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ABSTRACT The incidence of thyroid cancer is increasing globally, but mortality rates have remained steady. Many patients with thyroid cancer have low-risk, nonmetastatic intrathyroidal tumors smaller than 2 cm. Active surveillance has shown benefits in these patients, but the adoption of this approach remains below standard in Latin America. The purpose of this article is to identify ways to improve the incorporation of active surveillance into clinical practice for patients with low-risk thyroid carcinoma in Latin America, taking into consideration cultural and geographic factors. Current recommendations include three steps involving patient participation. The first step, which consists of the initial clinical examination, has eight factors requiring special attention. Anxiety must be managed while considering individual, disease-related, cognitive, and environmental aspects. Terms like "overdiagnosis", "incidentaloma," and "overtreatment" must be explained to the patient. Implementing precise terminology contributes to adequate disease perception, substantially reducing stress and anxiety. Clarifying the nonprogressive nature of thyroid cancer helps dispel myths surrounding the disease. The second step includes advice about procedures and guidelines for patients who choose active surveillance. Flexible monitoring techniques should be implemented, with regular check-ins scheduled based on patient needs. Reasons for adjusting treatment must be clearly communicated to the patient, and changes in preference regarding active surveillance should be considered in advance. The third step includes assistance during follow-up. Patients must be educated about ultrasound results and receive surgical indications from specialized physicians. The effectiveness of active surveillance can be reinforced by explaining to the patients the dynamics of changes in nodule size using clear and concise visual aids.
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Resumo Estudos acerca do consentimento informado de paciente no âmbito da odontologia são escassos e apresentam divergências, evidenciando a necessidade de aprofundar o conhecimento sobre definições, dinâmica, atos normativos, jurisprudência e limites de responsabilidade diante de fatores diversos e riscos inerentes à profissão. Por meio de revisão bibliográfica que incluiu estudos indexados nas bases de dados SciELO e LILACS, bem como livros-texto, buscou-se definir o que se entende por consentimento livre e esclarecido do paciente, distinguir diferentes tipos e destacar a denominada "escolha esclarecida", considerando que a atividade do cirurgião-dentista é classificada como serviço e é regulamentada pela Constituição Federal de 1988, Código de Defesa do Consumidor, Código Civil e leis especiais. Diante disso, busca-se verificar se é possível melhorar a obtenção do consentimento informado do paciente, transformando-a em processo de escolha esclarecida que considere tratamentos adequadamente indicados cuja finalidade principal é a saúde.
Abstract Studies on informed patient consent in the field of dentistry are scarce and present divergences, highlighting the need to deepen knowledge about definitions, dynamics, normative acts, case law and limits of responsibility in the face of diverse factors and risks inherent to the profession. From a bibliographic review that included studies indexed in the SciELO and LILACS databases, as well as textbooks, this study aimed to define what is meant by a patient's free and informed consent, distinguish different types and highlight the so-called "informed choice," considering that the activity of the dental surgeon is classified as a service and is regulated by the 1988 Federal Constitution of Brazil, the Consumer Defense Code, the Civil Code and special laws. The aim is to see if it is possible to improve the process of obtaining informed consent from patients, transforming it into a process of informed choice that takes into account appropriately indicated treatments whose main purpose is health.
Resumen Los estudios del consentimiento informado del paciente en odontología son escasos y presentan divergencias, lo que revela la necesidad de profundizar en el conocimiento en definiciones, dinámicas, actos normativos, jurisprudencia y límites de responsabilidad frente a diversos factores y riesgos relacionados a la profesión. A partir de una revisión bibliográfica en las bases de datos SciELO y LILACS, y en libros, se buscó definir qué se entiende por consentimiento informado del paciente, distinguir diferentes tipos e identificar la llamada "decisión aclarada", considerando que la actividad del cirujano dental está clasificada como un servicio y reglamentada por la Constitución Federal de 1988, el Código de Defensa del Consumidor, el Código Civil y leyes especiales. Se busca identificar si es posible mejorar el consentimiento informado al convertirlo en un proceso de obtención de decisión aclarada que considere adecuadamente los tratamientos cuya principal finalidad sea la salud.
Subject(s)
Decrees , Patient PreferenceABSTRACT
Resumen La empatía, la comunicación efectiva y la asertividad en la práctica médica actual representan habilidades y herramientas necesarias y vigentes en un mundo de grandes avances y realidades tecnológicas que no superan, en nuestra perspectiva, lo indispensable para mantener y fortalecer la relación del profesional de la salud con el paciente, específicamente la relación médico-paciente. Es conveniente identificar y reconocer el hecho de que estas relaciones interpersonales deben ser modificadas mediante el reconocimiento de su bidireccionalidad y deben centrarse en un carácter educativo, de retroalimentación y atención mutua, con una mejora continua de la regla de las "15 C": comunicación, cercanía, comprensión, compasión, confianza, capacidad, consistencia, certificación, creatividad, cooperación/coordinación, compromiso bidireccional y conexión, con las resultantes calidad y calidez.
Abstract Empathy, effective communication and assertiveness in current medical practice represent skills and tools necessary and current, in a world of great advances and technological realities that do not surpass, in our perspective, the indispensable use of such tools to maintain and strengthen the relationship of the health professional with the patient and specifically of the doctor-patient relationship. It is convenient to identify and recognize the fact that these interpersonal relationships must be modified by recognizing their bidirectionality and that they should focus on an educational, feedback and mutual attention, with a continuous improvement of the "15 C" rule: communication, closeness, understanding, compassion, confidence, capacity, consistency, certification, creativity, cooperation/coordination and bidirectional commitment and connection, with the resulting quality and warmth.
