Miracle-dz/UniFAR-FTUs huggingface dataset:
Os ruídos encontrados na construção de um modelo democrático e participativo de gestão hospitalar

A path leading to management modernization is based on an approach stressing dialog and discussions of the construction of a healthcare enhancement project whose main characteristic is its emphasis on joint management concepts at all levels. This paper assesses almost ten years of management by committee in a public hospital in Rio de Janeiro State, Brazil, seeking impacts on its micro-policies. The intention is to identify and analyze how the nursing staff experienced the implantation of this management model in the hospital. Empirical matters were analyzed at two levels: initially the comments of the players were grouped into themes, followed by cross-theme readings that analyzed the concept of "noise". The remarks made by the respondents indicated that this "noise" functions within the organization, demonstrating that the selected management process and the manner in which it was conducted are not sufficient to penetrate and intervene in institutional micro-policies, leaving gaps between the proposals set forth by this management model and the real situation of the workers.
The Cause of Epidemic Diarrhea, Nausea and Vomiting. (Viral Dysentery?)

Summary Among the 32 volunteers who inhaled nebulized filtered garglings, symptoms developed in 17; of the 21 who inhaled nebulized stool filtrates, 11 developed symptoms. Of the combined groups of 53 volunteers, 28 (53%) developed symptoms as compared with 22 out of 240 (9%) of the rest of the student body in which the natural disease apparently occurred during the period of the tests. No attacks occurred in 6 volunteers who inhaled serum nor in 24 volunteers who were fed serum or filtrates of garglings or stools. The results, considering the unideal circumstances during which the tests had to be made, suggest that the causative agent of the disease is filtrable, airborne, enters through the respiratory tract and is present in the oropharynx and stool but not in the blood. Tests are now being made in a nonepidemic period with material from the November epidemic preserved at −70°C.
Lessons learned from next‐generation sequencing in head and neck cancer

Scientific innovation has enabled whole exome capture and massively parallel sequencing of cancer genomes. In head and neck cancer, next‐generation sequencing has granted us further understanding of the mutational spectrum of squamous cell carcinoma. As a result of these new technologies, frequently occurring mutations were identified in NOTCH1, a gene that had not previously been implicated in head and neck cancer. The current review describes the most common mutations in head and neck cancer: TP53, NOTCH1, HRAS, PIK3CA, and CDKN2A. Emphasis is placed on the involved cellular pathways, clinical correlations, and potential therapeutic interventions. Additionally, the implications of human papillomavirus on mutation patterns are discussed. © 2012 Wiley Periodicals, Inc. Head Neck, 2013
Decision making in the management of recurrent head and neck cancer

Despite substantial improvements in head and neck squamous cell carcinoma (HNSCC) treatment, the major obstacle to long‐term survival remains disease recurrence. Salvage options are often limited due to prior therapy and the escalated morbidity of retreatment. The costs of treatment must be measured against the anticipated quality and quantity of life recovered, even with resectable disease. This review surveys the recurrent HNSCC literature to better guide decision making. Across multiple studies, negative prognostic factors include impaired performance status, advanced recurrent stage, brief disease‐free interval, previous chemotherapy, and nonlaryngeal sites of recurrence. When possible, surgical salvage remains the principal option for durable disease control, quality of life preservation, and cure. Nonsurgical therapies have also demonstrated measurable improvements in locoregional control. Interpretation of salvage literature must be tempered by recognition of significant selection bias. The decision for salvage therapy must be individualized, with management that involves well‐informed patients resulting in the best outcomes. © 2013 Wiley Periodicals, Inc. Head Neck 36: 144–151, 2014
Nonadherence with the Asthma Regimen

