pblicas e privadas e em instituies de cuidados de sade primrios da regio de sade de Lisboa e Vale do Tejo. Concluso: a utilizao de DMDIV permite diminuir o tempo de resposta do resultado analtico, o que se traduz numa maior rapidez do diagnstico e numa interveno clnica mais clere, com impacto ao nvel da reduo do nmero de admisses desnecessrias, do tempo de internamento e do nmero de consultas mdicas, com a consequente reduo do consumo de recursos hospitalares. Na regio de sade de Lisboa e Vale do Tejo, um nmero significativo de instituies de sade disponibiliza este tipo de equipamentos portteis que, de uma forma geral, tm uma boa aceitao por parte dos profissionais de sade.
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Based on the report for Project IV unit of the PhD programme on Technology Assessment (Doctoral Conference) at Universidade Nova de Lisboa (December 2011). This thesis research has the supervision of Antnio Moniz (FCT-UNL and ITAS-KIT) and Armin Grunwald (Karlsruhe Institute of Technology-ITAS, Germany). Other members of the thesis committee are Mrio Forjaz Secca (FCT-UNL) and Femke Nijboer (University of Twente, Netherlands).
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Dissertao para obteno do Grau de Mestre em Engenharia Informtica
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RESUMO: As Anlises Clnicas so um precioso elemento entre os meios complementares de diagnstico e teraputica permitindo uma enorme panplia de informaes sobre o estado de sade de determinado utente. O objetivo do laboratrio fornecer informao analtica sobre as amostras biolgicas, sendo esta caracterizada pela sua fiabilidade, relevncia e facultada em tempo til. Assim, tratando-se de sade, e mediante o propsito do laboratrio, notria a sua importncia, bem como, a dos fatores associados para o cumprimento do mesmo. O bom desenrolar do ciclo laboratorial, compreendido pelas fases pr-analtica, analtica e ps-analtica crucial para que o objetivo do laboratrio seja cumprido com rigor e rapidez. O presente trabalho O Erro na Fase Pr-Analtica: Amostras No Conformes versus Procedimentos, enquadrado no mestrado de Qualidade e Organizao no Laboratrio de Anlises Clnicas, pretendeu enfatizar a importncia da fase pr- analtica, sendo ela apontada como a primordial em erros que acabam por atrasar a sada de resultados ou por permitir que os mesmos no sejam fidedignos como se deseja, podendo acarretar falsos diagnsticos e decises clnicas erradas. Esta fase, iniciada no pedido mdico e finalizada com a chegada das amostras biolgicas ao laboratrio est entregue a uma diversidade de procedimentos que acarretam, por si s, uma grande diversidade de intervenientes, para alm de uma variabilidade de factores que influenciam a amostra e seus resultados. Estes fatores, que podem alterar de algum modo a veracidade dos resultados analticos, devem ser identificados e tidos em considerao para que estejamos convitos que os resultados auxiliam diagnsticos precisos e uma avaliao correta do estado do utente. As colheitas que por quaisquer divergncias no originam amostras que cumpram o objectivo da sua recolha, no estando por isso em conformidade com o pretendido, constituem uma importante fonte de erro para esta fase pr-analtica. Neste estudo foram consultados os dados relativos a amostras de sangue e urina no conformes detetadas no laboratrio, em estudo, durante o 1 trimestre de 2012, para permitir conhecer o tipo de falhas que acontecem e a sua frequncia. Aos Tcnicos de Anlises Clnicas, colaboradores do laboratrio, foi-lhes pedido que respondessem a um questionrio sobre os seus procedimentos quotidianos e constitussem, assim, a populao desta 2 parte do projeto. Preenchido e devolvido de forma annima, este questionrio pretendeu conhecer os procedimentos na tarefa de executar colheitas e, hipoteticamente, confront-los com as amostras no conformes verificadas. No 1semestre de 2012 e num total de 25319 utentes registaram-se 146 colheitas que necessitaram de repetio por se verificarem no conformes. A amostra no colhida foi a no conformidade mais frequente (50%) versus a m identificao que registou somente 1 acontecimento. Houve ainda no conformidades que no se registaram como preparao inadequada e amostra mal acondicionada. Os tcnicos revelaram-se profissionais competentes, conhecedores das tarefas a desempenhar e preocupados em execut-las com qualidade. Eliminar o erro no estar, seguramente, ao nosso alcance porm admitir a sua presena, detet-lo e avaliar a sua frequncia far com que possamos diminuir a sua existncia e melhorar a qualidade na fase pr-analtica, atribuindo-lhe a relevncia que desempenha no processo laboratorial.