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ABSTRACT Introduction: Participants in cardiac rehabilitation programs have low adherence to their sessions, which makes extremely important to recognize the barriers that cause non-adherence, identifying whether the type of service and level of adherence influence these barriers. Methods: This is a cross-sectional observational study, in which 220 individuals (66.80±11.59 years) of both genders who are members of public and private exercise-based cardiac rehabilitation programs participated. The volunteers were divided according to the level of adherence, considering patients with low adherence (PLA) those with < 70% of attendance and high adherence (PHA) those with > 70%. Then, initial evaluation, Cardiac Rehabilitation Barriers Scale, analysis of socioeconomic level, Hospital Anxiety and Depression Scale, and Mini-Mental State Examination were applied. Results: Higher total barriers were found in PLA in the public service compared to PHA in the private service (P=0.023). In the subscale "perceived need", PHA in the public service showed higher values than PLA and PHA in the private service (P≤0.001). The "access" barrier was higher for PHA in the public service when compared to PHA in the private service (P=0.024). PHA in the public service exhibited a higher barrier regarding questions about distance, transportation problems, cost, and time constraints. Conclusion: The public program presents higher barriers in the questions and categories compared to the private program, mainly the PHA. Furthermore, there are differences in the profile of the participants regarding socioeconomic and anxiety levels, treatment time, ethnicity, and city where they live.
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Objetivo: conhecer as vivências e demandas de pessoas transexuais ao buscar serviços de Atenção Primária à Saúde. Método: pesquisa descritiva com abordagem qualitativa, realizada com pessoas autodeclaradas transexuais que utilizam os serviços de Atenção Primária à Saúde. A coleta de dados se deu por meio de questionário on-line, esses foram submetidos à análise através de software livre para dados qualitativos e o corpus textual de pesquisa passou pela análise do tipo temático-categorial. Resultados: com a análise dos dados, foi criada a categoria: vivências e demandas no atendimento na Atenção Primária à Saúde, que representou 51,6% das Unidades de Registro. Conclusão: no cenário atual, a população trans ainda padece com dificuldades de acesso aos serviços de saúde e, portanto de terem seus direitos garantidos
Objectives: to know the experiences and demands of transgender people when seeking primary health care services. Method: descriptive research with a qualitative approach, conducted with self-declared transsexual scare people who use primary health care services. Data collection was performed through an online questionnaire, which were submitted to analysis through free software for qualitative data and the textual corpus of research was analyzed by thematic-category analysis. Results: with data analysis, two categories were created: experiences in primary health care, which represented 51.6% of the Registry Units. Conclusion: in the current scenario, the trans population still suffers from difficulties in accessing health services and therefore having their rights guaranteed
Objetivos: conocer las experiencias y demandas de las personas transgénero a la hora de buscar servicios de atención primaria de salud. Método: investigación descriptiva con enfoque cualitativo, realizada con personas autodeclaradas transexuales que utilizan los servicios de atención primaria de salud. La recolección de datos se realizó a través de un cuestionario en línea, que se sometió a análisis a través de software libre para obtener datos cualitativos y el corpus textual de investigación se analizó mediante análisis de categoría temática. Resultados: con el análisis de datos se crearon dos categorías: experiencias en atención primaria de salud, que representaron el 51,6% de las Unidades de Registro. Conclusión: en el escenario actual, la población trans aún sufre dificultades para acceder a los servicios de salud y, por lo tanto, tener garantizados sus derechos
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Transsexualism , Transgender Persons , Health Services AccessibilityABSTRACT
Objective:To explore the influence on the willingness to seek medical treatment by revising the recommendations for prevention and treatment in the medical examination report.Methods:Revising the prevention and treatment recommendations for four diseases, including proteinuria, hyperuricemia, hydronephrosis and renal insufficiency to clearly inform the etiology and prognosis of them. Using a cross-sectional study method, pre-revision prevention and treatment recommendations (version A) and post-revision prevention and treatment recommendations (version B) questionnaires were randomly distributed to medical examiners and at the health management center of our hospital in Wuhan. An ordinal logistic regression model and a binary logistic regression model were used to analyze the correlation of the understanding of diseases and the willingness to seek medical treatment with different connotation of the prevention and treatment recommendations, respectively.Results:A total of 530 valid questionnaires were collected, of which 267 were from version A and 263 from version B. There was no significant difference in the socio-demographic profile of respondents between version A and version B. For the four high risk factors of kidney diseases mentioned above, version B was better than version A in terms of understanding and willingness to seek medical treatment ( P<0.001). The level of understanding OR(95% CI) were 3.691(2.570, 5.301), 2.238(1.511, 3.320), 4.293(6.353, 2.903) and 5.275(7.877, 3.529) respectively. The willingness to seek medical treatment OR(95% CI) were 3.554(2.441, 5.175), 2.850(1.975, 4.114), 5.144(3.457, 7.654) and 4.225(2.868, 6.224) respectively. All the P values were lower than 0.001. Conclusions:Improving the connotation of prevention and treatment recommendations in the medical examination report can help increase the willingness for early medical consultation.
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RESUMO Este ensaio procurou discutir o papel dos pacientes e das famílias na qualidade dos cuidados e na segurança do paciente. Tradicionalmente, o papel dos profissionais de saúde - especialmente, dos médicos - tem sido predominante na discussão e na definição do que constitui um cuidado de saúde de alta qualidade. Entretanto, outros atores foram reconhecidos no debate contemporâneo sobre a qualidade do atendimento e, em particular, sobre a segurança do paciente e a centralidade do atendimento. O papel dos pacientes na qualidade do atendimento e até mesmo o seu protagonismo na identificação dos principais problemas presentes na prestação de cuidados e em como contribuir para um atendimento mais seguro são destacados. Inicialmente, discute-se o papel dos pacientes e seus familiares na qualidade do atendimento e na segurança do paciente. Em seguida, são discutidos os fatores que influenciam e dificultam a sua participação. Finalmente, são propostas estratégias para aumentar a participação dos pacientes. Pacientes e familiares podem desempenhar um papel essencial na melhoria da qualidade dos cuidados de saúde e da segurança do paciente. Entretanto, eles devem estar ativamente envolvidos para que isso ocorra, com suas contribuições consideradas em um ambiente favorável a uma cultura de segurança justa.
