ANTONIO JOSE RODRIGUES PEREIRA
Índice h a partir de 2011
4
Projetos de Pesquisa
Unidades Organizacionais
FMUSP, Hospital das Clínicas, Faculdade de Medicina
PAHC, Hospital das Clínicas, Faculdade de Medicina
PAHC, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- Building an outpatient telemedicine care pilot using Scrum-like framework within a medical residency program(2021) BIN, Kaio Jia; HIGA, Natalia; SILVA, Jessica Helena da; QUAGLIANO, Daniele Abud; HANGAI, Rosemeire Keiko; COBELLO-JUNIOR, Vilson; PEREIRA, Antonio Jose Rodrigues; CARNEIRO-D'ALBUQUERQUE, Luiz Augusto; CARRILHO, Flair Jose; WEN, Chao Lung; ONO, Suzane KiokoOBJECTIVES: A good health care does not only depend on good medical practice, but also needs great management of its resources, which are generally short. In this sense, PROAHSA has been training new health managers since 1972. With the arrival of the COVID-19 pandemic, it was clear that medicine will go through a new phase, where telehealth will be present in this ""Improved Normal"". This report is about how a pilot teleconsultation study was carried out for HCFMUSP patients through the Scrum-like framework. It is to deploy a pilot of remote assistance involving a doctor and a patient in the Ambulatory of Hepatology and Liver Transplantation of HCFMUSP. METHODS: We applied the Scrum-like framework to carry out this work with an interdisciplinary multi-functionality team. RESULTS: A full telemedicine service flow was implemented within eight weeks using existing infrastructure and resources implementing the Scrum methodology. Twenty-three teleconsultations were scheduled and eight guides built. CONCLUSION: Scrum framework has a great potential to improve the training of students and to conclude pilot projects.
- Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic(2024) RITTO, Ana Paula; ARAUJO, Adriana Ladeira de; CARVALHO, Carlos Roberto Ribeiro de; SOUZA, Heraldo Possolo De; FAVARETTO, Patricia Manga e Silva; SABOYA, Vivian Renata Boldrim; GARCIA, Michelle Louvaes; KULIKOWSKI, Leslie Domenici; KALLAS, Esper Georges; PEREIRA, Antonio Jose Rodrigues; COBELLO JUNIOR, Vilson; SILVA, Katia Regina; ABDALLA, Eidi Raquel Franco; SEGURADO, Aluisio Augusto Cotrim; SABINO, Ester Cerdeira; RIBEIRO JUNIOR, Ulysses; FRANCISCO, Rossana Pulcineli Vieira; MIETHKE-MORAIS, Anna; LEVIN, Anna Sara Shafferman; SAWAMURA, Marcio Valente Yamada; FERREIRA, Juliana Carvalho; SILVA, Clovis Artur; MAUAD, Thais; GOUVEIA, Nelson da Cruz; LETAIF, Leila Suemi Harima; BEGO, Marco Antonio; BATTISTELLA, Linamara Rizzo; DUARTE, Alberto Jose da Silva; SEELAENDER, Marilia Cerqueira Leite; MARCHINI, Julio; FORLENZA, Orestes Vicente; ROCHA, Vanderson Geraldo; MENDES-CORREA, Maria Cassia; COSTA, Silvia Figueiredo; CERRI, Giovanni Guido; BONFA, Eloisa Silva Dutra de Oliveira; CHAMMAS, Roger; BARROS FILHO, Tarcisio Eloy Pessoa de; BUSATTO FILHO, GeraldoIntroduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency.Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output.Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19.Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
- The Impact of Artificial Intelligence on Waiting Time for Medical Care in an Urgent Care Service for COVID-19: Single-Center Prospective Study(2022) BIN, Kaio Jia; MELO, Adler Araujo Ribeiro; ROCHA, Jose Guilherme Moraes Franco da; ALMEIDA, Renata Pivi de; COBELLO JUNIOR, Vilson; MAIA, Fernando Liebhart; FARIA, Elizabeth de; PEREIRA, Antonio Jose; BATTISTELLA, Linamara Rizzo; ONO, Suzane KiokoBackground: To demonstrate the value of implementation of an artificial intelligence solution in health care service, a winning project of the Massachusetts Institute of Technology Hacking Medicine Brazil competition was implemented in an urgent care service for health care professionals at Hospital das Clinicas of the Faculdade de Medicina da Universidade de Sao Paulo during the COVID-19 pandemic. Objective: The aim of this study was to determine the impact of implementation of the digital solution in the urgent care service, assessing the reduction of nonvalue-added activities and its effect on the nurses' time required for screening and the waiting time for patients to receive medical care. Methods: This was a single-center, comparative, prospective study designed according to the Public Health England guide ""Evaluating Digital Products for Health."" A total of 38,042 visits were analyzed over 18 months to determine the impact of implementing the digital solution. Medical care registration, health screening, and waiting time for medical care were compared before and after implementation of the digital solution. Results: The digital solution automated 92% of medical care registrations. The time for health screening increased by approximately 16% during the implementation and in the first 3 months after the implementation. The waiting time for medical care after automation with the digital solution was reduced by approximately 12 minutes compared with that required for visits without automation. The total time savings in the 12 months after implementation was estimated to be 2508 hours. Conclusions: The digital solution was able to reduce nonvalue-added activities, without a substantial impact on health screening, and further saved waiting time for medical care in an urgent care service in Brazil during the COVID-19 pandemic.
