RESUMO
BACKGROUND: The debate surrounding the efficacy of coronary physiological guidance compared with conventional angiography in achieving optimal post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) values persists. OBJECTIVES: The primary aim of this study was to demonstrate the superiority of physiology-guided PCI, using either angiography or microcatheter-derived FFR, over conventional angiography-based PCI in complex high-risk indicated procedures (CHIPs). The secondary aim was to establish the noninferiority of angiography-derived FFR guidance compared with microcatheter-derived FFR guidance. METHODS: Patients with obstructive coronary lesions and meeting CHIP criteria were randomized 2:1 to receive undergo physiology- or angiography-based PCI. Those assigned to the former were randomly allocated to angiography- or microcatheter-derived FFR guidance. CHIP criteria were long lesion (>28 mm), tandem lesions, severe calcifications, severe tortuosity, true bifurcation, in-stent restenosis, and left main stem disease. The primary outcome was invasive post-PCI FFR value. The optimal post-PCI FFR value was defined as >0.86. RESULTS: A total of 305 patients (331 study vessels) were enrolled in the study (101 undergoing conventional angiography-based PCI and 204 physiology-based PCI). Optimal post-PCI FFR values were more frequent in the physiology-based PCI group compared with the conventional angiography-based PCI group (77% vs 54%; absolute difference 23%, relative difference 30%; P < 0.0001). The occurrence of the primary outcome did not differ between the 2 physiology-based PCI subgroups, demonstrating the noninferiority of angiography- vs microcatheter-derived FFR (P < 0.01). CONCLUSIONS: In CHIP patients, procedural planning and guidance on the basis of physiology (through either angiography- or microcatheter-derived FFR) are superior to conventional angiography for achieving optimal post-PCI FFR values. (Physiology Optimized Versus Angio-Guided PCI [AQVA-II]; NCT05658952).
Assuntos
Doença da Artéria Coronariana , Reserva Fracionada de Fluxo Miocárdico , Intervenção Coronária Percutânea , Humanos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea/métodos , Resultado do TratamentoRESUMO
La pandemia por COVID19 impuso cambios en los modos de vida de las familias con las que trabajamos desde la Carrera de Especialización en Medicina Familiar, en el territorio "Las Tablitas", Villa El Libertador, Córdoba. Objetivos: Explorar los modos de vida de las familias de "Las Tablitas'' durante el período de pandemia 2020-2021. Metodología: estudio cualitativo, diseño fenomenológico y enfoque crítico. Se realizaron 10 entrevistas en profundidad con criterio de saturación teórica. Resultados: Se reconocen las modificaciones ocurridas durante el periodo aislamiento social preventivo obligatorio en la dinámica familiar. Los trabajos remunerados en condiciones irregulares fueron interrumpidos. El trabajo doméstico no remunerado aumentó para las mujeres, quienes sumaron las tareas educativas, presentando dificultades para el acompañamiento escolar. Las mujeres asumieron tareas de cuidado y gestión para la subsistencia sin problematizar ese rol. La atención de problemas no-COVID fue postergada, principalmente por miedo a los contagios. Si bien las redes comunitarias se activaron para resolver la situación alimentaria, con organización de copas de leche y ollas populares, se profundizó el aislamiento de las familias. Problemáticas planteadas: el agua, la falta de cloacas, el aumento de hechos delictivos y el deterioro ambiental. Conclusión: Reconocer los modos de vivir de las familias, explorar las representaciones de las mujeres, sus modos de organización familiar y prácticas de cuidado en tiempos de pandemia constituye una clave para poder diseñar estrategias en conjunto, oportunas y adecuadas (AU)
The COVID19 pandemic imposed changes in the lifestyles of the families with whom we work as of 2016 the Specialization Career in Family Medicine in the territory "Las Tablitas", Villa El Libertador, Córdoba. Explore the lifestyles of the families of "Las Tablitas" during the 2020-2021 pandemic period. Recognize health-disease processes, health care modes, and family and collective care practices. Qualitative study, phenomenological design, and critical approach. 