bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inovação: uma ferramenta estratégica para a gestão de serviços do setor saúde
Authors: Pádua Filho Wagner Cardoso , Ferreira Vinicius Lana , Rodrigues Barbara Bittencourt , Oliveira Marcelo Rocha , Pimentel Carla Christiane Souza Braga , França Gabriela Diniz 
Published: May 2016

A inovação vem sendo amplamente discutida como uma ferramenta importante para a modernização e o crescimento sustentável das empresas. Existe uma urgente necessidade de se buscar estratégias inovadoras capazes de agregar valor aos clientes, garantindo assim a fidelização dos mesmos no setor da saúde, visto que a competitividade do mercado neste setor tem sido determinante para o enfraquecimento de suas transações. A inovação é normalmente pensada sob a ótica da tecnologia e de produtos. Entretanto, há uma série de outras áreas na empresa onde se pode implementar estratégias inovadoras. Assim, a inovação pode ser abordada da seguinte maneira: 1) Inovações nas pessoas; 2) inovações no processo; 3) inovações e marketing; 4) inovação em produtos e serviços; 5) inovação organizacional; e 6) inovação em sustentabilidade. A inovação é ainda classificada em: radical, incremental, aberta, fechada ou distribuída. O conhecimento detalhado das metodologias e aplicabilidades da inovação é de relevância para a sua adoção como ferramenta estratégica de gestão. Avanços na implementação de ações inovadoras no setor de saúde certamente terão impactos positivos nos resultados do setor.
Consultoria em gestão de processos: estudo de caso de hospital privado em Teresina-PI
Authors: Rodrigues Stenio Lima , Sousa João Vitor De Oliveira , Fortes Paula Jordão De Oliveira Cerqueira 
Published: May 2016

O objetivo da pesquisa que fundamenta este artigo foi elaborar um manual de procedimentos em gestão de compras farmacêuticas através de uma consultoria organizacional. Para alcança-lo, foi realizado o mapeamento dos processos de gestão de compras farmacêuticas, validação de processos com quem lida diretamente com as operações além da compreensão da natureza dos problemas nos processos mapeados. A pesquisa teve como suporte o referencial teórico de gestão de processos de negócio. Seu delineamento aconteceu através do método estudo de caso simples com ênfase em estudos exploratórios descritivos dos processos estudados. Os resultados revelam as etapas necessárias para a elaboração do manual de procedimentos e realização da consultoria em gestão de processos. Com base nas dificuldades enfrentadas foi proposto um novo modelo para a realização de uma consultoria em gestão de processos no ambiente hospitalar. Observou-se com o estudo a necessidade de adoção de fluxogramas em manuais de procedimentos para treinamento dos funcionários da farmácia hospitalar pesquisada, bem como para obtenção de visão sistêmica das interações entre os processos organizacionais.
Patient Characteristics and Participation in a Genetic Study: A Type 2 Diabetes Cohort
Authors: Amiri Loabat , Cassidy-Bushrow Andrea E. , Dakki Heather , Li Jia , Wells Karen , Oliveria Susan A. , Yood Marianne Ulcickas , Thomas Abraham , Lanfear David E. 
Published: May 2016

Background Recruitment of large, diverse populations into genetic studies remains challenging. Potential strategies to overcome limitations include leveraging electronic health data and minimizing patient burden. We sought to describe the overall participation rate and identify characteristics associated with participation in a genetic substudy of patients with type 2 diabetes mellitus, in which patients were identified via electronic hospital data and asked to participate by providing DNA samples by mail. Methods During a phone interview, participants (n = 455) were asked to take part in a genetic substudy. Subjects verbally consenting were mailed saliva collection kits and written consent forms. We examined demographic and clinical variables associated with verbal consent and DNA kit return using logistic regression. Results Overall, 90% (n = 410) verbally consented to the genetic substudy during interviews. However, of those consenting, only 70% returned the DNA kit (n = 287). Among those consenting, after covariate adjustment, male sex (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.09–2.65), African American race (OR, 0.61; 95% CI, 0.39–0.95), hemoglobin A1c (HbA1c) (OR, 0.87; 95% CI, 0.75–1.00), and physical activity (OR, 0.58; 95% CI, 0.37–0.91) were significantly associated with DNA kit return. Conclusions To our knowledge, we are the first to demonstrate an inverse association between HbA1c and participation in genetic research, potentially indicating a compliance-related trait needing further exploration. The DNA kit return rate being notably lower than the verbal consent rate suggests that the greater convenience of a telephone/mail-in process did not drastically enhance full participation. Direct comparison to in-person donation may be warranted.
Intensive Therapy in Newly Diagnosed Type 2 Diabetes: Results of a 6-Year Randomized Trial
Authors: Harrison Lindsay B. , Adams-Huet Beverley , Li Xilong , Raskin Philip , Lingvay Ildiko 
Published: May 2016