Adherence to a clinical regimen is paramount in determining its effectiveness. In asthma it encompasses such components of self-management as avoidance of allergens and irritants, cessation of smoking, making use of individual guidelines to manage exacerbations, keeping scheduled appointments, and contacting the caregiver when appropriate. The average adherence rate with medication in pediatric studies is 48%. In a three-month investigation of adherence by children with asthma, those who suffered an exacerbation had a median adherence rate with inhaled corticosteroid therapy of 13.7%, while those whose disease remained under control had a rate of 68.2%. Factors that influence patients' commitment to their care are knowledge of the disease and its treatment, quality of the interaction between the patient and the provider, patient satisfaction, social and family support, health beliefs and attitudes, and factors associated with the illness and its treatment such as the duration and the complexity of the reg.
Regulating “Higher Risk, No Direct Benefit” Studies in Minors

(Goodyear-Smith et al. 2002). Significant difference across the judgment of ERCs without good reasons may itself be unfair and cause further confusion. The concept of minimal risk and its purposes may require further discussion. Providing a clear definition of minimal risk or its optimal and consistent interpretation may certainly be desirable. Nevertheless, it may not necessarily solve all the difficulties related to risk assessment. In practice, ERCs must grapple with a variety of research protocols to ensure that the ethical requirements including risk determination are fulfilled. What is important in the future may be more comprehensive and specific guidance on the ethics review process so that the participant’s well-being and social justice will be secured not only in terms of the level of risk involved but also with respect to other requirements for research to be ethically conducted. Much is left to be solved.
Skull Sutures: Radiographic Contour of Wormian Bone as an Individualising Epigenetic Marker

ABSTRACTAntemortem radiographic records are known to be more valuable than photographs in individualising skulls since the eventual identification is based on stable bony traits. A non-metric cranial trait exhibiting a great deal of morphogenetic variation—lambdridal wormian bone—seen in antemortem radiographic records was looked upon in this paper as an epigenetic marker providing positive forensic identification of the skull. The proposition is supported by an illustrative case. Contrasting the prevailing notion that endocranial sutures are patternless, it was found that the intracranial sutures in preadolescent growth period exhibit patterns. Further, it is indicated that the influence of endocranial sutures in wormian bone contour and other ectocranial suturai patterns seen in a preadolescent skull radiograph has to be noted while comparing such radiographic patterns with suture patterns seen in adult skulls.
Granulocitoaféresis en la enfermedad inflamatoria intestinal: Eficacia a 32 semanas con protocolo de inducción y sesiones de mantenimiento

INTRODUCTION: Granulocytapheresis (GCAP) eliminates activated granulocytes-monocytes from peripheral blood, thus modifying the circulating pool of leukocytes and reducing intestinal inflammation. OBJECTIVE: To evaluate the efficacy of GCAP in inflammatory bowel disease (IBD) using an induction and maintenance protocol. MATERIAL AND METHOD: A retrospective study including patients with active corticosteroid-dependent or refractory IBD. Induction included 5 sessions in ulcerative colitis (UC) and 7 sessions in Crohn's disease (CD); one monthly session was used thereafter until week 32. Clinical activity indices and use of corticosteroids were monitored. RESULTS: Eighteen patients were included (10 with UC, 8 with CD), 10 of them dependent on and 8 refractory to corticosteroids. Fourteen of them were refractory and a further 4 were intolerant to immunosuppressants (IS). Induction was not completed in 2 UC (severe relapses) and 1 CD (side-effects) patients. One UC and 3 CD patients withdrew during maintenance. Among patients who completed induction, response or remission was achieved in 87.5% of UC cases (2 and 5 patients) and 71.4% of CD cases (1 and 4 patients), respectively. At week 32 response-remission rates reached 75% in CU (3 and 3 patients) and 42.8% in CD (1 and 2 patients) cases, respectively. Corticosteroid withdrawal was possible in 14.2% of CD and in 62.5% of UC patients (25% in remission and 37.5% with response). There were two major side effects (thrombophlebitis and syncope). No colectomies were performed for UC patients who completed GCAP induction after a mean follow-up of 97.6 weeks (range: 72-128). CONCLUSIONS: both UC and CD respond well to GCAP induction. At 32 weeks UC patients maintain similar response-remission rates (87.5 vs. 75%), whereas almost one-third of CD patients lose response. Granolocytapheresis is an alternative, steroid-sparing treatment modality to induce and maintain remission in UC, while good patient selection and a maintenance protocol not well defined yet are needed for CD.
Establishment of the gut microbiota in Western infants

