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1.
Article in Portuguese | LILACS | ID: biblio-1551281

ABSTRACT

Modelo do estudo: Revisão de escopo recomendada pelo Instituto Joanna Briggs e PRISMA-ScR. Objetivo: Analisar e sintetizar as evidências científicas sobre questionários relacionados ao diabetes mellitus validados para língua portuguesa do Brasil. Método: Foram incluídos estudos com resumo disponível e que descreveram um questionário relacionado ao diabetes mellitus publicados em inglês, espanhol ou português em periódicos indexados no PubMed, Scopus, BVS e Web of Science e nos catálogos de dissertações/teses do Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior entre 2011 e 2022. Os descritores utilizados foram: diabetes mellitus; diabetes; sur-veys and questionnaires; reproducibility of results; psychometrics; validation studies; validation studies as topic; Brazil; Brazilian. O protocolo do estudo foi registrado na plataforma Open Science Framework (https://osf.io/asb-jz/). Resultados: Integraram esta revisão 39 publicações cujos questionários selecionados abordaram os temas: autocuidado/autogestão/autogerenciamento/autoeficácia; qualidade de vida; cuidado com a pele, úlceras e lesões; plano alimentar; adesão medicamentosa; estresse emocional/psicológico; conhecimento sobre diabetes; risco para desenvolvimento do diabetes; satisfação da qualidade dos cuidados em diabetes; manejo do diabetes em escolas; atitudes de profissionais da saúde frente ao diabetes. Conclusão: A utilização de questionários validados pode contribuir para a medida das barreiras e dificuldades encontradas por pessoas com diabetes mellitus e direcionar para a construção de estratégias de intervenções que sejam mais assertiva (AU).


Study design: Scoping review following the recommendations of the Joanna Briggs Institute and PRISMA-ScR. Objective: To analyze and synthesize scientific evidence on questionnaires related to diabetes mellitus validated in Brazilian Portuguese. Method: Studies with available abstracts and that described a questionnaire related to diabetes mellitus published in English, Spanish or Portuguese, in journals indexed in PubMed, Scopus, VHL and Web of Science and in the catalog of dissertations/theses of the Portal of the Coordination for the Improvement of Higher Education Personnel, between 2011 and 2022 were included. The descriptors used were: diabetes mellitus; diabetes; surveys and questionnaires; reproducibility of results; psychometrics; validation studies; validation studies as topic; Brazil; and Brazilian. The study protocol was registered on the Open Science Framework platform (https://osf.io/asbjz/). Results: This review included 39 publications in which selected questionnaires addressed the themes: self-care/self-management/self-efficacy; quality of life; skin, ulcer and wound care; food plan; medication adherence; emotional/psychological stress; knowledge about diabetes; risk for developing diabetes; satisfaction with the quality of diabetes care; diabetes management in schools; and attitudes of healthcare professionals towards diabetes. Conclusion: The use of validated questionnaires can contribute to the measurement of barriers and difficulties encountered by people with diabetes mellitus and direct the construction of more assertive intervention strategies (AU).


Subject(s)
Humans , Psychometrics , Surveys and Questionnaires , Outcome Assessment, Health Care , Validation Study , Diabetes Mellitus
2.
Rev. colomb. cir ; 38(3): 432-438, Mayo 8, 2023. fig
Article in Spanish | LILACS | ID: biblio-1438415

ABSTRACT

Introducción. La investigación quirúrgica es uno de los pilares de la cirugía académica, que integra el microambiente para lograr una adecuada práctica basada en la evidencia, realizar planteamientos y conseguir eventuales soluciones a necesidades quirúrgicas de una población. En el caribe colombiano existen brechas significativas en cuanto al aporte en investigación quirúrgica, comparado con otras regiones del país. Por ende, es necesaria una iniciativa que haga frente a estos retos. Métodos. El Grupo Colaborativo de Investigación en Cirugía General y Subespecialidades del Caribe Colombiano (GRINCIRCAR), es una iniciativa fundada por una colectividad de estudiantes de medicina, médicos residentes de cirugía y cirujanos académicos de universidades del caribe colombiano, que buscan impulsar la investigación quirúrgica y aportar a la resolución de problemas de salud en cirugía de la región. Discusión. De acuerdo al programa de investigación con políticas y prioridades en salud establecidos por el Instituto Nacional de Salud, existen por lo menos dos dimensiones donde se involucra directamente la cirugía. A pesar de esto, no existen datos sobre la distribución de recursos para la investigación quirúrgica en la región del Caribe colombiano, pese a que el acceso al cuidado quirúrgico básico y las enfermedades quirúrgicas, hace parte de las prioridades en salud y cirugía global. Conclusiones. Se necesita promover la cirugía académica y la investigación quirúrgica en la región del caribe colombiano. La investigación colaborativa podría ser una solución al integrar la participación de múltiples centros y participantes


Introduction. Surgical research is one of the cornerstones of academic surgery, which integrates the microenvironment to achieve an adequate evidence-based practice, asking the right questions to achieve eventual solutions to the surgical needs of a population. In the Colombian Caribbean, there are significant gaps in the contribution in surgical research, compared to other regions of the country. Therefore, an initiative is needed to address these challenges. Methods. The Collaborative Group for Research in General Surgery and Subspecialties of the Colombian Caribbean (GRINCIRCAR) is an initiative founded by a group of medical students, surgical residents and academic surgeons from Colombian Caribbean universities, who seek to promote surgical research and contribute to solutions of health problems in surgery in the region. Discussion. According to the research program, health policies and priorities established by the National Institute of Health, there are at least two dimensions where surgery is directly involved. Despite this, there are no data on the distribution of resources for surgical research in the Colombian Caribbean region, despite the fact that access to basic surgical care and surgical diseases are part of the priorities in global health and surgery. Conclusions. There is a need to promote academic surgery and surgical research in the Colombian Caribbean region. Collaborative research in the region could be a solution by integrating the participation of multiple centers and participants


Subject(s)
Humans , Research Design , Health Services Research , Research , General Surgery , Outcome Assessment, Health Care , Colombia
3.
Rev. colomb. cir ; 38(3): 501-511, Mayo 8, 2023. tab
Article in Spanish | LILACS | ID: biblio-1438578

