Clinical pharmacy input for hospital inpatients according to disease state

This study measured the clinical activities performed and times taken by hospital pharmacists to provide medication monitoring services to individual medical and surgical patients. Linking these data to hospital Patient Administration Systems showed how clinical pharmacy manpower needs are guided by patient partition, disease complexity and Diagnosis Related Group classification.

Staying healthy : the case of cotton and cane growers in Australia

Farmers and fishers have always been exposed to the vagaries of climate and global economic forces. However, in recent years there has been an accumulation of factors which are having a particularly severe impact upon rural Australia. The global financial crisis has negatively affected commodity prices and the viability of some rural communities is under threat. There is evidence to suggest that climate change is already impacting adversely on many primary producers and their ability to farm using traditional methods. Furthermore, many parts of rural Australia are still experiencing the effects of long-term drought and associated problems. Together, these circumstances can rightly be conceived of as 'difficult times'. Key areas recently identified in a decline in mental health among farmers include: increasing isolation, ongoing drought, increased government regulations, and a widening of the schism between urban and rural Australians. While there is a body of literature on behaviour around illness in the context of the stress of ' difficult times', there is little on preventative behaviours in these circumstances. This chapter reports preliminary findings from an exploratory research projects that investigates the process by which farmers and fishers achieve and maintain good physical and mental health in the context of 'difficult times'. The research takes a multiple case study approach, with five Australian sites, each with a different industry base, representing communities undergoing 'difficult times'. This chapter focuses on two of the sites and data obtained from interviews with farmers in the cotton and sugar industries. It discusses the behavioural choices that they make to maintain good physical health and mental wellbeing. These include choices about nutrition, physical activity, social connections such as participation in community, social or farm-related groups, opportunities for relaxation and regular medical check-ups.

The use of insects and associated arthropods in legal cases : a historical and practical perspective

 Forensic entomology has generally been recognised among law enforcement and the wider community as a science employed in the estimation of time since death. The utility of this science in contributing to the provision of time frames resulting in the focusing of valuable investigative resources has certainly been of the greatest importance. However, arthropods have been exploited extensively for their ability to provide information in a multitude of other situations, including cases of neglect, the food industry, and information relating to the cause and manner of death. This chapter will discuss the realm of information obtainable from insects and related groups in the forensic context, including and beyond the recognised time since death applications. Two areas of current research, molecular forensic entomology and entomotoxicology, will be discussed for their potential impact in the field.

Unsupervised DRG upcoding detection in healthcare databases

Diagnosis Related Group (DRG) upcoding is an anomaly in healthcare data that costs hundreds of millions of dollars in many developed countries. DRG upcoding is typically detected through resource intensive auditing. As supervised modeling of DRG upcoding is severely constrained by scope and timeliness of past audit data, we propose in this paper an unsupervised algorithm to filter data for potential identification of DRG upcoding. The algorithm has been applied to a hip replacement/revision dataset and a heart-attack dataset. The results are consistent with the assumptions held by domain experts.

Ontogenetic and seasonal variation in the Diel Vertical Migration of the Copepods Metridia lucens and Metridia longa

Plankton samples collected and analyzed by the Continuous Plankton Recorder survey were used to examine the length of time spent near the surface in the North Atlantic and the North Sea by three closely related groups of zooplankton (copepodite stages 1-4 Metridia spp., copepodite stages 5-6 Metridia lucens, and copepodite stages 5-6 Metridia longa). For all three groups, the mean daily length of time spent near the surface in each month of the year covaried seasonally with day length. In addition, the amount of time spent near the surface varied significantly between the three groups, being longest for the copepods of smallest body size (C 1-C4 Metridia spp.) and shortest for the copepods of largest body size (C5-C6 M. longa). These results support the suggestion that diel vertical migration serves to reduce the risk of mortality from visually orienting predators

Impacto clínico e econômico da redefinição dos critérios diagnósticos de infarto do miocárdio