ABSTRACT This essay sought to discuss the role of patients and families in quality of care and patient safety. Traditionally, the role of health professionals - especially physicians - has been predominant in discussing and defining what constitutes high-quality health care. However, other actors have been recognized in the contemporary debate on the quality of care and, in particular, patient safety and centrality of care. The patient's role in the quality of care and even their protagonism in identifying the main problems in the provision of care and how to contribute to safer care are highlighted. Initially, discusses the role of patients and relatives in the quality of care and patient safety. Then, the factors that influence and hinder their participation are discussed. Finally, strategies for increasing patient participation are proposed. Patients and families can play an essential role in improving the quality of health care and patient safety. However, they must be actively involved in making this happen, with their contributions considered in an environment favorable to a just safety culture.
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Introducción: El conocimiento obtenido a partir de las experiencias de los pacientes favorece una atención de calidad. El objetivo de este estudio cualitativo es conocer la percepción de los pacientes sobre su realimentación tras una cirugía colorrectal, y los factores condicionantes en relación con dicho proceso. Material y Método: En base a la directriz de Standards for Reporting Qualitative Research, se realiza un estudio cualitativo a partir de una entrevista de 8 preguntas de término abierto realizada a 20 pacientes seleccionados por un método de variación máxima de muestreo. Se realizó análisis temático. Resultados: Se identificaron cuatro dimensiones principales (con subtemas respectivos) que condicionan la alimentación en el postoperatorio: 1. propósitos del paciente tras la alimentación (búsqueda de alta, hidratación, búsqueda de salud, finalizar ayuno, deambulación); 2. propiedades y características de los alimentos (sazón, presentación, temperatura, porciones, consistencia, favoritos); 3. factores del paciente (físicos, psicológicos); y 4. relación equipo de salud-paciente (confianza, complacencia, información, agradecimiento). Conclusión: El proceso de ingesta de alimentos en este contexto está condicionado por las cuatro dimensiones mencionadas. Sería importante considerarlas al momento de crear y ejecutar pautas y guías de alimentación adaptadas a los pacientes.
Introduction: Knowledge obtained from the experiences of patients favors quality care. The aim of this study is to know the perception of patients regarding refeeding after colorectal surgery, and particular factors that condition postoperative intake from their perspective. Materials and Method: Based on the guideline of Standards for reporting qualitative Research, a qualitative study was constructed from an interview with 8 open-ended questions to 20 patients selected by a maximum sampling variation method. Thematic analysis was carried out. Results: Four main dimensions were identified that determine feeding in the postoperative period: 1. patient's goals after feeding (search for discharge, hydration, search for health, end fasting, ambulation); 2. properties and characteristics of food (seasoning, presentation, temperature, portions, consistency, favorites); 3 patient factors (physical, psychological); and 4. health team-patient relationship (trust, complacency, information, gratitude). Conclusion: The process of food intake in this context is conditioned by the four dimensions mentioned. It would be important to consider them when creating and executing feeding guidelines adapted to patients.
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Resumen: Los experimentos de elección discreta (DCE, su sigla en inglés), son una metodología usada para evaluar preferencias de desenlaces o intervenciones relacionadas con salud. A diferencia de otras técnicas de medición que utilizan métodos simples de elección o herramientas estadísticas básicas que fallan al evaluar los beneficios específicos de una intervención, proceso de entrega, beneficio, satisfacción y preferencia de los usuarios en términos de tiempo, calidad o atributo específico, los DCE combinan, en la generación de atributos y modelamiento matemático, complejas tareas de diseño y ejecución, que mejoran la calidad y optimizan la cantidad necesaria de información mediante el uso eficiente de recursos y resultados de excelente calidad. Este documento presenta la historia, el desarrollo y la fundamentación teórica de los DCE y muestra las críticas, las potenciales limitaciones y las precauciones.
Abstract: Discrete choice experiments (DCE) are a methodology for evaluate patient preferences for health-related outcomes or interventions. Other preference measurement techniques that use simple methods of choice or basic statistical tools that fail to evaluate the specific benefits of an intervention, delivery process, benefit, satisfaction and patients' preferences in terms of time, quality or specific attribute. The DCE combine in the generation of attributes and mathematical modeling, complex task of designing and execution, to improve the quality and optimize the necessary amount of information, achieving an efficient use of resources with excellent quality results. This document presents globally a brief of the history, development and theoretical foundation of the DCE and then presents in a critical way the potential limitations, precautions in their use and implementation that allow to establish the possible scenarios of use and development.
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Abstract Objective To evaluate the acceptance of telemedicine and determine its associated factors in an urogynecology outpatient clinic of a public hospital in Brazil. Methods The present was a cross-sectional study performed between June and November 2020. The included patients had their elective appointments postponed due to the coronavirus disease 2019 (COVID-19) pandemic. The variables considered regarding the acceptance of telemedicine were: urogynecologic diagnosis, age, level of schooling, place of residence, access to the internet, type of device used, frequency of internet use, and use of social media platforms. The categorical variables were described by their absolute and relative frequencies. The association among variables was evaluated through the Fisher exact test, and univariate and multivariate analyses, considering the acceptance of telemedicine as the dependent variable. Results A total of 225 patients were listed, and 182 agreed to participate. The mean age was 59 years old, 81.3% of the patients had access to the internet, and 87.3% of them accepted telemedicine. There were statistically significant associations regarding the acceptance of telemedicine and high levels of schooling (p< 0.01), internet access (p< 0.01), daily use of the internet (p< 0.01), access through personal mobile phone (p< 0.01), and access through the participant's own residence (p< 0.01). In the univariate and multivariate analyses, only high levels of schooling were associated with the acceptance of telemedicine (Adjusted odds ratio: 4.82; 95% confidence interval = 1.59-14.65). Conclusion Most of the urogynecology patients of a public hospital in a developing country accepted telemedicine. Internet access and level of schooling were the factors associated with the acceptance of telemedicine in urogynecology.
