Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-01-11T10:31:03Z No. of bitstreams: 1 mariadosocorrolinavankeulen.pdf: 2261237 bytes, checksum: 42a025939206e7e1f657e3fb828feb4a (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-01-23T12:39:01Z (GMT) No. of bitstreams: 1 mariadosocorrolinavankeulen.pdf: 2261237 bytes, checksum: 42a025939206e7e1f657e3fb828feb4a (MD5) / Made available in DSpace on 2018-01-23T12:39:01Z (GMT). No. of bitstreams: 1 mariadosocorrolinavankeulen.pdf: 2261237 bytes, checksum: 42a025939206e7e1f657e3fb828feb4a (MD5) Previous issue date: 2017-09-29 / Eventos adversos são danos desnecessários à saúde de um indivíduo causados pela atividade profissionais de saúde. No Brasil e no mundo, a saúde sofre com o alto custo do cuidado em saúde vinculado à incorporação tecnológica, ao aumento da carga de trabalho dos profissionais de saúde e à mudança no perfil epidemiológico da população, que apresenta maior longevidade e múltiplas doenças crônicas e emergem preocupações voltadas para a qualidade do cuidado, capacitação técnica e profissional e eficiência das organizações de saúde. O objetivo principal foi dimensionar os custos relativos ao tratamento de danos causados por eventos adversos no período de um ano na instituição proposta, em duas unidades: Unidade de Práticas Integradas de clínica e Unidade de Estrutura Funcional clínica, além de identificar e descrever os fatores relacionados à ocorrência de evento adverso. A população do estudo foi de pacientes hospitalizados para tratamento clínico. O desenho da pesquisa é observacional, seccional, com dados individuais e abordagem quantitativa, comparando dois setores de clínica médica do hospital para testar a hipótese de que não há diferença na quantidade de eventos adversos ocorridos entre duas unidades de tratamento clínico e um estudo tipo Cost of Illness, utilizando custos diretos como categoria analítica. Os critérios de inclusão foram: pacientes maiores de 18 anos, internados para tratamento clínico pelo Sistema Único de Saúde, com permanência maior que 24h e alta hospitalar a mais de 30 dias. Os critérios de exclusão são: pacientes internados para tratamento psiquiátrico. O método detecção de eventos adversos foi a Ferramenta Global Trigger Tool para, desenvolvida pelo Institute of Health Improvement. Foram detectadas 96 internações (20,0%) com pelo menos um (1) evento adverso, 144 eventos no total, correspondendo a uma média de 1,5 eventos por pacientes afetados, dos quais 31 (21,5%) estavam presentes na admissão e 125 (86,8%) foram considerados evitáveis. As características relacionadas a processos clínicos e cirúrgicos apresentaram razões de chance mais significativas: ter sido submetido à cirurgia aumentou a chance de ocorrer evento adverso em aproximadamente 8 vezes (OR 7,93) e o tempo de internação maior ou igual a 3 dias aumentou a chance de evento adverso em 4 vezes (OR 4,03). Ter sido internado em uma Unidade de Estrutura Funcional representou uma chance duas vezes e meia maior de sofrer um evento adverso em comparação com pacientes que foram internados em Unidade de Práticas Integradas. Foi observado que pacientes com evento adverso tiveram aumento na média do custo total de 98,83%, se comparados com pacientes que não tiveram evento adverso. Na Unidade de Práticas Integradas esta diferença representou um aumento de 131,2%, enquanto na Unidade de Estrutura Funcional, o custo de internações com evento adverso excedeu em 76,4% o custo de internações sem evento adverso. Para o Sistema Único de Saúde, a incidência de evento adverso custou um incremento na média da receita paga à instituição equivalente à 55%. Este custo médio na Unidade de Práticas Integradas foi de 61,5% e na Unidade de Estrutura Funcional foi de 36,9%. O estudo pode confirmar que eventos adversos são muito frequentes nesta amostra e representam um gasto excessivo para a instituição e para o Sistema Único de Saúde. / Adverse events are unnecessary damages to an individual’s health caused by professional’s health care. Brazil and other countries suffer from the high costs of health care related to technological incorporation, the increase of health professionals’ workload and the change in the epidemiological profile of the population that provides greater longevity and multiple chronic