CLAUDIA MARQUEZ SIMOES
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
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- Perceptions of gender equity in departmental leadership, research opportunities, and clinical work attitudes: an international survey of 11 781 anaesthesiologists(2020) ZDRAVKOVIC, Marko; OSINOVA, Denisa; BRULL, Sorin J.; PRIELIPP, Richard C.; SIMOES, Claudia M.; BERGER-ESTILITA, Joanayy Background: Women make up an increasing proportion of the physician workforce in anaesthesia, but they are consistently under-represented in leadership and governance. Methods: We performed an internet-based survey to investigate career opportunities in leadership and research amongst anaesthesiologists. We also explored gender bias attributable to workplace attitudes and economic factors. The survey instrument was piloted, translated into seven languages, and uploaded to the SurveyMonkey (R) platform. We aimed to collect between 7800 and 13 700 responses from at least 100 countries. Participant consent and ethical approval were obtained. A quantitative analysis was done with chi(2) and Cramer's V as a measure of strength of associations. We used an inductive approach and a thematic content analysis for qualitative data on current barriers to leadership and research. Results: The 11 746 respondents, 51.3% women and 48.7% men, represented 148 countries; 35 respondents identified their gender as non-binary. Women were less driven to achieve leadership positions (P<0.001; Cramer's V: 0.11). Being a woman was reported as a disadvantage for leadership and research (P<0.001 for both; Cramer's V: 0.47 and 0.34, respectively). Women were also more likely to be mistreated in the workplace (odds ratio: 10.6; 95% confidence interval: 9.4-11.9; P<0.001), most commonly by surgeons. Several personal, departmental, institutional, and societal barriers in leadership and research were identified, and strategies to overcome them were suggested. Lower-income countries were associated with a significantly smaller gender gap (P<0.001). Conclusions: Whilst certain trends suggest improvements in the workplace, barriers to promotion of women in key leadership and research positions continue within anaesthesiology internationally.
- Safety and costs analysis of early hospital discharge after brain tumour surgery: a pilot study(2020) NEVILLE, Iuri Santana; URENA, Francisco Matos; QUADROS, Danilo Gomes; SOLLA, Davi J. F.; LIMA, Mariana Fontes; SIMOES, Claudia Marquez; VICENTIN, Eduardo; RIBEIRO JR., Ulysses; AMORIM, Robson Luis Oliveira; PAIVA, Wellingson Silva; TEIXEIRA, Manoel JacobsenBackground A daily algorithm for hospital discharge (DAHD) is a key point in the concept of Enhanced Recovery After Surgery (ERAS) protocol. We aimed to evaluate the length of stay (LOS), rate of complications, and hospital costs variances after the introduction of the DAHD compared to the traditional postoperative management of brain tumour patients. Methods This is a cohort study with partial retrospective data collection. All consecutive patients who underwent brain tumour resection in 2017 were analysed. Demographics and procedure-related variables, as well as clinical outcomes, LOS and healthcare costs within 30 days after surgery were compared in patients before/pre-implementation and after/post-implementation the DAHD, which included: stable neurological examination; oral feeding without aspiration risk; pain control with oral medications; no intravenous medications. The algorithm was applied every morning and discharge was considered from day 1 after surgery if criteria was fulfilled. The primary outcome (LOS after surgery) analysis was adjusted for the preoperative performance status on a multivariable logistic regression model. Results A total of 61 patients were studied (pre-implementation 32, post-implementation 29). The baseline demographic characteristics were similar between the groups. After the DAHD implementation, LOS decreased significantly (median 5 versus 3 days; p = 0.001) and the proportion of patients who were discharged on day 1 or 2 after surgery increased (44.8% vs 3.1%; p < 0.001). Major and minor complications rates, readmission rate, and unplanned return to hospital in 30-day follow-up were comparable between the groups. There was a significant reduction in the median costs of hospitalization in DAHD group (US$2135 vs US$2765, p = 0.043), mainly due to a reduction in median ward costs (US$922 vs US$1623, p = 0.009). Conclusions Early discharge after brain tumour surgery appears to be safe and inexpensive. The LOS and hospitalization costs were reduced without increasing readmission rate or postoperative complications.
- Requirements specification of a software-intensive system in the health domain: An experience report(2020) ARENAS, Carolina; GARCES, Lina; CARMONA, Maria J. C.; SIMOES, Claudia MarquezA great variety of methods, techniques, or approaches have been proposed to systematize and facilitate activities of software systems' requirements elicitation and specification. Each of them has its specific purposes and contributes in its own way for obtaining a good understanding of software requirements. However, in practice, using an unique method is not enough to cover all tasks required during software-intensive system's requirement engineering. This work does not aim to propose a new or a hybrid method, since each software project has its own characteristics, and methods must be selected and sometimes adapted to fit in each project specificities. This work reports the authors' experience on howdifferent methods were used together in a coordinated way for requirements specification. Also, possible benefits and drawbacks found by combining methods are also presented.
- Intraoperative pulmonary hyperdistention estimated by transthoracic lung ultrasound: A pilot study(2020) TONELOTTO, Bruno; PEREIRA, Sergio Martins; TUCCI, Mauro Roberto; VAZ, Diogo Florenzano; VIEIRA, Joaquim Edson; MALBOUISSON, Luiz Marcelo; GAY, Frederick; SIMOES, Claudia Marquez; CARMONA, Maria Jose Carvalho; MONSEL, Antoine; AMATO, Marcelo Brito; ROUBY, Jean-Jacques; JR, Jose Otavio Costa AulerIntroduction: Transthoracic lung ultrasound can assess atelectasis reversal and is considered as unable to detect associated hyperdistention. In this study, we describe an ultrasound pattern highly suggestive of pulmonary hyperdistention. Methods: Eighteen patients with normal lungs undergoing lower abdominal surgery were studied. Electrical impedance tomography was calibrated, followed by anaesthetic induction, intubation and mechanical ventilation. To reverse posterior atelectasis, a recruitment manoeuvre was performed. Positive-end expiratory pressure (PEEP) titration was then obtained during a descending trial - 20, 18, 16, 14, 12, 10, 8, 6 and 4 cmH(2)O. Ultrasound and electrical impedance tomography data were collected at each PEEP level and interpreted by two independent observers. Spearman correlation test and receiving operating characteristic curve were used to compare lung ultrasound and electrical impedance tomography data. Results: The number of horizontal A lines increased linearly with PEEP: from 3 (0, 5) at PEEP 4 cmH(2)O to 10 (8, 13) at PEEP 20 cmH(2)O. The increase number of A lines was associated with a parallel and significant decrease in intercostal space thickness (p = 0.001). The lung ultrasound threshold for detecting pulmonary hyperdistention was defined as the number of A lines counted at the PEEP preceding the PEEP providing the best respiratory compliance. Six A lines was the median threshold for detecting pulmonary hyperdistention. The area under the receiving operating characteristic curve was 0.947. Conclusions: Intraoperative transthoracic lung ultrasound can detect lung hyperdistention during a PEEP descending trial. Six or more A lines detected in normally aerated regions can be considered as indicating lung hyperdistention.
- Unpredictable malfunction of the laryngeal mask Ambu(R)Aura-i (TM) as a conduit for fiberoptic bronchoscope intubation(2020) QUINTAO, Vinicius; SOUSA, Gabriel; MALAVAZZI, Marcella; SIMOES, Claudia