Resumo Objetivo Avaliar aceitação da telemedicina e determinar seus fatores associados em uma clínica de uroginecologia de um hospital público brasileiro. Métodos Trata-se de estudo transversal realizado entre junho e novembro de 2020. Foram recrutadas pacientes que tiveram seus atendimentos eletivos adiados devido à pandemia de doença do coronavírus 2019 (coronavirus disease 2019, COVID-19, em inglês). As variáveis consideradas para a aceitação da telemedicina foram: diagnóstico uroginecológico, idade, escolaridade, local de residência, acesso à internet, tipo de dispositivo, frequência do uso da internet, e uso de plataformas de redes sociais. As variáveis categóricas foras descritas na forma de suas frequências absoluta e relativa. A associação entre essas variáveis foi avaliada por meio do teste exato de Fisher e análises uni e multivariada, e a aceitação da telemedicina foi considerada a variável dependente. Resultados Um total de 225 pacientes foram listadas, e 182 concordaram em participar. A idade média das participantes foi de 59 anos; 81,3% delas tinham acesso à internet, e 87,3% aceitaram a telemedicina. Observaram-se associações estatisticamente significativas entre a aceitação e maior escolaridade (p< 0,01), acesso à internet (p< 0,01), uso diário da internet (p< 0,01), acesso por celular próprio (p< 0,01), e acesso da própria residência (p< 0,01). Nas análises uni e multivariada, somente alto nível de escolaridade esteve associado à aceitação da telemedicina (razão de probabilidades ajustada: 4,82; intervalo de confiança de 95% = 1,59-14,65). Conclusão A maioria das pacientes atendidas em um hospital público de um país em desenvolvimento concordaram com a telemedicina. Acesso à internet e nível de escolaridade foram fatores associados à aceitação da telemedicina nessa população.
Subject(s)
Humans , Female , Feasibility Studies , Telemedicine , Remote Consultation , Patient PreferenceABSTRACT
Health systems do not have the capacity to finance all services. The impact of choosing one option or another is important in order to prioritize health resources. Citizen participation can help to set priorities or to select the interventions that will receive public funding. We reviewed the literature searching for articles that reported mechanisms to gather information about citizens' values or preferences about health system coverage. We identified 363 publications, 18 articles were analyzed in full, and 7 articles were included in the review. Three articles were European, two were from Australia and two from Latin America. The most commonly used mechanisms to gather information were interviews and surveys. We conclude that there is a limited number of articles with examples of tools to capture information about values and preferences in health decision processes. The main barrier observed was the lack of standardized processes to collect the values and preferences of the community.
Subject(s)
Humans , Community Participation/methods , Australia , Surveys and Questionnaires , Latin AmericaABSTRACT
Heat-sensitive moxibustion is the appropriate technique of the external treatment in traditional Chinese medicine and it is widely used in community because of its "easy learning, simple operation and clear curative effect". Pragmatic randomized controlled trial is a main intervention design in the real world study, which provides a high-level evidence for the effectiveness assessment of heat-sensitive moxibustion in community management. Focusing on the key links of randomization, e.g. block randomization, stratified randomization, cluster randomization, sample size allocation, allocation concealment and blinding, the paper elaborates the advantages, disadvantages and technical details of two-stage randomization with consideration of patient preference in pragmatic randomized controlled trials of heat-sensitive moxibustion in community. It facilitates improving the quality of evidence, reproducibility and methodological homogeneity among different trials.
Subject(s)
Humans , Hot Temperature , Moxibustion , Patient Preference , Random Allocation , Reproducibility of ResultsABSTRACT
RESUMO Objetivo Comparar os limiares auditivos por via aérea obtidos em diferentes transdutores acústicos e verificar a preferência do usuário. Método Trata-se de um estudo observacional, analítico, transversal, realizado em 26 participantes de 18 a 30 anos, com audição dentro dos padrões de normalidade, sem histórico de exposição a altos níveis de pressão sonora ou queixa de zumbido no momento da avaliação. Realizou-se anamnese, meatoscopia, audiometria tonal liminar, logoaudiometria, e imitanciometria. Os limiares auditivos foram pesquisados duas vezes, cada uma com um tipo de transdutor acústico diferente: fone de inserção (E-A-R Tone) e fone circum-aural (HDA200). A ordem de realização foi aleatória, com intervalos de cinco minutos. Ao final, o participante foi questionado quanto ao conforto dos fones durante os testes. Os dados foram submetidos à análise estatística não paramétrica. Resultados Na pesquisa dos limiares auditivos, ao avaliar as medianas, o fone circum-aural apresentou resultados melhores em 250, 500, 2000 e 6000 Hz e o fone de inserção foi melhor em 3000 e 4000 Hz, sem diferença estatística para as frequências de 1000 e 8000 Hz. O fone circum-aural foi eleito o mais confortável. Conclusão O fone circum-aural apresentou melhores limiares auditivos em 250, 500, 2000 e 6000Hz quando comparado ao fone de inserção, além de ser o tipo de transdutor mais confortável relatado pelos pacientes.
