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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
571

Avaliação da qualidade do transporte inter-hospitalar e o perfil dos recém-nascidos transportados / Assessment of inter-hospital transport quality and the profile of transportes newborns

Nogueira, Marina Lucchini Pontes 19 September 2018 (has links)
Submitted by MARINA LUCCHINI PONTES NOGUEIRA (malpnogueira@hotmail.com) on 2018-10-15T14:42:37Z No. of bitstreams: 1 Dissertação de Mestrado. Marina Lucchini Pontes Nogueira.pdf: 2279326 bytes, checksum: d24b92bfe972adff14b64721bb4cfb22 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-10-16T12:58:11Z (GMT) No. of bitstreams: 1 nogueira_mlp_me_bot.pdf: 2279326 bytes, checksum: d24b92bfe972adff14b64721bb4cfb22 (MD5) / Made available in DSpace on 2018-10-16T12:58:11Z (GMT). No. of bitstreams: 1 nogueira_mlp_me_bot.pdf: 2279326 bytes, checksum: d24b92bfe972adff14b64721bb4cfb22 (MD5) Previous issue date: 2018-09-19 / Introdução: O transporte inter-hospitalar de recém-nascidos (RN) para centros terciários muitas vezes é inevitável e está associado a maior o risco para morbidades e para o óbito. A hipótese deste estudo é de que os transportes realizados na região estejam ocorrendo de forma inadequada, piorando o prognóstico dos RN transportados. Objetivos: Determinar o perfil dos RN transportados, avaliar a adequação dos transportes e calcular os escores de risco TRIPS e Ca-TRIPS, correlacionando-os com o risco de óbito e hemorragia peri-intraventricular (HPIV), na primeira semana pós-transporte. Metodologia: Estudo prospectivo de corte transversal, realizado de junho 2014 a dezembro de 2017, incluindo todos os RN submetidos a transporte e internados na Unidade Neonatal do Hospital das Clínicas da Faculdade de Medicina de Botucatu, sem exclusão. As variáveis avaliadas foram: peso ao nascer (PN), idade gestacional (IG), sexo, tipo de parto, apgar, necessidade de reanimação em sala de parto, indicação da transferência, utilização de incubadora apropriada, presença de acesso venoso, drogas e fluidos utilizados, suporte respiratório, tempo de vida à internação, temperatura axilar, padrão respiratório, pressão arterial, uso de drogas vasoativas, estado neurológico e valores dos escores de risco à internação. Os pacientes foram acompanhados na primeira semana pós-transporte em relação à evolução para HPIV ou óbito. Resultados apresentados em tabelas de frequência, com cálculo das médias e desvio padrão ou medianas e percentis; calculados os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para os escores. Teste do qui-quadrado foi utilizado no estudo das associações e realizado cálculo do risco relativo para análise dos desfechos (α=0,05). Resultados: Foram estudados 271 RN, a maioria nascidos a termo (medianas de peso: 2975g e IG: 38 semanas). Quase 30% dos pacientes foram transportados da própria cidade de Botucatu, porém 7,7% percorreram distâncias maiores que 150km. O transporte foi inadequado em 86% dos casos: sem incubadora de transporte: 26%; sem acesso venoso: 38%; sem infusão de fluidos: 40%; distermia: 53%; hipo ou hiperglicemia: 33%; hipoxemia: 20%; hipotensão: 19%; bradicardia: 3%. Os valores do TRIPS variaram de 0-65 (mediana: 6) e Ca-TRIPS de 0-60 (mediana: 20) e 31% dos RN apresentaram TRIPS ≥ 10. Valores de TRIPS ≥ 10 foram observados em 27% dos recém-nascidos a termo (RNT) vs 40% dos prematuros (PT) (P=0,04). TRIPS ≥ 10 aumentou o risco de HPIV entre os PT (R.R. = 4,04 - IC95%: 1,23-13,29 – P = 0,023) e o risco de morte