-----------ABSTRACT:Clinical analyses are a precious element among diagnostic and therapeutic tests as they allow an enormous variety of information on the state of health of a user. The aim of the laboratory is to supply reliable, relevant and timely analytical information on biological samples. In health-related matters, in accordance with the objective of the laboratory, their importance is vital, as is the assurance that all the tools are in place for the fulfillment of its purpose. A good laboratory cycle, which includes the pre-analytical, analytical and post-analytical phases, is crucial in fulfilling the laboratorys mission rapidly and efficiently. The present work - "Error in the pre-analytical phase: non-compliant samples versus procedures, as part of the Masters in Quality and Organization in the Clinical Analyses Laboratory, wishes to emphasize the importance of the pre-analytical phase, as the phase containing most errors which eventually lead to delays in the issue of results, or the one which enables those results not to be as reliable as desired, which can lead to false diagnosis and wrong clinical decisions. This phase, which starts with the medical request and ends with the arrival of the biological samples to the laboratory, entails a variety of procedures, which require the intervention of different players, not to mention a great number of factors, which influence the sample and the results. These factors, capable of somehow altering the truth of the analytical results, must be identified and taken into consideration so that we may ensure that the results help to make precise diagnoses and a correct evaluation of the users condition. Those collections which, due to any type of differences, do not originate samples capable of fulfilling their purpose, and are therefore not compliant with the objective, constitute an important source of error in this pre-analytical phase. In the present study, we consulted data from non-compliant blood and urine samples, detected at the laboratory during the 1st quarter of 2012, to find out the type of faults that happen and their frequency. The clinical analysis technicians working at the laboratory were asked to fill out a questionnaire regarding their daily procedures, forming in this way the population for this second part of the project. Completed and returned anonymously, this questionnaire intended to investigate the procedures for collections and, hypothetically, confront them with the verified non-compliant samples. In the first semester of 2012, and out of a total of 25319 users, 146 collections had to be repeated due to non-compliance. The uncollected sample was the most frequent non-compliance (>50%) versus incorrect identification which had only one occurrence. There were also unregistered non-compliance issues such as inadequate preparation and inappropriately packaged sample. The technicians proved to be competent professionals, with knowledge of the tasks they have to perform and eager to carry them out efficiently. We will certainly not be able to eliminate error, but recognizing its presence, detecting it and evaluating its frequency will help to decrease its occurrence and improve quality in the pre-analytical phase, giving it the relevance it has within the laboratory process.
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A Masters Thesis, presented as part of the requirements for the award of a Research Masters Degree in Economics from NOVA School of Business and Economics
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The objective of the study was to report the first occurrence of the parasitoid Brachymeria podagrica in pupae of Ophyra aenescens, a fly of medical-sanitary importance. Human feces was used as bait to collect the insects. In the study 20 pupae of Ophyra aenescens (Wiedemann) (Diptera: Muscidae) were obtained, of which 20% of the total yielded the parasitoid Brachymeria podagrica (Hymenoptera: Chalcididae).
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A survey was done to determine the most common hospital accidents with biologically contaminated material among students at the Medical College of the Federal University of Minas Gerais. Six hundred and ninety-four students (between fifth and twelfth semesters of the college course) answered the questionnaire individually. Three-hundred and forty-nine accidents were reported. The accident rate was found to be 33.9% in the third semester of the course, and increased over time, reaching 52.3% in the last semester. Sixty-three percent of the accidents were needlestick or sharp object injuries; 18.3% mucous membrane exposure; 16.6% were on the skin, and 1.7% were simultaneously on the skin and mucous membrane exposure. The contaminating substances were: blood (88.3%), vaginal secretion (1.7%), and others (9.1%). The parts of the body most frequently affected were: hands (67%), eyes (18.9%), mouth (1.7%), and others (6.3%). The procedures being performed when the accidents occurred were: suture (34.1%), applying anesthesia (16.6%), assisting surgery (8.9%), disposing of needles (8.6%), assisting delivery (6.3%), and others (25.9%). Forty-nine percent of those involved reported the accident to the accident control department. Of these 29.2% did not receive adequate medical assistance. Eight percent of those involved used antiretroviral drugs and of these 86% discontinued the treatment on receiving the Elisa method applied to the patient (HIV-negative); 6.4% discontinued the treatment due to its side-effects; and 16% completed the treatment.