Background This study aimed to assess the efficacy of early intensive diabetes therapy with either insulin plus metformin (INS) or triple oral therapy (TOT) with metformin, glyburide, and pioglitazone on glycemic control and A-cell function. Methods Fifty-eight treatment-naive newly diagnosed patients with type 2 diabetes underwent a 3-month lead-in treatment period with insulin and metformin, then were randomized to INS or TOT for 6 years. β-Cell function was measured using mixed-meal challenge test. β-Cell function remained stable throughout the 6-year study in both groups, as measured by the C-peptide area under the curve (AUC; P = 0.13), the AUC C-peptide/AUC glucose ( P = 0.9), and by the disposition index ( P = 0.8). Excellent glycemic control was maintained in both groups (end-of-study hemoglobinA1c, 7.3% [SD, 1.7%] INS vs 6.4% [1.4%] TOT; P = 0.4). There were 8 treatment failures (confirmed hemoglobinA1c, 98%) in INS and 6 in TOT ( P = 0.93). The predictors of treatment failure included higher fasting glucose ( P = 0.008), fasting C-peptide ( P = 0.008), systolic blood pressure ( P = 0.004), and lower insulin sensitivity ( P = 0.04) at randomization. Conclusions Early intensive treatment at the time of type 2 diabetes diagnosis—initial short-term insulin treatment followed by either insulin-based or intensive oral hypoglycemic–based therapy—stabilizes β-cell function for at least 6 years. Treatment failure was independent of intervention and was associated with worse disease pathology at baseline.
Effects of Low-Dose Corticosteroids on the Bone Mineral Density of Patients with Rheumatoid Arthritis
Authors: Lee Young Ho , Woo Jin-Hyun , Choi Seong Jae , Ji Jong Dae , Song Gwan Gyu 
Published: May 2016

Background The effects of long-term high-dose corticosteroids on bone mineral density (BMD) are clear, but the effects of low-dose corticosteroids in patients with rheumatoid arthritis (RA) remain controversial. The aim of this study was to assess the effects of low-dose corticosteroids on BMD in patients with RA. Methods The authors surveyed randomized controlled studies that examined the effects of low-dose corticosteroids on BMD in patients with RA using MEDLINE and the Cochrane Controlled Trials Register and by performing manual searches. Data were collected on BMD (end-of-period or change-from-baseline) after longest recorded treatment durations. Meta-analysis was performed using a random effects model; outcomes are presented as standardized mean differences (SMDs). Results Seven studies were included in this meta-analysis, which included 7 studies on lumbar BMD meta-analysis and 6 studies on femur BMD meta-analysis. Corticosteroids resulted in a moderate worsening in lumbar BMD compared with controls (SMD = −0.483; 95% confidence interval [CI], −0.815 to −0.151, P = 0.004), whereas the femoral BMD differences were not siginificant (SMD = −0.224; 95% CI, −0.663 to 0.215, P = 0.318). Subgroup analysis of BMD data performed on a change-from-baseline basis showed that corticosteroids had a clear effect on both lumbar and femoral BMDs (SMD = −0.354; 95% CI, −0.620 to −0.088, P = 0.009; SMD = −0.488; 95% CI, −0.911 to −0.065, P = 0.024, respectively). Conclusions This meta-analysis shows BMD loss after low-dose corticosteroid treatment in patients with RA. These findings have practical implications for the long-term management of patients with RA on low-dose corticosteroids.
Cigarette Smoke Alters Tissue Inhibitor of Metalloproteinase 1 and Matrix Metalloproteinase 9 Levels in the Basolateral Secretions of Human Asthmatic Bronchial Epithelium in Vitro
Authors: Watson Alan M. , Benton Angela S. , Rose Mary C. , Freishtat Robert J. 
Published: May 2016