diseases. Concerns arises regarding the quality of care, technical and professional training, and the efficiency of health organizations. The main objective was to estimate the costs related to the treatment of damages caused by adverse events within one year in the institution, comparing two units: Integrated Practices Unit of Internal Medicine and Functional Structure Unit besides in order to measure the incidence and describe the factors related to the occurrence of adverse event. The study population was patients hospitalized for clinical treatment. This was a retrospective, observational, sectional design, using individual data and quantitative approach comparing two clinical practice sectors of a hospital to test the hypothesis that there is no difference in the adverse events’ amount between these two units. Besides that a study of Cost of Illness using direct costs as analytical category was done. Inclusion criteria were: patients over 18 years of age hospitalized for clinical treatment by Brasilian Health system: Sistema Único de Saúde, with length of stay longer than 24 hours and hospital discharge over 30 days. Exclusion criteria were: inpatients for psychiatric treatment. The method of adverse events’ detection was the Global Trigger Tool developed by the Institution of Health Improvement (IHI). In 96 hospitalizations (20.0%) at least one (1) adverse event was detected and 144 adverse events representing an average of 1.5 events per affected patients. Thirty-one adverse events (21.5%) were present in Admission and 125 (86.8%) were considered preventable. The characteristics related to clinical and surgical procedures had more significant odds ratio: being submitted to surgery increased the chance of AD occurring in approximately 8-fold (OR 7.93) and the hospital’s length of stay greater than or equal to 3 days increased the chance of adverse event in 4 times (OR 4.03). The admission to a Functional Structure Unit represented a two and a half times greater chance of suffering an adverse event compared to patients who were hospitalized in Integrated Practices Unit. It was observed that hospitalizations with adverse event costs of 98.83% to the institution if compared to hospitalizations without adverse event. In the Integrated Practices Unit adverse event represented an increase of 131.2% while in the Functional Structure Unit the costs of adverse event exceeded 76.4. The incidence of adverse event increased around 55% the amount SUS should pay the health service deliver. This average cost was 61.5% in Integrated Practices Unit and 36.9% in Functional Structure Unit. The study have shown that adverse events are very frequent in this sample and represent an excessive expenditure for the institution and the Unified Health System.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / The inexistence of medicines that act only in one target cell leads to a possible interaction at others cell structures which are not related to their therapeutic action, coming to the appearance of adverse drug reactions (ADR). The Pharmacovigillance System may lead to a better ADR analysis at a health or research institution, making itself essential for adverse events (AE) registering throughout clinical trials and more efficient investigation and notification afterwards. With the objective of evaluation of AE registered during bioequivalence trials, it was done a retrospective analysis of the voluntaries profiles from these trials in the period of 2000 to 2003. It was evaluated the frequency and the incidence of the events observed from the main pharmacological groups involved in the trials. For the two events more frequent from each pharmacological group, it was evaluated their causuality registered according to the present information found at the scientific literature. A total of 625 AE were analyzed with a mean value of 156 events per year, an incidence of 55,8% of AE per trial and a frequency of 13,89%. To make a standard causuality classification, it was proposed a specific classificatory model for bioequivalence trials. Therefore, the implementation of a standard method for AE causuality classification is essential for a better interpretation and safer notification of ADR. / A inexistÃncia de medicamentos que atuem exclusivamente em um Ãnico