ABSTRACT Purpose To compare the air-conduction hearing thresholds obtained with different acoustic transducers and verify the users' preferences regarding them. Methods This is a cross-sectional, analytical, observational study with 26 participants aged 18 to 30 years, with normal hearing and no history of exposure to high sound pressure levels or complaints of tinnitus at the time of the assessment. We surveyed their medical history and performed meatoscopy, pure-tone threshold audiometry, speech audiometry, and acoustic immittance. The auditory thresholds were surveyed twice, each time with a different type of acoustic transducer: insert (E-A-RTONE) and circumaural earphones (HDA200). The assessments were performed in a random order, with 5-minute intervals. In the end, we asked the participants which earphones they found more comfortable in the tests. The data were submitted to nonparametric statistical analysis. Results Assessing the medians in the auditory threshold survey, the circumaural earphones obtained better results at 250, 500, 2000, and 6000 Hz, while the insert earphones were better at 3000 and 4000 Hz; there were no statistical differences at 1000 and 8000 Hz. The circumaural was elected the most comfortable earphone. Conclusion The circumaural earphones had better auditory thresholds at 250, 500, 2000, and 6000 Hz than the insert earphones and were reported by the patients as the most comfortable type of transducer.
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RESUMO Objetivo: Conhecer a percepção de pacientes sobre a comunicação médica, bem como suas necessidades durante internação na unidade de cuidados intensivos. Métodos: Estudo transversal descritivo e qualitativo exploratório, com 103 pacientes internados ou com alta recente da unidade de cuidados intensivos de quatro hospitais da Grande Florianópolis (SC). Foram estudadas variáveis sociodemográficas e clínicas dos pacientes, sua nota para qualidade da comunicação médica pelo Quality of Communication Questionnaire, seus comentários espontâneos com reflexões ou justificativas para as notas dadas e suas respostas sobre como se sentiam e que ajuda complementar gostariam de receber. Os dados quantitativos foram analisados com estatística descritiva e analítica e os qualitativos com análise de conteúdo temática. Resultados: A média do Quality of Communication Questionnaire foi 5,1 (desvio-padrão - DP = 1,3), sendo 8,6 (DP = 1,3) na subescala de comunicação geral e 2,1 (DP =1,8) na de terminalidade de vida. A linguagem médica teve compreensão variável. Alguns médicos pareciam "apressados", segundo alguns pacientes. Outros pacientes gostariam de informações mais frequentes e detalhadas e/ou serem respeitados e levados "mais a sério" quando referiam sentir dor. Ansiedade, tristeza e/ou medo estavam entre os sentimentos referidos. Outras necessidades abrangeram silêncio, mais tempo para visitas, presença de acompanhante, atenção psicológica e de serviço social, banheiro que pudessem usar e melhor qualidade da comida na unidade de cuidados intensivos. Conclusão: A qualidade da comunicação médica com os pacientes é boa e poderia melhorar com maior disponibilidade de tempo do médico e da equipe para ela. Outras necessidades sentidas incluem respeito, alívio da dor e adaptações na dinâmica e no ambiente da unidade de cuidados intensivos.
ABSTRACT Objective: To understand the perception of patients about medical communication as well as their needs during hospitalization in the intensive care unit. Methods: This study was cross-sectional descriptive and qualitative exploratory including 103 patients admitted to or recently discharged from the intensive care units of four hospitals in Greater Florianópolis, Santa Catarina state, Brazil. The patients' sociodemographic and clinical variables were studied, as were the score they gave to the quality of medical communication through the Quality of Communication Questionnaire and their spontaneous comments with reflections or justifications for the scores given, and their responses on how they felt and what complementary help they would have liked to receive. The quantitative data were analyzed by descriptive and analytical statistics, and the qualitative data were analyzed by thematic content analysis. Results: The mean Quality of Communication Questionnaire score was 5.1 (standard deviation - SD = 1.3), with 8.6 (SD = 1.3) on the general communication subscale and 2.1 (SD = 1.8) on the end-of-life communication subscale. The patients had a variable understanding of medical language. Some physicians seemed to be "rushed", according to some patients. Other patients would like to receive more frequent and detailed information and/or be respected and taken "more seriously" when they reported pain. Anxiety, sadness, and fear were among the reported feelings. Other needs included silence, more time for visits, the presence of a companion, psychological and social-work care, a bathroom that they could use, and better food in the intensive care unit. Conclusion: The quality of medical communication with patients is good but could improve if physicians and the healthcare team had more time for patients. Other felt needs included respect, pain relief, and adjustments in the intensive care unit dynamics and environment.
Subject(s)
Humans , Communication , Intensive Care Units , Perception , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
RESUMO Objetivo: descrever as evidências disponíveis na literatura sobre as estratégias de envolvimento dos pacientes e acompanhantes em ações de promoção da segurança do paciente em unidades hospitalares. Método: revisão integrativa da literatura nas bases de dados PubMed, CINAHL, Web of Science, Scopus e Cochrane entre 2005 e 2020. Resultados: foram selecionados nove artigos na amostra final, os quais recomendaram a padronização de comunicação, recursos tecnológicos, vídeos, folhetos, jogos, entrevistas dialogadas, questionários e cartilhas como estratégias de envolvimento dos pacientes e acompanhantes. Os estudos ressaltaram a importância de se conhecer o perfil dos participantes para escolha das estratégias considerando as potencialidades e limitações de cada intervenção. Conclusões: constatou-se que, apesar da escassez de estudos com altas evidências, os artigos encontrados apresentam estratégias importantes para o fortalecimento das práticas de inclusão do paciente e dos acompanhantes na segurança do paciente, além de motivar a realização de novas produções nessa temática.
