ABSTRACT
Resumen El tratamiento de un paciente anticoagulado con antagonistas de la vitamina K (AVK) sigue siendo un desafío, especialmente en regiones donde, por el costo, los dicumarínicos son todavía la alternativa más buscada a la hora de elegir un anticoagulante oral. Las clínicas de anticoagulación han demostrado ser la forma más eficiente y segura de evitar complicaciones trombóticas y hemorrágicas y de mantener al paciente en rango óptimo de tratamiento. Sin embargo, requieren de una adecuada infraestructura y personal capacitado para que funcionen eficientemente. En este consenso argentino se propone una serie de parámetros para la gestión efectiva de una clínica de anticoagulación. El objetivo es lograr una elevada calidad desde el punto de vista clínico-asistencial a través de un laboratorio de hemostasia de excelencia. Los criterios desarrollados en el documento fueron consensuados por un amplio grupo de expertos especialistas en hematología y en bioquímica de todo el país. Estos criterios deben adaptarse a la irregular disponibilidad de recursos de cada centro, pero siempre se los debe tener en cuenta a la hora de indicar el tratamiento anticoagulante con estas drogas. Tener en consideración estas premisas nos permitirá optimizar la atención del enfermo anticoagulado con AVK y de esta forma minimizar las intercurrencias trombóticas y hemorrágicas a las que está expuesto, para así honrar nuestra promesa de no dañar al paciente.
Abstract Treating an anticoagulated patient with vitamin K antagonists (VKA) remains a challenge, especially in areas where dicoumarins are still the first drug of choice due to the cost of other oral anticoagulants. Anticoagulation clinics have proven to be the most efficient and safe way to avoid thrombotic and hemorrhagic complications and to keep patients in optimal treatment range. However, they require adequate infrastructure and trained personnel to work properly. In this Argentine consensus we propose a series of guidelines for the effective management of the anticoagulation clinics. The goal is to achieve the excellence in both the clinical healthcare and the hemostasis laboratory for the anticoagulated patient. The criteria developed in the document were agreed upon by a large group of expert specialists in hematology and biochemistry from all over the country. The criteria presented here must always be considered when indicating VKA although they had to be adapted to the unequal reality of each center. Taking these premises into consideration will allow us to optimize the management of the anticoagulated patient with VKA and thus minimize thrombotic and hemorrhagic intercurrences, in order to honor our promise not to harm the patient.
Subject(s)
Humans , Vitamin K/antagonists & inhibitors , Practice Guidelines as Topic , Fibrinolytic Agents/therapeutic use , Ambulatory Care Facilities/organization & administration , Anticoagulants/therapeutic use , Administration, Oral , International Normalized Ratio , Consensus , Ambulatory Care Facilities/standardsABSTRACT
O presente trabalho teve como objetivo investigar a influência dos vínculos organizacionais na consolidação dos Centros de Atenção Psicossocial (CAPS) II e AD da cidade de Petrolina (PE). Entrevistas semiestruturadas foram realizadas com 18 membros da equipe multiprofissional de ambos os CAPS, sendo a amostra constituída por um representante de cada categoria profissional. A apreciação crítica dos dados baseou-se em análise de conteúdo elaborada a partir de categorizações dos discursos. Os resultados evidenciaram que, de modo geral, as equipes não possuem um conhecimento teórico suficiente sobre o sistema no qual estão inseridas. Além disso, embora haja um alto índice de satisfação, as precárias condições de trabalho, como a falta de reconhecimento profissional e insumos de trabalho, acabam afetando esta dinâmica institucional. Por fim, foi verificada também uma equivalência quantitativa referente aos aspectos afetivo e calculativo do comprometimento organizacional e uma estreita relação entre tempo de serviço e envolvimento com o trabalho.
This article seeks to investigate the influence of organizational ties in the consolidation of Psychosocial Care Centers (CAPS - II and AD [Alcohol and Drugs]) in the city of Petrolina, State of Pernambuco, Brazil. Based on qualitative research, semi-structured interviews were conducted with a multi-professional team from both CAPS, with the sample consisting of one representative from each professional category. A critical review of the data was based on content analysis prepared from categorization of the discourses. The results showed that, in general, the teams do not possess sufficient theoretical knowledge about the system of which they are part. Moreover, although there is a high level of satisfaction, precarious working conditions and a lack of professional recognition and labor input can negatively affect the institutional dynamics. Lastly, a quantitative equivalence was also detected regarding affective and calculative aspects of organizational commitment and a close relationship between length of service and involvement with the work.