Background Asthma, a major cause of chronic lung disease worldwide, has increased in prevalence in all age and ethnic groups, particularly in urban areas where cigarette smoking is common. Cigarette smoke (CS) significantly impacts the development of asthma and is strongly associated with increased asthma-related morbidity. Purpose To evaluate bioinformatic analyses predicting that CS would alter expression of tissue inhibitor of metalloproteinase (TIMP) 1 and matrix metalloproteinase (MMP) 9 in asthmatic epithelium. Methods Primary differentiated normal (n = 4) and asthmatic (n = 4) human respiratory epithelia on collagen-coated Transwells at air-liquid interface were exposed for 1 hour to CS condensate (CSC) or hydrogen peroxide (H2O2). Tissue inhibitor of metalloproteinase 1 and MMP-9 protein levels were measured at 24 hours by enzyme-linked immunosorbent assay in cell lysates and in apical and basolateral secretions. Results Tissue inhibitor of metalloproteinase 1 and MMP-9 levels in the apical secretions of normal and asthmatic epithelia were unchanged after exposure to CSC and H2O2. However, CSC increased TIMP-1 levels in the basolateral secretions of both normal and asthmatic epithelia, but decreased MMP-9 levels only in asthmatic basolateral secretions, resulting in a 2.5-fold lower MMP-9/TIMP-1 ratio that corresponded to decreased MMP-9 activity in CS-exposed asthmatic basolateral secretions. Conclusions These data validate our prior bioinformatic analyses predicting that TIMP-1 plays a role in the stress response to CS and indicate that asthmatics exposed to CS may be more susceptible to MMP-9-mediated airway remodeling. This is in agreement with the current paradigm that a reduction in the MMP-9/TIMP-1 ratio is a milieu that favors subepithelial airway remodeling in chronic asthma.
Method of LDL Cholesterol Measurement Influences Classification of LDL Cholesterol Treatment Goals
Authors: Agrawal Mayank , Spencer Horace J. , Faas Fred H. 
Published: May 2016

Background Low-density lipoprotein cholesterol (LDL-C) has been clearly associated with the risk of developing coronary heart disease. The best and most convenient method for determining LDL-C has come under increased scrutiny in recent years. We present comparisons of the Friedewald calculated LDL-C (C-LDL-C) and direct LDL-C (D-LDL-C) using 3 different homogenous assays. This highlights differences between the 2 methods of LDL-C measurement and how this affects the classification of samples into different LDL-C treatment goals as determined by the National Cholesterol Education Program Adult Treatment Panel III guidelines thus potentially affecting treatment strategies. Methods Lipid profiles of a total of 2208 clinic patients were retrieved from the Central Arkansas VA Healthcare System clinical laboratory database. Samples studied were of 1-week period during the 3 periods studied: 2000 (period 1), 2002 (period 2), and 2005 (period 3). Different homogenous assays for D-LDL-C measurement were used for each of the 3 periods. Results There is a fundamental disagreement between D-LDL-C and C-LDL-C, although Pearson correlation coefficients are 0.93, 0.97, and 0.98 for periods 1, 2, and 3, respectively. Using the model for period 1, when C-LDL-C is 70 mg/dL, the predicted D-LDL-C is 95 mg/dL (36% higher). The differences between C-LDL-C and predicted D-LDL-C progressively decrease at higher LDL-C cut points. In the assay used in period 3, there are 290 samples with D-LDL-C values between 100 and 130 mg/dL. Of these, only 182 samples show agreement with C-LDL-C values, whereas 90 samples with a D-LDL-C in the 100- to 130-mg/dL range are in the 70- to 100-mg/dL range using the C-LDL-C assay. Although the κ statistics suggests the LDL-C measures have relatively high levels of agreement, the significant generalized McNemar tests ( P < 0.01) provide additional evidence of disagreement between C-LDL-C and D-LDL-C during all the 3 periods. Conclusions Our results highlight D-LDL-C measurements using 3 different assays during 3 different periods. In all assays, there is a substantial lack of agreement between D-LDL-C and C-LDL-C, which, in most cases, resulted in higher D-LDL-C values than C-LDL-C. This leads to clinically significant misclassification of patient's LDL-C to a different LDL-C treatment goal, which would potentially result in more drug usage, thus exposing patients to more potential adverse effects and at a much greater cost with little evidence of benefit.
“Getting from Here to There”-Mechanisms and Limitations to the Activation of the Androgen Receptor in Castration-Resistant Prostate Cancer
Authors: Sharifi Nima , McPhaul Michael J. , Auchus Richard J. 
Published: May 2016