ABSTRACT

Introducción. La mortalidad perioperatoria en el mundo representa 4,2 millones de muertes anuales. El cuarto indicador de The Lancet Commission on Global Surgery permite estandarizar la mortalidad perioperatoria. En Colombia, existen aproximaciones por datos secundarios, limitando el análisis y las intervenciones aplicables a nuestra población. El objetivo de este estudio fue describir la mortalidad perioperatoria a través de datos primarios que permitan sustentar políticas públicas. Métodos. Se hizo el análisis preliminar de un estudio observacional, de cohorte prospectiva, multicéntrico en 6 instituciones del departamento de Tolima. Se incluyeron los pacientes llevados a procedimientos quirúrgicos por una semana, con posterior seguimiento hasta el egreso, fallecimiento o 30 días de hospitalización. La mortalidad perioperatoria fue el desenlace primario. Resultados. Fueron incluidos 378 pacientes, con mediana de 49 años (RIC 32-66), buen estado funcional (ASA I-II 80 %) y baja complejidad quirúrgica (42 %). Las cirugías más comunes fueron por Ortopedia (25,4 %) y Cirugía plástica (23,3 %). El 29,7 % presentaron complicaciones postoperatorias, las más comunes fueron síndrome de dificultad respiratoria agudo e íleo postoperatorio. La mortalidad perioperatoria fue de 1,3 %. Discusión. La mortalidad perioperatoria discrepó de la reportada en otros estudios nacionales, aun cuando los pacientes tenían un bajo perfil de riesgo y baja complejidad de los procedimientos. Sin embargo, coincide con la reportada internacionalmente y nos acerca a la realidad del país. Conclusión. La determinación del cuarto indicador es de vital importancia para mejorar la atención quirúrgica en Colombia. Este es el primer acercamiento con datos primarios que nos permite tener información aplicable a nuestra población


Introduction. Perioperative mortality accounts for 4.2 million deaths annually. The fourth indicator of The Lancet Commission on Global Surgery allows standardizing perioperative mortality. In Colombia, there are approximations based on secondary data, limiting the analysis and interventions applicable to our population. The objective of this study is to describe perioperative mortality through primary data that allow supporting public policies. Methods. A preliminary analysis of an observational, prospective cohort, multicenter study was carried out at six institutions in the District of Tolima. Patients undergoing surgical procedures were included for one week, for subsequent follow-up until discharge, death, or 30 days of hospitalization. Perioperative mortality was the primary outcome and was presented as a proportion. Results. A total of 378 patients were included, with a median age of 49 years (RIC 32-66), low-risk profile (ASA I-II 80%), and low surgical complexity (42%). The most common surgeries were Orthopedic (25.4%) and Plastic Surgery (23.3%). Postoperative complications occurred in 29.7%, the most common were ARDS and postoperative ileus. Perioperative mortality was 1.3%. Discussion. Perioperative mortality differed from that reported in national studies, even when the patients had a low-risk profile and low complexity of the procedures. However, it coincides with that reported internationally and brings us closer to the reality of the country. Conclusion. The determination of the fourth indicator is of vital importance to improving surgical care in Colombia. This is the first approach with primary data that allows us to have applicable information for our population


Subject(s)
Humans , Postoperative Complications , Outcome Assessment, Health Care , General Surgery , Public Health , Hospital Mortality
4.
Rev. bras. ortop ; 58(3): 435-442, May-June 2023. tab
Article in English | LILACS | ID: biblio-1449825

ABSTRACT

Abstract Objective To assess the risk factors involving longer hospital stays and early postoperative complications (first 30 days after surgery) in patients undergoing total knee arthroplasty (TKA). Materials and Methods Across-sectional study was conducted with collection of data of patients who underwent TKA in a private hospital between 2015 and 2019. The following data were collected: age, gender, body mass index, and clinical comorbid-ities. We also collected intraoperative data such as the grade on the classification of the American Society of Anesthesiologists (ASA), the duration of the surgery, the length of stay, the postoperative complications, and readmission within 30 days. Statistical models were used to investigate the possible risk factors associated with longer hospital stays and postoperative complications. Results There was evidence of an increase in the length of hospital stay in older patients, with higher grades on the ASA classification or who suffered postoperative complications. For each increase in 1 year of age, we expect the length of stay to be multiplied by 1.008 (95% confidence interval [95%CI]: 1.004 to 1.012; p < 0,001). In patients who were ASA grade III, the time is expected to be multiplied by 1.297 (95%CI: 1.083 to 1.554; p = 0,005) when compared with grade-I patients. In patients who suffered postoperative complications, the time is expected to be multiplied by 1.505 (95%CI: 1.332 to 1.700; p < 0.001) compared with patients without complications. Conclusion The present study demonstrated that, in patients who underwent primary TKA, preoperative characteristics such as older age and ASA grade > III, as well as the development of postoperative complications, independently predict the increase in the length of hospital stay.


Resumo Objetivo Avaliar os fatores de risco relacionados a um tempo de internação mais longo e às complicações pós-operatórias precoces (primeiros 30 dias após a cirurgia) em pacientes submetidos a artroplastia total do joelho (ATJ). Materiais e Métodos Este é um estudo transversal com coleta de dados de pacientes submetidos a ATJ em um hospital privado entre 2015 e 2019. Os seguintes dados foram coletados: idade, gênero, índice de massa corporal, e comorbidades clínicas. Também coletamos dados intraoperatórios, como o grau na classificação da American Society of Anesthesiologists (ASA) e a duração da cirurgia, além do tempo de internação, as complicações pós-operatórias, e a readmissão em 30 dias. Os possíveis fatores de risco associados a um tempo de internação mais longo e às taxas de complicações pós-operatórias foram investigados por meio de modelos estatísticos. Resultados Os pacientes mais velhos, com graus mais elevados na classificação da ASA ou que sofreram complicações pós-operatórias, ficaram internados por mais tempo. Para cada aumento em um ano de idade, esperamos que o tempo de internação seja multiplicado por 1,008 (intervalo de confiança de 95% [IC95%]: 1,004 a 1,012; p < 0,001). Em pacientes de grau III na classificação da ASA, espera-se que o tempo seja multiplicado por 1,297 (IC95%: 1,083 a 1,554; p = 0,005) em comparação com pacientes de grau I. Em pacientes com complicações pós-operatórias, espera-se que o tempo seja multiplicado por 1,505 (IC95%: 1,332 a 1,700; p < 0,001) em comparação com pacientes sem complicações. Conclusão Este estudo demonstrou que, em pacientes submetidos a ATJ primária, características pré-operatórias, como idade avançada e grau ≥ III na classificação da ASA, e o desenvolvimento de complicações pós-operatórias predizem o aumento do tempo de internação hospitalar de forma independente.


