bluuebunny/crossref_metadata_2025_split huggingface dataset:
Análise do Timi Risk score em pacientes com infarto agudo do miocárdio com supradesenvolvimento do segmento ST após 6 meses
Authors: Ketzer Bernardo Mazzini , Gil Érlon , Rodrigues Gustavo Reis , Kawata Marcelo Fukuhara , Gun Carlos , Luca Fábio Augusto de 
Published: January 2020

Introdução: O escore de TIMI RISK (TR) para infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM) foi descrito originalmente por Morrow et al. (2000),baseado em 8 variáveis. Foi utilizado no estudo In TIME II como preditor de morte em 30m dias e diversos estudos têm relatado com sucesso o TR como índice prognóstico para IAM, no entanto poucos relatos avaliam a evolução tardia desses pacientes e relação como o escore. Objetivo: Avaliar a evolução em 6 meses dos pacientes internados em Hospital Escola com IAM e sua relação com a estradição do TR.Casuística e Método: Foram acompanhados ambulatorialmente em hospital escola, 89 pacientes, durante6 meses após determinação inicial do escore do TR realizado durante internação por IAM. Foram avaliados os seguintes parâmetros: óbito, reinternação por evento cardiovascular e necessidade de revascularização. Divididos em 3 grupos de acordo com o escore: Grupo I (0, 1, 2); Grupo II (3, 4, 5);Grupo III (> 5), foram submetidos à análise estatística pelo método de Qui-Quadrado. Resultados: Óbito, revascularização e reinternação respectivamente: GI- 4,1%, 20%, 25%; GII- 10%, 30% e GIII- 52%, 48%, 60%. Conclusão: O escore de TR manteve significativo aumento de eventos nos grupos II e III em relação ao grupo I; mostrando a possível aplicabilidade do escore também como preditor a longo prazo (6 meses).
O aprendizado baseado em problemas - PBL
Authors: Tibério Iolanda De F. L. Calvo , Atta José Antonio , Lichtenstein Arnaldo 
Published: January 2020

O Aprendizado Baseado em Problemas (ou “Problem Based Learning – PBL”) é uma técnica de ensino que utiliza problemas (que podem ser casos clínicos, problemas epidemiólogicos, dilemas éticos etc) a serem discutidos em um grupo relativamente pequeno de alunos. Em aplicação em vários centros universitários desde a década de 1960, dois grandes centros são referência no mundo todo: asuniversidades de McMaster, no Canadá e a de Maastricht, na Holanda. Nesses grupos, chamados grupos tutoriais, todos dão sua contribuição e, ao final, objetivos de estudo são delimitados. Depois, fora do grupo tutorial, os objetivos são estudados utilizando os meios à disposição (biblioteca, consulta a especialistas, Internet) sendo rediscutidos em outro grupo tutorial. Currículos baseados nessa técnica deensino são habitualmente estruturados em blocos e não mais em disciplinas tradicionais, além de contarem com espaços livres na grade curricular para que o aluno possa estudar. Apesar das vantagens sobre os métodos tradicionais como por exemplo tornar o aluno mais independente na busca do conhecimento, permitir maior integração entre as disciplinas, implicar em capacitação constante do corpo docente,aparentemente os alunos formados por esse método não apresentam vantagens sobre os alunos de métodostradicionais nas provas e concursos realizados imediatamente ao final do curso médico, mas alguns estudos sugerem maior retenção do conhecimento após um ano.
Currículo do curso de medicina da Faculdade de Medicina da Universidade de São Paulo
Authors: Martins Milton Arruda 
Published: January 2020

A primeira turma a ter tido contato com o currículo nuclear está se formando, e esse fato suscita vários questionamentos. Para respondê-los, ainda que em parte, uma avaliação está em curso. O currículo nuclear possibilitou aos estudantes oportunidade de ampliar e individualizar sua formaçãoacadêmica, sem, no entanto, deixar de atender alguns requisitos, como a ênfase na formação geral. Outros pontos considerados foram a centralização no aluno, a atividade didática, a relação professoraluno e a integração das áreas básica e clínica. Alguns foram sucedidos, outros não.
Major Adverse Cardiovascular Events Associated With Postoperative Atrial Fibrillation After Noncardiac Surgery
Authors: AlTurki Ahmed , Marafi Mariam , Proietti Riccardo , Cardinale Daniela , Blackwell Robert , Dorian Paul , Bessissow Amal , Vieira Lucy , Greiss Isabelle , Essebag Vidal , Healey Jeff S. , Huynh Thao 
Published: January 2020

Background:
Postoperative atrial fibrillation (POAF) is a frequent occurrence after noncardiac surgery. It remains unclear whether POAF is associated with an increased risk of major adverse events. We aimed to elucidate the risk of stroke, myocardial infarction, and death associated with POAF following noncardiac surgery by a meta-analysis of randomized controlled studies and observational studies.

