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OALib Journal期刊

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The simple and the simpler in pneumonia diagnosis
Thiago Lisboa, Jordi Rello
Critical Care , 2007, DOI: 10.1186/cc5933
Abstract: El Solh and coworkers [1] present an interesting study in which they evaluated use of quantitative endotracheal aspirate (QEA) cultures as a diagnostic tool for determining presence of pneumonia in ventilated patients admitted from nursing homes. The 2005 American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) guidelines [2] recommend that the approach to such patients should be like that in patients with ventilator-associated pneumonia (VAP). One of the strengths of this study is that it evaluates this specific population. The study compared the diagnostic accuracy of QEA with that of protected specimen brush (PSB) and bronchoalveolar lavage (BAL). Unfortunately, the impact of the findings on antibiotic therapy and patient outcomes was not assessed. Other potential limitations not discussed in the report include the lack of evaluation of QEA sample quality, which is a major problem in interpretation of study findings [3], and failure to consider the influence of co-morbidities such as chronic obstructive pulmonary disease (COPD).The study shows that bacterial counts obtained through QEA correlate with those obtained by PSB (r = 0.71) and BAL (r = 0.77). However, Table 2 highlights an important weakness of aetiological diagnosis based on a threshold; Staphylococcus aureus was isolated in 50% more cases in BAL samples as compared with PSB samples, using the recommended threshold. Furthermore, the authors constructed receive operating characteristic (ROC) curves to evaluate the diagnostic accuracy of QEA, and found a sensitivity of 90% and a specificity of 77% when 104 colony-forming units/ml was used as the diagnostic threshold. The threshold of 104 colony-forming units/ml is lower than thresholds recommended by IDSA/ATS [2] to differentiate colonization from infection in QEA cultures. Therefore, what threshold should be used at the bedside?Use of bacterial counts as a diagnostic threshold in pneumonia has been proposed to differentiate colonizat
C-reactive protein in community-acquired sepsis: you can teach new tricks to an old dog
Jorge IF Salluh, Thiago Lisboa
Critical Care , 2011, DOI: 10.1186/cc10301
Abstract: Assessment of clinical resolution criteria and response to treatment in sepsis is a complex and unresolved issue. The intricate pathophysiology limits our ability to anticipate outcomes and to effectively use tools to improve the decision-making process in sepsis. In the previous issue of Critical Care, Póvoa and colleagues [1] provide us clinically relevant data on how we can obtain the best information when using a biomarker to assess clinical response and identify relevant evolution patterns in septic patients.This large observational multicenter study evaluated serial C-reactive protein (CRP) measurements to describe the clinical course of community-acquired sepsis in patients admitted to the ICU. Instead of using a traditional approach for biomarker evaluation (that is, analyzing mean differences of absolute values), the authors performed a complex analysis of serial measurements of CRP within 5 days of ICU admission. As early as day 3, a clinical response pattern was identified as a function of CRP variation and was assessed as the ratio between CRP value on each day and the baseline CRP. This approach of dynamic evaluation using the CRP ratio was used in different studies involving patients with ventilator-associated pneumonia (VAP) to assess an association between CRP variation and appropriateness of antibiotic therapy [2,3]. Although CRP is frequently criticized because of its relative unspecific increases occurring as a result of several non-infectious inflammatory stimuli, CRP values usually present a sharp decrease after the withdrawal of the inflammatory injury [4]. Therefore, when the patient is his or her own control (that is, a relative variation in the same patient is considered a marker for clinical response), we may control for the potential differences secondary to different base-line inflammation response level and assess the variation occurring according to the actual resolution of infectious stimulus.In the original study evaluating clinical r
Prevención de infecciones nosocomiales: estrategias para mejorar la seguridad de los pacientes en la Unidad de Cuidados Intensivos
Lisboa,T.; Rello,J.;
Medicina Intensiva , 2008,
Abstract: infection prevention is an intervention opportunity to promote patient safety. the strategies to obtain the full implementation of available prevention measures is the main challenge in clinical practice. using care bundles, continuing education and feedback on adherence to the measures proposed are key points to improve the safety of patients in the intensive care unit.