Despite the clinical regression that typifies the initial response of advanced prostate cancer to gonadal testosterone depletion, tumors eventually progress. However, evidence supports the concept that signaling via the androgen receptor (AR) is important in progression to castration-resistant prostate cancer (CRPC). Steroid hormones are synthesized from cholesterol in a series of tightly regulated steps involving the cleavage of carbon-carbon bonds, the introduction of functional groups derived from activated molecular oxygen, and the oxidation and reduction of carbon-carbon and carbon-oxygen bonds. In the adrenal cortex and gonads, steroidogenesis is tightly regulated, very efficient, and highly directional. In contrast, steroid metabolism in peripheral tissues is characterized by competing enzymes and pathways, low efficiency, and great variability. Many steps are mechanistically and functionally irreversible, but some are not, and the repertoire of specific enzymes, intracellular redox state, and access to hormone precursors all contribute to steroid flux and accumulation. The investigation of steroid metabolizing enzymes in CRPC often assumes that the pathways and the patterns of metabolism mirror those defined in the adrenals and the gonads and validated by human deficiency syndromes. Unfortunately, several potential pathways using different enzymes might contribute substantially to androgen synthesis in CRPC. Finally, a number of mechanisms have been reported by which the AR is activated independent of ligand. Recent observations have suggested that AR forms with constitutive activity occur in CRPC, stimulating transcription without a requirement for ligand. This overview outlines a broad view of how the mechanisms by which the AR may be activated, whether by alternate pathways of androgen synthesis or the production of alternate forms of the AR, with an emphasis on what aspects must be accounted for when using model systems to explore the biology of human prostate cancer.
Efficacy, Tolerability, and Factors Affecting the Efficacy of the Sequential Therapy in Curing Helicobacter Pylori Infection in Clinical Setting
Authors: Tursi Antonio , Elisei Walter , Giorgetti GianMarco , Picchio Marcello , Brandimarte Giovanni 
Published: May 2016

Background Sequential therapy is currently suggested as first-line therapy in curing Helicobacter pylori infection, but results coming from its use in clinical practice are scarce. We evaluated the efficacy of this therapy regimen in our current clinical practice. Methods A retrospective study was conducted on 437 consecutive dyspeptic patients with proven H. pylori infection. Patients received a 10-day sequential therapy with proton pump inhibitor (PPI) plus amoxicillin 1 g for the first 5 days, followed by PPI, clarithromycin 500 mg, and tinidazole 500 mg for the remaining 5 days (all twice daily) plus PPI every day for further 4 weeks in case of active peptic ulcer or severe gastritis detected at endoscopy. One month after conclusion of therapy, endoscopy was performed in those patients for whom the examinations were clinically relevant. The remaining patients were checked by 13C-urea breath test. Results Three-hundred ninety-eight patients (91.08%; 95% confidence interval [CI], 87.91%-93.50%) were fully compliant, 19 patients (4.35%; 95% CI, 2.71%-6.83%) took less than 80% of the prescribed drugs, 11 patients (2.52%; 95% CI, 1.33%-4.60%) were withdrawn because of side effects, and 9 patients (2.06%; 95% CI, 1.01%-4.01%) were lost to follow-up. The H. pylori eradication was obtained in 395 (90.39%, 95% C.I. 87.14% to 92.91%) of 437 and in 362 of 437 (82.84%, 95% C.I. 78.90% to 86.19%) as per-protocol and intention-to-treat analyses, respectively. Conclusions Sequential regimen seems to be a valid therapeutic strategy for the management of H. pylori infection in clinical practice.
Health Coverage and Its Relation to the Prevalence and Intensity of Symptomatic Knee Osteoarthritis
Authors: Clearfield Jacob , Segal Neil A. 
Published: May 2016

Objective This study aimed to determine whether health coverage among older adults is associated with (1) the prevalence of symptomatic knee osteoarthritis (OA) and (2) disablement in those with symptomatic knee OA. Methods Data were collected from the Osteoarthritis Initiative data set 5.2.1, a cohort study of subjects with or at risk for knee OA. Prevalence of symptomatic knee OA (knee symptoms on most of the last 30 days and Kellgren-Lawrence grade >2 on knee radiograph) was compared between those with and without health coverage among subjects aged 45 to 65 years, adjusted for age and body mass index. For those with symptomatic knee OA, Physical Activity for the Elderly scores and Knee Osteoarthritis Outcomes Survey function, pain, and quality-of-life scores were compared between those with and without health coverage before and after adjustment for age and body mass index. Results Among subjects with health coverage, 27.8% had symptomatic knee OA compared with 36.1% of those without health coverage ( P = 0.0204 before and P > 0.24 after adjustment). Among subjects with symptomatic knee OA with and without health coverage physical activity differed significantly ( P = 0.048), as did pain ( P < 0.0001), function ( P = 0.0001), and quality of life ( P < 0.0001). Conclusions Lack of health coverage was not associated with the prevalence of symptomatic knee OA after adjustment. However, those with symptomatic knee OA without health coverage reported reduced physical activity, greater pain, worse functional limitations, and decreased quality of life.
Levels of Soluble Advanced Glycation End Product-Receptors and Other Soluble Serum Markers as Indicators of Diabetic Neuropathy in the Foot
Authors: El-Mesallamy Hala O. , Hamdy Nadia M. , Ezzat Omnia A. , Reda Ahmed M. 
Published: May 2016

