In this sample, the greatest impairment of QoL in individuals with SCA10 was observed in "physical functioning" and "physical role".
Background: The rapid evaluation of non-contrast-enhanced computed tomography (NCCT) brain scans in patients with anterior stroke symptoms saves time and favors optimal and prompt treatment. e-ASPECTS is a tool that automatically calculates the Alberta Stroke Program Early CT Score (ASPECTS) values, leading to a more accurate and timely image evaluation. Objective: To determine the ability of e-ASPECTS in differentiating images with and without injury. Methods: One-hundred sixteen patients admitted to a stroke unit in a Brazilian tertiary hospital underwent a CT scan at admission and at least one control brain imaging (NCCT or magnetic resonance imaging - MRI) 24 hours after admission. ASPECTS evaluation was performed by three neuroradiologists, three neurologists, and three neurology residents, all blinded to the symptoms and the injury side. The scores were compared to the ground truth, and an ASPECTS score was provided by two independent non blinded evaluators. Sensitivity and specificity were analyzed, and receiver operating characteristic curves, Bland-Altman plots with mean error score, and Matthews correlation coefficients (MCCs) were obtained for ASPECTS scores, assuming values equal to 10 for images without injury and values other than 10 for images with ischemic injury. Results: e-ASPECTS demonstrated similar performance to that of neuroradiologists and neurologists, with an area under the curve of 0.78 and an MCC value of 0.48 in the dichotomous analysis. The sensitivity and specificity of e-ASPECTS were 75% and 73%, respectively. Conclusion: e-ASPECTS is a validated and reliable tool for determining early signs of ischemia in NCCT.
Validação psicométrica do instrumento Creighton para avaliação de competências clínicas em simulação Psychometric validation of the Creighton Competency Evaluation Instrument in simulation Validación psicométrica del instrumento Creighton para evaluar competencias clínicas en simulacro
Introdução: Os períodos gestacional e puerperal são ideais para o aconselhamento do planejamento familiar. A Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO) aconselha o uso dos dispositivos intrauterinos no puerpério, após o parto transpélvico ou cesárea. A inserção após o parto se divide em imediata (até 10 minutos após a dequitação placentária), precoce (entre 10 minutos e 48 horas de pós-parto) ou tardia (após 4 semanas de pós-parto). Sua principal complicação é a expulsão, e está relacionada ao momento da inserção. Objetivo: Analisar o perfil epidemiológico das participantes e comparar as taxas de expulsão entre dois dispositivos intrauterinos, o DIU-TCu380A e o Sistema Intrauterino Liberador de Levonorgestrel (SIU-LNG), inseridos durante o pós-parto e transcesárea, sob diferentes técnicas e períodos. Métodos: Os dispositivos foram oferecidos a 206 puérperas da Maternidade Victor Ferreira do Amaral de Curitiba - PR, 117 optaram pelo SIU-LNG e 89 pelo DIU-TCu308A. Foram incluídas 155 participantes, 15 (9,67%) inserções ocorreram durante a cesárea e 140 (90,32%) após o parto transpélvico. Após 45 dias da inserção, foi realizada uma avaliação ginecológica e ultrassonográfica do dispositivo. Em relação à inserção após o parto transpélvico, o estudo foi dividido em 4 fases de acordo com a técnica de inserção utilizada. A primeira fase (n: 34; 21,93%) utilizou o aplicador do produto. A segunda (n: 12; 7,74%), utilizou o aplicador com o pinçamento do colo uterino. A terceira (n: 14; 9,03%) utilizou a Pinça Cheron 25cm. E a quarta fase (n: 80; 51,61%), a Pinça Collin Coração Curva 24cm. Resultados: A idade média das participantes foi de 27,1 anos (±5,9) e a paridade 2,1 filhos (±1,1). As taxas de expulsão foram de 44% (n: 15), 42% (n: 5) e 36% (n: 5) nas três primeiras fases, e 13,75% (n: 11) na última fase (p=0,00028). O SIU-LNG apresentou 14,6% de expulsões (n: 7) e o DIU-TCu380A 12,5% (n: 5)(p=0,7751). No pós-parto, a taxa de insucesso de ambos os dispositivos foi de 13,8% (n: 11) e na cesárea de 6,6% (n: 1)(p=0,403). Conclusão: A população estudada apresentou faixa etária entre 21 e 30 anos e possuía até 2 filhos. A maioria (56,2%) estava em união estável e 92% declarou-se satisfeita ou muito satisfeita com o uso do DIU. A técnica de inserção utilizada na fase 4 obteve melhores resultados. As variáveis relacionadas ao tipo de inserção, o tempo de inserção e o dispositivo usado não interferiram na taxa de expulsão. Descritores: Medidas em epidemiologia, Anticoncepção, Período pós-parto, Dispositivos intrauterinos, Expulsão de dispositivo intrauterinoABSTRACTIntroduction: The gestational and puerperal period are ideal for family planning. The Brazilian Federation of Gynecology and Obstetrics Associations advises the intrauterine devices in puerperium after transpelvic delivery or during cesarean. Postpartum insertion is divided into immediate (up to 10 minutes after placental clearance), early (between 10 minutes and 48 hours postpartum) or late (after 4 weeks postpartum). Expulsion is the main complication, and is related to the time of insertion. Objective: Analyze the epidemiological profile and compare the expulsion rates between two intrauterine devices, the IUD-TCu380A and the Levonorgestrel Releasing Intrauterine System (SIU-LNG), inserted during postpartum and transceiver, under different techniques and periods. Methods: The devices were offered to 206 postpartum women of Victor Ferreira do Amaral Maternity of Curitiba - PR, 117 opted for SIU-LNG and 89 for IUD-TCu308A. Were included 155, 15 (9.67%) insertions occurred in cesarean and 140 (90.32%) after transpelvic delivery. After 45 days insertion, was performed a gynecological and ultrasonographic evaluation. The insertion after transpelvic delivery was divided into 4 phases according to the insertion technique. The first phase (n: 34; 21.93%) used the product applicator. The second (n: 12; 7.74%) used the applicator with cervical clamping. The third (n: 14; 9.03%) used Cheron Tweezers 25cm. And the fourth phase (n: 80; 51.61%), Collin Heart Curved Tweezers 24cm. Results: The participants' mean age was 27.1 (±5.9) and parity 2.1 (±1.1). The expulsion rates were 44% (n: 15), 42% (n: 5) and 36% (n: 5) in the first three phases, and 13.75% (n: 11) in the last phase (p=0.00028). SIU-LNG presented 14.6% of expulsions (n: 7) and IUD-TCu380A 12.5% (n: 5) (p=0.7751). Postpartum failure rate was 13.8% (n: 11) and cesarean 6.6% (n: 1) (p=0.403). Conclusion: Approximately 2/3 of women were up to 30 years old and up to 2 children. The insertion technique used in phase 4 obtained better results. Variables related to insertion type, insertion time and the device used did not affect the expulsion rate.Keywords: Epidemiologic studies, Contraception, Postpartum period, Intrauterine devices. Intrauterine device expulsion
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