- Adherence to non-pharmacological preventive measures among healthcare workers in a middle-income country during the first year of the COVID-19 pandemic: Hospital and community setting(2022) COSTA, Silvia Figueiredo; VERNAL, Sebastian; GIAVINA-BIANCHI, Pedro; PERES, Carlos Henrique Mesquita; SANTOS, Lanuse G. D. dos; SANTOS, Roseli E. B.; SANTOS, Rita C. C.; FRANCISCO, Maria Cristina P. B.; SATIE, Fatima M.; SECCO, Ligia M. dal; CORA, Aline Pivetta; SANTOS, Carolina Lazari dos; DUARTE, Alberto Jose da Silva; BONFA, Eloisa Silva Dutra de Oliveira; PERREIRA, Antonio Jose; SABINO, Ester Cedeira; SEGURADO, Aluisio Cotrin; LEVIN, Anna SaraThis study assessed, using a self-reported questionnaire, the adherence to PPE (mask, gowns, and gloves) at the workplace, as well as to non-pharmacological preventive measures (NPPM) (physical distance defined as hardly ever and/or never approaches other people within 1.5 meters, social isolation as leaving home less than once a week, hand hygiene was defined as performing hand hygiene >= 6 times per period, and adherence to the use of a mask outside of the workplace was defined as on all outings and hardly ever and/or never removes the mask) outside of the workplace among 1,296 health care workers (HCWs), including if NPPM adherence was associated with COVID-19 in HCWs. High adherence to PPE was independently associated with younger age, professional category, work in an area of direct patient assistance; use of public transportation, or adherence to NPPM outside of the workplace.
- Immunothrombosis and COVID-19-a nested post-hoc analysis from a 3186 patient cohort in a Latin American public reference hospital(2023) LIMA, Clarice Antunes de; GONCALVES, Fabio Augusto Rodrigues; BESEN, Bruno Adler Maccagnan Pinheiro; PEREIRA, Antonio Jose Rodrigues; PERAZZIO, Sandro Felix; TRINDADE, Evelinda Marramon; FONSECA, Luiz Augusto Marcondes; SUMITA, Nairo Massakazu; PINTO, Vanusa Barbosa; DUARTE, Alberto Jose da Silva; MANIN, Carolina Broco; LICHTENSTEIN, ArnaldoObjective: COVID-19 is associated with an elevated risk of thromboembolism and excess mortality. Difficulties with best anticoagulation practices and their implementation motivated the current analysis of COVID-19 patients who developed Venous Thromboembolism (VTE). Method: This is a post-hoc analysis of a COVID-19 cohort, described in an economic study already published. The authors analyzed a subset of patients with confirmed VTE. We described the characteristics of the cohort, such as demographics, clinical status, and laboratory results. We tested differences amid two subgroups of patients, those with VTE or not, with the competitive risk Fine and Gray model. Results: Out of 3186 adult patients with COVID-19, 245 (7.7%) were diagnosed with VTE, 174 (5.4%) of them dur-ing admission to the hospital. Four (2.3% of these 174) did not receive prophylactic anticoagulation and 19 (11%) discontinued anticoagulation for at least 3 days, resulting in 170 analyzed. During the first week of hospitaliza-tion, the laboratory most altered results were C-reactive protein and D-dimer. Patients with VTE were more criti-cal, had a higher mortality rate, worse SOFA score, and, on average, 50% longer hospital stay. Conclusion: Proven VTE incidence in this severe COVID-19 cohort was 7.7%, despite 87% of them complying completely with VTE prophylaxis. The clinician must be aware of the diagnosis of VTE in COVID-19, even in patients receiving proper prophylaxis.
- Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study(2021) GONCALVES, Fabio Augusto Rodrigues; BESEN, Bruno Adler Maccagnan Pinheiro; LIMA, Clarice Antunes de; CORA, Aline Pivetta; PEREIRA, Antonio Jose Rodrigues; PERAZZIO, Sandro Felix; GOUVEA, Christiane Pereira; FONSECA, Luiz Augusto Marcondes; TRINDADE, Evelinda Marramon; SUMITA, Nairo Massakazu; DUARTE, Alberto Jose da Silva; LICHTENSTEIN, ArnaldoOBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level >= 4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level >= 220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level >= 4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level >= 220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p <0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.
