Página 1 dos resultados de 3297 itens digitais encontrados em 0.014 segundos

Avaliação da concordância em diferentes fases do processo diagnóstico, embasada na necropsia, no HCFMRPUSP, nos anos de 1980, 1990 e 2000 ; Assessment of the agreement on different phases of the diagnostic process, based on necropsy, at HCFMRPUSP, in 1980, 1990 and 2000.

Grade, Márcio Henrique Carvalho
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 04/06/2007 PT
Relevância na Pesquisa
35.99%
O processo diagnóstico na medicina traduz-se por uma complexa interação entre conhecimentos, habilidades e procedimentos técnicos em condições de incerteza. As variáveis que o cercam são inúmeras e de difícil caracterização, dificultando o desenvolvimento de estudos mais aprofundados sobre o processo de elaboração do diagnóstico. O papel da necropsia na avaliação da performance do diagnóstico clínico já está bem demonstrado, sendo geralmente aceito que ela pode ser usada como uma ferramenta para analisar possíveis discrepâncias. A literatura médica vem apresentando com maior freqüência a questão dos erros no cuidado à saúde, e têm proposto que novos estudos são necessários para avaliar os erros diagnósticos e com isto propiciar condições para uma melhora desta questão. Nós propusemos um estudo para verificar a concordância diagnóstica em três fases deste processo, em pacientes do Hospital das Clínicas de Ribeirão Preto. Analisamos retrospectivamente todos os diagnósticos de trezentos pacientes que faleceram em nosso hospital, sendo cem pacientes para cada ano escolhido para este estudo (1980, 1990 e 2000). Classificamos os diagnósticos em: clínicos iniciais, considerados aqueles de entrada do paciente sem o apoio de exames complementares dentro do hospital; clínicos finais...

Perfis comportamentais e estilos de mobilização de enfermeiros gestores de um serviço de medicina diagnóstica; Behavioral profiles and mobilization styles of managing nurses of a diagnostic medicine service

Sápia, Tatiana
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 26/06/2009 PT
Relevância na Pesquisa
46.07%
O mercado de trabalho para os enfermeiros vem sofrendo mudanças, constatando-se que os profissionais têm ampliado seus papéis profissionais, requerendo que desenvolvam um leque maior de competências. Nesse contexto, este estudo objetivou caracterizar demograficamente os enfermeiros gestores de um serviço de medicina diagnóstica; identificar os perfis comportamentais e estilos de mobilização dos enfermeiros gestores; relacionar os perfis comportamentais com as competências individuais dos enfermeiros gestores, conforme definidas pela empresa; e, por fim, subsidiar políticas de treinamento e desenvolvimento de enfermeiros que atuam nesse setor. A investigação caracteriza-se como pesquisa exploratória, do tipo descritiva, desenvolvida na modalidade de estudo de caso. O cenário do estudo foi uma organização privada, prestadora de serviços de saúde, com a particularidade de atuar no campo da medicina diagnóstica. Os sujeitos da pesquisa foram constituídos pela totalidade dos 36 enfermeiros gestores atuantes nas unidades de atendimento, assessoria e diretoria de educação da empresa. A coleta de dados foi realizada em duas etapas, entre agosto e outubro de 2008. A primeira etapa consistiu de uma pesquisa documental. Na segunda etapa houve a aplicação de um questionário com questões norteadoras que permitissem caracterizar demograficamente os enfermeiros gestores e também foi entregue o questionário diagnóstico M.A.R.E.® das orientações motivacionais...

Qualidade da assistência de enfermagem em medicina diagnóstica na percepção da equipe de enfermagem de uma instituição privada; Quality of the nursing care in diagnostic medicine according to the perception of the nursing team in a private institution