Subject(s)
Humans , Postoperative Complications , Outcome Assessment, Health Care , Arthroplasty, Replacement, Knee , Length of Stay
5.
Rev. colomb. cir ; 38(2): 300-312, 20230303. tab
Article in Spanish | LILACS | ID: biblio-1425203

ABSTRACT

Introducción. La condición de pandemia por COVID-19 impactó a la sociedad y los sistemas de salud a nivel mundial. Las adaptaciones institucionales procuraron mantener la calidad de la atención a pesar de un contexto organizacional desfavorable. La apendicitis aguda requirió ser manejada en un nuevo escenario institucional. El objetivo de este estudio fue evaluar la efectividad del tratamiento quirúrgico de la apendicitis durante la pandemia. Métodos. Estudio observacional analítico, retrospectivo, en el que se incluyeron pacientes sometidos a apendicectomía, antes y durante la pandemia por COVID-19. Se evaluaron las complicaciones, infección del sitio operatorio, reingresos y estancia hospitalaria. Adicionalmente, se analizaron los desenlaces en los 3 picos epidemiológicos de la pandemia. Se efectuaron estadísticas descriptivas y analíticas entre los grupos a comparar. Resultados. Se incluyeron 1521 pacientes con apendicitis, 48,3 % operados antes y 51,7 % durante la pandemia. No hubo diferencias entre los grupos en complicaciones (p=0,352), infección del sitio operatorio (p=0,191), reingreso en los primeros 30 días (p=0,605) y estancia hospitalaria (p=0,514). El manejo de la apendicitis durante el tercer pico fue similar a las prácticas habituales. El tiempo de evolución fue mayor durante la pandemia (p=0,04) y los pacientes fueron llevados a cirugía más pronto que previo a la pandemia (p<0,001). Conclusiones. No se evidenció un incremento de complicaciones quirúrgicas, reingresos, estancia hospitalaria ni infección del sitio operatorio en los pacientes operados durante la pandemia. Hubo un efecto favorable para los pacientes como consecuencia de la adaptación institucional en la pandemia por COVID-19


Introduction. COVID-19 pandemic impacted society and health systems worldwide. The institutional adaptations sought to maintain the quality of care in an unfavorable organizational context. Acute appendicitis was required to be managed in a new institutional setting. The effectiveness of surgical treatment of appendicitis during the pandemic was evaluated. Methods. Retrospective analytical observational study, in patients with appendectomy, before and during COVID-19 pandemic. Complications, surgical site infections, readmissions, and hospital stay were evaluated. Additionally, the outcomes in the 3 epidemiological peaks of the pandemic were analyzed. Descriptive and analytical statistics were performed between the groups to be compared. Results. A total of 1521 patients with appendicitis were included, 48.3% before and 51.7% during the pandemic. There were no differences in complications (p=0.352), operative site infection (p=0.191), readmission at 30 days (p=0.605), and hospital stay (p=0.514) between the groups. Management of appendicitis during the 3rd peak was like usual practices. There was a long evolution time during the pandemic (p=0.04) and the patients were taken to surgery sooner than before the pandemic (p<0.001). Conclusions. There was no evidence of an increase in surgical complications, readmissions, hospital stay, and surgical site infections during patients who underwent surgery. There was a favorable effect for patients because of institutional adaptation in the COVID-19 pandemic


Subject(s)
Humans , Appendicitis , Outcome Assessment, Health Care , Coronavirus Infections , Postoperative Complications , Pandemics , Length of Stay
6.
MedUNAB ; 26(2): 282-291, 20230108.
Article in Spanish | LILACS | ID: biblio-1555145

ABSTRACT

Introducción. La monitorización de la utilización del conocimiento y la evaluación de resultados permiten conocer la aplicación de la evidencia, cambios en los conocimientos y actitudes, el impacto en resultados de salud y la integración y el mantenimiento de las prácticas adoptadas. Existen debilidades relacionadas con la falta de sistematización, limitaciones de los registros y calidad del proceso. El objetivo de este artículo es describir la experiencia en la generación de estrategias de monitorización y evaluación de resultados de implantación de Guías de Buenas Prácticas en España. División de temas tratados. En primer lugar, se revisan los procesos de medición de resultados en la implantación de Guías, en el marco del Programa Best Practice Spotlight Organizations®, cuya herramienta para liderar el cambio incluye la monitorización y evaluación como una de las seis fases del ciclo de acción. En segundo lugar, se analizan las estrategias de monitorización y evaluación propuestas en la literatura, destacando la Asociación Profesional de Enfermeras de Ontario. Finalmente, se analizan las estrategias de monitorización y evaluación generadas por dos instituciones españolas participantes en el programa, centradas en adecuación de registros, explotación y análisis de indicadores, desarrollo de herramientas, procedimientos de evaluación y mecanismos de difusión y retroalimentación. Conclusiones. La definición de estrategias de monitorización y evaluación planificada de forma temprana contribuye a la viabilidad de la evaluación de la implantación y su sostenibilidad. Es necesario adaptarlas al contexto, con estrategias transversales que alcancen a toda la institución, facilitadas por la institución. Palabras clave: Ciencia de la Implementación; Práctica Clínica Basada en la Evidencia; Evaluación de Resultado en la Atención de Salud; Mecanismos de Evaluación de la Atención de Salud; Indicadores de Calidad de la Atención de Salud


Introduction. Monitoring the usage of knowledge and evaluating results permits one to know the application of the evidence, knowledge, and attitude changes, the impact on health results, integration, and maintenance of the adopted practices. There exist weaknesses related to lack of systematization, limitation of the records, and quality of the process. This article's objective is to describe the experience generating monitoring strategies and evaluation of the results regarding the implementation of good practice guides in Spain. Topics for Reflection. In the first place, the measurement process of the results regarding the implementation of guides are reviewed, in the Best Practice Spotlight Organizations® program frame, whose tool to lead the change includes monitoring and evaluation as one of the sixth phases of the action cycle. In the second place, monitoring and evaluation strategies proposed in the literature are analyzed, highlighting the Professional Nurses Association of Ontario. Finally, the monitoring and evaluation strategies are analyzed by two Spanish institutions participating in the program, focused on the adequation of records, exploitation and indicator analysis, tools development, evaluation procedures, dissemination, and feedback mechanisms. Conclusions: The definition of monitoring and evaluation strategies planned in advance contributes to the viability of the evaluation regarding the implementation and its sustainability. Is necessary to adapt them to the context, with transversal strategies that reach the whole institution, facilitated by the institution. Keywords: Implementation Science; Evidence-Based Practice; Outcome Assessment, Health Care; Health Care Evaluation Mechanisms; Quality Indicators, Health Care