In adult individuals, the intestinal microbiota comprises several hundred, mostly anaerobic, bacterial species. This complex ecosystem is formed through the successive establishment of different bacteria in infancy and early childhood. Facultative and aerotolerant bacteria establish first, followed by more and more strict anaerobes. The bacteria derive from different sources and the colonization pattern is influenced by delivery mode and environmental factors. Commensal microbes provide the major drive for maturation of the immune system. Increased hygiene appears to have changed the gut flora of Western infants, which may affect the risk of developing immune mediated diseases.
Reliability of the Beck Depression Inventory in opiate-dependent patients

Abstract Background: The prevalence of depressive disorder in opioid-dependent patients in methadone treatment has been found to be between 19 to 74.3%. Beck Depression Inventory (BDI) is commonly used as a screening for depressive symptoms. The objective of this study is assessing BDI in opiate-dependent patients. Methods: A total of 415 patients over 18 years old in a methadone maintenance program that is part of an outpatient drug clinic treated with stable doses of methadone in the last month were assessed using Structured Clinical Interview for Axis I Disorders of the DSM-IV (SCID-I) and BDI. Results: A sample of 118 patients completed the evaluation; 77.96% showed depressive symptoms (N: 92) (BDI scores ≥ 10). Patients who met criteria for depression with SCID-I and BDI (6.7%) showed a higher score in BDI which did not reach significance. Statistical differences were found in the depressive group. Predictive value of BDI was 6.61% with a cut-off point of BDI ≥ 10, growing to 11.7% with a cut-off point of BDI > 30. Conclusions: BDI is not effective for diagnosing depressive disorder. An adequate psychometric tool is needed to improve the detection of depressive symptoms and depressive diagnosis in opiate-dependent patients in order to reduce risk of relapse and improve treatment strategies.
Surgical molecular navigation with ratiometric activatable cell penetrating peptide for intraoperative identification and resection of small salivary gland cancers

We evaluated the use of intraoperative fluorescence guidance by enzymatically cleavable ratiometric activatable cell‐penetrating peptide (RACPPPLGC(Me)AG) containing Cy5 as a fluorescent donor and Cy7 as a fluorescent acceptor for salivary gland cancer surgery in a mouse model.
La reazione polimerasica a catena (PCR) nella diagnosi delle infezioni genitali da Papillomavirus umano (HPV)

In a three year time (2001-2003) we evaluated the use of HPV testing and typing in 520 cytologically abnormal women (322 LSIL, 198 HSIL), in 25 squamous and 18 adeno invasive cancers. HPV testing was performed by polymerase chain reaction (PCR) using L1 consensus primers; HPV typing was performed using specific primers for low and high risk types. The prevalence of high risk HPV was: LSIL 41%; HSIL 74%; squamous invasive cancers 96% and adeno 100%. HPV 16 is the most represented type in all lesions. We also evaluated the usefulness of p53 typing in the early identification of women at risk for cervical cancer.
Social morbidity of a long-stay mental hospital population with chronic schizophrenia

STEVENMILNE,Senior Registrar, St Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT; DAVIDCURSON, Honorary Senior Research Fellow, Charing Cross and Westminster Medical School, Academic Unit, Horton Hospital, Epsom, Surrey and Medical Director, Department of Psychological Medicine, The Royal Masonic Hospital, Ravenscourt Park, London, W6; ALCUINWILKIE, Registrar, Horton Hospital, Epsom, Surrey KT19 8PZ; and CHRISTOS PANTELIS, Associate in Psychiatry, Mental Health Research Institute, Royal Park Hospital, Park Street, Parkville, Victoria 3052, Australia
Hepatitis C Virus Subtype 6a Infection in an Iranian Patient: A Case Report