Garzin, Ana Cláudia Alcântara
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 25/03/2011 PT
Relevância na Pesquisa
66.1%
Trata-se de um estudo quantitativo com delineamento exploratório-descritivo, cujos objetivos foram analisar a percepção dos trabalhadores de enfermagem de uma empresa de medicina diagnóstica acerca da qualidade da assistência de enfermagem prestada, considerando-se as dimensões de estrutura, processo e resultado e conhecer os fatores intervenientes na qualidade dessa assistência sob a ótica dos trabalhadores de enfermagem. A população foi constituída por 203 profissionais de enfermagem de uma empresa de medicina diagnóstica. A coleta de dados ocorreu entre os meses de maio e junho de 2010, por meio de um questionário, empregando-se a escala de Likert. Os dados foram analisados em função dos índices percentuais e testes estatísticos específicos. O instrumento de coleta de dados mostrou-se confiável, obtendo-se o Alpha de Cronbach igual a 0,90. Na caracterização dos sujeitos, foi verificado que 55% eram auxiliares de enfermagem, 36% técnicos de enfermagem e 9% enfermeiros; 83% pertenciam ao sexo feminino e 17% ao sexo masculino, com idade média de 34,1 anos e, em média, 10,8 anos de formação e 6,6 anos de atuação na instituição. Na dimensão de estrutura, os participantes demonstraram percepção favorável aos aspectos que envolveram os materiais...

Prospecção de cenários tecnológicos: perspectivas para o setor de medicina diagnóstica no Brasil; Prospection of technological scenarios: perspectives of the diagnostic medicine industry in Brazil.

Okamura, Arnaldo Mamoru
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 15/12/2014 PT
Relevância na Pesquisa
46.2%
O presente estudo apresenta quatro cenários tecnológicos do setor de medicina diagnóstica no Brasil para o ano de 2025. Trata do rastreamento de possíveis futuros do setor a partir da identificação e análise de seus fundamentos no tempo presente, indicando como organizações podem se preparar para esses futuros. A pesquisa foi desenvolvida buscando respostas às seguintes questões: Como rastrear eventos futuros a partir dos sinais emitidos no presente? Quais são os fundamentos no tempo presente que projetam o futuro? Quais são os quatro principais possíveis cenários tecnológicos no setor de medicina diagnóstica? Quais sinais de aviso emitidos no presente a serem rastreados e monitorados tendo em vista esses possíveis cenários futuros? Quais são as decisões e medidas fundamentais a serem tomadas hoje tendo em vista esses possíveis futuros? A pesquisa foi realizada a partir de pesquisa bibliográfica preliminar e a realização de sete entrevistas semiestruturadas. Adotou-se a estratégia de pesquisa qualitativa Grounded Theory combinada com técnicas de cenários intuitivo-lógicos, permitindo o rastreamento de possíveis eventos futuros a partir dos sinais existentes no presente. Identificou-se as tecnologias de point of care e medicina personalizada como os principais fundamentos para o futuro de setor de medicina diagnóstica. Foram gerados quatro cenários tecnológicos para o setor denominados Boutique da Saúde...

Implantação do modelo lean thinking em saúde: um estudo de caso em serviço de medicina diagnóstica; Implementation of lean thinking model in healthcare: a case study in medicine diagnostic service.

Eiro, Natalia Yuri
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 24/11/2014 PT
Relevância na Pesquisa
45.96%
Os desperdícios e a necessidade de oferecer um atendimento de qualidade constituem um verdadeiro desafio para as empresas de saúde. Para tanto, a adoção da filosofia enxuta - particularmente do lean healthcare - pode contribuir para a redução dos desperdícios e melhoria da qualidade. Neste contexto, este trabalho teve como objetivo analisar os motivos e como ocorreu a implantação do lean thinking nos processos de atendimento em uma empresa de medicina diagnóstica, bem como identificar os resultados alcançados. MÉTODOS: Trata-se de uma pesquisa exploratória de abordagem qualitativa, em que foi realizado um estudo de caso incorporado. Para a construção das questões orientadoras das entrevistas realizou-se uma pesquisa bibliográfica que gerou seis temas: operações, cultura organizacional, apoio da alta administração, redução de custos e desperdícios, foco no cliente e comunicação e capacitação. A coleta de dados foi realizada com dez participantes, divididos em três grupos e por meio de observações diretas. RESULTADOS: O modelo lean thinking foi aplicado na empresa pela iniciativa de líderes que conheciam o modelo. No entanto, ocorreu de forma incompleta - os colaboradores operacionais não foram envolvidos na capacitação inicial; os princípios básicos e ferramentas que fundamentam o modelo lean não foram incorporados como modelo de trabalho da empresa; não houve a integração de toda a organização...