alvo celular permite a possÃvel interaÃÃo com outras estruturas que nÃo estÃo relacionadas com sua aÃÃo terapÃutica, vindo a gerar reaÃÃes adversas a medicamentos (RAM). O sistema da FarmacovigilÃncia viabiliza uma melhor anÃlise de RAM em uma instituiÃÃo de saÃde ou de pesquisa necessita, tornando-se fundamental para o registro de eventos adversos durante estudos clÃnicos, posterior investigaÃÃo e notificaÃÃo dos mesmos. Com o objetivo de avaliar os registros de eventos adversos de ensaios clÃnicos de bioequivalÃncia, realizou-se uma anÃlise retrospectiva dos prontuÃrios de voluntÃrios desses ensaios no perÃodo de 2000 a 2003. Foram avaliadas a freqÃÃncia e a incidÃncia dos eventos observados dos principais grupos farmacolÃgicos envolvidos nos ensaios. Para os dois eventos mais freqÃentes de cada grupo farmacolÃgico, avaliou-se sua causalidade registrada no estudo com as informaÃÃes presentes na literatura cientÃfica. Um total de 625 eventos adversos foram analisados, com uma mÃdia de 156 eventos por ano, incidÃncia de 55,8% de eventos adversos por ensaio e freqÃÃncia de 13,89%. Para a padronizaÃÃo da classificaÃÃo de causalidade, propÃs-se um modelo classificatÃrio especÃfico para ensaios de bioequivalÃncia Faz-se, entÃo, viÃvel a implementaÃÃo de um mÃtodo padronizado de classificaÃÃo de causalidade de eventos adversos para uma melhor interpretaÃÃo e notificaÃÃo segura de reaÃÃes adversas.

Studies indicate that voluntary reporting detects relatively few adverse events (AEs) (Ehland et al., 1999, Cooper et al., 1984). At Boston Children’s Hospital (BCH), several systems exist to document AEs. First, anesthesiologists document clinical care and AEs in the patient medical record (the Anesthesia Information Management System (AIMS)). Second, in an effort to capture AEs, the Department of Anesthesiology, Critical Care and Pain Medicine developed an internal tool, the Anesthesia System for Clinical Event Tracking (ASCENT), which is integrated into clinicians’ electronic documentation. Finally, a BCH hospital-wide reporting system, the Safety Event Reporting System (SERS), allows all employees and patients to report an AE.  The goals of this study are 1) to compare the effectiveness of documentation in AIMS, ASCENT, and SERS, 2) to determine the incidence of AEs in January 2018 and June 2019, independently, and 3) compare the effectiveness of documentation AEs in ASCENT after implementation of an improved, integrated reporting system. After IRB approval, a manual chart review of 3,3204 cases requiring anesthesia in January 2018 and 3,387 cases requiring anesthesia in June 2019 was conducted. Anesthesia notes, vital signs, and administered medications documented in AIMS were reviewed to determine if an AE had occurred. Descriptions of each case were recorded, and cases with indications for AEs were verified by clinicians. Next, each AE was categorized by event type. Both ASCENT and SERS were then queried for the reported adverse events during the same time period. The total number of AEs was described using counts with the distribution of types of AEs presented using percentages.     Among the 3,204 cases reviewed in January 2018, there were 569 events documented in AIMS, out of which, 39 (6.9%) were documented in ASCENT, and 2 (0.4%) in SERS. The overall rate of AEs was determined to be 1.8 events/10 cases. For June 2019, a total of 3,387 cases were reviewed for the occurrence of AEs. Among the reviewed cases, there were 396 events documented in AIMS, out of which, 106 (26.8%) were documented in the ASCENT database, and 3 (0.8%) in SERS. The overall rate of AEs was determined to be 1.2 events/10 cases. This study demonstrates that voluntary reporting of AEs may be improved if the reporting systems are better-integrated with patient medical records. In agreement with existing literature, this study also illustrates that hospital-wide reporting systems, such as SERS, fail to collect most adverse events (Levinson, 2012). To achieve comprehensive reporting of AEs, systems must be integrated into clinicians’ workflow. Education regarding the reporting systems along with technology improvements may further enhance the capture of AEs. Further investigation will be conducted to determine severity, preventability and association with anesthesia.