Hepatitis C virus (HCV) isolates have been divided into six major genotypes, each of them further divided into several subtypes. Previous studies have shown that the most frequent genotype in Iranian patients with HCV infection is 1a, followed by 3a, 1b and 4. Infections with genotype 6 isolates have not previously been observed in these patients. In this report, we will describe the first diagnosis of HCV genotype-6 infection in Iran. The case was a 62-year-old man with positive anti-HCV antibody. Alanine aminotransferase and aspartate aminotransferase levels were 14 and 32 IU/L respectively. Viral RNA was extracted from plasma. HCV RNA level was determined using real-time reverse transcription polymerase chain reaction (PCR). Following the synthesis of the complementary DNA, 5’-UTR/core region of the HCV genome was amplified and subjected to direct sequencing. Genetic distances were estimated and phylogenetic tree was constructed. HCV viral load was 9,572,718 IU/mL. The mean inter-genotypic distance between the case sequence and the corresponding sequences of other genotype 6 isolates was 3.7%. In the phylogenetic tree, the 5’-UTR/core sequence of the subject was located in a cluster representing HCV subtype 6a. The patient was infected with HCV subtype 6a. Prior to this case, there have been no previous reports on the isolation of this genotype/subtype from any other Iranian patient. Previous epidemiological studies provide valuable information about the distribution patterns of different HCV genotypes. However, infection with genotypes other than common ones should be flagged by specialists and diagnostic laboratories, especially in patients with high-risk behavioral backgrounds.
The Safety, Tolerability, and Efficacy of a Liquid Formulation of Deferiprone in Young Children With Transfusional Iron Overload

Limited data are available on the use of deferiprone in children younger than 10 years of age. This study evaluated the safety and efficacy of a new liquid formulation of deferiprone for the treatment of transfusional iron overload in children 1-10 years old. One hundred children (91 thalassemia major, 8 Hb E-β thalassemia, and 1 sickle cell disease) were enrolled for a 6-month treatment with deferiprone (50 to 100 mg/kg/d). The safety profile was similar to or better than that reported in earlier studies with deferiprone tablets in older children and adults. No unexpected adverse reactions were observed. Gastrointestinal intolerance (GI) was observed in 11% and an increased serum ALT in 12% of the children. Both events were transient. Mild neutropenia, observed in 6% of patients, did not progress to agranulocytosis and resolved despite continuous deferiprone treatment. Two patients experienced agranulocytosis that resolved without complications upon discontinuation of therapy. Deferiprone use was associated with a significant decline in mean serum ferritin level from 2532±1463 μg/L at baseline to 2176±1144 μg/L (P<0.0005). The results of this study show a favorable benefit/risk ratio of deferiprone oral solution for the treatment of young children with transfusional iron overload.
Integrated systems design for customer focused health care performance measurement: a strategic service unit approach

The health care industry can expect an expanding need to measure and report the quality of performance and related outcomes. This article presents a flexible application operationalizing the strategies of total quality management and continual and rapid improvement in the area of assessing patient satisfaction. Mountain States Health Alliance established seven strategic criteria for the Outcomes Assessment Strategy and Information System (OASIS) design based on its own strategic initiatives and quality improvement principals. These initiatives are supported by the software application referred to as ContAct. Substantial process improvements have resulted. As pressures from stakeholders continue to mount, it will become increasingly important that patient satisfaction information be used to improve processes. The system presented provides one piece of an overall approach that will result in a rise to world‐class status for the health care industry.
Interventions in community settings that prevent or delay disablement in later life: an overview of the evidence