Suggestion of a national diagnostic reference level for 18F-FDG/PET scans in adult cancer patients in Brazil

Oliveira,Cássio Miri; Sá,Lidia Vasconcellos de; Alonso,Thêssa Cristina; Silva,Teógenes Augusto da
Fonte: Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Publicador: Colégio Brasileiro de Radiologia e Diagnóstico por Imagem
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2013 EN
Relevância na Pesquisa
35.96%
Objective To suggest a national value for the diagnostic reference level (DRL) in terms of activity in MBq.kg–1, for nuclear medicine procedures with fluorodeoxyglucose (18F-FDG) in whole body positron emission tomography (PET) scans of adult patients. Materials and Methods A survey on values of 18F-FDG activity administered in Brazilian clinics was undertaken by means of a questionnaire including questions about number and manufacturer of the installed equipment, model and detector type. The suggested DRL value was based on the calculation of the third quartile of the activity values distribution reported by the clinics. Results Among the surveyed Brazilian clinics, 58% responded completely or partially the questionnaire; and the results demonstrated variation of up to 100% in the reported radiopharmaceutical activity. The suggested DRL for 18F-FDG/PET activity was 5.54 MBq.kg–1 (0.149 mCi.kg–1). Conclusion The present study has demonstrated the lack of standardization in administered radiopharmaceutical activities for PET procedures in Brazil, corroborating the necessity of an official DRL value to be adopted in the country. The suggested DLR value demonstrates that there is room for optimization of the procedures and 18F-FDG/PET activities administered in Brazilian clinics to reduce the doses delivered to patients. It is important to highlight that this value should be continually revised and optimized at least every five years.

Diagnostic accuracy of sonography for pleural effusion: systematic review

Grimberg,Alexandre; Shigueoka,David Carlos; Atallah,Álvaro Nagib; Ajzen,Sergio; Iared,Wagner
Fonte: Associação Paulista de Medicina - APM Publicador: Associação Paulista de Medicina - APM
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2010 EN
Relevância na Pesquisa
36.02%
CONTEXT AND OBJECTIVE: The initial method for evaluating the presence of pleural effusion was chest radiography. Isolated studies have shown that sonography has greater accuracy than radiography for this diagnosis; however, no systematic reviews on this matter are available in the literature. Thus, the aim of this study was to evaluate the accuracy of sonography in detecting pleural effusion, by means of a systematic review of the literature. DESIGN AND SETTING: This was a systematic review with meta-analysis on accuracy studies. This study was conducted in the Department of Diagnostic Imaging and in the Brazilian Cochrane Center, Discipline of Emergency Medicine and Evidence-Based Medicine, Department of Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil. METHOD: The following databases were searched: Cochrane Library, Medline, Web of Science, Embase and Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). The references of relevant studies were also screened for additional citations of interest. Studies in which the accuracy of sonography for detecting pleural effusion was tested, with an acceptable reference standard (computed tomography or thoracic drainage), were included. RESULTS: Four studies were included. All of them showed that sonography had high sensitivity...

Diagnostic imaging at its centennial: the past, the present and the future.

Doris, C I
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 01/11/1995 EN
Relevância na Pesquisa
36.03%
Since the discovery of x-rays by Wilhelm Conrad Röntgen 100 years ago, diagnostic imaging has profoundly influenced the practice of medicine. As a result of discoveries during this period, ultrasonography, nuclear imaging, computed tomography and magnetic resonance imaging, as well as conventional radiography, have assumed a major role in diagnostic medicine. In addition to their traditional role in diagnosis, imaging techniques are becoming an increasingly important factor in innovative treatment methods, and this role is likely to expand. In the current climate of rising health care costs, radiologists and other health care providers who use imaging must increasingly account to health care funders for the cost-effectiveness of imaging in relation to other diagnostic and interventional techniques. They must also assure minimum standards of quality and training, and determine the appropriate role for diagnostic imaging in health care systems of the future.