10 in-depth interviews were conducted with key informants with theoretical saturation criteria. The modifications that occurred during the period of compulsory preventive social isolation in family dynamics are recognized. Most of the paid jobs under irregular conditions were interrupted. Unpaid domestic work increased for women, who added educational tasks, presenting difficulties for school accompaniment. The women with whom they assume care and management tasks for subsistence without problematizing that role. Health care for various chronic diseases or emerging situations was postponed, mainly due to fear of COVID infections. Although the community networks were activated to resolve the food situation, with the organization of milk cups and popular pots, the isolation within the families deepened. The problems raised with respect to the neighborhood are mainly the question of habitat, with water as its axis, the lack of sewers, the increase in criminal acts and environmental deterioration. The recognition of the ways of living of families, the exploration of the representations of women, their ways of family organization and care practices in times of pandemic constitute a key to be able to design timely strategies to comprehensively the Health - Disease - Attention - Care Process (AU)
Assuntos
Humanos , Masculino , Feminino , Mulheres , Saúde da Família , Pandemias , COVID-19 , Processo Saúde-Doença , Emprego , Relações FamiliaresRESUMO
Medicina Familiar constituye un espacio de integración curricular en la Práctica Final de Medicina de la Universidad Nacional de Córdoba. Objetivo: identificar aportes de la asignatura para adquisición de competencias según resolución CONEAU N° 1314. Material y método: Estudio descriptivo cualicuantitativo, transversal. Período 2016 2017. Encuesta de autoevaluación y test de observación directa al inicio y al final del cursado. Se realizó análisis de contenido. Resultados: Autoevaluación inicial y final: competencias de alto impacto (investigación de la dolencia, búsqueda de opinión y acuerdo en tratamientos, investigación contexto). Competencias de bajo impacto (identificación motivo de consulta, explicación al paciente que se lo va a examinar, uso racional de métodos complementarios). Análisis cualitativo competencia "Búsqueda de acuerdo y consenso", categorías: explicar el problema, diagnóstico, alternativas de tratamiento; consultar comprensión del problema, dudas, preferencias. Competencia "Investigación contexto social, categorías: estructura familiar; condiciones laborales; contexto. Evaluación competencias pre y pos cursado (observación directa): impacto intermedio, valoraciones satisfactorias sin modificaciones significativas pre y post. Comparación percepción de los alumnos/ nivel de desarrollo de competencias: mayor divergencia ("organización de entrevista", "claridad para realizar examen físico", "precisión para definir los problemas", "selección de tratamientos según efectividad"). Conclusión: se logró el afianzamiento de competencias relacionadas con la entrevista y el abordaje integral (AU)
Family medicine constitutes a space of curricular integration in the final practice of the career of medicine of the National University of Córdoba.Objectives: to identify the contributions of the subject in the acquirement of competence according to CONEAU Ìs resolution N° 1314.Material and methods: transversal descriptive cuali-cuantitative study. During the period of the years 2016-2017. Self-evaluation survey and a direct observation test in the begging and the end of the classes. Analysis of the data: SPSS statistics and analysis of the content.Results: Initial and final self- evaluation: High impact competences (inquiry of the disease, search for opinions and agreements about the treatments, investigation of the social and family context and support network). Low impact competences (identifying reason of the consultation, explaining to the patient that they were going to be examined, rational use of complementary methods). Qualitative competence analysis "Search for agreements and consensus", categories: to explain the problem, diagnosis, treatment alternatives; consultation about (consult of) the comprehension of the problem, doubts and preferences. Competence "Investigation of the social context", categories: family structure, working conditions, neighborhood context, family relationships. Evaluation of the competences pre and post taking classes (direct observation): intermediate impact: satisfactory evaluations without significant modification pre and post. Student perception and level of competence development comparison: grater divergence (" organization of the interview", "clarity to do a physical exam", "precision to define problems", "chose of treatments according to effectiveness"). Conclusion: Family medicine managed to secure professional Ìs competences related to clinical interview and integral approach of the person (AU)