Introdução. Monitorizar a utilização do conhecimento e avaliar os resultados permite-nos conhecer a aplicação das evidências, as mudanças nos conhecimentos e atitudes, o impacto nos resultados de saúde e a integração e manutenção das práticas adotadas. Existem fragilidades relacionadas à falta de sistematização, limitações de registros e qualidade do processo. O objetivo deste artigo é descrever a experiência na geração de estratégias de monitoramento e avaliação dos resultados da implementação de Manuais de Boas Práticas na Espanha. Divisão dos temas abordados. Em primeiro lugar, são revistos os processos de medição de resultados na implementação dos Manuais, no âmbito do Programa Best Practice Spotlight Organizations®, cuja ferramenta para liderar a mudança inclui a monitorização e avaliação como uma das seis fases do ciclo de ação. Em segundo lugar, são analisadas as estratégias de monitoramento e avaliação propostas na literatura, com destaque para a Associação Profissional de Enfermeiros de Ontário. Por fim, são analisadas as estratégias de monitoramento e avaliação geradas por duas instituições espanholas participantes do programa, focadas na adaptação de registros, exploração e análise de indicadores, desenvolvimento de ferramentas, procedimentos de avaliação e mecanismos de divulgação e feedback. Conclusões. A definição de estratégias de monitoramento e avaliação planeadas antecipadamente contribui para a viabilidade da avaliação da implementação e para a sua sustentabilidade. É necessário adaptá-los ao contexto, com estratégias transversais que alcancem toda a instituição, facilitadas pela instituição. Palavras-chave: Ciência da Implementação; Prática Clínica Baseada em Evidências; Avaliação de Resultados em Cuidados de Saúde; Mecanismos de Avaliação da Assistência à Saúde; Indicadores de Qualidade em Assistência à Saúde


Subject(s)
Evidence-Based Practice , Outcome Assessment, Health Care , Health Care Evaluation Mechanisms , Quality Indicators, Health Care , Implementation Science
7.
MedUNAB ; 26(2): 251-261, 20230108.
Article in Spanish | LILACS | ID: biblio-1555173

ABSTRACT

Introducción. Tomar decisiones clínicas basadas en la mejor evidencia disponible es una buena práctica que favorece los resultados en salud. Su uso ha sido promovido por diferentes organismos; sin embargo, aún existen algunas barreras entre profesionales de la salud para su apropiación. El objetivo fue el análisis exploratorio del efecto de un curso sobre los conocimientos, habilidades y actitudes frente a la Medicina Basada en la Evidencia (MBE) en profesionales de la salud que ejercen en Bogotá, Colombia. Metodología. Estudio exploratorio que incluyó un componente cuantitativo y uno cualitativo de carácter descriptivo. El estudio se desarrolló entre agosto de 2022 y abril de 2023. Para el componente cuantitativo se construyó un cuestionario tipo test, compuesto por 38 preguntas, aplicado antes y después del curso. Respecto de lo cualitativo, se realizaron en total 6 entrevistas semiestructuradas a docentes, estudiantes y uno de los gestores del proyecto. Resultados. Los resultados cuantitativos permitieron identificar cambios relacionados con la toma de decisiones clínicas, una mejora en el conocimiento y aplicación de herramientas para la evaluación de la calidad de estudios para resolver preguntas clínicas. El componente cualitativo permitió identificar dos temáticas centrales: pedagogía de la toma de decisiones y los aspectos que posibilitan o no la implementación de estas herramientas para tomar decisiones clínicas. Discusión. Los resultados sobre los efectos del curso son similares a los reportados por otros estudios en contextos diferentes al colombiano. Se requiere investigación que a mediano y largo plazo mida el impacto de la formación en el cambio de práctica. Conclusión. El curso sugiere tener efectos en los conocimientos y habilidades para mejorar la búsqueda y evaluación de la evidencia, así como para la formulación de preguntas clínicas, la comprensión de la certeza de la evidencia y mejorar la actitud hacia el uso de la evidencia para fundamentar la toma de decisiones en la clínica. Palabras clave: Medicina Basada en la Evidencia; Capacitación Profesional; Toma de Decisiones Clínicas; Desarrollo de Personal; Evaluación de Resultado en la Atención de Salud.


Introduction. Making clinical decisions based on the best available evidence is a good practice that favors health outcomes. Different organizations have promoted its use; however, there are still some barriers to its appropriation among health professionals. The objective was the exploratory analysis of the effect of a course on knowledge, skills, and attitudes towards Evidence-Based Medicine (EBM) in health professionals practicing in Bogotá, Colombia. Methodology. Exploratory study that included quantitative and qualitative components with a descriptive approach. The study was conducted between August 2022 and April 2023. For the quantitative component, a questionnaire was developed with 38 questions, applied before and after the course. In the qualitative component, 6 semi-structured interviews were conducted with teachers, students, and a Project manager. Results. The quantitative results showed changes in clinical decision-making and the improvement in the knowledge and application of study quality assessment tools to resolve clinical issues. The qualitative component identified two main themes: pedagogy in decision-making and the aspects that either allow or do not allow the implementation of these tools for clinical decision-making. Discussion. The results on the effects of the course are similar to those reported by other studies in contexts other than Colombia. Research is needed in the medium and long term to measure the impact of the training on practice change. Conclusion. The course suggests effects on knowledge and skills related to searching for and evaluating evidence, formulating clinical questions, understanding the certainty of evidence, and improving attitudes toward the use of evidence to inform clinical decision-making. Keywords: Evidence-Based Medicine; Professional Training; Clinical Decision-Making; Staff Development; Outcome Assessment Health Care