Development of microfluidics as endothelial progenitor cell capture technology for cardiovascular tissue engineering and diagnostic medicine

Plouffe, Brian D.; Kniazeva, Tatiana; Mayer, John E.; Murthy, Shashi K.; Sales, Virna L.
Fonte: The Federation of American Societies for Experimental Biology Publicador: The Federation of American Societies for Experimental Biology
Tipo: Artigo de Revista Científica
Publicado em /10/2009 EN
Relevância na Pesquisa
45.9%
We have developed a unique microfluidic platform capable of capturing circulating endothelial progenitor cells (EPCs) by understanding surface chemistries and adhesion profiles. The surface of a variable-shear-stress microfluidic device was conjugated with 6 different antibodies [anti-CD34, -CD31, -vascular endothelial growth factor receptor-2 (VEGFR-2), -CD146, -CD45, and -von Willebrand factor (vWF)] designed to match the surface antigens on ovine peripheral blood-derived EPCs. Microfluidic analysis showed a shear-stress-dependent decrease in EPC adhesion on attached surface antigens. EPCs exhibited increased adhesion to antibodies against CD34, VEGFR-2, CD31, and CD146 compared to CD45, consistent with their endothelial cell-specific surface profile, when exposed to a minimum shear stress of 1.47 dyn/cm2. Bone-marrow-derived mesenchymal stem cells and artery-derived endothelial and smooth muscle cells were used to demonstrate the specificity of the EPC microfluidic device. Coated hematopoietic specific-surface (CD45) and granular vWF antibodies, as well as uncoated bare glass and substrate (1% BSA), were utilized as controls. Microfluidic devices have been developed as an EPC capture platform using immobilized antibodies targeted as EPC surface antigens. This EPC chip may provide a new and effective tool for addressing challenges in cardiovascular disease and tissue engineering.—Plouffe...

Clinical Decision Making—A Functional Medicine Perspective

Pizzorno, Joseph E.
Fonte: Global Advances in Health and Medicine Publicador: Global Advances in Health and Medicine
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
36.02%
As 21st century health care moves from a disease-based approach to a more patient-centric system that can address biochemical individuality to improve health and function, clinical decision making becomes more complex. Accentuating the problem is the lack of a clear standard for this more complex functional medicine approach. While there is relatively broad agreement in Western medicine for what constitutes competent assessment of disease and identification of related treatment approaches, the complex functional medicine model posits multiple and individualized diagnostic and therapeutic approaches, most or many of which have reasonable underlying science and principles, but which have not been rigorously tested in a research or clinical setting. This has led to non-rigorous thinking and sometimes to uncritical acceptance of both poorly documented diagnostic procedures and ineffective therapies, resulting in less than optimal clinical care.

Performance of Physical Examination Skills in Medical Students during Diagnostic Medicine Course in a University Hospital of Northwest China

Li, Yan; Li, Na; Han, Qunying; He, Shuixiang; Bae, Ricard S.; Liu, Zhengwen; Lv, Yi; Shi, Bingyin
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Publicado em 15/10/2014 EN
Relevância na Pesquisa
45.9%
This study was conducted to evaluate the performance of physical examination (PE) skills during our diagnostic medicine course and analyze the characteristics of the data collected to provide information for practical guidance to improve the quality of teaching. Seventy-two fourth-year medical students were enrolled in the study. All received an assessment of PE skills after receiving a 17-week formal training course and systematic teaching. Their performance was evaluated and recorded in detail using a checklist, which included 5 aspects of PE skills: examination techniques, communication and care skills, content items, appropriateness of examination sequence, and time taken. Error frequency and type were designated as the assessment parameters in the survey. The results showed that the distribution and the percentage in examination errors between male and female students and among the different body parts examined were significantly different (p<0.001). The average error frequency per student in females (0.875) was lower than in males (1.375) although the difference was not statistically significant (p = 0.167). The average error frequency per student in cardiac (1.267) and pulmonary (1.389) examinations was higher than in abdominal (0.867) and head...