Atopic dermatitis (AD) typically develops in patients with a history of allergic ailments, and is characterised by an itchy, inflammatory skin condition with scaling, lichenification, papules, excoriations and pruritus. In AD patients a chronic relapsing inflammatory condition is seen, associated with IgE hyper production. AD flares are largely triggered by environmental factors. However, the exact etiology of AD is unclear and there is a pressing need for new treatment regimens as AD is a chronic condition and requires long term treatment. Historically Aloe has been used to treat skin conditions as well as a variety of other diseases. To further explore the pathogenesis and treatment of AD, Balb/c mice were sensitized and challenged with 2,4-dinitrochlorobenzene (DNCB) for atopic dermatitis induction. Thereafter, mice were treated with either Aloe ferox or Aloe vera applied daily on the dorsal skin for 10 consecutive days. A placebo gel was used for the control mice. Blood was collected at the end of the treatment period and serum IgE levels measured. Serum IgE levels were significantly lowered in the Aloe ferox group than in the Aloe vera group. This study demonstrated Aloe’s immunoregulatory potential for alleviating atopic dermatitis through influencing of Th2 cell activation. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Pharmacology / unrestricted

No description available.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18857号 / 医博第3968号 / 新制||医||1008(附属図書館) / 31808 / 京都大学大学院医学研究科医学専攻 / (主査)教授 前川 平, 教授 江藤 浩之, 教授 河本 宏 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第20289号 / 社医博第78号 / 社新制||医||9(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 山田 亮, 教授 中山 健夫, 教授 古川 壽亮 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Proton MR spectroscopy is a tool that provides quantified brain bioprofiles. Two methods exist: single- and multi-voxel spectroscopy. No studies compare their clinical validity in vivo. Gadolinium based MR contrast agents are used to improve lesional conspicuity. Adverse events are reported. Brain deposition occurs following administration in people and murine models. In dogs, doses are anecdotal and deposition is not described. Eight normal dogs underwent MRI at 3 Tesla with two methods of spectroscopy and were administered varying doses of gadodiamide. No differences were seen between single- and multi-voxel spectroscopy when interrogating identical regions of interest. Brains were harvested and evaluated for gadolinium depots using inductively coupled plasma mass spectrometry. Gadolinium was found in the brains of all dogs with dose dependency. Further, adequate normal brain conspicuity was seen at a dose of 0.5 mmol/kg. Thus, clinical trials of gadolinium chelated contrast agents at this dose are recommended.

It is becoming increasingly important to understand biological networks in order to understand complex diseases, identify novel, safer protein targets for therapies and design efficient drugs. 'Systems biology' has emerged as a discipline to uncover biological networks through genomic data. Computational methods for identifying these networks become immensely important and have been growing in number in parallel to increasing amount of genomic data under the discipline of 'Systems Biology'. In this thesis we introduced novel computational methods for identifying topological and dynamic properties of biological networks. Biological data is available in various forms. Experimental data on the interactions between biological components provides a connectivity map of the system as a network of interactions and time series or steady state experiments on concentrations or activity levels of biological constituents will give a dynamic picture of the web of these interactions. Biological data is scarce usually relative to the number of components in the networks and subject to high levels of noise. The data is available from various resources however it can have missing information and inconsistencies. Hence it is critical to design intelligent computational methods that can incorporate data from different resources while considering noise component. This thesis is organized as follows; Chapter 1 and 2 will introduce the basic concepts for biological network types. Chapter 2 will give a background on biochemical network identification data types and computational approaches for reverse engineering of these networks. Chapter 3 will introduce our novel constrained total least squares approach for recovering network topology and dynamics through noisy measurements. We proved our method to be superior over existing reverse engineering methods. Chapter 4 is an extension of chapter 3 where a Bayesian parameter estimation algorithm is presented that is capable of incorporating noisy time series and prior information for the connectivity of network. The quality of prior information is critical to be able to infer dynamics of the networks. The major drawback of prior connectivity data is the presence of false negatives, missing links. Hence, powerful link prediction methods are necessary to be able to identify missing links. At this junction a novel link prediction method is introduced in Chapter 5. This method is capable of predicting missing links in a connectivity data. An application of this method on protein-protein association data from a literature mining database will be demonstrated. In chapter 6 a further extension into link prediction applications will be given. An interesting application of these methods is the drug adverse effect prediction. Adverse effects are the major reason for the failure of drugs in pharmaceutical industry, therefore it is very important to identify potential toxicity risks in the early drug development process. Motivated by this chapter 6 introduces our computational framework that integrates drug-target, drug-side effect, pathway-target and mouse phenotype-mouse genes data to predict side effects. Chapter 7 will give the significant findings and overall achievements of the thesis. Subsequent steps will be suggested that can follow the work presented here to improve network prediction methods.