Introdução: Estudos sobre implicações clínicas da nova definição de infarto do miocárdio (IAM), incorporando novos marcadores de lesão miocárdica, são escassos na literatura. A prevalência de IAM e das suas complicações são diretamente dependentes do critério diagnóstico utilizado. Objetivo: Avaliar o impacto diagnóstico, prognóstico e econômico da nova definição de IAM proposta pela AHA/ ESC usando troponina T (TnT) como marcador de lesão cardíaca. Métodos: Um total de 740 pacientes com dor torácica admitidos na Emergência do Hospital de Clínicas de Porto Alegre no período de julho/ 1999 a janeiro/ 2002 foram incluídos no estudo. Creatina quinase total (CK), CK-MB atividade e TnT foram dosados em uma amostra de 363 pacientes, representativa de toda a coorte. Para redefinição de IAM foram utilizados como ponto de corte valores pico de TnT > 0,2 mg/dl. Os desfechos avaliados foram classificados como eventos cardíacos maiores (angina recorrente, insuficiência cardíaca congestiva, choque cardiogênico e óbito) e como procedimentos de revascularização. Também foram avaliados o manejo prescrito, os custos e o faturamento hospitalar. Resultados: Nos 363 pacientes com marcadores dosados, foram diagnosticados 59 casos de IAM (16%) pelos critérios clássicos; enquanto 40 pacientes (11%) tiveram o diagnóstico de IAM pelo critério redefinido, o que corresponde a um incremento de 71% na incidência. Pacientes com IAM redefinido eram significativamente mais idosos e do sexo masculino, apresentaram mais dor atípica e diabetes mellitus. Na análise multivariada, pacientes com infarto redefinido tiveram um risco 5,1 [IC 95% 1,0-28] vezes maior para óbito hospitalar e 3,4 [IC 95% 1,1-10] vezes maior para eventos combinados em relação aqueles sem IAM. O manejo dos casos de IAM redefinido foi semelhante ao manejo daqueles com IAM tradicional, exceto pelos procedimentos de revascularização que foram menos freqüentes (25% vs. 51%, P < 0,001). O grupo com IAM redefinido permaneceu mais tempo internado e foi submetido a procedimentos mais tardiamente. Do ponto de vista institucional, o uso dos novos critérios para IAM poderia resultar em um aumento de 9% (mais R$ 2.756,00 por grupo de 100 pacientes avaliados) no faturamento baseado em diagnóstico segundo a tabela do SUS. Conclusões: O novo diagnóstico de IAM acrescenta um número expressivo de indivíduos com infarto aos serviços de emergência. A incorporação deste critério é importante na medida que estes pacientes têm um prognóstico semelhante aos demais casos tradicionalmente diagnosticados. Como a identificação destes casos poderia resultar em um manejo mais qualificado e eficiente destes pacientes, esforços deveriam ser adotados para reforçar a adoção da redefinição de IAM.

Uma comparação entre os custos atuais, custos por pacote e reembolso hospitalar para o procedimento de revascularização miocárdica

In Brazil, the supplemental healthcare system is going through a transition period from the traditional Fee-for-service reimbursement system to the Package reimbursement system, similar to the American model known as the Diagnoses Related Groups (DRG) system. Although the Package concept is nothing new to the hospital environment, it is still seldom used since this system calls for a level of control and analytical knowledge of hospital costs that are poorly developed in Brazilian institutions. This study focuses on determining how much the reimbursement for a Myocardial Revascularization Package actually covers of the current costs for patients submitted to this procedure. A prospective analysis method for determining the cost per patient has been developed and 13 patients were individually followed-up during all their hospitalization period. The expenses with intensive care unit and in-patient clinical care, as well as the type of admittance - whether elective or emergency - were determined for each patient. Additionally, all the resources and materials for the surgical procedure were included, comprising specialized personnel, surgical fees, procedures and tests, biomedical equipment, and all the materials and medication used during the hospital stay. Based on this data, the current total costs were calculated and compared to the reimbursement for the Package previously agreed upon by the institution and the healthcare carriers. The study found an average cost of BR$ 8,826 for a Myocardial Revascularization surgical procedure, while the respective reimbursement for the Package is of BR$ 7,476. Therefore, the reimbursement does not cover the current costs of the procedure.