Objective Advanced glycation end products (AGEs) and the interaction with their receptors (RAGE) play an important role in the pathogenesis of diabetic foot (DF) associated with diabetic neuropathy. Our study examined the association between asymmetric dimethyl arginine (ADMA), fructosamine, nitric oxide (NO), and soluble (s) RAGE levels in serum of diabetic patients with and without neuropathy. Methods Circulating levels of ADMA, fructosamine, NO, and sRAGE, estimated either chemically or by enzyme-linked immunosorbent assay, were examined in 60 type 2 diabetes mellitus (T2DM) overweight/obese (body mass index, 30.5 ± 1.5 kg/m2) male patients and 20 age-matched (55 ± 3 years) obese healthy subjects as control group. The T2DM subjects were categorized as patients without DF (n = 30), and the remaining were patients with DF associated with neuropathy. Results First sRAGE levels were significantly increased in T2DM patients without DF in comparison to healthy controls (1656.6 [1198.8-2065.4] vs 1111.7 [909-1605.3] pg/mL, respectively; P < 0.05). However, in the DF group (1049.6 [783.7-1221.8] pg/mL), its level decreased significantly in comparison to both groups ( P < 0.05). However, ADMA and fructosamine were significantly higher in diabetic patients with DF than both T2DM without DF and healthy controls. Moreover, NO was significantly lower in DF than in diabetic patients without DF and controls (5 ± 0.4 and 8 ± 0.4 vs 42 ± 2.5 μmol/L, respectively; P < 0.05). Finally, sRAGE levels were significantly correlated with ADMA, fructosamine, and NO. Conclusions Soluble forms of the receptor for advanced glycation end product could be an endogenous protection factor against occurrence of DF, hence may be of therapeutic value in the treatment of DF.
Continuous Furosemide Infusion in the Management of Ascites
Authors: Rogers Nicholas A. , Gupta Samir , Cuthbert Jennifer A. 
Published: May 2016

Background The current therapy for patients hospitalized with ascites requires titration of oral diuretics and often needs several days. A faster method for predicting the response to a given dose of diuretic may allow this process to be completed more rapidly. Aim The objective of this study was to describe the short-term safety and efficacy of a diuretic infusion to predict net sodium excretion in patients with cirrhosis, ascites, and edema using a fractional excretion of sodium (FENa) of 1% or greater as the target. Methods We conducted a retrospective case series of patients admitted for management of ascites who received intravenous furosemide by continuous infusion in ascites management. Patients were stratified depending on whether they had edema or received an intravenous bolus of furosemide or a large-volume paracentesis. The primary outcome was the proportion of patients achieving a FENa of 1% or greater during the infusion. Secondary outcomes included development of electrolyte abnormalities or acute kidney injury during or immediately following the infusion and natriuresis on titrated oral furosemide. Results Forty-seven patients meeting criteria were identified from 721 patients seen in consultation. Ten of the patients had edema and received neither bolus intravenous diuretic therapy nor therapeutic paracentesis; all 10 achieved a FENa of 1% or greater. One patient had transient hypokalemia. Of 37 patients who either had no edema or received additional treatment options, all but 6 patients achieved a FENa of 1% or greater. Transient complications in 31 patients with natriuresis included hyponatremia (n = 1), hypokalemia (n = 5), and acute kidney injury (n = 3). Twenty-four-hour urine sodium averaged more than 4 g/d on the titrated oral furosemide regimen in 19 patients completing the collection. Conclusions Use of a short continuous furosemide infusion can achieve a FENa of 1% or greater in patients with cirrhotic ascites and may be safe and efficacious for diuresis, meriting further study.