- User Experience Regarding Digital Primary Health Care in Santarem, Amazon: Evaluation of Patient Satisfaction and Doctor's Feedback(2023) BIN, Kaio Jia; ALVES, Patricia Gabriela Santana; COSTA, Raquel; EIRAS, Paula Cruz; ARAUJO, Luciano Nader de; PEREIRA, Antonio Jose Rodrigues; CARVALHO, Carlos; MALIK, Ana MariaBackground: With the arrival of the pandemic, telemedicine has been widely used to provide medical care and can be used to assist patients in regions far from urban centers that are difficult to access, such as riverside communities in the Brazilian Amazon region. A telemedicine project connecting Sao Paulo, a mega-metropolis, to Paysandu, a riverside district in the Amazon, was built to serve the local population where access to the nearest medical care is 6 hours away by speedboat. Objective: This study aims to assess the feedback from patients and doctors regarding the use of telemedicine in outpatient care at Paysandu, a riverside district in the Amazon. Methods: This is a single-center study following the guidelines ""Evaluating digital health products"" from Public Health England, with local adaptations for the project and the Brazilian reality, that was conducted between Sao Paulo and Santarem in Brazil. A survey was carried out with patients who were treated by a doctor in the city of Sao Paulo, about 2500 km from the local basic health unit, between September 27 to December 15, 2021. At the end of each teleconsultation, the attending physician answered an administrative survey form, and the patient answered a satisfaction survey. Results: A total of 111 patients completed the satisfaction survey from a total of 220 consultations carried out during the period (95% CI margin error 0.22%). According to the survey, more than 95% of patients were satisfied with the service, 87.4% (n=97) had previous experience with videoconferencing, and 76.6% (n=85) reported that their demand was fully solved. Additionally, according to the hired doctor's feedback, the average duration of the consultations was between 15 and 20 minutes. Of the 220 teleconsultations performed, 90.9% (n=200) of the demands were solved with support from the local health team, and 99.1% Conclusions: This teleconsultation project between Sao Paulo and Paysandu showed that it is possible to offer medical care from more developed locations to communities far from urban centers, as is the case with Paysandu District. Beyond the feasibility of the infrastructure, acceptance and satisfaction among patients were high. This health care supply model has proven to be functional and should be expanded nationally or perhaps internationally to regions lacking medical assistance. Escalation of the project does not seem too difficult once infrastructure issues are solved.
- Scientific legacy of COVID-19 at the FMUSP-HC academic health system: current status and implications for the future(2021) BUSATTO, Geraldo Filho; SILVA, Clovis Artur; PEREIRA, Antonio Jose Rodrigues; BONFA, Eloisa; BARROS-FILHO, Tarcisio Eloy Pessoa de
- Overcoming barriers to providing comprehensive inpatient care during the COVID-19 pandemic(2020) MIETHKE-MORAIS, Anna; PERONDI, Beatriz; HARIMA, Leila; MONTAL, Amanda C.; BALDASSARE, Renato Madrid; MORAES, Danielle P.; PEDROSO, Lucila; RAMOS, Marcelo C. A.; FUSCO, Solange R. G.; PEREIRA, Antonio Jose; BARROS-FILHO, Tarci Prime Sio E. P.; BONFA, Eloisa; UTIYAMA, Edivaldo M.; SEGURADO, Aluisio C.
- Telemedicine in Brazil: Teleconsultations at the Largest University Hospital in the Country(2023) SCUDELLER, Paula Gobi; PEREIRA, Antonio Jose; CERRI, Giovanni Guido; JATENE, Fabio Biscegli; BEGO, Marco; AMARAL, Talita Freitas; GARCIA, Michelle Louvaes; LAMAS, Celina Almeida; ALVARENGA, Aline Morgan; GUTIERREZ, Marco Antonio; COBELLO JUNIOR, Vilson; CARVALHO, Carlos Roberto Ribeiro de; Teleconsultation HCFMUSP Study GrpThe coronavirus disease (COVID-19) pandemic leveraged telemedicine worldwide mainly due to the need for social distancing, patient safety, and infection prevention. The Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP) was a key reference site in the treatment of COVID-19 severe cases in the country. To continue patient's health care, it became necessary to increase the number of teleconsultations and standardize it institutionally. Herein, we briefly described how the HCFMUSP improved the teleconsultation health care service during the COVID-19 pandemic, highlighting the implementation of important innovations and the throughout standardization process, including patients and professional workflow. We also detailed the methodology used to implement or improve teleconsultation in a medical/multidisciplinary specialty at HCFMUSP. All these efforts made the HCFMUSP reach the goal of converting 15% of all face-to-face consultations into teleconsultations only in 2021. In addition, there were more than 370,000 teleconsultations until the end of 2022. Our experience has shown that having a supporting team, a digital certification process, and the data integration were key factors toward the successful implementation of the teleconsultation services. We believe that progressing toward teleconsultation will improve the population covered by health care services in Brazil, as well as contribute to a reduction of waiting time, and solving costs to health care institutions and patients. We expect this report of our experience in teleconsultation implementation could inspire and guide other health care institutions in the development of telemedicine.