Methods:
We searched electronic databases from inception up to August 1, 2019 for all studies that reported stroke or myocardial infarction in adult patients who developed POAF following noncardiac surgery. We used random-effects models to summarize the studies.

Results:

The final analyses included 28 studies enrolling 2 612 816 patients. At 1-month (10 studies), POAF was associated with an ≈3-fold increase in the risk of stroke (weighted mean 2.1% versus 0.7%; odds ratio [OR], 2.82 [95% CI, 2.15–3.70];
P
<0.001). POAF was associated with ≈4-fold increase in the long-term risk of stroke with (weighted mean, 2.0% versus 0.6%; OR, 4.12 [95% CI, 3.32–5.11];
P
≤0.001) in 8 studies with ≥12-month follow-up. There was a significant overall increase in the risk of stroke and myocardial infarction associated with POAF (weighted mean, 2.5% versus 0.9%; OR, 3.44 [95% CI, 2.38–4.98];
P
<0.001) and (weighted mean, 12.6% versus 2.7%; OR, 4.02 [95% CI, 3.08–5.24];
P
<0.001), respectively. Furthermore, POAF was associated with a 3-fold increase in all-cause mortality at 30 days (weighted mean, 15.0% versus 5.4%; OR, 3.36 [95% CI, 2.13–5.31];
P
<0.001).

Conclusions:
POAF was associated with markedly higher risk of stroke, myocardial infarction, and all-cause mortality following noncardiac surgery. Future studies are needed to evaluate the impact of optimal cardiovascular pharmacotherapies to prevent POAF and to decrease the risk of major adverse events in these high-risk patients.
When Sinus Tachycardia Becomes Too Much
Authors: Stewart Julian M. , Medow Marvin S. , Visintainer Paul , Sutton Richard 
Published: January 2020

Background:
Upright posture reduces venous return, stroke volume, and cardiac output (CO) while causing reflex sinus rate (heart rate [HR]) increase. Yet, in inappropriate sinus tachycardia (IST), postural tachycardia syndrome (POTS), and vasovagal syncope (VVS), symptomatic excessive HR occurs. We hypothesized that CO reaches maximum as function of HR in all.

Methods:
We recruited 12 healthy controls, 9 IST, 30 VVS, and 30 POTS patients (13-23years) selected randomly by disorder not by HR, each fulfilled appropriate diagnostic criteria. Subjects were instrumented for electrocardiography, beat-to-beat blood pressure, respiratory rate, CO-Modelflow algorithm, and central blood volume from impedance cardiography; 10-minute data were collected supine; subjects were tilted head-up for ≤10 minutes. We computed phase differences, ΔΦ, between fluctuations of HR (ΔHR) and CO (ΔCO) tabulating data when phases were synchronized, determined by a squared nonlinear phase synchronization index >0.5, describing extent/validity of CO/HR coupling. We graphed results supine, 1-minute post-tilt-up, mid-tilt, and pre-tilt-down using polar coordinates (HR—radius, ΔΦ—angle) plotting cos(ΔΦ) versus HR to determine if transition HR exists at which in-phase shifts to antiphase above which CO decreases when HR further increases.

Results:

At baseline HR, diastolic and mean arterial pressures in IST and POTS were higher versus controls. Upright HR increased most in POTS then IST and VVS, with diverse changes in CO, SVR, and central blood volume. Each patient grouping was separately and collectively analyzed for HR change showing transition from in-phase to anti-phase (ΔΦ) as HR increased: HR
transition
=115±6 (IST), 123±8 (POTS), 124±7 (VVS),
P
=ns. Controls never reached transitional HR.