Toward a new autoantibody diagnostic orthodoxy: understanding the bad, good and indifferent

Fritzler, Marvin J.
Fonte: Springer Milan Publicador: Springer Milan
Tipo: Artigo de Revista Científica
Publicado em 21/03/2012 EN
Relevância na Pesquisa
36.05%
Rapid advances in diagnostic technologies used to detect autoantibodies have made it difficult for even the most modern laboratory to keep abreast of the changing approaches and platforms, not to mention the clinicians who are hard pressed to keep abreast of evolving diagnostic paradigms attended by these newer techniques. While autoantibody testing is traditionally considered to be primarily serving the realm of diagnostic medicine, there is little doubt that autoantibodies are also being recognized as an approach to providing prognostic and therapeutic information. Accordingly, along with related proteomics, genomics and metabolomics, it is taking on increasing importance in the realm of personalized medicine. In today’s world of autoantibody diagnostics, overarching concerns about false-negative and false-positive autoantibodies tests cannot be summarily dismissed by citing pros or cons of any one technology or diagnostic platform, but often point to persisting gaps in our knowledge about, and understanding of, the origin and roles of autoantibodies. Before we can hope to completely understand the enigmas that attend the results of autoantibody diagnostic tests, perhaps it is time to step back and re-examine long-accepted paradigms and beliefs. This review will address some of the issues that impact on autoantibody detection technologies and some of the considerations and issues that will attend a new orthodoxy of autoantibody diagnostics. These issues will be addressed in the context of “bad” (pathogenic)...

Identification of Mimotopes with Diagnostic Potential for Trypanosoma brucei gambiense Variant Surface Glycoproteins Using Human Antibody Fractions

Van Nieuwenhove, Liesbeth; Büscher, Philippe; Balharbi, Fatima; Dieltjens, Tessa; Guisez, Yves; Lejon, Veerle; Humbert, Michael
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
46.05%
Background: At present, screening of the population at risk for gambiense human African trypanosomiasis (HAT) is based on detection of antibodies against native variant surface glycoproteins (VSGs) of Trypanosoma brucei (T.b.) gambiense. Drawbacks of these native VSGs include culture of infective T.b. gambiense trypanosomes in laboratory rodents, necessary for production, and the exposure of non-specific epitopes that may cause cross-reactions. We therefore aimed at identifying peptides that mimic epitopes, hence called “mimotopes,” specific to T.b. gambiense VSGs and that may replace the native proteins in antibody detection tests. Methodology/Principal Findings A Ph.D.-12 peptide phage display library was screened with polyclonal antibodies from patient sera, previously affinity purified on VSG LiTat 1.3 or LiTat 1.5. The peptide sequences were derived from the DNA sequence of the selected phages and synthesised as biotinylated peptides. Respectively, eighteen and twenty different mimotopes were identified for VSG LiTat 1.3 and LiTat 1.5, of which six and five were retained for assessment of their diagnostic performance. Based on alignment of the peptide sequences on the original protein sequence of VSG LiTat 1.3 and 1.5, three additional peptides were synthesised. We evaluated the diagnostic performance of the synthetic peptides in indirect ELISA with 102 sera from HAT patients and 102 endemic negative controls. All mimotopes had areas under the curve (AUCs) of ≥0.85...

Modeling of Novel Diagnostic Strategies for Active Tuberculosis – A Systematic Review: Current Practices and Recommendations

Zwerling, Alice; White, Richard G.; Vassall, Anna; Cohen, Ted; Dowdy, David W.; Houben, Rein M. G. J.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
46.11%
Introduction: The field of diagnostics for active tuberculosis (TB) is rapidly developing. TB diagnostic modeling can help to inform policy makers and support complicated decisions on diagnostic strategy, with important budgetary implications. Demand for TB diagnostic modeling is likely to increase, and an evaluation of current practice is important. We aimed to systematically review all studies employing mathematical modeling to evaluate cost-effectiveness or epidemiological impact of novel diagnostic strategies for active TB. Methods: Pubmed, personal libraries and reference lists were searched to identify eligible papers. We extracted data on a wide variety of model structure, parameter choices, sensitivity analyses and study conclusions, which were discussed during a meeting of content experts. Results & Discussion From 5619 records a total of 36 papers were included in the analysis. Sixteen papers included population impact/transmission modeling, 5 were health systems models, and 24 included estimates of cost-effectiveness. Transmission and health systems models included specific structure to explore the importance of the diagnostic pathway (n = 4), key determinants of diagnostic delay (n = 5), operational context (n = 5), and the pre-diagnostic infectious period (n = 1). The majority of models implemented sensitivity analysis...