Darbo tikslas - ištirti privačios ir VŠĮ (viešoji įstaiga) pirminės sveikatos priežiūros paslaugas teikiančios įstaigos personalo požiūrį į kokybės vadybos sistemos įgyvendinimą. Uždaviniai: išsiaiškinti sveikatos priežiūros įstaigos darbuotojų dalyvavimą įgyvendinant kokybės vadybos principus; nustatyti nepageidaujamų įvykių valdymą ir registravimą sveikatos priežiūros įstaigoje personalo požiūriu; ištirti medicinos personalo požiūrį į pokyčius sveikatos priežiūros įstaigoje kokybės vadybos sistemos įdiegimo laikotarpiu. Tyrimo metodika. 2014 m. vasario - balandžio mėn. atlikta anketinė apklausa. Apklausti 248 darbuotojai, dirbantys VŠĮ ir privačioje pirminės sveikatos priežiūros įstaigoje. Anketinių duomenų analizei naudota statistinė programa SPSS 17.0. Rezultatai. 95,8 proc. apklaustųjų žino, jog jų įstaigoje yra įdiegta kokybės vadybos sistema, o 59,1 proc. yra ja visiškai patenkinti. 87,9 proc. apklaustųjų vykdo dokumentuotas procedūras ir laikosi patvirtintos tvarkos, o 9,8 proc. tyrimo dalyvių kokybės vadybos sistemos tobulinime nedalyvauja. 45,5 proc. respondentų nori dalyvauti įstaigos kokybės valdyme. Didžioji dauguma nurodo, kad nepageidaujamų įvykių (NĮ) registravimas, priežasčių analizavimas padeda nustatyti problemas (94,9 proc.) ir mažina galimų neatitikčių skaičių (94,7 proc.). 87,2 proc. teigia, kad NĮ registracija gerina teikiamų paslaugų kokybę ir didina pacientų saugumą (88,2 proc.), tačiau nedaug įtakoja gerinant darbo aplinką darbuotojams (67,3 proc... [toliau žr. visą tekstą] / Aim of the study - to explore the attitude of private and PI (Public Institution) of Primary Health Care Institution‘s personnel towards the implementation of Quality management system. Objectives: to determine the participation of Health Care Institution‘s personnel in the implementation of Quality management principles; to determine the management and registration of Adverse Events at Health Care Institution according to its personnel, to explore medical personnel‘s attitude towards the changes at Health Care Institution during the implementaiotn of Quality management system. Methods. A questionnaire survey was conducted in February – April 2014. 248 public and private Primary Health Care Institution employees were interviewed. Questionnaire data analysis was performed using SPSS 17.0 statistical software. Results. 95.8 % of respondents know that a Quality management system has been implemented at their Institution, while 59.1 % are completely satisfied with it. 87.9 % of the respondents exercise documented procedures and follow the approved order and 9.8 % of study participants do not take part in the improvement of Quality management system. 45.5 % are willing to participate in the management of Institution‘s quality. The vast majority states that the recording of Adverse Events as well as reason analysis help to identify the problems (94.9 %) and reduce the number of potential discrepancies (94.7 %). 87.2 % affirm that Adverse Event registration improves service... [to full text]