Class of 2012 Abstract / Specific Aims: The purpose of this study was to evaluate the effectiveness of various post-operative prophylaxis methods in lung transplant patients by comparing the incidence of venous thromboembolism (VTE) before and after the implementation of a standardized hospital order set at the University of Arizona Medical Center (UAMC) in April 2007. Methods: Paper and electronic medical charts were retrospectively reviewed if patients had a lung transplant date between October 31, 2003 – October 31, 2010. A computerized database was used to collect demographic data, length of stay (LOS), comorbid conditions, prophylaxis type (including dose/frequency), and date/type of thromboembolic events in the post-operative period prior to discharge and up to 1-year post- discharge. Main Results: Ninety-two patient charts were included in the study with 35 charts in the pre-order set (“Before”) group and 57 charts in the post- order set (“After”) group. All baseline characteristics were similar between groups except age (mean age difference 8.1 yrs, p=0.003), use of mycophenolate (Before n=24, After n=54; p=0.002), and use of medications that increase risk of VTE (Before n=6, After n=2; p=0.05). The April 2007 protocol significantly increased the number of patients receiving any method of prophylaxis (p<0.0001). However, receiving prophlyaxis did not significantly reduce event rates or readmissions due to VTE. Conclusions: Although implementation of the April 2007 protocol did not significantly reduce VTE event rates and readmissions, VTE prophylaxis should continue to remain a priority. Adherence to the implemented protocol may reduce the number of patients left without effective methods of prophylaxis.

Class of 2012 Abstract / Specific Aims: The primary aim of this study was to determine the incidence of posaconazole and voriconazole concentration monitoring that occurs in transplant patients receiving antifungal prophylaxis therapy. The secondary aim was to determine whether voriconazole and posaconazole serum concentrations were used for dose adjustments. Methods: Patients status post either a liquid or solid organ transplant over the age of 1 year who received invasive fungal infection prophylaxis with either posaconazole or voriconazole between the dates of February 1, 2010 through January 31, 2011 while admitted to academic medical center were included in this descriptive retrospective study. This study has been approved by the Institutional Review Board. Data collected on each subject included demographic information, type of transplant, posaconazole or voriconazole concentrations, and duration and dosage adjustments. Main Results: 54 subjects were identified who received either voriconazole or posaconazole for fungal prophylaxis after transplant. For subjects who were prescribed posaconazole (N = 8), concentration monitoring was performed in 50% of subjects and 0% of posaconazole dose adjustments were based on concentrations. For subjects who were prescribed voriconazole, concentration monitoring and dose adjustments based on voriconazole concentrations were performed in 20% and 78% of subjects respectively. Adverse outcomes associated with the use of antifungal therapy were reported in 0% of the posaconazole therapy group and 17% of the voriconazole therapy group. Conclusions: Both posaconazole and voriconazole concentrations were obtained from patients who were receiving antifungal therapy for invasive fungal infection prophylaxis. Adjustments of prophylactic doses are not well characterized.

Class of 2007 Abstract / Objectives: To compare the cost-effectiveness of amitriptyline, divalproex, propranolol, and topiramate in the prophylactic treatment of migraine headaches based on published data. Methods: A MEDLINE search was done to identify all randomized, controlled clinical trials evaluating the efficacy of amitriptyline, divalproex, propranolol, and topiramate in the prophylactic treatment of migraine headaches. Results from these studies were then combined with drug cost and health care service costs related to treatment failure and adverse events to assess the relative cost-effectiveness of each medication. A decision tree model was created and Monte Carlo simulation was done to determine each products cost-effectiveness. Results: Amitriptyline was both most effective and least costly of the four treatment regimens studied. The mean costs for a 90 day treatment of each of the four respective medications were found to be: amitriptyline $62, divalproex $450, propranolol $91, and topiramate $802. An acceptability curve demonstrated that amitriptyline was most cost-effective 90% of the time, propranolol 10% of the time, and divalproex and topiramate were never the most cost-effective treatment. Conclusions: Among the most common medications used for migraine prophylaxis are amitriptyline, divalproex, propranolol, and topiramate. Based upon this analysis, amitriptyline was found to be the most cost-effective medication. Therefore, it is logical from the perspective of a managed-care organization to recommend amitriptyline as a first-line agent for migraine prophylaxis.