entre todos os RN (R.R. = 7,45 - IC95%: 2,87-19,52 - P < 0,001). RN com Ca-TRIPS ≥ 20,5, apresentaram maior risco de morte (R.R. = 13,3 - IC95%: 4,05-43,81 - P < 0,001). Ambos os escores apresentaram valores preditivos positivos e negativos semelhantes. Conclusão: O transporte foi inadequado na maioria dos casos. Embora apenas 30% dos RN tenham sido PT, estes apresentaram valores mais altos de TRIPS e Ca-TRIPS, em comparação aos RNT. Pacientes com escores de risco mais elevados apresentaram maior riscos de óbito e HPIV. / Introduction: Interhospital transport of newborns (NB) to tertiary centers is often unavoidable and associated with greater risk for morbidity and death. The hypothesis of this study is that transport in the region is occurring inadequately, worsening the prognosis of the transported NB. Objectives: To determine the profile of the transported NB, to assess the adequacy of the transports and to calculate the TRIPS and Ca-TRIPS risk scores, correlating them with the risk of death and peri-intraventricular hemorrhage (PIVH) in the first week after transport. Methods: Prospective cross-sectional study, carried out from June 2014 to December 2017, including all NB submitted to transportation and hospitalized at the Neonatal Unit of the Hospital das Clínicas da Faculdade de Medicina de Botucatu, without exclusion. The variables evaluated were: birth weight, gestational age, sex, type of delivery, apgar, need for resuscitation in the delivery room, indication of transference, use of appropriate incubator, presence of venous access, drugs and blood flow used, respiratory support, age at admission, axillary temperature, breathing pattern, blood pressure, use of vasoactive drugs, neurological status, and values of risk scores at the time of admission. Patients were followed in the first post-transport week in relation to the progression to PIVH or death. Results presented in frequency tables, with calculation of means and standard deviation or medians and percentiles; values of sensitivity, specificity, positive predictive value and negative predictive value were calculated for the scores. Chi-square test was used in the study of associations and relative risk (RR) was calculated for the analysis of the outcomes (α=0.05). Results: We studied 271 newborns most born at term (medians weight: 2975g and gestacional age: 38 weeks). Almost 30% of the patients were transported from the city of Botucatu, but 7,7% traveled more than 150km. Transport was inadequate in 86% of cases: without transport incubator: 26%; without venous access: 38%; without fluid infusion: 40%; dysthermia: 53%; hypo or hyperglycemia: 33%; hypoxemia: 20%; hypotension: 19%; bradycardia: 3%. The TRIPS values ranged from 0-65 (median: 6) and Ca-TRIPS from 0-60 (median: 20) and 31% from the NB presented TRIPS ≥10. TRIPS values ≥ 10 were observed in 27% of the full-term newborn vs. 40% of preterm (P = 0.04). TRIPS ≥ 10 increased the risk of PIVH among premature infants (RR = 4.04 - 95% CI: 1.23-13.29 - P = 0.023) and the risk of death among all NB (RR=7,45 – IC95%: 2.87-19.52 - P <0.001). NB with Ca-TRIPS ≥ 20.5 presented higher risk of death (RR=13.3 - 95% CI: 4.05-43.81 - P <0.001). Both scores had similar positive and negative predictive values. Conclusion: Transportation was inadequate in most cases. Although only 30% of the newborns were preterm infants, they presented higher values of TRIPS and Ca-TRIPS compared to the full-term newborns. Patients with higher risk scores had a higher risk of death and PIVH.
572