RESUMEN Objetivo: describir la evidencia disponible en la literatura sobre las estrategias para involucrar a pacientes y cuidadores en acciones de promoción de la seguridad del paciente en las unidades hospitalarias. Método: revisión integrativa de la literatura en las bases de datos PubMed, CINAHL, Web of Science, Scopus y Cochrane entre 2005 y 2020. Resultados: se seleccionaron nueve artículos en la muestra final, los cuales recomendaban la estandarización de la comunicación, recursos tecnológicos, videos, folletos, juegos, entrevistas dialogadas, cuestionarios y folletos como estrategias para involucrar a pacientes y cuidadores. Los estudios destacaron la importancia de conocer el perfil de los participantes para elegir estrategias considerando el potencial y las limitaciones de cada intervención. Conclusiones: se encontró que, a pesar de la escasez de estudios con alta evidencia, los artículos encontrados presentan estrategias importantes para fortalecer las prácticas de inclusión de pacientes y acompañantes en la seguridad del paciente, además de motivar la realización de nuevas producciones sobre este tema.
ABSTRACT Objective: to describe the evidence available in the literature on the strategies for involving patients and caregivers in actions to promote patient safety in hospital units. Method: integrative literature review in PubMed, CINAHL, Web of Science, Scopus, and Cochrane databases between 2005 and 2020. Results: nine articles were selected in the final sample, which recommended the standardization of communication, technological resources, videos, leaflets, games, dialogued interviews, questionnaires, and booklets as strategies for involving patients and caregivers. The studies highlighted the importance of knowing the profile of participants to choose strategies considering the potential and limitations of each intervention. Conclusions: it was found that, despite the scarcity of studies with high evidence, the articles found present important strategies for strengthening the practices of inclusion of the patient and caregivers in patient safety, in addition to motivating the realization of new productions on this theme.
Subject(s)
Humans , Caregivers , Patient Safety , Hospital Units , Family , Patient PreferenceABSTRACT
RESUMO Objetivo traduzir e adaptar culturalmente o questionário Expected Consequences of Hearing aid Ownership para aplicação na população brasileira. Métodos o Expected Consequences of Hearing aid Ownership é constituído por 15 questões e investiga a expectativa de adultos com perda auditiva quanto ao uso de aparelho de amplificação sonora individual. A tradução foi realizada por três professores tradutores-intérpretes de inglês, que não tiveram contato prévio com o instrumento. Um grupo revisor constituído por um profissional da Fonoaudiologia, um da Psicologia e do Serviço Social, reuniu a melhor tradução encontrada para cada questão em um único questionário em português. Para melhorar a qualidade da tradução, outros três tradutores realizaram nova versão para o inglês e o grupo revisor analisou, comparando-as com o original. Para pré-testagem, o questionário foi aplicado por dois avaliadores em 30 pacientes com diagnóstico de deficiência auditiva. Resultados foi realizada a tradução para o português: "Questionário de Expectativa com Uso de Auxiliares Auditivos". Durante o processo de tradução, houve pequenas diferenças entre as versões, sendo, em sua maioria, referentes à tradução literal. Para a adaptação, as três traduções foram analisadas e, por consenso, foram escolhidas as melhores expressões e palavras em todas as questões, adaptando o texto ao conhecimento e compreensão da população brasileira. Conclusão o questionário Expected Consequences of Hearing aid Ownership encontra-se traduzido e adaptado para a cultura brasileira e pode ser utilizado como importante ferramenta para fonoaudiólogos no conhecimento das expectativas do paciente e melhor delineamento do processo de reabilitação.
ABSTRACT Purpose To translate and culturally adapt the Expected Consequences of Hearing aid Ownership (ECHO) for application in the Brazilian population. Methods The Expected Consequences of the Hearing aid Ownership questionnaire consists of 15 questions and investigates the expectation of adults with hearing loss regarding the use of an Individual hearing aid. The translation was carried out by three English translating teachers who had no previous contact with the instrument. A review group made up of a professional in speech therapy and another in psychology and social work gathered the best translation found for each question in a single questionnaire in Portuguese. To improve the quality of the translation, three other translators made a new version in English, and the review group analyzed it by comparing them with the original. For pre-testing, the questionnaire was offered by two evaluators for 30 patients diagnosed with hearing loss. Results A translation into Portuguese was made: "Questionário de Expectativa com uso de Auxiliares Auditivos." During the translation process, there was little difference between the versions, mostly referring to a literal translation. For adaptation, the three translations were analyzed and by consensus the best expressions and words were chosen for all questions, adapting the text to the knowledge and understanding of the Brazilian population. Conclusion The Expected Consequences of Hearing aid Ownership questionnaire has been translated and adapted to the Brazilian culture. This questionnaire can be used as an important tool for speech therapists in understanding the patient's expectations and can better outlinethe rehabilitation process.
Subject(s)
Humans , Translations , Brazil , Cross-Cultural Comparison , Surveys and Questionnaires , Hearing Loss , Speech, Language and Hearing Sciences , Hearing AidsABSTRACT
RESUMO Indivíduos acometidos pelo acidente vascular cerebral (AVC) tendem a manter um padrão sedentário de vida com nível de atividade física insuficiente, gerando limitações funcionais, restrição na participação e dificuldade de envolvimento em programas de exercícios. Compreender a preferência de exercícios desta população é importante para o entendimento dos fatores contextuais e a adequação de programas voltados à promoção de saúde e funcionalidade. Trata-se de um estudo transversal com amostra de conveniência, cujos objetivos foram identificar a preferência de exercícios de indivíduos na fase crônica do AVC usuários do Sistema Único de Saúde em Belo Horizonte, (MG), Brasil, e investigar a associação com o grau de comprometimento motor, velocidade de marcha, nível de atividade física e qualidade de vida. A preferência de exercícios foi avaliada pelo Questionário de Preferência de Exercícios(AVC)-Brasil. Foram entrevistados 24 indivíduos (59±15 anos) que reportaram preferência por exercícios realizados em ambientes controlados e ofertados em grupo. Os exercícios favoritos foram a caminhada e o treino de força muscular. Não houve correlação entre a preferência de exercícios e as variáveis investigadas. Identificar a preferência de exercícios desta população pode contribuir para uma melhor assistência à saúde fornecida pelos serviços públicos, além de aumentar a adesão desses indivíduos aos programas de promoção à saúde e funcionalidade.