Fluxos migratórios de mulheres para o trabalho reprodutivo: a globaliza??o da assistência
Lisboa, Teresa Kleba;
Revista Estudos Feministas , 2007, DOI: 10.1590/S0104-026X2007000300017
Abstract: based on an experience as a member of the group that worked with the theme of migration of women at the internationale frauen universit?t (ifu) in 2000, this article presents a discussion about the migratory flows of women who work as domestic servants. there is a true globalization of assistance in this process, which even establishes chains between women of different nations, classes and ethnicities. the main causes of the migrations are linked to the struggle for survival and the opportunity to work, study and achieve independence from violence and oppression. i propose that, to contain migratory flows, public policies that meet the basic needs of the women in their countries of origin are necessary.
VERTICAL TRANSMISSION OF HTLV-I/II: A review
BITTENCOURT, Achiléa Lisboa;
Revista do Instituto de Medicina Tropical de S?o Paulo , 1998, DOI: 10.1590/S0036-46651998000400008
Abstract: the vertical transmission of the human t-cell lymphotropic virus type i (htlv-i) occurs predominantly through breast-feeding. since some bottle-fed children born to carrier mothers still remain seropositive with a frequency that varies from 3.3% to 12.8%, an alternative pathway of vertical transmission must be considered. the prevalence rate of vertical transmission observed in japan varied from 15% to 25% in different surveys. in brazil there is no evaluation of this form of transmission until now. however, it is known that in salvador, bahia, 0.7% to 0.88% of pregnant women of low socio-economic class are htlv-i carriers. furthermore the occurrence of many cases of adult t-cell leukemia/lymphoma and of four cases of infective dermatitis in salvador, diseases directly linked to the vertical transmission of htlv-i, indicates the importance of this route of infection among us. through prenatal screening for htlv-i and the refraining from breast-feeding a reduction of ~ 80% of vertical transmission has been observed in japan. we suggest that in brazil serologic screening for htlv-i infection must be done for selected groups in the prenatal care: pregnant women from endemic areas, japanese immigrants or japanese descendents, intravenous drug users (idu) or women whose partners are idu, human immunodeficiency virus carriers, pregnant women with promiscuous sexual behavior and pregnant women that have received blood transfusions in areas where blood donors screening is not performed. there are in the literature few reports demonstrating the vertical transmission of htlv-ii.
Em busca de uma política externa brasileira de meio ambiente: três exemplos e uma exce??o à regra
LISBOA, MARIJANE VIEIRA;
S?o Paulo em Perspectiva , 2002, DOI: 10.1590/S0102-88392002000200006
Abstract: brazil′s foreign environmental policy lacks clear principles, objectives and strategies. in its failure to understand the significance of sustainable development, the itamaraty often favors short-term economic interests, to the detriment of environmental protection. the basil convention, the cartagena protocol and the stockholm convention are three supporting examples of this thesis, while the convention on climate change is the exception that confirms the rule.
Gênero, feminismo e Servi?o Social: encontros e desencontros ao longo da história da profiss?o
Lisboa, Teresa Kleba;
Revista Katálysis , 2010, DOI: 10.1590/S1414-49802010000100008
Abstract: this article looks at the growing needs found in situations that involve the issue of gender in the common intervention of social workers. it discusses the gap between social work and feminist studies, by sketching a historic parallel between the trajectories of the two fields. it criticizes the submission of the profession to andro-centric theories that exercise power and control in the production of knowledge. it suggests that feminist theories and gender studies provide significant theoretical and methodological support for social work. the paper questions "how to guarantee equality while respecting differences," and points to the principal critical areas that impede the development of women and mark gender inequality. it concludes that the adoption of a gender perspective in theoretical mediations allows a new look at reality, based on women and with women, revolutionizing the order of power and submission.