Made available in DSpace on 2014-06-11T19:22:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-25Bitstream added on 2014-06-13T20:28:21Z : No. of bitstreams: 1 gameiro_lfo_me_botfm.pdf: 394316 bytes, checksum: c4ccb5566de03b88d30de704ccedc832 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Universidade Estadual Paulista (UNESP) / Avaliar de forma subjetiva e objetiva a força muscular do assoalho pélvico (AP) em mulheres primigestas, na faixa etária de 20 a 30 anos, utilizando palpação vaginal, perineometria e eletromiografia (EMG), nos seguintes momentos: 20ª e 36ª semanas da gestação, aos 45, 90 e 180 dias após o parto. Foram estudadas na UNESP – Botucatu – SP, 50 primigestas saudáveis, sem queixas urinárias, na faixa etária de 20 a 30 anos, 36 completaram o estudo e realizaram avaliação funcional do assoalho pélvico, os achados foram correlacionados com possíveis alterações da continência urinária. Elas foram subdivididas na dependência do tipo de parto: Grupo 1 (G1): 17 mulheres submetidas a parto vaginal (PV), Grupo 2 (G2): 19 submetidas a parto cesárea (PC), foi feito questionário clínico, palpação bidigital vaginal, perineometria e eletromiografia (EMG) de contrações rápidas e sustentadas com o equipamento Myotrac Infiniti 3G. A média de idade do G1 foi de 22,8 anos e do G2 de 22,5 anos (p>0,05). O IMC foi de 24,76 e 25,13 kg/cm² em G1 e G2, considerado peso adequado (p>0,05). No G2, na 20ª semana de gestação, observamos perda de urina significativamente menor (5,8%) que no G1(35%), com diferença estatística entre os grupos (p<0,05). Em todo período de avaliação, observamos que houve aumento progressivo da perda urinária nos 2 grupos, sem diferença estatística entre os momentos (p>0,05). Na avaliação subjetiva (palpação vaginal) e objetiva (perineometria), observamos piora significativamente maior da força muscular (FM) do AP no G1 em relação ao G2 (p<0,05). Na EMG do AP, durante a contração rápida, houve diminuição significativa da FM na 36ª semana de gestação e no pós-parto, sem diferença entre os momentos no G1. No G2, a FM foi significativamente menor na 20ª semana de gestação, em comparação aos diferentes momentos. Na contração... / The aim of this study was to assess pelvic floor muscle strength (PFM) in primiparous women, using subjective and objective evaluation by vaginal palpation, perineometer and electromyography (EMG) in five moments as following: at the 20th and the 36th week gestation and after 45, 90 and 180 days of postpartum. Fifty healthy primiparous women with age between 20 and 30 years and without urinary complaints were evaluated at UNESP, Botucatu -SP. Thirty-six women completed the study and the functional analysis of pelvic floor muscle. Findings were correlated with possible disturbances of urinary continence. Participants were distributed according the childbirth in group 1 (n=17) for vaginal childbirth and group 2 (n=19) for cesarean. They fulfilled a clinical questionnaire and underwent transvaginal digital palpation (TDP), as well perineometer and eletromiography evaluation performed with Myotrac Infinit 3G. Muscle activity was measured at rest and force was obtained with three fast contractions and three sustained contractions. Mean age for G1 was 22.8 years and 22.5 years for G2 (p>0.05); body mass index was 24.7 and 25.1 Kg/m² for G1 and G2 respectively (p<0.05), both considered appropriate. On the 20th week of gestation G2 presented a urinary loss of 5.8% significant lower than G1 (35%); (p<0.05). During all period of study there was a gradual increase of loss urinary in both groups, without difference statistical between the moments (p>0.05). Subjective assessment (TDP) and objective evaluation by perineometer showed a greater worsening of PFM strength for G1 compared to G2 (p<0.05). EMG for fast contraction showed statistical decrease of PFM at the 36TH gestation week and on post-partum, without difference between moments for G1. While for G2 PFM was significantly lower at the 20th gestation week compared to different moments. In the sustained contraction there was a significantly... (Complete abstract click electronic access below)