RESUMEN Los individuos afectados por accidente cerebrovascular (ACV) tienden a mantener un patrón de vida sedentario con niveles insuficientes de actividad física, lo que resulta en limitaciones funcionales, participación restringida y dificultad para realizar programas de ejercicio físico. Conocer la preferencia del tipo de ejercicios en esta población es importante para entender los factores contextuales y la adecuación de los programas destinados a promover la salud y la funcionalidad de estas personas. Este es un estudio transversal, con una muestra de conveniencia, y sus objetivos fueron: identificar la preferencia de tipo de ejercicio de los individuos en fase crónica de ACV usuarios del Sistema Único de Salud en Belo Horizonte (Minas Gerais, Brasil) e investigar la asociación con el grado de deterioro motor, velocidad de marcha, nivel de actividad física y calidad de vida. La preferencia del tipo de ejercicio fue evaluada por el Cuestionario de Preferencia de Ejercicios (ACV)-Brasil. Se evaluaron a 24 individuos (59±15 años) quienes informaron preferir ejercicios realizados en ambientes controlados y en grupo. Los ejercicios favoritos fueron caminata y entrenamiento de fuerza muscular. No se encontró correlación entre la preferencia de ejercicios y las variables investigadas. El conocimiento de la preferencia de ejercicio de esta población puede ayudar a una mejor asistencia sanitaria de los servicios públicos, además de incrementar la adherencia de estas personas a los programas de promoción de la salud y la funcionalidad.
ABSTRACT Individuals affected by stroke tend to maintain a sedentary lifestyle with insufficient level of physical activity, generating functional limitations, restricted participation, and difficulty in engaging in exercise programs. Understanding the exercise preference of this population is important to understand contextual factors and the adequacy of programs aimed at promoting health and functionality. This is a cross-sectional study with a convenience sample, whose objectives were: to identify the exercise preference of individuals in the chronic phase of stroke users of the Brazilian Unified Health System in Belo Horizonte/MG/Brazil and to investigate the association with degree of motor impairment, gait speed, level of physical activity, and quality of life. Exercise preference was assessed using the e Exercise Preference Questionnaire(stroke)-Brazil. In total, 24 individuals (59±15 years old) who reported a preference for exercises performed in controlled environments and offered in groups were evaluated. Favorite exercises were walking and muscle strength training. There was no correlation between exercise preference and the investigated variables. Identifying the exercise preference of this population can contribute to better health care provided by public services, in addition to increasing these individuals' adherence to health and functionality promotion programs.
ABSTRACT
O presente estudo objetivou identificar como o paciente neurológico, em atendimento no setor de Terapia Ocupacional (T.O), percebe a influência desse serviço em sua saúde global. O estudo foi desenvolvido em um Centro Especializado em Reabilitação II (CER II), de uma cidade de médio porte do interior de São Paulo, que dispõe do serviço de Terapia Ocupacional em Neurologia Ambulatorial Adulto e Idoso. O instrumento utilizado para a coleta de dados foi um roteiro de perguntas semiestruturado, aplicado na forma de entrevista. Foram abordados tópicos para a caracterização dos participantes e para o registro de suas percepções. Os temas destacados abrangeram: como o usuário se sente com o tratamento; quais sentimentos se destacam nesse processo; mudanças percebidas no decorrer das intervenções; e grau de satisfação com o serviço. A análise de dados foi realizada de forma qualitativa por meio dos dados provindos das entrevistas. Houve a prevalência do sexo masculino (n=10), na faixa etária acima de 18 anos e menor de 60 (n=8), com maior incidência de Acidente Vascular Encefálico (n=6). Nas questões abertas foi possível identificar a prevalência de sentimentos positivos, a percepção do usuário sobre a contribuição positiva da T.O em relação ao ganho de independência, qualidade de vida e que todos os participantes recomendariam o serviço ofertado pela T.O. O estudo possibilitou um feedback sobre a intervenção prestada e demonstrou que o significado da intervenção contempla a complexidade da base holística do tratamento.
El objetivo de la presente investigación es evaluar como el paciente neuropata, en cuidados por la Terapia Ocupacional (T.O), percibe la importancia del servicio en su salud general. La investigación fue desarrollada en el Centro Especialista en Rehabilitación II (CER II), ubicado en una ciudad del departamento de São Paulo, el centro cuenta con un ambulatorio de terapia ocupacional neurológica para adultos y ancianos. Para recolectar los informes fue puesta en práctica una encuesta con un cuestionario semiestructurado, fueron abordados temas con el fin de caracterizar y registrar sus visiones con las siguientes cuestiones principales: ¿Cómo se siente el paciente con el tratamiento recebido?, ¿Cuáles son los sentimientos destacados en este proceso?, los cambios percibidos por el paciente hacia las citas y el grado de satisfacción con el servicio. El análisis de datos fue hecho cualitativamente con los datos recibidos de la encuesta. Hubo un predominio del sexo masculino (n = 10), en el grupo de edad mayor de 18 años y menor de 60 (n = 8), con mayor incidencia de accidente vascular encefálico (n = 6). En las preguntas abiertas fue posible identificar el predominio de sentimientos positivos, la percepción del paciente sobre la contribución positiva de la T.O en relación con la ganancia de independencia, calidad de vida y que todos los participantes recomendarían el servicio ofrecido por la T.O. La investigación proporcionó un feedback positivo sobre la intervención y demostró que el significado de la intervención, aborda la complejidad de la base holística del tratamiento.
