RODRIGO DIAZ OLMOS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
DVCLME-62, Hospital Universitário
DVCLME-62, Hospital Universitário
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
conferenceObject Zero calcium scores is not reliable to rule out coronary artery disease in the emergency room(2012) STANIAK, Henrique L.; BITTENCOURT, Marcio S.; SHAROVSKY, Rodolfo; BENSENOR, Isabela; GOULART, Alessandra; CASTRO, Claudio C.; SANTOS, Itamar; OLMOS, Rodrigo; LOTUFO, PauloIntroduction: Several diagnostic tools have been proposed to investigate patients with acute chest pain in the emergency room. Recently, coronary computed angiotomography (CTA) has been studied for this purpose. Since CTA has some limitations including the use of ionizing radiation, iodine contrast and the need of drugs such as beta blockers and nitrates to achieve good image quality some authors have suggested that a negative calcium score would yield those patients with very low risk in which CTA could be safely avoided. Objectives: Evaluate the diagnostic accuracy of a negative calcium score when compared with CTA in the acute setting and subsequent downstream evaluation Methods: 65 patients (32 female) with acute chest pain, normal eletrocardiogram and cardiac biomarkers who underwent calcium score and CTA which had a negative calcium score were included. The exams were performed in a 64 detectors CT device with standard settings, and the CTA was performed using prospective acquisition, after beta blocker and nitrate unless contraindicated. The calcium score exams were compared to the CTA results. The CTA was considered positive if any lesion 50% was identified. Results: 65 patients were evaluated from February to August 2011. The mean age was 53.8 14.7 years and mean heart rate was 62 bpm. 2 of these zero calcium scores had non obstructive disease (50%), 3 of these zero calcium scores had obstructive disease and 1 patient had an invaluable CTA due to motion artifacts. These last 4 patients were furtherstratified with invasive coronary angiography and all 4 underwent coronary angioplasty. Conclusion: 8.2% of the patients with coronary artery disease would be misdiagnosed if coronary calcium score was used as the sole imaging strategy in this sample. Not only that, 4 patients which had an intervention performed would remain untreated.- Cerebrovascular risk factors and their time-dependent effects on stroke survival in the EMMA cohort study(2023) GOULART, A. C.; VARELLA, A. C.; TUNES, G.; ALENCAR, A. P.; SANTOS, I. S.; ROMAGNOLLI, C.; GOODEN, T. E.; THOMAS, G. N.; LIP, G. Y. H.; OLMOS, R. D.; LOTUFO, P. A.; BENSENOR, I. M.To investigate the time-dependent effects of traditional risk factors on functional disability in all-cause mortality post-stroke, we evaluated data from a long-term stroke cohort. Baseline cerebrovascular risk factors (CVRF) and functionality at 1 and 6 months were evaluated in survivors from a prospective stroke cohort using the modified Rankin scale (m-RS), which classifies participants as improvement of disability, unchanged disability (at least moderate), and worsening disability. Cox regression models considering baseline risk factors, medication use, and functionality 6 months after stroke were fitted to identify their time-dependent effects up to 12 years of follow-up. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) are presented. Among 632 survivors (median age 68, 54% male, 71% first-ever episode), age and functional disability (unchanged and worsening) 6 months after ischemic stroke had time-dependent effects on all-cause mortality risk up to 12 years of follow-up. The most impacting risk factors were unchanged (at least moderate) (HR, 2.99; 95%CI: 1.98-4.52) and worsening disability (HR, 2.85; 95%CI: 1.26-6.44), particularly in the first two years after a stroke event (Time 1: >= 6 mo to <2.5 y). Worsening disability also impacted mortality in the period from >= 2.5 to <7.5 years (Time 2) of follow-up (HR, 2.43 (95%CI: 1.03-5.73). Other baseline factors had a fixed high-risk effect on mortality during follow-up. Post-stroke and continuous medication use had a fixed protective effect on mortality. Functional disability was the main contributor with differential risks of mortality up to 12 years of follow-up.