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Made available in DSpace on 2014-06-11T19:32:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-02-08Bitstream added on 2014-06-13T20:44:08Z : No. of bitstreams: 1 frias_dfr_dr_jabo.pdf: 1729107 bytes, checksum: 3f0233fa6c43b0d328c863a2e8d85231 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A avaliação dos casos de agressão por animais, sem critérios bem definidos, podem levar à indicação equivocada de tratamento antirrábico humano pós-exposição. O número desses tratamentos, em muitos municípios em todo o Brasil, tem preocupado as autoridades sanitárias. Assim, o presente trabalho objetivou avaliar os registros e a conduta da profilaxia antirrábica humana no Município de Jaboticabal, no período de 2007 a 2010, e propor uma nova metodologia de ação. Foi elaborada uma nova ficha de atendimento antirrábico humano, a ficha referência de atendimento a agressão animal e a ficha de visita zoossanitária, todas com seus respectivos manuais de instrução para preenchimento. Além disso, realizou-se a capacitação dos responsáveis pela aplicação das mesmas e as visitas zoossanitárias. Foram avaliadas as informações das fichas de atendimento e dos resultados de visitas domiciliares e observação dos animais agressores; os dados foram tabulados em Excel e analisados com softwares EpiInfo e Action. Também calculou-se o custo direto das vacinas antirrábicas humanas aplicadas. Em 1.366 fichas analisadas, computou-se um agravo para cada 212 habitantes; das pessoas agredidas, 74,3% receberam tratamento pós-exposição, num total de 1.251 doses de vacina. A análise detalhada dos dados, aliada ao fato de Jaboticabal ser considerada região controlada para a raiva, permite questionar que 894 pessoas podem ter recebido vacina sem necessidade, totalizando 1.094 doses a um custo aproximado de 20 mil reais. Nas visitas zoossanitárias constatou-se que, dentre os animais agressores, 78,1% eram domiciliados; 84,4% estavam sadios nos dias 0 e 10; 55% dos ataques foram provocados, e 73% das agressões ocorreram nas próprias residências. Assim, maior atenção deve ser dispensada ao atendimento a agravos por... / A poor assessment of cases of animal attacks towards humans may lead to inadequate human rabies prophylaxis. The high number of post exposure prophylaxis (PEP) treatments in many Brazilian cities has become a concern for Public Health authorities. The present study aimed to assess the records and the conduct of human PEP in the municipality of Jaboticabal, within 2007-2010, and to propose a new methodology. Versions for the following forms, together with instructions for filling them out, are proposed: human rabies medical attention form, animal attack notification form and a zoossanitary form. The personnel in charge of the health sector were trained for filling out these forms and conducting visits. It was evaluated the analysis of patient’s records and the results of home visitation and animal observation data. Data was organized in Excel spreadsheet and analyzed by EpiInfo and Action softwares. Direct cost of human vaccination was also calculated. In 1,366 analyzed records, there was one animal attack per 212 inhabitants. Among injured people, 74.3% received PEP, resulting in a total of 1,251 vaccines shots. The fact that Jaboticabal is located in a region that have controlled status for rabies, coupled with data analysis, allowed questioning that 894 persons may have received rabies shots unnecessarily, which resulted in a total of 1,094 shots at a cost of approximately 20 thousand reais. During zoossanitary visits, it was observed that among the aggressors, 78.1% were domiciled animals; 84.4% remained healthy between observation days 0 to 10; 55% of attacks were provoked and 73% of aggressions happened inside the domicile. It can be concluded that greater importance should be given to the attention of animal attacks cases. Adequacy should be made to the patient’s records, animal attack notification... (Complete abstract click electronic access below)

Orientador: Adolorata Aparecida Bianco Carvalho / Banca: Angela Cleuza de Fatima Banzatto de Carvalho / Banca: Karina Paes Bürger / Banca: Maria de Lourdes Aguiar Bonadia Reichmann / Banca: Maria Angélica Dias / Resumo: A avaliação dos casos de agressão por animais, sem critérios bem definidos, podem levar à indicação equivocada de tratamento antirrábico humano pós-exposição. O número desses tratamentos, em muitos municípios em todo o Brasil, tem preocupado as autoridades sanitárias. Assim, o presente trabalho objetivou avaliar os registros e a conduta da profilaxia antirrábica humana no Município de Jaboticabal, no período de 2007 a 2010, e propor uma nova metodologia de ação. Foi elaborada uma nova ficha de atendimento antirrábico humano, a ficha referência de atendimento a agressão animal e a ficha de visita zoossanitária, todas com seus respectivos manuais de instrução para preenchimento. Além disso, realizou-se a capacitação dos responsáveis pela aplicação das mesmas e as visitas zoossanitárias. Foram avaliadas as informações das fichas de atendimento e dos resultados de visitas domiciliares e observação dos animais agressores; os dados foram tabulados em Excel e analisados com softwares EpiInfo e Action. Também calculou-se o custo direto das vacinas antirrábicas humanas aplicadas. Em 1.366 fichas analisadas, computou-se um agravo para cada 212 habitantes; das pessoas agredidas, 74,3% receberam tratamento pós-exposição, num total de 1.251 doses de vacina. A análise detalhada dos dados, aliada ao fato de Jaboticabal ser considerada região controlada para a raiva, permite questionar que 894 pessoas podem ter recebido vacina sem necessidade, totalizando 1.094 doses a um custo aproximado de 20 mil reais. Nas visitas zoossanitárias constatou-se que, dentre os animais agressores, 78,1% eram domiciliados; 84,4% estavam sadios nos dias 0 e 10; 55% dos ataques foram provocados, e 73% das agressões ocorreram nas próprias residências. Assim, maior atenção deve ser dispensada ao atendimento a agravos por... