BackgroundThe efficacy of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) therapy has already been established in clinical trials but their effectiveness in several clinical settings remains undetermined. This study aimed to assess the effectiveness of ICD and CRT-D therapies within the Brazilian National Health System (SUS).MethodsAll patients who underwent ICD or CRT-D implantation within the SUS from 2001 to 2007 were included in the study. We compared estimated Kaplan-Meier survival curves using the Peto’s test. Prognostic factors were selected using Cox’s models.ResultsThere were included 3,295 patients in the ICD group and 681 patients in the CRT-D group. Cardiac causes accounted for 79% of all deaths in both groups and Chagas’ heart disease accounted for 31% of these deaths. In the CRT-D group, survival significantly decreased around the fourth year of follow-up, with a decrease from 59.5% to 38.3% in 5.5 months. Transvenous implantation technique was used in 62% of CRT-D patients. In-hospital case-fatality rates were higher in those undergoing surgical implantation (5.3%) than those undergoing transvenous implantation (1.6%) (p = 0.02).ConclusionsThe results show that short-term, medium-term and long-term effectiveness of ICD therapy appears to be similar to that evidenced in clinical trials. In the CRT-D group, in-hospital case-fatality and 30-day case-fatality were higher than those reported in other studies. Surgical epicardial implantation technique was performed in this group at a higher frequency than that reported in the literature and was associated with poorer short-term prognosis.
BackgroundHeart valve surgery outcomes are unknown in middle-income countries and thus cannot be used in health system decision making processes. This study estimated in-hospital mortality and medium and long-term survival.MethodsThis was a retrospective study of 78,806 patients who underwent heart valve surgery between 2001 and 2007 in Brazil. Two national databases were used, the Hospital Information System and the Mortality Information System. Kaplan-Meier survival analysis and log-rank tests were performed. Maximum and median follow-up was 7.7 and 2.8 years, respectively (0.002–7.707).ResultsValve replacement accounted for 69.1% of procedures performed. Mitral stenosis, the most common valve injury, represented 38.9% of the total. In 94.7% of mitral stenosis patients, aetiology was rheumatic heart disease. In-hospital mortality was 7.6% and was higher for women, for patients who had undergone concomitant coronary artery bypass grafting (CABG) and for the elderly. Overall survival was 69.9% at the end of follow-up. Survival was worst among elderly, male and concomitant CABG patients (P<0.001).ConclusionsRheumatic heart disease is still a major public health problem in Brazil. In-hospital mortality and global survival rates of patients who have undergone heart valve surgery were less satisfactory than those reported in high-income countries. The findings of this study can contribute to guiding decision making processes in middle-income countries similar to Brazil and others concerned with improving the quality of care.
Pesquisa qualitativa sobre possibilidade de transposição e aplicabilidade da Estratégia de Ensino Metacognitivo (EEM) Embedded Metacognitive Prompts Based on Nature of Science. A estratégia utiliza módulos com comandos metacognitivos que direcionam o estudo de conteúdo científico baseado na natureza da ciência (NDC). O objetivo foi avaliar os constructos e teorias da pesquisa primária, relacioná-los com a descrição dos passos para e verificar as condições e possibilidade de sua reprodução no contexto escolar. Verificamos que as teorias sobre NDC, metacognição e autorregulação foram explicitadas e apresentadas de forma adequada para produção de protocolos com foco na utilização na educação básica, especialmente como suporte ao professor que pretenda utilizá-la. Entretanto, observamos limitações quanto à operacionalização e explicação insuficiente para a reprodução dos protocolos e necessidade de articulação entre os comandos metacognitivos, o aspecto da NDC e o conteúdo científico.
The advances in the biotechnology area imposes a new reality, creating products that are present in our daily lives, affecting directly ResumoOs avanços da ciência na área da Biotecnologia impõem uma nova realidade e cada vez mais os produtos destas pesquisas estão presentes no dia a dia, atingindo a população de forma direta ou indireta. Aplicações relacionadas às tecnologias do DNA nas áreas da indústria, agricultura e medicina esbarram em questões sociais e éticas, além das implicações ecológicas e sobre a saúde humana. Com o objetivo de criar uma alternativa para estimular alunos na carreira científica e no aprendizado da biotecnologia e biologia molecular, desenvolvemos um projeto de iniciação científica júnior com alunos do ensino médio do Instituto Federal de Educação, Ciência e Tecnologia do Espírito Santo, que visou à construção de um kit didático para o ensino prático da eletroforese. O kit construído neste trabalho é constituído por uma fonte de 70 V, por acessórios e reagentes de fácil obtenção, baixo custo e baixo risco à saúde dos usuários. Com o kit foi possível realizar corridas eletroforéticas tanto com ácidos nucleicos quanto com corantes alimentícios. O kit possui ainda uma apostila sobre Tecnologias do DNA e o manual de utilização do aparelho com sugestões de experimentos simulando teste de paternidade, casais em disputa por guarda de criança e identificação de vírus. A aplicação do kit em aulas práticas junto a alunos e professores da educação básica demonstrou eficácia ao reduzir o número de erros em respostas contidas em um questionário relacionado à eletroforese e suas aplicações. Professores de Biologia avaliaram positivamente o material impresso que acompanha o kit didático, 75% dos professores entrevistados consideraram a linguagem do material bastante adequada, a apresentação dos componentes do kit esclarecedora e a técnica executável para utilização em suas turmas.Palavras-chave: DNA; biotecnologia na escola; práticas de biologia; ensino de biologia molecular
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