Chromosomes of Theridiidae spiders (Entelegynae): interspecific karyotype diversity in Argyrodes and diploid number intraspecific variability in Nesticodes rufipes

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Evaluation of the floral vasculature of the Janusia, Mascagnia and Tetrapterys species as a tool to explain the decrease of floral organs in Malpighiaceae

The family Malpighiaceae is considered monophyletic, but the intra-family classification is conflicting. Analyses of floral vasculature allow the identification of reductions, connations and adnations and can even reveal evolutionary steps prior to current floral morphology. The present work analysed the floral vasculature of Janusia mediterranea, Mascagnia cordifolia and Tetrapterys chamaecerasifolia using material processed by traditional methods for light microscopy. A general pattern was observed of three bundle traces supplying each sepal and one trace per petal and stamen; Mascagnia is an exception, as its eglandular sepal has only a median trace but shares lateral traces with adjacent sepals. No dorsal traces are emitted to the carpels; however, three intercarpellary complexes are emitted that divide into six ventral bundles, supplying the ovule. Mascagnia demonstrates connation between the anterior and adjacent sepal glands; reductions of the anterior sepal glands were registered in Tetrapterys and Janusia. This work reveals two distinct processes for gland loss in non-related groups of the family that resulted in similar present appearances. Our evaluation of the number of calyx glands and the processes of glandular loss in species with less than ten glands improves our understanding of the evolution of calyx glands in Malpighiaceae. © 2013 Elsevier GmbH.

Qualidade de vida em mulheres com ausência ou presença de terapia de reposição hormonal

The objective of this study was to evaluate the quality of life (QL) of a group of menopausal women in the presence or absence of hormone replacement therapy (HRT). It consists of a cross-sectional analytical study involving women from the School Health Center - Unity Village Farmers' and Town Railway on the city of Botucatu. Participants were divided into two related groups of studies: run HRT and do not realize. We used the SF 36 and QRS, and a questionnaire to characterize the study population. No differences were seen when comparing the groups with regard to age, age at menarche and menopause. It was observed that 92% were white women and who have studied up to primary education (p = 0.0209), and those who had a partner (p = 0.0055), were the most reported changes in QL. The most frequent comorbidities were hypertension and diabetes, which is significantly more important in women without HRT. The account of the lower of QL was expressed by 28% of the sample, and the population obtained in MRS score more negative (p, 0.05). The correlation of the eight components of the SF36 and the MRS, with the presence or absence of TRH showed no significant differences. The concept of quality of life and evaluation of it is subjective and individual. However they can notice changes in QL, evidenced by instruments. One can see that menopause is not necessarily accompanied by changes in QL, however, when expressed, tend to be perceived more negatively. Despite the lower level of social and low education and women interviewed have QL as good. There is a need for studies to improve a more real relationship between HRT and QL

Análise histomorfológica e molecular de lesões granulomatosas sugestivas de tuberculose bovina

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estratégias de relativização nas variedades lusófonas

This paper, which examines restrictive and non-restrictive constructions in the Lusophone varieties, assumes that Portuguese has a set of relativization strategies that are recognized by typological linguistics as constructions that define related groups of languages. Thus, it is possible that these different strategies, when employed by the same linguistic system, not really constitute variants of the same syntactic variable but the speaker’s actual choices facing the necessity to perform different social and discursive functions.

Construções relativas nas variedades do português: uma interpretação discursivo-funcional

This work examines relative constructions in Portuguese varieties based on the principle that Portuguese has a set of relativization strategies that are recognized in typological linguistics as constructions that define related groups of languages. It is postulated that these different strategies, when employed by the same linguistic system, do not really constitute variants of the same syntactic variable, but they are the speaker’s actual choices facing the necessity to perform different social and discursive functions.

[Heterogeneity of costs and performance for penetrating eye injuries and suturing amniotic membranes under DRG conditions : Analysis of case constellations of the G-DRG C01B of the Regensburg University eye clinic]

Patients with penetrating eye injuries are a very heterogeneous group both medically and economically. Since 2009, treatment involving sutures for open eye injuries and cases requiring amniotic membrane transplantation (AMT) were allocated to DRG C01B of the German diagnosis-related group system. However, given the significant clinical differences between these treatments, an inhomogeneity of costs to performance is postulated. This analysis describes case allocation problems within the G-DRG C01B category and presents solutions.

Health Care Cost Analysis

This afternoon you will be working on descriptive statistics, such as what is the total number of discharges in the state of Montana for a given Diagnosis Related Group (DRG), what is the average payment of a given DRG, and what is the range of payments of a given DRG. We will also formulate and solve a statistical question such as is there a relationship between the size of a hospital and the average payment of a given DRG.