The accuracy of prostate biopsy to assign patients with low-grade prostate cancer to active surveillance

Ghleilib, Intisar Ali 12 March 2016 (has links)
PURPOSE: To determine the accuracy of prostate biopsy Gleason score (GS) compared to prostatectomy GS. To determine whether a biopsy is a satisfactory diagnostic procedure to offer active surveillance for patients with low-grade prostate cancer. METHODS: This study was conducted in Tuft Medical Center as retrospective cohort study over the period from 2007-2010. The study included 83 patients for whom biopsy and prostatectomy GS were available. MEASUREMENTS: Gleason scores of 6, 7, and 8-10 were assigned to low, moderate, and high-grades, respectively. The kappa statistic was calculated to assess the degree of agreement between biopsy and prostatectomy. The ROC curve was used to evaluate the sensitivity and specificity of prostate biopsy for different Gleason grades. Also, compared whether the use of specific criteria for active surveillance (Johns Hopkins and UCSF) may decrease the level of up-grading in patient with low-grade prostate cancer using Chi-square test. RESULTS: The distribution of low, moderate, and high-grade cancer in biopsy (52%, 32%, 16%) and prostatectomy specimen (33%, 55%, 12%) showed fair agreement with weighted kappa 0.35. The prostate biopsy accurately predicted GS in 46%, up-graded in 38%, and down-graded in 16%. The patients with low-grade cancer and potentially eligible for active surveillance showed up-grading in 50% of cases. This up-grading reduced to 40% with the use of Johns Hopkins criteria and to 41% with the use of UCSF criteria. CONCLUSIONS: The accuracy of biopsy GS in predicting prostatectomy GS is severely limited and therefore biopsy is not enough diagnostic procedure to offer active surveillance.
573

The great commission, a sacred cantata for mixed chorus, soloists, and symphony orchestra

Breitweiser, David Paul January 1955 (has links)
Thesis (Ph.D.)--Boston University / The Great Commission is a sacred cantata written for mixed chorus, soprano, messo soprano, tenor, and bass soloists, and symphony orchestra. The main text, St. Mark xvi. 15-18, determines the general plan. It is composed in six parts with a finale. Part I contains the command of Jesus, "Go ye into all the world and preach the gospel." Parts II to VI are each made up of, (1) an introduction with the pronouncement of one of the signs which would follow, and, (2) a musical setting of a biblical text which is a fulfilment. Part I begins with a processional type introduction in g minor for full orchestra and marked Moderato maestoso. It is formed of irregular length phrases punctuated by short rests and introduces the entrance of the chorus, singing in unison, "Jesus came...and spoke", with the sopranos beginning on a high G. [TRUNCATED]
574

Digital image analysis for tumor cellularity and gleason grade to tumor volume analysis in prostate cancer

Chaniotakis, Sotiris 11 July 2018 (has links)
PURPOSE: This study was undertaken to compare HALO™ software image analysis measurements of cellularity with visual estimations from the pathologist and to outline a protocol for future experimental determinations of cellularity using HALO™. Secondly, this study investigated the clinically challenging prostate cancers of Gleason score 7 by analyzing a large database of radical prostatectomy (RP) specimens with regard to their Gleason grade composition and percentage tumor volume composition. The importance of these values of tumor cellularity, prostate volume, and tumor volume data were discussed in terms of future diagnostic endeavors. Finally, this study provided a brief background on prostate cancer, prostate cancer epidemiology, digital pathology, and the limitations and difficulties in the technological transition to digital pathology. All work for this study was done at Dana-Farber Cancer Institute (Boston, MA). METHODS: In the first part of this study, histological slides were acquired by radical prostatectomy (RP) and contained 12 tumor foci of varying degrees and sizes. These slides were scanned and imported into the HALO™ image analysis software. The tumor foci, previously demarcated by a pathologist, were annotated by hand in HALO™. An algorithm for image analysis was created by training classifiers to recognize and differentiate between epithelial tissue, stromal tissue, glass, and other. This process was accomplished by classifying 62 regions which were tested for accuracy before becoming the components of an algorithm to analyze the entire annotation layer. Each tumor focus was analyzed individually, and the results were exported into Microsoft® Excel from which relevant data were extracted. Cellularity was calculated by the percentage of tumor area that the algorithm characterized as epithelial. Cellularity values derived from HALO™ measurements for each tumor focus were compared with the visual estimations of cellularity provided by the pathologist using Pearson's correlation analysis. In the second part of this study, a database of 1386 slides containing tumors with Gleason scores between 6 and 9 was compiled from 140 RP cases. The average percentages of Gleason grades 3, 4, and 5 in each case were determined. The percentage of each slide that was occupied by the tumor was also averaged for each case, yielding an average percentage of tumor volume for each case. The average Gleason grade 3, 4, or 5 percentage for each case was plotted against the associated average tumor volume percentage of that case. The cases of Gleason score 7 (3+4, 4+3) were then isolated and plotted in a similar manner. Pearson’s correlation analysis was used to determine the degree of linear correlation between the two variables in each plot. Results: In the first part of this study, a statistically significant positive correlation between the cellularity estimations of the pathologist and the HALO™ cellularity measurements was found (r = 0.92, p < 0.01, n =12). In the second part of this study, there was a statistically significant negative correlation between average Gleason grade 3 percentage per case and average tumor volume percentage per case (r = -0.55, p <0.001, n = 140). There was also a statistically significant positive correlation between average Gleason grade 4 percentage per case and average tumor volume percentage per case (r = 0.55, p <0.001, n = 140). After slides containing Gleason score 6 (3+3) tumor were removed from the data, a statistically significant negative correlation remained between average Gleason grade 3 percentage per case and average tumor volume percentage per case (r = -0.51, p <0.001, n = 78), and a statistically significant positive correlation remained between average Gleason grade 4 percentage per case and average tumor volume percentage per case (r = 0.5, p <0.001, n = 101). A statistically significant relationship between average Gleason grade 5 percentage and average tumor volume percentage was not found (r = 0.32, p = 0.14, n = 23). CONCLUSIONS: In the first part of this study, the strong positive correlation between HALO™ cellularity values and visual estimations by the pathologist suggests that image analysis may be an effective tool for determining cellularity in digital histological images. More research using larger sample sizes is recommended to further validate the correlation between algorithm-derived cellularity from HALO™ and visual estimation by the pathologist. In the second part of this study, it appears that the volume of prostate tumors of Gleason score 7 may have prognostic power, considering that an increased percentage composition of Gleason grade 4 correlated with larger tumor volumes. Because this result may have significant clinical implications, further research specifically on tumors of Gleason score 7 is suggested to verify this relationship.
575