Introdução. Tomar decisões clínicas baseadas nas melhores evidências disponíveis é uma boa prática que favorece os resultados em saúde. A sua utilização tem sido promovida por diferentes instâncias, contudo, ainda existem algumas barreiras entre os profissionais de saúde para a sua apropriação. O objetivo foi a análise exploratória do efeito de um curso sobre conhecimentos, habilidades e atitudes em relação à Medicina Baseada em Evidências (MBE) em profissionais de saúde que atuam em Bogotá, Colômbia. Metodologia. Estudo exploratório que incluiu uma componente quantitativa e uma componente qualitativa descritiva. O estudo foi realizado entre agosto de 2022 e abril de 2023. Para a componente quantitativa foi criado um questionário do tipo teste, composto por 38 questões, aplicado antes e após o curso. Quanto aos aspectos qualitativos, foram realizadas um total de 6 entrevistas semiestruturadas com professores, alunos e um dos gestores do projeto. Resultados. Os resultados quantitativos permitiram identificar mudanças relacionadas à tomada de decisão clínica, melhoria no conhecimento e aplicação de ferramentas de avaliação da qualidade dos estudos para resolução de questões clínicas. A componente qualitativa permitiu identificar dois temas centrais: a pedagogía da tomada de decisão e os aspectos que possibilitam ou não a implementação destas ferramentas para a tomada de decisões clínicas. Discussão. Os resultados sobre os efeitos do curso são semelhantes aos relatados por otros estudos noutros contextos que não a Colômbia. É necessária investigação a médio e longo prazo para medir o impacto da formação na mudança de práticas. Conclusão. O curso sugere ter efeitos sobre conhecimentos e competências para melhorar a procura e avaliação de evidências, bem como para formular questões clínicas, compreender a certeza das evidências e melhorar a atitude em relação ao uso de evidências para fundamentar a tomada de decisões na clínica. Palavras-chave: Medicina Baseada em Evidências; Capacitação Profissional; Tomada de Decisão Clínica; Desenvolvimento de Pessoal; Avaliação de Resultados em Cuidados de Saúde


Subject(s)
Evidence-Based Medicine , Staff Development , Outcome Assessment, Health Care , Professional Training , Clinical Decision-Making
8.
MedUNAB ; 26(2): 177-186, 20230108.
Article in Spanish | LILACS | ID: biblio-1555209

ABSTRACT

Introducción. La instauración de una ostomía digestiva tiene una importante repercusión física y emocional en las personas. El objetivo de este estudio es analizar la adherencia de las enfermeras a las buenas prácticas en el manejo de las ostomías, la disminución de complicaciones y la adquisición de destrezas de los pacientes en su propio autocuidado tras la implementación de la Guía de Buenas Prácticas de la asociación de enfermeras de Ontario. Metodología. Estudio cuasiexperimental prospectivo en una unidad de cirugía digestiva desde 2017 hasta 2022. La intervención ha consistido en la implementación de las recomendaciones de cuidados de una Guía de Buenas Prácticas, analizando variables de proceso y de resultados en la salud a lo largo del proceso. Resultados. Se han encontrado diferencias significativas (p<0.05) en las variables de adherencia: educación sanitaria preoperatoria, marcaje del estoma, evaluación integral posoperatoria y educación sanitaria posoperatoria. No se han encontrado diferencias significativas en las variables de complicaciones del estoma (del 37.5% al 27.8%), ni en las complicaciones de la piel periestomal (del 12.5% al 10.2%). Sí se han encontrado diferencias en la variable de adquisición de destrezas del paciente en su autocuidado (del 44.44% al 98%). Discusión. Implantar recomendaciones de buenas prácticas mejora la calidad de los cuidados y disminuye las complicaciones. Conclusiones. La implementación de la guía ha aumentado la adherencia de las enfermeras a las buenas prácticas basadas en la evidencia y ha mejorado la adquisición de destrezas de los pacientes en su autocuidado, disminuyendo las complicaciones (aunque sin significación). Palabras clave: Estomía; Autocuidado; Guía de Práctica Clínica; Enfermería Basada en la Evidencia; Evaluación de Resultado en la Atención de Salud


Introduction. The establishment of a digestive ostomy has an essential physical and emotional repercussion. This study aims to analyze nurses' adherence to the good practice of management in ostomy, the decrease of complications, and the acquisition of patients' ability in self-care after implementing the Ontario Nurses' Good Practices guide. Methodology. A quasi-experimental prospective study in a digestive surgery unit from 2017 to 2022. The intervention consists of implementing the recommendations made in the Good Practices Guide and analyzing variables of process and health throughout the process. Results. Significative differences have been found (p<0.05) in the adherence variables: preoperatory sanitary education, marking of stoma, post-operatory integral evaluation, and sanitary post-operatory education. The investigators did not find significant differences in the variable of stoma complications (from 37.5% to 27.8%) or the peristoma skin complications (from 12.5% to 10.2%). A difference in the acquisition of abilities of the patient self-care was found (from 44.4% to 98%). Discussion. To make good practice recommendations improves the quality of the care and reduces complications. Conclusions. Implementing the guide has increased the nurses' adherence to the good practices based on the evidence and the acquisition of abilities in the patient's self-care, decreasing the complications (even though it didn't show significance). Keywords: Ostomy; Self Care; Practice Guideline; Evidence-Based Nursing; Outcome Assessment, Health Care


Introdução. A realização de uma ostomia digestiva tem um importante impacto físico e emocional nas pessoas. O objetivo deste estudo é analisar a adesão das enfermeiras às boas práticas no manejo de ostomias, a redução de complicações e a aquisição de habilidades dos pacientes no seu próprio autocuidado após a implementação das diretrizes de boas práticas dos Associação de Enfermeiras de Ontário. Metodologia. Estudo prospectivo quase-experimental numa unidade de cirurgia digestiva de 2017 a 2022. A intervenção consistiu na implementação das recomendações de cuidados das Diretrizes de Boas Práticas, analisando variáveis de processo e resultados de saúde ao longo do processo. Resultados. Foram encontradas diferenças significativas (p<0.05) nas variáveis de adesão: educação em saúde préoperatória, marcação do estoma, avaliação pós-operatória abrangente e educação em saúde pós-operatória. Não foram encontradas diferenças significativas nas variáveis de complicações do estoma (de 37.5% para 27.8%), nem nas complicações da pele periestomal (de 12.5% para 10.2%). Foram encontradas diferenças na variável aquisição de habilidades de autocuidado pelo paciente (de 44.44% para 98%). Discussão. A implementação de recomendações de boas práticas melhora a qualidade dos cuidados e reduz complicações. Conclusões. A implementação das diretrizes aumentou a adesão das enfermeiras às boas práticas baseadas em evidências e melhorou a aquisição de habilidades de autocuidado pelos pacientes, diminuindo complicações (embora não significativamente). Palavras-chave: Estomia; Autocuidado; Guia de Prática Clínica; Enfermagem Baseada em Evidências; Avaliação de Resultados em Cuidados de Saúde


Subject(s)
Practice Guideline , Self Care , Ostomy , Outcome Assessment, Health Care , Evidence-Based Nursing
9.
Psicol. ciênc. prof ; 43: e244243, 2023.
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1431131