– The population of older people in the UK is expected to rise rapidly over the next 20 years and therefore identification of effective interventions that prevent functional decline and disablement is a public health priority. This review summarises the evidence for interventions in community settings that aim to prevent or delay disablement in later life. , – A search of review‐level literature was conducted for the period September 1999 and 2009 of Ovid MEDLINE, EMBASE and CINAHL databases. It included interventions that aimed to prevent disablement of community dwelling older people (50+ years old). It excluded interventions carried out in institutional care and those focused on specific disease. The reviews were screened using the AMSTAR assessment tool. , – The search identified 62 reviews of complex interventions (preventative home visits (n=9), integrated service delivery/case management and comprehensive geriatric assessment (n=6), falls prevention (n=17), exercise (n=15), nutritional needs (n=3), medication review (n=2), telecare/telehealth (n=5), social integration interventions (n=3) and vision screening (n=2). , – The review identified many areas of unknown effectiveness, partly due to unstandardised use of outcomes and poor experimental design. The most promising complex interventions include: assessment of risk factors; and direct referral to an easily accessible, comprehensive range of interventions that are tailored to need and include long‐term follow up. There is consistent evidence that exercise can be beneficial, particularly in preventing falls, but overall, the evidence‐base for other specific interventions is limited.
Nasal juvenile angiofibroma: Current perspectives with emphasis on management

Juvenile angiofibroma is an uncommon, benign, locally aggressive vascular tumor. It is found almost exclusively in young men. Common presenting symptoms include nasal obstruction and epistaxis. More advanced tumors may present with facial swelling and visual or neurological disturbances. The evaluation of patients with juvenile angiofibroma relies on diagnostic imaging. Preoperative biopsy is not recommended. The mainstay of treatment is resection combined with preoperative embolization. Endoscopic surgery is the approach of choice in early stages, whereas, in advanced stages, open or endoscopic approaches are feasible in expert hands. Postoperative radiotherapy (RT) or stereotactic radiosurgery seem valuable in long‐term control of juvenile angiofibroma, particularly those that extend to anatomically critical areas unsuitable for complete resection. Chemotherapy and hormone therapy are ineffective. The purpose of the present review was to update current aspects of knowledge related to this rare and challenging disease. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1033–1045, 2017
Adaptations of the Denver II Scoring System to Assess the Developmental Status of Children With Medically Complex Conditions

Determining the developmental status of children with medically complex conditions is important. This article examines the rationale for assessing the developmental status of such children using the Denver Developmental Screening Test II (Denver II; Frankenburg et al., 1990). The traditional method of scoring the Denver II is compared to a method the authors have adapted for use with children with medically complex conditions. This proposed adaptation of the Denver II scoring system can be used to determine children's variability in developmental skills between domains, assess their progress over time, and compare development in relation to other children.
Effectiveness and confusion of the Time to Change anti-stigma campaign

Aims and method Several national anti-stigma campaigns have been devised in the UK, including the current Time to Change campaign in England. Our aim was to assess whether the campaign promotional materials were likely to have any effect on public attitudes towards mental illness. Postcards, leaflets and bookmarks promoting the campaign were posted to 250 participants recruited from a representative panel of members of the public. Two weeks later a questionnaire was sent to assess the impact the campaign materials had. Results The response rate was 78%. Only 23% of participants recognised the Time to Change logo after 2 weeks and only 20% correctly reported that one in four people were affected by mental health problems when presented with five alternative responses. Almost as many participants thought the campaign was promoting a British political party rather than discrimination against mental illness. Clinical implications A single exposure to Time to Change campaign materials is unlikely to be effective. The title of the campaign is likely to be confused with political campaigning in Britain.
Opportunities for the Treatment of Erectile Dysfunction by Modulation of the NO Axis -Alternatives to Sildenafil Citrate

SummaryErectile function in man depends upon a complex interaction of psychogenic, neurologic, hormonal and vascular factors, and therefore the management of erectile dysfunction (ED) reflects this complexity of control. Therapeutic options include psychological and non-pharmacological approaches as well as drug treatments. The effectiveness of the type-5 cGMP phosphodiesterase inhibitor sildenafil citrate (Viagra®) confirms the pivotal role of the NO-cGMP axis in promoting and maintaining erection. Although widely acclaimed, sildenafil leaves many questions unanswered, especially regarding its susceptibility to pharmacokinetic drug interactions, and its safety in patients with ischaemic heart disease and those taking nitrates. In view of the epidemiological link between erectile dysfunction and cardiovascular disease in the elderly, this limitation might have much broader implications. The presently available scientific documentation, although less extensive, indicates that NO donors, such as topically a.