The following study aimed to identify how the neurological patient, who is receiving care in the occupational herapy (O.T.) sector, realizes on this service's influence in their global health. The study was developed in a Specialized Center for Rehabilitation II (CER II), located in a medium-sized town in the interior of São Paulo, which has an Occupational Therapy in Adult and Elderly Outpatient Neurology Service. The instrument used for data collection was a semi-structured questionnaire, applied as an interview. Topics for characterizing the participants and recording their perceptions were addressed. The highlighted topics covered: how the user feels about the treatment; what feelings stand out in this process; changes perceived in the course of activities; and degree of satisfaction with the service. Data analysis was performed qualitatively based on the information from the interviews. There was a prevalence of males (n = 10) aged over 18 and under 60 (n = 8), with a higher incidence of stroke (n = 6). In the open questions it was possible to identify positive feelings prevalence, the user's perception of the positive contribution of O.T. regarding gaining independence and quality of life and that all participants would recommend the service offered by O.T. The study provided feedback on the intervention given and showed that the intervention meaning fulfills the complexity of holistic basis of treatment.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Patient Satisfaction , Neurodegenerative Diseases/rehabilitation , Ambulatory Care , Quality of Life , Attitude to Health , Surveys and Questionnaires , Occupational Therapy , Qualitative ResearchABSTRACT
Background: Theoretically, the exercise of good medicine requires physicians who possess and practice virtues. There are good reasons to believe that virtue ethics would be highly appreciated by patients. Aim: To determine the importance that patients attribute to the possession virtues among physicians. Material and Methods: Patients hospitalized in a private and a public hospital were invited to answer a three-question survey. The questions were: first, what do you expect of a good physician? Second, please evaluate, in a scale from 1 to 5, the importance of physician virtues to consider him a good doctor (fidelity to trust given by the patient, benevolence, postponement of self-interests, compassion, intellectual honesty, justice and prudence). Third, among the seven former virtues, select the three more important, and then the most important of all. Results: Most patients responded that they valued that a good physician should have good communication skills, a cordial relationship, commitment to the patient and knowledge. All virtues studied were considered important or very important by almost all patients. The virtues considered the most important were intellectual honesty and fidelity to trust given by the patient. Conclusions: These results support the theoretical argument that, for patients, the practice of virtue ethics is essential for a good medical practice.
Subject(s)
Humans , Male , Physicians , Medicine , Physician-Patient Relations , Surveys and Questionnaires , Virtues , Empathy , Ethics, MedicalABSTRACT
Resumo Fundamento: Selecionar a estratégia de tratamento ideal para a revascularização coronária é um desafio. Um desfecho crucial a ser considerado no momento dessa escolha é a necessidade de refazer a revascularização, uma vez que ela se torna muito mais frequente após a intervenção coronária percutânea (ICP) do que após a cirurgia de revascularização do miocárdio (CRM). Objetivo: Pretende-se, com este estudo, trazer reflexões acerca das preferências dos pacientes pelas estratégias de revascularização sob a perspectiva de pacientes que tiveram que refazer a revascularização. Métodos: Selecionamos uma amostra de pacientes que haviam sido submetidos à ICP e hospitalizados para refazer a revascularização coronária e elicitamos suas preferências por nova ICP ou CRM. Morte perioperatória, mortalidade a longo prazo, infarto do miocárdio e repetir a revascularização foram utilizados para a construção de cenários a partir da descrição de tratamentos hipotéticos que foram rotulados como ICP ou CRM. A ICP era sempre apresentada como a opção com menor incidência de morte perioperatória e maior necessidade de se refazer o procedimento. O modelo logístico condicional foi empregado para analisar as escolhas dos pacientes, utilizando-se o software R. Valores de p <0,05 foram considerados estatisticamente significativos. Resultados: Ao todo, 144 pacientes participaram, a maioria dos quais (73,7%) preferiram a CRM à ICP (p < 0,001). Os coeficientes de regressão foram estatisticamente significativos para o rótulo ICP, mortalidade a longo prazo da ICP, morte perioperatória da CRM, mortalidade a longo prazo da CRM e refazer a CRM. O rótulo ICP foi o parâmetro mais importante (p < 0,05). Conclusão: A maioria dos pacientes que enfrentam a necessidade de refazer a revascularização coronária rejeitam uma nova ICP, com base em níveis realistas de riscos e benefícios. Incorporar as preferências dos pacientes à estimativa do risco-benefício e às recomendações de tratamento poderia melhorar o cuidado centrado no paciente.
Abstract Background: Selecting the optimal treatment strategy for coronary revascularization is challenging. A crucial endpoint to be considered when making this choice is the necessity to repeat revascularization since it is much more frequent after percutaneous coronary intervention (PCI) than after coronary artery bypass grafting (CABG). Objective: This study intends to provide insights on patients' preferences for revascularization, strategies in the perspective of patients who had to repeat revascularization. Methods: We selected a sample of patients who had undergone PCI and were hospitalized to repeat coronary revascularization and elicited their preferences for a new PCI or CABG. Perioperative death, long-term death, myocardial infarction, and repeat revascularization were used to design scenarios describing hypothetical treatments that were labeled as PCI or CABG. PCI was always presented as the option with lower perioperative death risk and a higher necessity to repeat procedure. A conditional logit model was used to analyze patients' choices using R software. A p value < 0.05 was considered statistically significant. Results: A total of 144 patients participated, most of them (73.7%) preferred CABG over PCI (p < 0.001). The regression coefficients were statistically significant for PCI label, PCI long-term death, CABG perioperative death, CABG long-term death and repeat CABG. The PCI label was the most important parameter (p < 0.05). Conclusion: Most patients who face the necessity to repeat coronary revascularization reject a new PCI, considering realistic levels of risks and benefits. Incorporating patients' preferences into benefit-risk calculation and treatment recommendations could enhance patient-centered care.