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: A poor assessment of cases of animal attacks towards humans may lead to inadequate human rabies prophylaxis. The high number of post exposure prophylaxis (PEP) treatments in many Brazilian cities has become a concern for Public Health authorities. The present study aimed to assess the records and the conduct of human PEP in the municipality of Jaboticabal, within 2007-2010, and to propose a new methodology. Versions for the following forms, together with instructions for filling them out, are proposed: human rabies medical attention form, animal attack notification form and a zoossanitary form. The personnel in charge of the health sector were trained for filling out these forms and conducting visits. It was evaluated the analysis of patient's records and the results of home visitation and animal observation data. Data was organized in Excel spreadsheet and analyzed by EpiInfo and Action softwares. Direct cost of human vaccination was also calculated. In 1,366 analyzed records, there was one animal attack per 212 inhabitants. Among injured people, 74.3% received PEP, resulting in a total of 1,251 vaccines shots. The fact that Jaboticabal is located in a region that have controlled status for rabies, coupled with data analysis, allowed questioning that 894 persons may have received rabies shots unnecessarily, which resulted in a total of 1,094 shots at a cost of approximately 20 thousand reais. During zoossanitary visits, it was observed that among the aggressors, 78.1% were domiciled animals; 84.4% remained healthy between observation days 0 to 10; 55% of attacks were provoked and 73% of aggressions happened inside the domicile. It can be concluded that greater importance should be given to the attention of animal attacks cases. Adequacy should be made to the patient's records, animal attack notification... (Complete abstract click electronic access below) / Doutor

Orientador: Alfio José Tincani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T10:32:32Z (GMT). No. of bitstreams: 1 Langner_Erwin_M.pdf: 2289241 bytes, checksum: 64e6c2459e9b291a72fd0a9ad73fe0b9 (MD5) Previous issue date: 2013 / Resumo: O hipoparatireoidismo é uma das mais frequentes complicações da cirurgia tireoidiana, com incidência variando de 1,6% a 87% em sua forma transitória. Os objetivos deste estudo incluem avaliar o uso de cálcio oral profilático após tireoidectomia total, para prevenção de hipocalcemia sintomática, e desenvolver uma estratégia viável para suplementação de cálcio oral após tireoidectomia total. Foi realizado estudo prospectivo de quarenta e sete pacientes submetidos a tireoidectomia total de Janeiro de 2007 a Fevereiro de 2012, e divididos em dois grupos: (1) Grupo I, sem reposição de cálcio; (2) Grupo II, com reposição de cálcio, 3 g por dia, iniciada no primeiro dia pós operatório e prosseguindo até o sexto dia pós operatório. Os pacientes foram seguidos pelo período mínimo de seis meses, incluindo no mínimo cinco dosagens de cálcio iônico: preoperatório, 16 horas após cirurgia, sétimo dia pós operatório, 90o dia pós operatório e 180o dia pós operatório. Dos 47 pacientes, 3 eram homens e 44 mulheres. Vinte e quatro pacientes (51,9%) possuíam doença benigna e 23 pacientes doença maligna suspeitada ou confirmada. Hipocalcemia pós-operatória foi significativamente maior no Grupo I no primeiro e 180o dia pós-operatório, enquanto hipocalcemia sintomática foi significativamente maior no Grupo I no primeiro, sétimo e 90o dia pós-operatório. Outros dados não mostraram diferenças significativas entre os dois grupos. Concluiu-se que a suplementação de cálcio pós-operatório efetivamente previne hipocalcemia sintomática e laboratorial após tireoidectomia total, podendo ser usada com segurança. A estratégia de uso de cálcio oral profilático apresentada neste estudo pode ser reproduzida de modo viável e sistemático / Abstract: The hypoparathyroidism is one of the most frequent complications of thyroid surgery, the incidence varying from 1,6% to 87% in the transient form. This study aims to evaluate the use of prophylactic oral calcium after total thyroidectomy, for prevention of symptomatic hypocalcaemia, and development of a rational strategy of oral calcium supplementation after total thyroidectomy. Prospective study of forty-seven patients undergoing total