The Non-Criminal Consequences of Gang Membership: Impacts on Education and Employment in the Life-Course

January 2012 (has links)
abstract: Research on the consequences of gang membership is limited mainly to the study of crime and victimization. This gives the narrow impression that the effects of gang membership do not cascade into other life domains. This dissertation conceptualized gang membership as a snare in the life-course that disrupts progression in conventional life domains. National Longitudinal Survey of Youth Cohort of 1997 (NLSY97) data were used to examine the effects of adolescent gang membership on the nature and patterns of educational attainment and employment over a 12-year period in the life-course. Variants of propensity score weighting were used to assess the effects of gang joining on a range of outcomes pertaining to educational attainment and employment. The key findings in this dissertation include: (1) selection adjustments partially or fully confounded the effects of gang joining; despite this (2) gang joiners had 70 percent the odds of earning a high school diploma and 42 percent the odds of earning a 4-year college degree than matched individuals who avoided gangs; (3) at the 11-year mark, the effect of gang joining on educational attainment exceeded one-half year; (4) gang joiners made up for proximate deficits in high school graduation and college matriculation, but gaps in 4-year college degree and overall educational attainment gained throughout the study; (5) gang joiners were less likely to be employed and more likely to not participate in the labor force, and these differences accelerated toward the end of the study; (6) gang joiners spent an additional one-third of a year jobless relative to their matched counterparts; and (7) the cumulative effect of gang joining on annual income exceeded $14,000, which was explained by the patterning of joblessness rather than the quality of jobs. The theoretical and policy implications of these findings, as well as directions for future research, are addressed in the concluding chapter of this dissertation. / Dissertation/Thesis / Ph.D. Criminology and Criminal Justice 2012
576

Optimalizace univerzitní bezdrátové sítě pro provoz hlasových služeb

Konečný, Jakub January 2015 (has links)
This diploma thesis focuses on the issue of evaluation VoIP services (from the perspective of QoE) and their quality in university network. It includes theoretical basics of VoIP testing, principals of QoS, and also overview of QoE/MOS measurement methods. Next part describes the test bed and methodology used for measurements and evaluating of results. Site survey results and VoIP quality measurement are evaluated at the end, followed by recommendations that can lead to better VoIP quality in MENDELU wireless network.
577

Nada é sempre a mesma coisa. Um motivo em desdobramento através da Labanálise / Nothing is ever the same. a motif developed through laban movement analysis