Conclusions:
Excessive HR independently and equivalently reduces upright CO, in IST, POTS, and VVS.
Reuse of open data in Quebec: from economic development to government transparency
Authors: Boudreau Christian 
Published: January 2020

Based on the history of open data in Quebec, this article discusses the reuse of these data by various actors within society, with the aim of securing desired economic, administrative and democratic benefits. Drawing on an analysis of government measures and community practices in the field of data reuse, the study shows that the benefits of open data appear to be inconclusive in terms of economic growth. On the other hand, their benefits seem promising from the point of view of government transparency in that it allows various civil society actors to monitor the integrity and performance of government activities. In the age of digital data and networks, the state must be seen not only as a platform conducive to innovation, but also as a rich field of study that is closely monitored by various actors driven by political and social goals. Points for practitioners Although the economic benefits of open data have been inconclusive so far, governments, at least in Quebec, must not stop investing in opening up their data. In terms of transparency, the results of the study suggest that the benefits of open data are sufficiently promising to continue releasing government data, if only to support the evaluation and planning activities of public programmes and services.
Theology of Resilience Amidst Vulnerability in the Book of Ruth
Authors: Panganiban Alicia Besa 
Published: January 2020

This article explores Ruth’s theology of resilience amidst vulnerability: a resilience rooted in ḥesed (loving kindness, a generosity beyond the call of duty). Ḥesed is a powerful social force that could address current issues for those both in privileged positions and in vulnerable situations. A re-reading of Ruth offers modern theologians and serious students of the Bible pathways towards building resilience amidst vulnerability, and in caring for those in vulnerable positions. The text at hand offers a pathway to be true to one’s core values and character, even amidst desperate situations. In Ruth resilience is developed by caring for others, identifying with a particular faith community, and taking initiatives while maintaining integrity. The narrative unveils a sustainable life of resilience that happens when one’s private and public life is lived congruently to each other. This article also reads Ruth’s narrative through a lens of a minority foreign woman that uses feminist and post-colonial approaches while looking at Ruth through a hermeneutic of trust. First, the author identifies her assumptions and considerations. Secondly, the article examines resilience as rooted in one’s identity and explores ḥesed under cultural and spiritual frameworks, within the narrative of Ruth and Naomi’s road scene from Moab to Bethlehem. Lastly, it examines resilience as rooted in ḥesed, within the narrative of the threshing floor scene encounter between Ruth and Boaz. The road and threshing floor scenes are decisive moments for Ruth. Her words and actions in each instance reveal her resilience: her strength of mind, emotion, and spirit, in spite of her vulnerability.
Effect of Hydroxyurea Treatment on the Inflammatory Markers Among Children With Sickle Cell Disease
Authors: Zahran Asmaa M. , Nafady Asmaa , Saad Khaled , Hetta Helal F. , Abdallah Alam-Eldin M. , Abdel-Aziz Safwat M. , Embaby Mostafa M. , Abo Elgheet Amir M. , Darwish Sanaa F. , Abo-Elela Mohamed Gamil M. , Elhoufey Amira , Elsayh Khalid I. 
Published: January 2020

Background: Neutrophil-to-lymphocyte ratio (NLR) was introduced as a potential inflammatory marker in sickle cell disease (SCD). This study aimed to evaluate the impact of hydroxyurea (HU) treatment on the value of NLR and some inflammatory mediators in SCD. Methods: The hematological parameters and clinical events were analyzed in 35 children with SCD under HU treatment and followed up for 1 year and in 20 healthy controls. Enzyme-linked immunosorbent assay was performed for the evaluation of proinflammatory cytokines, including interleukin (IL) 6, IL-8, high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor α (TNF-α). Results: Hydroxyurea significantly improves most of the hematological parameters in children with SCD. The percentages of hemoglobin fraction S, serum levels of TNF-α and IL-6 were significantly decreased when compared to baseline value but did not reach the value of the healthy control. The HU treatment led to a significant decrease in NLR compared to the baseline values and reached healthy control values. Neutrophil-to-lymphocyte ratio was positively correlated with hs-CRP, TNF-α, and IL-8 serum levels and negatively correlated with percentage of fetal hemoglobin and hematocrit values. The cutoff value of NLR to expect a response to HU among SCD was 3.0, with 76% specificity and 85% sensitivity (area under the curve: 0.85, P < .0001). In conclusion, hydroxyurea induced a decrease in NLR and inflammatory cytokines, which represent a biomarker of inflammation in SCD. The calculation of NLR is a straightforward and cheap method for SCD outcome prediction in young children.
Análisis de la capacidad de respuesta comunitaria para desarrollar iniciativas de promoción de la salud
Authors: Villanueva-Borbolla María Ángeles , Cervantes-Ortega Eugenia , Campos-Rivera Marisol 
Published: January 2020