thyroidectomy from January 2007 to February 2012 was performed , and patients were allotted to one of the following groups: (1) Group I, no postoperative calcium; (2) Group II, oral calcium - 3g per day, starting at first postoperative day and used until sixth postoperative day .The patients were evaluated for the minimum period of six months, including minimum of five ionic calcium measurements: preoperative, 16 hours after operation, seventh postoperative day , PO 90 and PO 180. The analysis of 47 patients included 3 men and 44 women, showed that 24 patients (51,9%) had benign disease, and 23 patients had malignant disease suspected or confirmed. Postoperative hypocalcaemia was significantly higher in Group I at PO1 and PO 180, while symptomatic hypocalcaemia was significantly higher in Group I (PO 1, PO 7 and PO 90). Other data were not significantly different between the groups. We concluded that postoperative calcium supplementation effectively prevents symptomatic and laboratorial hypocalcaemia after total thyroidectomy, and can be safely used. The strategy of oral calcium supplementation presented may be done viable and systematic way / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

HIV transmission continues to increase for Gay men, especially for those Gay men in nonmonogamous serodiscordant relationships. As the use of PreExposure Prophylaxis (PrEP) increases, much less is known about how PrEP is creating social meaning and transforming the sexual behaviors of HIV negative, non-monogamous Gay men. Accordingly, the purpose of this study was to investigate the meaning making experiences of Gay men in nonmonogamous serodiscordant relationships. Using the Minority Stress Model, Resiliency Theory, and Queer Theory as theoretical frameworks, the research question for the study focused on how HIV negative Gay men who are on PrEP and involved in nonmonogamous serodiscordant relationships navigate their sexual lives. Interpretative Phenomenological Analysis was employed within a purposeful sample of 13 Gay men. The two themes of resiliency and reframing emerged from the descriptive coding, member checking, and triangulation of the data. Of the two themes identified, participants noted pre-PrEP resiliency strategies including looks and trust, while current PrEP strategies included strategic positioning, getting educated about HIV and PrEP, and dating undetectable men. Reframing experiences included marketability, greater feeling of sexual freedom and responsibility, new rules around nonmonogamy, increased sexual confidence, and new masculine terms for condomless anal sex. Findings and recommendations from the study may advance positive social change when researchers and practitioners combat stigma, understand perceived lower risk of HIV transmission through new resiliency techniques, and facilitate the reframing of sex within an individual, relational, and Gay cultural context.

The CDC estimates that one in 20 patients admitted to the hospital is a carrier of methicillin-resistant Staphylococcus aureus (MRSA). Staphylococci are commonly found on the skin and mucous membranes within the anterior nares, which provides the principle reservoir for this organism. These organisms can go on to cause surgical site infections in hospitalized patients. Mupirocin is an effective topical medication used to eliminate nasal carriage of Staphylococcus aureus (S. aureus). Based on Level A evidence, the 2007 Society of Thoracic Surgeons has made a Class I recommendation for the use of mupirocin for all patients undergoing cardiac surgery in the absence of documentation of a negative culture for staphylococcal colonization. The purpose of this before-and-after study is to examine the rates of surgical site infections (SSI) for cardiac surgery patients who came through the pre-admission testing unit prior to same-day admission (SDA) for surgery before and after providing 2% mupirocin nasal ointment. Specific aims: 1. To examine the relationship between providing mupirocin to the SDA cardiac surgery patient and the prevalence of SSI. 2. To examine the cost-effectiveness of providing mupirocin to the SDA cardiac surgery patient and SSI. 3. To examine the adherence of SDA preoperative cardiac surgery patients and the use of mupirocin preoperatively, if the medication is provided at no cost to the patient. Retrospective chart reviews were completed on 330 patients: 175 patients in the pre-provision of mupirocin and 150 in the mupirocin provided group. Chi Square and students' t-tests were used to analyze the data. There were five SSIs in the pre-provision of mupirocin group and no SSIs in the mupirocin provided group. This was a significantly statistical difference between the groups (X2 = 4.497, p > 0.5) Continued provision of 2% nasal mupirocin to prevent SSI in the cardiac surgery patients is recommended.