Sastre, Cibele January 2009 (has links)
Este é um memorial descritivo e dissertativo da investigação artística feita através da utilização da Motif Writing (escrita por motivos) como propulsora de tarefas de movimento para a construção de dramaturgia em dança. A coreografia que resultou deste processo, A Cadeira _/ Uma Ilha, foi criada a partir da Motif Writing de um trecho do solo Experimento da Cadeira, visando a recriação e a multiplicação das qualidades expressivas dos movimentos do motif em outros corpos/sujeitos e relações dinâmicas entre estes, objetos, espaço e tempo. A pesquisa-criação conta com a participação das bailarinas Juliana Vicari e Luciana Hoppe, transformando o solo original em um trio. A escrita do motif relativo ao trecho selecionado da obra de referência utiliza o instrumental da Análise Laban de Movimento como ferramenta metodológica utilizada também para a condução do processo de criação. Inserido num contexto de pesquisa pós-positivista, com perspectiva artística, este memorial contém aspectos dissertativos sobre a Análise Laban em Movimento e a dramaturgia da dança como aportes para o relato do processo de criação. Ambos ajudam a compreender algumas das opções de trabalho buscadas e alcançadas, ou não, nesta investigação. Ao final deste texto comprovo a eficácia da motif writing tanto como ferramenta para reposição como para recriação da dramaturgia da obra de referência e que uma construção através deste procedimento requer a auto-revelação dos artistas. Descubro a 'reduplicação do Outro em mim‘ como potência criadora e afirmativa da minha ação como intérprete. / This thesis describes the creative and analytical process I used to develop choreography for three dancers called The Chair_/ An Island. I developed this trio choreography from one fragment of an earlier solo choreography called Chair Experiment, using an aspect of Laban Movement Analysis called "motif writing". I used this method as a score to multiply the original motifs into other bodies/subjects, objects, spaces, and time. My work was done in Brazil in collaboration with two other dancers, Juliana Vicari and Luciana Hoppe. From a post-positivist approach and artistic perspective, this thesis describes features of Laban Movement Analysis and Dance Dramaturgy which enhance the creative process. Both help us to understand possible choices and directions which are available to us when creating a choreography. I conclude that motif writing is efficient as a movement score for dramaturgy composition or reposition and that the use of this procedure encourages the artists for a self revelation. I found the 'reduplication of the Other in myself‘ as a creative potential and affirmative way as a performer.
578

Avaliação do efeito terapêutico da avilamicina no controle da enterite necrótica em perus de corte

Lancini, João Batista January 2011 (has links)
A enterite necrótica causada por Clostridium perfringens é, comprovadamente, um grande problema para frangos de corte, seja sob a forma clínica ou subclínica , com elevados prejuízos produtivos. Em perus, não está claramente identificada a influência deste patógeno sobre os resultados produtivos, e provavelmente por razões econômicas, o volume de pesquisa nesta área é limitado. Em dois experimentos consecutivos, conduzidos em granjas experimentais diferentes, e sobre cama nova e reutilizada, perus de 14 dias, sem medicação com anticoccidianos, foram inoculados, a partir de uma amostra de campo patogênica, com uma superdosagem de aproximadamente 1 x 1010 UFC/ml de Clostridium perfringens, tipo A; bactéria anaeróbica Gram positiva, que compõe a microflora intestinal dos perus. Lesões necróticas severas, com grande destruição da mucosa intestinal, foram observadas após o 4º dia de inoculação. Nos dois experimentos, a resposta dos perus à infecção foi diferente da descrita em frangos de corte. A mortalidade foi muito baixa ou nula e a recuperação das aves, independente da medicação utilizada, foi rápida com pouco ou nenhum comprometimento zootécnico. Escores das lesões histológicas foram desenvolvidos, para tentar correlacionar as lesões macroscópicas com as lesões microscópicas, mas a correlação foi baixa. Frente ao alto desafio observado, não foi possível avaliar adequadamente a ação do antimicrobiano utilizado. As respostas frente aos desafios de Clostridium perfringens nos perus, aparentam ser diferentes em relação às observadas em frangos de corte, sendo necessária cautela ao extrapolar padrões de uma espécie para outra. O uso de critérios subjetivos nas avaliações podem comprometer a tomada de decisão em relação aos tratamentos e as respostas esperadas. / Necrotic enteritis caused by Clostridium perfringens represents a major challenge in broilers, causing clinical or sub clinical diseases, and results in important economic losses for the poultry industry. In turkeys, however, the importance of this pathogen is not clearly defined, and there are few studies assessing its effects on the performance of turkeys, most probably for economic reasons. In two consecutive trials, conducted in two experimental farms, 14 day old turkey poults were reared on new and reused wood shavings litter, without any anticoccidials in the feed, and were inoculated with an overdose of approximately 1x1010 CFU/ml of a pathogenic field sample of Clostridium perfringens type A. This Gram positive anaerobic bacterium is a normal inhabitant of the gut micro flora in the enteric tract of turkeys. Severe necrotic lesions, with major damage to the intestinal mucosa were observed on Day 4 after inoculation. In both trials, the response to the turkeys to the clostridial infection was clearly different from what is described in the literature for broilers. The mortality rate was very low or inexistent, and the birds in all treatments groups recovered very fast, with little or no impact on performance results. An attempt was made to establish a pattern to correlate histological lesion scores with macroscopic and microscopic lesions, but the resulting correlation was very low. Considering the high level of challenge induced in both trials, it was not possible to evaluate in activity of the antibiotic in proper terms. The response of turkeys to a high level of challenge with Clostridium perfringens seems to be different when compared to what is observed in broilers under similar experimental conditions, and caution should be applied when using the same diagnostic methods for different species. The use of subjective criteria to assess and describe the lesions can lead to erroneous treatments decisions and misinterpretation of the responses to treatment.
579