Objetivo: analizar la capacidad de respuesta comunitaria (CR) hacia la obesidad, diabetes e hipertensión (ODH) para el desarrollo de iniciativas de promoción de la salud en una comunidad de origen náhuatl en México. Material y métodos: estudio basado en el Modelo de Capacidad de Respuesta Comunitaria (MCRC) con abordaje cualitativo. Entrevistamos ocho informantes clave. Realizamos la asignación de valores por dimensión utilizando la escala del MCRC y el análisis de contenido para comprender los factores involucrados en la CR. Resultados: la etapa de CR identificada fue de “concientización vaga” (valor 3). Se reconocieron los elementos que dificultan el involucramiento de la comunidad. Discusión: valorar la CR es imprescindible para generar estrategias apropiadas. El MCRC resultó útil para profundizar en la ODH como fenómeno social en un contexto como el de Xoxocotla. El análisis cualitativo fue indispensable para comprender la CR y las consideraciones necesarias para generar iniciativas efectivas.
Feasibility of a New Approach to Initiate Insulin in Type 2 Diabetes
Authors: Aradóttir Tinna B. , Bengtsson Henrik , Jensen Morten L. , Poulsen Niels K. , Boiroux Dimitri , Jensen Lea L. , Schmidt Signe , Nørgaard Kirsten 
Published: January 2020

Background: Treatment inertia and prescription complexity are among reasons that people with type 2 diabetes (T2D) do not reach glycemic targets. This study investigated feasibility of a new approach to basal insulin initiation, where the dose needed to reach a glycemic target is estimated from two weeks of insulin and continuous glucose monitoring (CGM) data. Methods: This was an exploratory single arm study with a maximum length of 84 days. Eight insulin naïve people with T2D, planning to initiate basal insulin, wore a CGM throughout the study period. A predetermined regime was followed for the first two weeks after which the end dose was estimated. The clinician decided whether to follow this advice and continued the titration until target was reached using a twice weekly stepwise titration algorithm. The primary outcome was the comparison between the estimated and the actual end doses. Results: Median age of participants was 57 years (range: 50-77 years), duration of diabetes was 16 years (range: 5-29 years), and Bodi Mass Index (BMI) was 30.2 kg/m2 (range: 22.0-36.0 kg/m2). The median study end dose was 37 U (range: 20-123 U). The estimated end dose was smaller than or equal to the study end dose in all cases, with median error of 26.7% (range: 0.0%-75.8% underestimation). No self-monitoring of blood glucose values were below 70 mg/dL and no severe hypoglycemia occurred. Conclusion: While accuracy may be improved, it was found safe to predict the study end dose of insulin degludec from two weeks of data.
Scaffolds for Knee Chondral and Osteochondral Defects: Indications for Different Clinical Scenarios. A Consensus Statement
Authors: Filardo Giuseppe , Andriolo Luca , Angele Peter , Berruto Massimo , Brittberg Mats , Condello Vincenzo , Chubinskaya Susan , de Girolamo Laura , Di Martino Alessandro , Di Matteo Berardo , Gille Justus , Gobbi Alberto , Lattermann Christian , Nakamura Norimasa , Nehrer Stefan , Peretti Giuseppe M. , Shabshin Nogah , Verdonk Peter , Zaslav Kenneth , Kon Elizaveta 
Published: January 2020

Objective To develop patient-focused consensus guidelines on the indications for the use of scaffolds to address chondral and osteochondral femoral condyle lesions. Design The RAND/UCLA Appropriateness Method (RAM) was used to develop patient-specific recommendations by combining the best available scientific evidence with the collective judgement of a panel of experts guided by a core panel and multidisciplinary discussers. A list of specific clinical scenarios was produced regarding adult patients with symptomatic lesions without instability, malalignment, or meniscal deficiency. Each scenario underwent discussion and a 2-round vote on a 9-point Likert-type scale (range 1-3 “inappropriate,” 4-6 “uncertain,” 7-9 “appropriate”). Scores were pooled to generate expert recommendations. Results Scaffold (chondral vs. osteochondral), patient characteristics (age and sport activity level), and lesion characteristics (etiology, size, and the presence of osteoarthritis [OA]) were considered to define 144 scenarios. The use of scaffold-based procedures was considered appropriate in all cases of chondral or osteochondral lesions when joints are not affected by OA, while OA joints presented more controversial results. The analysis of the evaluated factors showed a different weight in influencing treatment appropriateness: the presence of OA influenced 58.3% of the indications, while etiology, size, and age were discriminating factors in 54.2%, 29.2%, and 16.7% of recommendations, respectively. Conclusions The consensus identified indications still requiring investigation, but also the convergence of the experts in several scenarios defined appropriate or inappropriate, which could support decision making in the daily clinical practice, guiding the use of scaffold-based procedures for the treatment of chondral and osteochondral knee defects.
Menopause – Understanding the impact on women and their partners
Authors: Currie Heather , Moger Sara J 
Published: January 2020