ABSTRACT

A Avaliação Terapêutica (AT) é um processo avaliativo e interventivo proposto para ser semiestruturado e colaborativo com o objetivo de promover mudanças positivas no cliente, que é convidado a ter uma participação ativa durante o processo. Na AT, os resultados dos testes psicológicos padronizados ganham destaque como facilitadores do processo de autoconhecimento do cliente. Desse modo, usualmente, integram-se os achados de testes psicológicos de autorrelato com os métodos projetivos para gerar informações que possam ampliar a visão que o cliente tem de si. Neste artigo, buscou-se compreender o potencial de uso dos testes psicológicos e da relação colaborativa a partir de um caso atendido na perspectiva da AT. A participante, Violeta (nome fictício), foi atendida em 10 sessões com duração entre 60 e 115 minutos. Foram utilizados os testes psicológicos Escala de Bem-Estar Psicológico (Ebep), Escala de Vulnerabilidade e Estresse no Trabalho (Event), Bateria Fatorial de Personalidade (BFP), Método de Rorschach e Inventários de Habilidades Sociais 2 (IHS-2). Observou-se que, durante o processo, Violeta ampliou sua autopercepção, o que possibilitou mudanças no modo de agir em seus relacionamentos amorosos e na reflexão sobre como sua postura era vista por si e por seus colegas de trabalho. Acredita-se que a AT cumpriu com o objetivo de estabelecer uma experiência terapêutica que possibilitasse mudanças positivas para a cliente. Este estudo de caso contribuiu para ampliar a compreensão sobre a importância e o uso dos testes psicológicos neste modelo de avaliação psicológica.(AU)


The Therapeutic Assessment (TA) is an evaluative and interventional process proposed to be semi-structured and collaborative with the objective of promoting positive changes in the client, who is invited to have an active participation during the process. At the TA, the results of standardized psychological tests are highlighted as facilitators of the client's self-knowledge process. In this way, the findings of psychological self-report tests are usually integrated with projective methods to generate information that can broaden the client's view of themselves. In this article, understanding the potential use of psychological tests and of the collaborative relationship from a case treated from the TA perspective was sought. The participant, Violet (fictitious name), was assisted in 10 sessions lasting between 60 and 115 minutes. The psychological tests Psychological Well-Being Scale (EBEP), Vulnerability and Stress at Work Scale (EVENT), Personality Factorial Battery (BFP), Rorschach Method and Social Skills Inventories 2 (IHS-2) were used. It was observed that, during the process, Violet increased her self-perception, which allowed changes in her way of acting in her love life and in her reflection on how her posture was seen by herself and herco-workers. It is believed that TA fulfilled the objective of establishing a therapeutic experience that would enable positive changes for the client. This case study contributed to broaden the understanding about the importance and use of psychological testing in this psychological assessment model.(AU)


La Evaluación Terapéutica (ET) es un proceso de evaluación e intervención que se propone ser semiestructurado y colaborativo, con el objetivo de lograr cambios positivos en el cliente, quien es invitado a tener participación activa durante el proceso. En la ET se destacan los resultados de las pruebas psicológicas estandarizadas como facilitadoras del proceso de autoconocimiento del cliente. Los hallazgos de las pruebas psicológicas de autoinforme suelen integrarse con métodos proyectivos para generar información que pueda ampliar la visión que el cliente tiene de sí mismo. En este artículo se buscó comprender el uso potencial de las pruebas psicológicas y de la relación colaborativa a partir de un estudio de caso tratado desde la perspectiva de la ET. Atendieron a la participante Violeta (nombre ficticio), en 10 sesiones que duraron entre 60 y 115 minutos. Se utilizaron las pruebas psicológicas Escala de Bienestar Psicológico (EBEP), Escala de Vulnerabilidad y Estrés en el Trabajo (EVENT), Batería de Factorial de la Personalidad (BFP), Método de Rorschach e Inventario de Habilidades Sociales 2 (IHS-dos). Se observó que, durante el proceso, Violeta amplió su autopercepción, lo que permitió cambios en la forma de actuar en sus relaciones amorosas y en el reflejo de como ella y sus compañeros de trabajo veían su postura. Así, se cree que ET ha cumplido el objetivo de establecer una experiencia terapéutica que permitió cambios positivos a la cliente. Este estudio contribuyó a ampliar la comprensión sobre la importancia y el uso de las pruebas psicológicas en este modelo de evaluación psicológica.(AU)


Subject(s)
Humans , Female , Adult , Therapeutics , Psychological Techniques , Psychological Distress , Anxiety Disorders , Projection , Psychoanalysis , Psychological Tests , Psychology , Psychotherapy , Rabies , Rorschach Test , Shame , Social Adjustment , Social Behavior , Social Environment , Social Identification , Social Isolation , Social Support , Socialization , Avoidance Learning , Sublimation, Psychological , Temperance , Thinking , Unconscious, Psychology , Behavior and Behavior Mechanisms , Behaviorism , Shyness , Adaptation, Psychological , Attitude , Mental Health , Efficacy , Outcome Assessment, Health Care , Negotiating , Mental Competency , Codependency, Psychological , Communication , Neurobehavioral Manifestations , Counseling , Affect , Disaster Vulnerability , Personal Autonomy , Defense Mechanisms , Behavior Control , Harm Reduction , Researcher-Subject Relations , Trust , Stress Disorders, Traumatic , Aggression , Dependency, Psychological , Depression , Diagnosis , Emotions , Escape Reaction , Exercise Therapy , Extraversion, Psychological , Fantasy , Resilience, Psychological , Fear , Video-Audio Media , Self-Control , Psychological Trauma , Psychosocial Support Systems , Occupational Stress , Neuroticism , Free Association , Frustration , Sadness , Respect , Leadership and Governance Capacity , Betrayal , Patient Care , Psychosocial Functioning , Psychosocial Intervention , Social Interaction , Information Avoidance , Listening Effort , Gestalt Therapy , Psychological Well-Being , Helping Behavior , Human Development , Identification, Psychological , Identity Crisis , Individuation , Interpersonal Relations , Interview, Psychological , Introversion, Psychological , Leadership , Loneliness , Mental Disorders , Mental Processes , Motivation , Negativism , Neurotic Disorders
10.
Demetra (Rio J.) ; 18: 77540, 2023. ^eilus
Article in English, Portuguese | LILACS | ID: biblio-1532679