“Appropriate” diagnostic testing: supporting diagnostics with evidence-based medicine and shared decision making

Polaris, Julian JZ; Katz, Jeffrey N
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
36.15%
Background: Evidence-based medicine is an important approach to avoiding care that is unlikely to benefit patients in both the treatment and the diagnostic context. The medical evidence alone may not determine the most appropriate care decision. Patient interests are best served when the advantages and risks of a diagnostic test are viewed through the lens of the patient’s values. That is, the paradigm of evidence-based medicine should be complemented by the paradigm of shared decision making. Analysis Diagnostic testing may offer physiological and psychological benefits. Clinicians should also discuss the potential harms, however, which may be physiological (e.g. radiation or scarring), psychological (e.g. anxiety), and financial (e.g. cost-sharing burdens). All three of these concerns are compounded by the risk of false positives or incidental findings that are not serious, but which require decisions about further testing or treatment. Conclusion: We suggest that patient-centered decision making around diagnostic testing involves a two-step inquiry: Is the test medically appropriate? Does the available evidence documenting short- and long-term risk and benefits support the test for its intended use, given the patient’s characteristics and symptoms?Is the test appropriate for this patient? Has the provider initiated a conversation about tradeoffs that helps the patient evaluate whether the balance of risks and benefits is consonant with the patient’s own values and preferences? Potential benefits and harms to consider include the physiological...

Evidências de validade do Millon Behavioral Medicine Diagnostic (MBMD) na avaliação psicológica de candidatos à cirurgia bariátrica

Lucena, Marianna Carla Maia Dantas de
Fonte: Universidade Federal do Rio Grande do Norte; BR; UFRN; Programa de Pós-Graduação em Psicologia; Psicologia, Sociedade e Qualidade de Vida Publicador: Universidade Federal do Rio Grande do Norte; BR; UFRN; Programa de Pós-Graduação em Psicologia; Psicologia, Sociedade e Qualidade de Vida
Tipo: Dissertação Formato: application/pdf
POR
Relevância na Pesquisa
36.23%
the Millon Behavioral Medicine Diagnostic is an instrument, developed from a consensus among health professionals, to identify psychological factors that may compromise the conducting of medical treatment in order to allow a better adhesion. As it has been one of the most used tools to assess bariatric surgery, the objective of this research is to verify the evidence validity of Millon Behavioral Medicine Diagnostic (MBMD) for psychological assessment of candidates for bariatric surgery. Method: males and females volunteers, aged 18 to 70, grouped in 150 patients admitted for surgical procedures or suffering from chronic diseases (control group) and 426 patients candidates for bariatric surgery, contacted in person or by the internet. For the study in the face group were also administered Millon Index of Personality Styles (MIPS), the Millon Clinical Multiaxial Inventory-III (MCMI-III) and the General Health Questionnaire of Goldberg, just in bariatric surgery patients. Results: there are indicators of semantic adaptation of the instrument, with 27 factors in five areas of the instrument, all with satisfactory levels of validity. The reliabitity indicators were satisfactory in 18 of the 32 scales that comprise the MBMD, while relations with the other three instruments showed significant variations compared to the original indicators. The MBMD was sensitive to differences between groups about gender...

Individual patient data meta-analysis of diagnostic and prognostic studies in obstetrics, gynaecology and reproductive medicine

Broeze, K.; Opmeer, B.; Bachmann, L.; Broekmans, F.; Bossuyt, P.; Coppus, S.; Johnson, N.; Khan, K.; ter Riet, G.; van der Veen, F.; van Wely, M.; Mol, B.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
36.17%
Background: In clinical practice a diagnosis is based on a combination of clinical history, physical examination and additional diagnostic tests. At present, studies on diagnostic research often report the accuracy of tests without taking into account the information already known from history and examination. Due to this lack of information, together with variations in design and quality of studies, conventional meta-analyses based on these studies will not show the accuracy of the tests in real practice. By using individual patient data (IPD) to perform meta-analyses, the accuracy of tests can be assessed in relation to other patient characteristics and allows the development or evaluation of diagnostic algorithms for individual patients. In this study we will examine these potential benefits in four clinical diagnostic problems in the field of gynaecology, obstetrics and reproductive medicine. Methods/design: Based on earlier systematic reviews for each of the four clinical problems, studies are considered for inclusion. The first authors of the included studies will be invited to participate and share their original data. After assessment of validity and completeness the acquired datasets are merged. Based on these data, a series of analyses will be performed...