- Shadow'' OSCE examiner. A cross-sectional study comparing the shadow'' examiner with the original OSCE examiner format(2019) RODRIGUES, Marcelo Arlindo Vasconcelos; OLMOS, Rodrigo Diaz; KIRA, Celia Maria; LOTUFO, Paulo Andrade; SANTOS, Itamar Souza; TIBERIO, Iolanda de Fatima Lopes CalvoOBJECTIVES: Feedback is a powerful learning tool, but a lack of appropriate feedback is a very common complaint from learners to teachers. To improve opportunities for feedback on objective structured clinical examinations (OSCEs), a modified examiner role, termed the ""shadow'' examiner, was tested. This study aims to present and analyze comparisons between the ""shadow'' examiner and the original OSCE examiner format. METHODS: In 2011, experiments were carried out with modifications to the examiner's role to define the ""shadow'' examiner format. From February 2012 to May 2014, research was conducted with 415 6th-year medical students. Of these students, 316 were randomly assigned to assessments by both ""shadow'' and ""fixed'' examiners. Pearson correlation analysis with linear regression, Student's t-tests and Bland-Altman plots were the statistical methods used to compare the assessment modes. To strengthen the analysis, checklist items were classified by domain. RESULTS: High correlations between the ""shadow'' and ""fixed'' examiners' global scores were observed. The results of the analysis of specific domains demonstrated higher correlations for cognitive scores and lower correlations for affective scores. No statistically significant differences between the mean examiner global scores were found. The Bland-Altman analysis showed that the ""shadow'' examiners' affective scores were significantly higher than those of the ""fixed'' examiners, but the magnitude of this difference was small. CONCLUSION: The modified examiner role did not lead to any important bias in the students' scores compared with the original OSCE examiner format. This new strategy may provide important insights for formative assessments of clinical performance.
- Atrial fibrillation in low- and middle-income countries: a narrative review(2020) SANTOS, Itamar S.; GOULART, Alessandra C.; OLMOS, Rodrigo D.; THOMAS, G. Neil; LIP, Gregory Y. H.; LOTUFO, Paulo A.; BENSENOR, Isabela M.Preventing premature non-communicable disease mortality necessitates a thorough review of one of the most important risk factors for stroke, which is atrial fibrillation (AF). The latter and AF-related stroke are still considered to be problems of high-income countries and are frequently overlooked in low- and middle-income countries (LMICs). In this narrative review, we provide an overview of studies that evaluated at least one of the following determinants of AF burden in LMICs: current epidemiology and trends, stroke prevention, health outcomes, and economic burden. Studies focusing on samples close to the general population (including community- and primary care-based samples) indicate sex-specific prevalence rates up to 7.4% in LMICs. Although AF prevalence is still higher in high-income countries than LMICs, the gap in AF burden between these two groups has been reducing in the past three decades. Oral anticoagulant (OAC) therapy for stroke prevention is underused in LMICs, and there are little data on OAC therapy in relation to stroke risk scores, such as CHA(2)DS(2)-VASc. Available data also points to higher morbidity and mortality for patient with AF in LMICs than their counterparts in high-income countries. Data on the consequent economic burden in LMICs is scarce, but it is reasonable to consider it will follow the same trend as that observed for health outcomes. Raising the visibility of AF as a public health problem in LMICs is necessary as a first step to providing adequate care for patients with this condition.
- Cardiovascular medications and long-term mortality among stroke survivors in the Brazilian Study of Stroke Mortality and Morbidity (EMMA)(2022) SOUZA, Karla A. S.; VARELLA, Ana C.; OLMOS, Rodrigo D.; ROMAGNOLLI, Carla; GOODEN, Tiffany E.; THOMAS, G. Neil; LIP, Gregory Y. H.; SANTOS, Itamar S.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; GOULART, Alessandra C.Aim To investigate the association between medication use and long-term all-cause mortality in a Brazilian stroke cohort. Methods Both ischemic and hemorrhagic stroke were evaluated. Medication use was assessed as: never, only pre-stroke, only post-stroke, and continuous use. We evaluated anti-hypertensives, anti-diabetics, lipid-lowering drugs, anti-platelets, and anti-coagulants. Cox regression models were adjusted for sociodemographic and cardiovascular risk factors. Results Among 1173 incident stroke cases (median age: 68; 86.8% were ischemic, 70% first-ever stroke), medication use was low (overall: 17.5% pre-stroke, 26.4% post-stroke, and 40% were under continuous use). Anti-hypertensives and anti-platelets (aspirin) were the continuous cardiovascular medications used most often, at 83.5% and 72%, respectively, while statins (39.7%) and anti-diabetics (31.3%) were the least used. Medication use (pre-stroke, post-stroke and continuous use) was associated with a reduction in all-cause mortality risk, particularly among those under continuous use (multivariable hazard ratio, 0.52; 95% confidence interval (CI), 0.46-0.66) compared with never-users. Among ischemic stroke patients, this effect was similar (multivariable hazard ratio, 0.52; 95% CI, 0.40-0.68). No significant associations were evident among hemorrhagic stroke patients. Conclusions The risk of all-cause mortality was reduced by 48% among those with ischemic stroke under continuous use of medications. Secondary prevention should be emphasized more strongly in clinical practice. Geriatr Gerontol Int 2022; center dot center dot: center dot center dot-center dot center dot.