Infec o por patógenos multi-resistentes na UTI: como escapar? Infection with multi-resistant agents in the ICU: how to escape?
Thiago Lisboa,Fabiano Nagel
Revista Brasileira de Terapia Intensiva , 2011, DOI: 10.1590/s0103-507x2011000200003
Abstract:
A Gauchidade Midiática no RS: Apontamentos sobre a Cultura Regional na Mídia
Flavi Ferreira Lisboa Filho
Revista Comunica??o Midiática , 2012,
Abstract: In this work we try to presenting mediatic experiences that explore the “gauchidade” (a regional culture) in the cities of Rio Grange do Sul, in addition to make a panorama about the emergence of television in the state of Rio Grande do Sul, Brazil, and the influence of local television producers. Thus, we concluded that the exploring of ‘gauchidade’ in the media is a dynamic and changeable phenomenon that allows people to personalize their practice, embody the culture they belong in their way and demonstrate their feeling, their affection and memories. However, it is clean that this phenomenon praises the month of September, when the media and the subjects of this state show their involvement with the regional culture in many ways.
“Até ao fim do mundo”: Amor, rancor e guerra em Hélia Correia “To the end of the world”: Love, resentment and war in Hélia Correia “Jusqu’à la fin du monde” : amour, ranc ur et guerre chez Hélia Correia
Maria Manuel Lisboa
Revista Crítica de Ciências Sociais , 2012, DOI: 10.4000/rccs.1081
Abstract: A pe a de teatro de Hélia Correia, O rancor: Exercício sobre Helena, oferece a base para uma análise textual do entendimento clássico e moderno do papel da mulher no contexto da guerra. As mulheres, na vers o contemporanea de Hélia Correia, reproduzem e acentuam alguns dos indícios já disseminados pela tragédia e epopeia gregas, nomeadamente a problemática da sexualidade feminina e da paix o, enquanto for as contrapostas ao instinto belicoso masculino, por aquelas eventualmente derruido. A leitura aqui apresentada focaliza aspectos variados da justaposi o dos sexos no contexto da guerra: nomeadamente, a dinamica entre m e e filha enquanto agentes de um feminino solidário em confronta o com o imperativo belicoso masculino; a rela o m e-filho conforme inscrita no dilema edipiano filial de op o entre o pai guerreiro e a m e atavicamente amada; a quest o da maternidade/paternidade e do sacrifício voluntário ou recusado de filhos e filhas aos interesses da guerra; e o problema da representa o passional do inimigo enquanto objecto de desejo e figura o do ideal do bem-amado. Hélia Correia’s play O rancor: Exercício sobre Helena is the basis for a textual analysis of both classical and modern understandings of the role of women in the context of war. In Hélia Correia’s contemporary version, women reproduce and highlight some of the signs already present in Greek tragedy and epic poetry in what concerns the problematic of female sexuality and passion, as countervailing forces to the male warlike instinct, which they eventually overthrow. The reading presented here focuses on different aspects of the juxtaposition of the sexes in the context of war: namely, the dynamic between mother and daughter as agents of female solidarity in confrontation with the male warlike imperative; the mother-son relationship as inscribed in the filial oedipal dilemma of choice between the warrior father and the atavistically loved mother; the question of maternity/paternity and of the voluntary or refused sacrifice of sons and daughters to the interests of war; and the problem of the passional representation of the enemy as an object of desire and figuration of the ideal of the beloved. La pièce de théatre d’Hélia Correia, La ranc ur : exercice sur Helena, sert ici de fond pour une analyse textuelle de l’appréhension classique et moderne du r le de la femme dans le contexte de la guerre. Les femmes, dans la version contemporaine d’Hélia Correia, reproduisent et relèvent certains indices disséminés par la tragédie et l’épopée grecques, notamment la problématique de la sexualité
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