JOAQUIM EDSON VIEIRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
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- Is the Bland-Altman plot method useful without inferences for accuracy, precision, and agreement?(2024) SILVEIRA, Paulo Sergio Panse; VIEIRA, Joaquim Edson; SIQUEIRA, Jose de OliveiraOBJECTIVE: This study aims to propose a comprehensive alternative to the Bland -Altman plot method, addressing its limitations and providing a statistical framework for evaluating the equivalences of measurement techniques. This involves introducing an innovative three -step approach for assessing accuracy, precision, and agreement between techniques, which enhances objectivity in equivalence assessment. Additionally, the development of an R package that is easy to use enables researchers to efficiently analyze and interpret technique equivalences. METHODS: Inferential statistics support for equivalence between measurement techniques was proposed in three nested tests. These were based on structural regressions with the goal to assess the equivalence of structural means (accuracy), the equivalence of structural variances (precision), and concordance with the structural bisector line (agreement in measurements obtained from the same subject), using analytical methods and robust approach by bootstrapping. To promote better understanding, graphical outputs following Bland and Altman's principles were also implemented. RESULTS: The performance of this method was shown and confronted by five data sets from previously published articles that used Bland and Altman's method. One case demonstrated strict equivalence, three cases showed partial equivalence, and one showed poor equivalence. The developed R package containing open codes and data are available for free and with installation instructions at Harvard Dataverse at https://doi.org/10.7910/DVN/AGJPZH. CONCLUSION: Although easy to communicate, the widely cited and applied Bland and Altman plot method is often misinterpreted, since it lacks suitable inferential statistical support. Common alternatives, such as Pearson's correlation or ordinal least -square linear regression, also fail to locate the weakness of each measurement technique. It may be possible to test whether two techniques have full equivalence by preserving graphical communication, in accordance with Bland and Altman's principles, but also adding robust and suitable inferential statistics. Decomposing equivalence into three features (accuracy, precision, and agreement) helps to locate the sources of the problem when fixing a new technique.
- Ultrasound-guided pericapsular nerve group and obturator nerve phenol neurolysis for refractory inpatient hip cancer metastasis pain: a case report(2024) V, Marcio Pimenta; NAKAMURA, Amanda T.; ASHMAWI, Hazem A.; VIEIRA, Joaquim E.; FERNANDES, Hermann dos SantosIntroduction: Bone cancer metastasis may produce severe and refractory pain. It is often difficult to manage with systemic analgesics. Chemical neurolysis may be an effective alternative in terminally ill patients. Case report: Female terminally ill patient with hip metastasis of gastric cancer in severe pain. Neurolytic ultrasound-guided blocks of the pericapsular nerve group and obturator nerve were performed with 5% phenol. This led to satisfactory pain relief for 10 days, until the patient's death. Discussion: This approach may be effective and safe as an analgesic option for refractory hip pain due to metastasis or pathologic fracture in terminally ill patients. (c) 2021 Sociedade Brasileira de Anestesiologia.
- Comparison of terbutaline and atosiban as tocolytic agents in intrauterine repair of myelomeningocele: a retrospective cohort study(2024) SANTOS, Shirley Andrade; NANI, Fernando Souza; MOURA, Elaine Imaeda de; CARVALHO, Diogo Lima de; MIGUEL, Guilherme Jorge Mattos; HADDAD, Cristiane Maria Federicci; VIEIRA, Joaquim Edson; BUNDUKI, Victor; CARVALHO, Mario Henrique Burlacchini de; FRANCISCO, Rossana Pulcineli Vieira; CARDEAL, Daniel Dante; FERNANDES, Hermann dos SantosBackground: Myelomeningocele (MMC) is a neural tube defect disease. Antenatal repair of fetal MMC is an alternative to postnatal repair. Many agents can be used as tocolytics during the in utero fetal repair such as b2-agonists and oxytocin receptor antagonists, with possible maternal and fetal repercussions. This study aims to compare maternal arterial blood gas analysis between terbutaline or atosiban, as tocolytic agents, during intrauterine MMC repair. Methods: Retrospective cohort study. Patients were divided into two groups depending on the main tocolytic agent used during intrauterine MMC repair: atosiban (16) or terbutaline (9). Maternal arterial blood gas samples were analyzed on three moments: post induction (baseline, before the start of tocolysis), before extubation, and two hours after the end of the surgery. Results: Twenty- five patients were included and assessed. Before extubation, the terbutaline group showed lower arterial pH (7.347 +/- 0.05 vs. 7.396 +/- 0.02 for atosiban, p = 0.006) and higher arterial lactate (28.33 +/- 12.76 mg.dL - 1 vs. 13.06 +/- 6.35 mg.dL - 1 , for atosiban, p = 0.001) levels. Conclusions: Patients who received terbutaline had more acidosis and higher levels of lactate, compared to those who received atosiban, during intrauterine fetal MMC repair. (c) 2024 Sociedade Brasileira de Anestesiologia.
- The progress test as a structuring initiative for programmatic assessment(2024) ALAVARCE, Debora Cristina; MEDEIROS, Melyssa Lima de; VIANA, Danylo de Araujo; ABADE, Flavia; VIEIRA, Joaquim Edson; MACHADO, Jose Lucio Martins; COLLARES, Carlos FernandoBackground The Progress Test is an individual assessment applied to all students at the same time and on a regular basis. The test was structured in the medical undergraduate education of a conglomerate of schools to structure a programmatic assessment integrated into teaching. This paper presents the results of four serial applications of the progress test and the feedback method to students.Methods This assessment comprises 120 items offered online by means of a personal password. Items are authored by faculty, peer-reviewed, and approved by a committee of experts. The items are classified by five major areas, by topics used by the National Board of Medical Examiners and by medical specialties related to a national Unified Health System. The correction uses the Item Response Theory with analysis by the ""Rasch"" model that considers the difficulty of the item.Results Student participation increased along the four editions of the tests, considering the number of enrollments. The median performances increased in the comparisons among the sequential years in all tests, except for test1 - the first test offered to schools. Between subsequent years of education, 2nd-1st; 4th-3rd and 5th-4th there was an increase in median scores from progress tests 2 through 4. The final year of undergraduate showed a limited increase compared to the 5th year. There is a consistent increase in the median, although with fluctuations between the observed intervals.Conclusion The progress test promoted the establishment of regular feedback among students, teachers and coordinators and paved the road to engagement much needed to construct an institutional programmatic assessment.