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[Evaluation of the quality of the care given to elderly patients in nursing homes].
The aim of this study is to evaluate the quality of care for elderly patients in nursing homes. The sample was obtained from a sample of files containing resident’s health records (N = 4,147) from nursing homes in the State of Paraná, Brazil, in 2005. There was a total of 674 files randomly selected; the data that considered care quality were extracted from these files. The care evaluation methods used were: 100% medical records data, indicators of nursing and medicine, and interviews with the nurses and nursing team. The results showed significant differences between the care given to the elderly patients according to the Nursing Home Group and the average score. The qualitative evaluation of the care showed that lack of teaching and supervision by the nursing team and medicines and nursing team are the major deficiencies.Safety and efficacy of plasmapheresis as first-line treatment for atypical hemolytic uremic syndrome.
We report the results of plasmapheresis, a highly effective and safe first-line therapy in 5 children with atypical hemolytic uremic syndrome (aHUS). All children received plasmapheresis within 5 days of diagnosis, and in all cases the aHUS phenotype was confirmed by genetic analysis. Plasmapheresis was initially indicated for microangiopathic thrombocytopenia purpura and was initially instituted because of refractory thrombocytopenia and microangiopathic hemolytic anemia. Before plasmapheresis, 4 of 5 children were on dialysis. One child showed rapid recovery after single plasmapheresis, whereas in 4 children, dialysis was temporarily discontinued after a few sessions of plasmapheresis. After a median of 10 sessions (range, 5-14), platelet count, renal function, and anemia returned to normal. Two children had anti-factor H autoantibodies before plasmapheresis; after plasmapheresis, all remained negative. No patient required a second plasmapheresis. Platelet counts, thrombocytopenia, and microangiopathic hemolytic anemia recurred in 4 of 5 patients. Median follow-up time was 34 months (range, 4-100). Analyses of genetic mutations in children with aHUS are