- Patient and Public Involvement and Engagement (PPIE): first steps in the process of the engagement in research projects in Brazil(2022) BENSENOR, I. M.; GOULART, A. C.; THOMAS, G. N.; LIP, G. Y. H.; ARASALINGAM, Ajini; BEANE, Abi; BENSENOR, Isabela M.; BROCKLEHURST, Peter; CHENG, Kar Keung; EL-BOURI, Wahbi; FENG, Mei; GREENFIELD, Sheila; GUO, Yutao; GURUPARAN, Mahesan; GUSSO, Gustavo; GOODEN, Tiffany E.; HANIFFA, Rashan; HUMPHREYS, Lindsey; JOLLY, Kate; JOWETT, Sue; KODIPPILY, Chamira; KUMARENDRAN, Balachandran; LANCASHIRE, Emma; LANE, Deirdre A.; LI, Xuewen; LIP, Gregory Y. H.; LI, Yan-guang; LOBBAN, Trudie; LOTUFO, Paulo A.; MANASEKI-HOLLAND, Semira; MOORE, David; NIRANTHARAKUMAR, Krishnarajah; OLMOS, Rodrigo D.; PASCHOAL, Elisabete; PIRASANTH, Paskaran; POWSIGA, Uruthirakumar; ROMAGNOLLI, Carla; SANTOS, Itamar S.; SHANTSILA, Alena; SHERON, Vethanayagan Antony; SHRIBAVAN, Kanesamoorthy; SZMIGIN, Isabelle; SUBASCHANDREN, Kumaran; SURENTHIRAKUMARAN, Rajendra; TAI, Meihui; THAVARAJAH, Bamini; THOMAS, G. Neil; TOIPPA, Timo; VARELLA, Ana C.; WANG, Hao; WANG, Jingya; ZHANG, Hui; ZHONG, JiaoyuePatient and Public Involvement and Engagement (PPIE) - sometimes called Community Engagement and Involvement (CEI) - comes as a big challenge but one that can be very helpful for health care professionals and stakeholders in planning better health policies for attending to the main needs of the community. PPIE involves three pillars: public involvement, public engagement, and participation. Public involvement occurs when members of the general population are actively involved in developing the research question, designing, and conducting the research. Public engagement tells people about new studies, why they are important, the impact of results, the possible implication of the main findings for the community, and the possible impact of these new findings in society, as well as, in the dissemination of knowledge to the general population. Participation is being a volunteer in the study. Our experience with PPIE, to the best of our knowledge the first initiative in Brazil, is a partnership with the University of Birmingham, the University of Liverpool, and the NIHR Global Health Group on Atrial Fibrillation (AF) Management focusing on the AF care pathway exploring the important aspects of diagnosis and treatment in the primary care system from a low-middle income area in Sao Paulo. The involvement of patients/public in the research represents a new step in the process of inclusion of all segments of our society based on patient illness and the gaps in knowledge aiming to open new horizons for continuous improvement and better acceptance of research projects.
- The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity(2022) GOULART, Alessandra C.; OLMOS, Rodrigo Diaz; SANTOS, Itamar S.; TUNES, Gisela; ALENCAR, Airlane P.; THOMAS, Neil; LIP, Gregory Y. H.; LOTUFO, Paulo A.; BENSENOR, Isabela M.Background Atrial fibrillation is a predictor of poor prognosis after stroke. Aims To evaluate atrial fibrillation and all-cause and cardiovascular mortality in a stroke cohort with low socioeconomic status, taking into consideration oral anticoagulant use during 12-year follow-up. Methods All-cause mortality was analyzed by Kaplan-Meier survival curve and Cox regression models to estimate hazard ratios and 95% confidence intervals (95% CI). For specific mortality causes, cumulative incidence functions were computed. A logit link function was used to calculate odds ratios (OR) with 95% CIs. Full models were adjusted by age, sex, oral anticoagulant use (as a time-dependent variable) and cardiovascular risk factors. Results Of 1121 ischemic stroke participants, 17.8% had atrial fibrillation. Overall, 654 deaths (58.3%) were observed. Survival rate was lower (median days, interquartile range-IQR) among those with atrial fibrillation (531, IQR: 46-2039) vs. non-atrial fibrillation (1808, IQR: 334-3301), p-log rank < 0.0001). Over 12-year follow-up, previous atrial fibrillation was associated with increased mortality: all-cause (multivariable hazard ratios, 1.82; 95% CI: 1.43-2.31) and cardiovascular mortality (multivariable OR, 2.07; 95% CI: 1.36-3.14), but not stroke mortality. In the same multivariable models, oral anticoagulant use was inversely associated with all-cause mortality (oral anticoagulant time-dependent effect: multivariable hazard ratios, 0.47; 95% CI: 0.30-0.50, p = 0.002) and stroke mortality (oral anticoagulant time-dependent effect >= 6 months: multivariable OR, 0.09; 95% CI: 0.01-0.65, p-value = 0.02), but not cardiovascular mortality. Conclusions Among individuals with low socioeconomic status, atrial fibrillation was an independent predictor of poor survival, increasing all-cause and cardiovascular mortality risk. Long-term oral anticoagulant use was associated with a markedly reduced risk of all-cause and stroke mortality.