Objective To provide a greater understanding of the expectations, symptoms and impact of the menopause among women and their partners. Study design Three online surveys were conducted among women aged ≥45 years with menopause symptoms (currently or within previous 10 years). Two questionnaires focussed on symptoms and treatments and were conducted before (Survey 1, 2015; n = 1000) and after (Survey 2, 2016, n = 1000) publication of the National Institute for Health and Care Excellence (NICE) menopause guidelines. Survey 3 (2017) focussed on the psychosocial impact of the menopause and was also conducted among partners (women n = 650; partners n = 350). Results Women experienced an average of seven symptoms; 42% reported them to be worse than expected. Approximately one-fifth of women were not expecting common symptoms, such as sleep disturbance and cognitive problems, and were uncertain how long symptoms could last. A significant proportion of women reported negative effects on work and relationships. There was a reluctance to talk openly about the menopause or consult a healthcare professional (HCP). Partners expressed a desire to provide support but were unsure how to do so. Often women felt isolated and 41% considered the information and support available to them was insufficient. Only 3% of women were aware of the NICE guidelines but the majority (66%) were interested in learning more. Conclusions These findings underscore the knowledge gaps and lack of support for women impacted by the menopause. Improved HCP training and education is required to ensure that high-quality menopause support can be accessed as standard.
Hepatitis B vaccine knowledge and self-reported vaccination status among healthcare workers in a conflict region in northeastern Nigeria
Authors: Dayyab Farouq Muhammad , Iliyasu Garba , Ahmad Bashir Garba , Bako Abdulaziz Tijjani , Ngamariju Sepu Saraya , Habib Abdulrazaq Garba 
Published: January 2020

Background Hepatitis B virus (HBV) infection is highly endemic in Nigeria. The primary objective of this study is to describe the knowledge, self-reported vaccination status, and intention of healthcare workers to receive hepatitis B vaccine at a tertiary referral center in conflict-ravaged northeastern Nigeria. Methods This was cross-sectional analytical study among medical practitioners, nurses, laboratory workers, health attendants, pharmacists, and radiographers working at Federal Medical Center Nguru, Yobe State. Written informed consent was obtained from all study participants. Data were obtained using questionnaires and entered into a Microsoft Excel spreadsheet, cleaned and analyzed using JMP Pro software. Results Of the 182 participants, we found that 151 (82.97%), 81 (44.51%), 85 (46.70%), and 33 (18.13%) had good knowledge of HBV, good knowledge of hepatitis B vaccine, were vaccinated against HBV by the least dose, and had a complete hepatitis B vaccination status, respectively. The lack of availability of the vaccine was the main reason for not receiving the vaccine among the unvaccinated 36/91 (39.56%), followed by not knowing where to access the vaccine 19/91 (20.88%). Conclusion The study highlights the need for strategies to ensure the availability of hepatitis B vaccine in conflict settings and need for vaccinology training given the suboptimal level of awareness and uptake of the hepatitis B vaccine among the healthcare workers.
Virus-specific T-cell therapies for patients with primary immune deficiency
Authors: Keller Michael D. , Bollard Catherine M. 
Published: January 2020

AbstractViral infections are common and are potentially life-threatening in patients with moderate to severe primary immunodeficiency disorders. Because T-cell immunity contributes to the control of many viral pathogens, adoptive immunotherapy with virus-specific T cells (VSTs) has been a logical and effective way of combating severe viral disease in immunocompromised patients in multiple phase 1 and 2 clinical trials. Common viral targets include cytomegalovirus, Epstein-Barr virus, and adenovirus, though recent published studies have successfully targeted additional pathogens, including HHV6, BK virus, and JC virus. Though most studies have used VSTs derived from allogenic stem cell donors, the use of banked VSTs derived from partially HLA-matched donors has shown efficacy in multicenter settings. Hence, this approach could shorten the time for patients to receive VST therapy thus improving accessibility. In this review, we discuss the usage of VSTs for patients with primary immunodeficiency disorders in clinical trials, as well as future potential targets and methods to broaden the applicability of virus-directed T-cell immunotherapy for this vulnerable patient population.