Avaliação da qualidade do transporte inter-hospitalar e o perfil dos recém-nascidos transportados

Nogueira, Marina Lucchini Pontes January 2018 (has links)
Orientador: João Cesar Lyra / Resumo: Introdução: O transporte inter-hospitalar de recém-nascidos (RN) para centros terciários muitas vezes é inevitável e está associado a maior o risco para morbidades e para o óbito. A hipótese deste estudo é de que os transportes realizados na região estejam ocorrendo de forma inadequada, piorando o prognóstico dos RN transportados. Objetivos: Determinar o perfil dos RN transportados, avaliar a adequação dos transportes e calcular os escores de risco TRIPS e Ca-TRIPS, correlacionando-os com o risco de óbito e hemorragia peri-intraventricular (HPIV), na primeira semana pós-transporte. Metodologia: Estudo prospectivo de corte transversal, realizado de junho 2014 a dezembro de 2017, incluindo todos os RN submetidos a transporte e internados na Unidade Neonatal do Hospital das Clínicas da Faculdade de Medicina de Botucatu, sem exclusão. As variáveis avaliadas foram: peso ao nascer (PN), idade gestacional (IG), sexo, tipo de parto, apgar, necessidade de reanimação em sala de parto, indicação da transferência, utilização de incubadora apropriada, presença de acesso venoso, drogas e fluidos utilizados, suporte respiratório, tempo de vida à internação, temperatura axilar, padrão respiratório, pressão arterial, uso de drogas vasoativas, estado neurológico e valores dos escores de risco à internação. Os pacientes foram acompanhados na primeira semana pós-transporte em relação à evolução para HPIV ou óbito. Resultados apresentados em tabelas de frequência, com cálculo das médias e desvio ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Interhospital transport of newborns (NB) to tertiary centers is often unavoidable and associated with greater risk for morbidity and death. The hypothesis of this study is that transport in the region is occurring inadequately, worsening the prognosis of the transported NB. Objectives: To determine the profile of the transported NB, to assess the adequacy of the transports and to calculate the TRIPS and Ca-TRIPS risk scores, correlating them with the risk of death and peri-intraventricular hemorrhage (PIVH) in the first week after transport. Methods: Prospective cross-sectional study, carried out from June 2014 to December 2017, including all NB submitted to transportation and hospitalized at the Neonatal Unit of the Hospital das Clínicas da Faculdade de Medicina de Botucatu, without exclusion. The variables evaluated were: birth weight, gestational age, sex, type of delivery, apgar, need for resuscitation in the delivery room, indication of transference, use of appropriate incubator, presence of venous access, drugs and blood flow used, respiratory support, age at admission, axillary temperature, breathing pattern, blood pressure, use of vasoactive drugs, neurological status, and values of risk scores at the time of admission. Patients were followed in the first post-transport week in relation to the progression to PIVH or death. Results presented in frequency tables, with calculation of means and standard deviation or medians and percentiles; values of sensiti... (Complete abstract click electronic access below) / Mestre
580