ABSTRACT

Objetivo: Descrever os resultados da influência de imunonutrientes na taxa de mortalidade, tempo de internação, tempo de permanência na Unidade de Terapia Intensiva (UTI) e incidência de infecções em pacientes críticos adultos e idosos. Método: Revisão integrativa da literatura realizada nas bases de dados PubMed, LILACS, SciELO, Medline e Google Scholar, usando os descritores: ("immunomodulation" OR "immunonutrients") AND ("fattyAcids, Omega-3" OR "eicosapentaenoic Acid") AND ("glutamine") AND ("criticalillness" OR "criticalillnesses" OR "criticallyill"), sem restrição de idioma, com pesquisas realizadas no período de 2012 a 2022. Resultados: Nas buscas realizadas, foram encontradas 15 publicações, das quais 11 atenderam a todos os critérios estabelecidos ao início do estudo. Apesar de alguns estudos com indivíduos suplementados com fórmulas imunomoduladoras demonstrarem melhora no tempo de internação de UTI, redução de ocorrência de sepse e choque séptico, e redução de taxa de infecções, em sua maioria os estudos avaliados não mostraram diferença entre os grupos suplementados e os grupos controle, ou não apresentaram resultados estatisticamente significativos. Conclusão: O manejo do cuidado em pacientes críticos deve ser cuidadoso e individualizado, sendo imprescindível que a conduta clínica tenha como base evidências científicas. No presente estudo, a análise dos estudos clínicos que compuseram esta pesquisa verificou que os efeitos da imunomodulação na mortalidade, tempo de internação na UTI e hospitalização total e incidência de infecções, demonstrou ausência de resultados significativos para a prática de uso de imunonutrientes em pacientes críticos, sendo necessário realizar outros estudos para comprovar os reais benefícios da adoção dessa conduta.


Objective: To describe the outcomes regarding the impact of immunonutrients on mortality rates, length of hospitalization, duration of Intensive Care Unit (ICU) stays, and the incidence of infections in adult and elderly critical patients. Method: An integrative literature review was conducted using the PubMed, LILACS, SciELO, Medline, and Google Scholar databases, using the descriptors: ("immunomodulation" OR "immunonutrients") AND ("fatty acids, Omega-3" OR "eicosapentaenoic Acid") AND ("glutamine") AND ("critical illness" OR "critical illnesses" OR "critically ill"), without language restrictions. The search encompassed studies that were published between 2012 and 2022. Results: Fifteen publications were identified in the conducted searches, of which eleven met all the established criteria at the outset of the study. Although some studies involving individuals supplemented with immunomodulatory formulas demonstrated improvements in ICU leng­th of stay, a reduced incidence of sepsis and septic shock, and a lower infection rate, most of the evaluated studies did not reveal significant differences between the supplemented groups and the control groups or did not yield statistically significant outcomes. Conclusion: The management of care for critical patients necessitates a cautious and individualized approach, underpinned by scientific evidence. The analysis of clinical studies forming part of this research revealed an absence of statistically significant  results pertaining to the practice of immunomodulation  utilization in critical patients with respect to effects on mortality, ICU length of stay, total hospitalization, and the incidence of infections. Further studies are required to validate the genuine benefits of adopting this approach.


Subject(s)
Humans , Outcome Assessment, Health Care , Critical Illness , Immunomodulation , Clinical Studies as Topic , Immunonutrition Diet , Intensive Care Units
11.
Rev. otorrinolaringol. cir. cabeza cuello ; 83(3): 236-243, 2023. ilus, tab
Article in Spanish | LILACS | ID: biblio-1522099

ABSTRACT

Introducción: El cuidado postoperatorio de la rinoplastia ha evolucionado, paralelamente, al desarrollo de la técnica quirúrgica. Existen varias recomendaciones, sin embargo, hay una gran variabilidad interprofesional de las indicaciones post quirúrgicas. Objetivo: Realizar una revisión sistemática de la literatura científica sobre los cuidados post operatorios de la rinoplastia. Material y Método: Para la realización de este estudio se llevaron a cabo búsquedas en PubMed y en Cochrane Database of Systematic Reviews con los perfiles: ([rhinoplasty] AND [post operative care]) y ([rhinoplasty] AND [post surgical care]). Se seleccionaron los artículos publicados en los últimos 10 años, desde 2013 hasta 2023, ambos inclusive. Resultados: Los documentos analizados recogen la evidencia de los diferentes métodos de cuidados post quirúrgicos en rinoplastia. Estos confirman la utilización de corticoides en el período postoperatorio, así como el reposo en 90° y exponen la variabilidad interprofesional que existe en el protocolo postquirúrgico de esta cirugía. Conclusión: El uso de corticoides y el reposo en 90° disminuyen las complicaciones postquirúrgicas de la rinoplastia. Debe existir una clara información sobre lo que el paciente debe esperar post cirugía. El uso de opioides debe ser restringido y la analgesia debe ser multimodal. Es preciso realizar estudios futuros con mayor nivel de evidencia y tener protocolos uniformes para la práctica clínica.


Introduction: The postoperative care of rhinoplasty has evolved along with the development of the surgical technique. There are several recommendations, however there is enormous interprofessional variability of post-surgical indications. Aim: To carry out a systematic review of the scientific literature on rhinoplasty postoperative care. Material and Method: To carry out this study, searches were carried out in PubMed and in the Cochrane Database of Systematic Reviews with the profiles: ([rhinoplasty] AND [post operative care]) and ([rhinoplasty] AND [post surgical care]). Articles published in the last 10 years were selected, from 2013 to 2023, both inclusive. Results: The documents analyzed collect the evidence of the different methods of post-surgical care in rhinoplasty, they confirm the use of corticosteroids in the postoperative period as well as rest at 90° and expose the interprofessional variability that exists in the post-surgical protocol of this surgery. Conclusion: The use of corticosteroids and rest at 90° reduce the post-surgical complications of rhinoplasty. There must be clear information about what the patient should expect post surgery. The use of opioids must be restricted and analgesia must be multimodal. It is necessary to carry out future studies with a higher level of evidence and have uniform protocols for clinical practice.