Extracting Physician Group Intelligence from Electronic Health Records to Support Evidence Based Medicine

Weber, Griffin M.; Kohane, Isaac S.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
45.92%
Evidence-based medicine employs expert opinion and clinical data to inform clinical decision making. The objective of this study is to determine whether it is possible to complement these sources of evidence with information about physician “group intelligence” that exists in electronic health records. Specifically, we measured laboratory test “repeat intervals”, defined as the amount of time it takes for a physician to repeat a test that was previously ordered for the same patient. Our assumption is that while the result of a test is a direct measure of one marker of a patient's health, the physician's decision to order the test is based on multiple factors including past experience, available treatment options, and information about the patient that might not be coded in the electronic health record. By examining repeat intervals in aggregate over large numbers of patients, we show that it is possible to 1) determine what laboratory test results physicians consider “normal”, 2) identify subpopulations of patients that deviate from the norm, and 3) identify situations where laboratory tests are over-ordered. We used laboratory tests as just one example of how physician group intelligence can be used to support evidence based medicine in a way that is automated and continually updated.

Sistemas de agendamento em serviços de medicina diagnóstica; Appointment systems in diagnostic medicine services

Oleskovicz, Marcelo
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 01/10/2015 PT
Relevância na Pesquisa
66.1%
Objetivos: este estudo busca propor um modelo de sistema de agendamento para serviços ambulatoriais, tendo como foco os prestadores de serviços de medicina diagnóstica com diversidade de portfólio de serviços agendados. Método: a pesquisa foi conduzida na forma de simulação, tendo como unidade de análise um laboratório de medicina diagnóstica de grande porte. Utilizando modelagem quantitativa, os cenários do caso analisado foram reproduzidos para aplicação de modelos de sistemas de agendamento buscados na literatura. Resultados: tendo como critérios a compatibilidade com os objetivos da pesquisa e o contexto do caso analisado, foram selecionados modelos de sistemas de agendamento com potencial de aplicação. Adotando indicadores de custos identificados na revisão teórica, o modelo de maior potencial foi avaliado, tendo como referência modelos considerados tradicionais para fins comparativos. Os resultados apontam para desempenho superior do modelo proposto na grande maioria dos cenários analisados. Conclusões: a flexibilidade do modelo proposto, no sentido de abranger uma extensa gama de cenários, aliada a desempenho superior e uma baixa complexidade de implantação, o configuram como uma interessante alternativa para aplicação prática.; Objectives: This study aims to propose an appointment system model for outpatient services...

Diagnostic use of procedures and measurements used during clinical lumbosacral radiculopathy examination according to the principles of evidence-based medicine: a systematic review; Utilidade diagnóstica dos procedimentos e medidas no exame clínico de radiculopatias lombossacrais segundo os princípios da Medicina Baseada em Evidências: revisão sistemática

Santos Filho, Carlos Souto dos; Sá, Eduardo Costa
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Formato: application/pdf
Publicado em 11/09/2011 POR
Relevância na Pesquisa
36.24%
A importância da incorporação da Medicina Baseada em Evidência na capacidade dos testes e medidas clínicas em predizer diagnósticos de radiculopatias não pode ser menosprezada. A síndrome radicular lombossacral é auto-limitante na maioria dos casos e os sintomas desaparecem espontaneamente em semanas ou meses. Já a cronificação produz importante incapacidade física e laboral. Diante da falta de conhecimento técnico, fez-se uma revisão de literatura sobre a utilidade diagnóstica dos testes clínicos para esta patologia. Este estudo teve por objetivo pesquisar as melhores práticas médicas baseada em evidências científicas dos procedimentos e medidas no exame clínico e os critérios diagnósticos das radiculopatias lombossacrais, listar os testes mais utilizados, levantar as propriedades diagnósticas dos testes, além de avaliar a objetividade destes. Os autores realizaram uma discussão de 53 artigos selecionados nas bases de dados Medline, Web of Science, Embase, Scopus, Lilacs e SciELO, usando como descritores “Evidence-based Medicine”, “Diagnostic Techniques and Procedures”, “Radiculopathy”, “Lumbosacral Region”, “Diagnostic Tests”, “Nerve Compression Syndromes”, “Diagnostic Techniques...