Validação do escore de risco do EBMT (European Group for Blood and Marrow Transplantation) na população de pacientes submetidos ao transplante de células-tronco hematopoéticas no Hospital de Clínicas de Porto Alegre

Araújo, Beatriz Stela Gomes de Souza Pitombeira January 2012 (has links)
INTRODUÇÃO: O Transplante de Células-tronco Hematopoéticas (TCTH) alogênico é uma modalidade de tratamento com capacidade de curar várias doenças hematológicas benignas e malignas. Os progressos nesta área aumentaram o número e melhoraram os desfechos dos procedimentos realizados, porém sua morbimortalidade permanece elevada. Em 2009, o escore de risco do EBMT foi validado como um método simples para predizer, com dados pré-transplante, os desfechos de um paciente após o TCTH alogênico. OBJETIVOS: O objetivo deste estudo foi validar a aplicabilidade do escore de risco do EBMT em pacientes brasileiros do Hospital de Cínicas de Porto Alegre (HCPA), submetidos a TCTH alogênico. MÉTODOS: Foi realizado um estudo retrospectivo, observacional, com dados coletados de prontuários de 278 pacientes (156 homens (56%) com mediana de idade de 32 anos) submetidos ao TCTH alogênico no HCPA para doenças malignas e anemia aplástica severa, entre 1994 e 2010. Foi aplicado o escore de risco do EBMT e analisados os desfechos sobrevida global (OS), mortalidade não relacionada à recaída (NRM) e taxa de recaída (RR). RESULTADOS: OS, NRM e RR em cinco anos foram de 53,4%, 39% e 30,7%, respectivamente. A OS em pacientes com risco 0 foi significativamente maior (81,8%) do que os de risco 6 (20%) (p<0,001). Da mesma forma, pacientes com risco 0 tiveram menor NRM (13,6%) do que os com risco 6 (80%) (p=0,001). O estágio avançado da doença foi associado com aumento de RR em todas as patologias neoplásicas avaliadas. CONCLUSÃO: O escore de risco do EBMT pode ser utilizado como um dado adicional na avaliação de pacientes com doenças malignas e anemia aplástica severa com indicação de TCTH alogênico no nosso centro. / BACKGROUND: Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) is a treatment modality able to cure many hematological disorders. Although utilized with increasing frequency and success, it is still associated with a high transplant related mortality rate. In 2009, the EBMT risk score was validated as a simple tool to predict outcome after allogeneic HSCT for acquired hematological disorders. OBJECTIVES: The aim of this study was to validate the applicability of the EBMT risk score for allogeneic HSCT on south Brazilian patients, from a single center. METHODS: A retrospective observational study was performed based on patients’ records and data base of Hematology and Bone Marrow Transplantation Department at Hospital de Clínicas de Porto Alegre, including all allogeneic transplants for malignant and severe aplastic anemia from 1994 to 2010. Patients were categorized according to EBMT risk score and overall survival (OS), non-relapse mortality (NRM) and relapse rate (RR) were analyzed. RESULTS: There were 278 evaluable patients, of whom 56% were male, and the median age was 32 years. OS, NRM, and RR at five years median follow up, were 53,4%, 39%, and 30,7%, respectively. The OS was 81,8% for risk score 0 and 20% for score 6 (p<0,001), and NRM 13,6% and 80% for risk score 0 and 6, respectively (p=0,001). Advanced disease stage was associated with an increased RR in all evaluated neoplastic disorders. CONCLUSION: The EBMT risk score can be utilized as a tool for clinical decision-making before allogeneic HSTC for malignant hematological diseases and severe aplastic anemia at a single center, in Brazil.

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