Subject(s)
Humans , Pain, Postoperative/drug therapy , Rhinoplasty/methods , Arnica , Glucocorticoids/therapeutic use , Postoperative Period , Outcome Assessment, Health Care , Pregabalin/therapeutic use , Analgesics/therapeutic use
12.
Audiol., Commun. res ; 28: e2769, 2023. tab, graf
Article in Portuguese | LILACS | ID: biblio-1520260

ABSTRACT

RESUMO Objetivo mapear as medidas de avaliação vocal utilizadas para verificar o efeito da intervenção em indivíduos vocalmente saudáveis. Estratégia de pesquisa trata-se de uma revisão de escopo baseada na questão de pesquisa: "Quais as medidas de avaliação vocal utilizadas para verificar o efeito da intervenção em indivíduos vocalmente saudáveis?" A busca foi realizada de forma eletrônica nas bases de dados MEDLINE (PubMed), LILACS (BVS), Scopus (Elsevier), Web of Science (Clarivate), Embase e Cochrane. Critérios de seleção a seleção dos estudos foi baseada na leitura dos títulos, resumos, palavras-chave e textos completos, aplicando-se os critérios de elegibilidade. Foram extraídos os dados relacionados às informações bibliográficas da publicação, características da amostra e da intervenção, os efeitos da intervenção nas medidas de autoavaliação, perceptivo-auditivas, acústicas, aerodinâmicas, eletroglotográficas, resultado do exame laríngeo, entre outros. Os dados foram resumidos e apresentados de forma quantitativa e descritiva. Resultados foram selecionados 97 artigos, entre os 979 estudos mapeados nesta revisão. A análise acústica foi a medida mais utilizada (n=70, 72,3%) para verificar os efeitos do treinamento vocal nos estudos selecionados, seguida pela eletroglotografia (n= 55, 56,7%), autoavaliação (n= 38, 39,2%), aerodinâmica (n= 33, 34,0%), julgamento perceptivo-auditivo (n= 22, 22,7%) e exame laríngeo (n= 16, 16,5%). Conclusão a análise acústica é a medida utilizada na maioria dos estudos para verificar o efeito da intervenção em indivíduos vocalmente saudáveis.


ABSTRACT Purpose to map the vocal assessment measures used to verify the effect of the intervention in vocally healthy individuals. Research strategy This is a scope review based on the research question: What vocal assessment measures are used to verify the effect of the intervention in vocally healthy individuals? The search was carried out electronically in MEDLINE (PubMed), LILACS (BVS), Scopus (Elsevier), Web of Science (Clarivate), Embase and Cochrane databases. Selection criteria The selection of studies was based on reading the titles, abstracts, keywords and full texts, applying the eligibility criteria. Data related to the publication's bibliographic information, sample and intervention characteristics, the effects of the intervention on self-assessment, auditory-perceptual, acoustic, aerodynamic, electroglottographic measures, laryngeal examination results, among others, were extracted. The data were summarized and presented in a quantitative and descriptive way. Results 97 articles were selected, among the 979 studies mapped in this review. Acoustic analysis was the most used measure (n=70, 72.3%) to verify the effects of vocal training in the selected studies, followed by electroglottography (n= 55, 56.7%), self-assessment (n= 38, 39 .2%), aerodynamics (n= 33, 34.0%), auditory-perceptual judgment (n= 22, 22.7%) and laryngeal examination (n= 16, 16.5%). Conclusion Acoustic analysis is the measure used in most studies to verify the effect of the intervention in vocally healthy individuals.


Subject(s)
Humans , Auditory Perception , Voice Quality , Voice Training , Outcome Assessment, Health Care , Healthy Volunteers
13.
Rev. bras. ginecol. obstet ; 45(11): 724-728, 2023. tab, graf
Article in English | LILACS | ID: biblio-1529899

ABSTRACT

Abstract Objective To determine if the use of lubricating gel on the speculum during the cervicovaginal cytology examination interferes with the results obtained, as well as whether it reduces reported discomfort in patients. Data sources A systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, with a search in the Pubmed/Medline, Scielo, Cochrane Library, Embase databases of articles published between January 2011 and May 2022. The keywords used were cytology, speculum, lubricant, result, and pain. Selection of studies The initial search resulted in 306 articles, of which were excluded three because they were duplicates, 257 after reading the title and abstract and 41 after reading the full text. Thus, five articles were selected for the study: four randomized clinical trials and one metanalysis. Data collection The selection of articles was performed by two investigators. The 5 selected articles were read in full and submitted to a comparative analysis. Data synthesis Screening through cervicovaginal cytology allows for early diagnosis and reduction of associated mortality, but the procedure can be associated with pain. A small amount of aqueous lubricating gel in the speculum can be used to reduce the discomfort associated with performing cervicovaginal cytology. Conclusion The use of lubricating gel in the speculum does not seem to be associated with a change in the cytology result and reduces the discomfort associated with its insertion into the vagina.


Resumo Objetivo Determinar se o uso de gel lubrificante no espéculo durante o exame de citologia cervicovaginal interfere com os resultados obtidos e se diminui o desconforto relatado por pacientes. Fontes de dados Foi realizada uma revisão sistemática segundo as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), com pesquisa nas bases de dados Pubmed/Medline, Scielo, Cochrane Library, Embase, de artigos publicados entre janeiro de 2011 e julho de 2022. Utilizaram-se as palavras-chave citologia, espéculo, lubrificante, resultado e dor. Seleção dos estudos A pesquisa inicial resultou em 306 artigos, dos quais foram excluídos três por se encontrarem duplicados, 257 após a leitura do título e do resumo e 41 após a leitura integral. Assim, foram selecionados cinco artigos para o estudo: quatro ensaios clínicos aleatorizados e uma metanálise. Coleta de dados A seleção dos artigos foi realizada por dois investigadores. Os cinco artigos selecionados foram lidos na íntegra e submetidos a uma análise comparativa. Síntese dos dados O rastreio através da citologia cervicovaginal permite um diagnóstico precoce e redução da mortalidade associada, mas a sua realização pode estar associada a dor. Uma pequena quantidade de gel lubrificante aquoso pode ser utilizada no espéculo para diminuir o desconforto associado à realização da citologia cervicovaginal. Conclusão A utilização de gel lubrificante não está associada a alteração do resultado da citologia e diminui o desconforto associado à sua introdução na vagina.


Subject(s)
Humans , Female , Surgical Instruments , Pain Measurement , Outcome Assessment, Health Care , Lubricants/administration & dosage , Cell Biology
14.
The Nigerian Health Journal ; 23(3): 780-789, 2023. tables
Article in English | AIM | ID: biblio-1512047

ABSTRACT

Most seizures in children occur outside the hospital and effective first aid would protect individuals from harm. Study assessed the knowledge, attitude and home-based interventions for childhood seizures.Methodology: This was a descriptive cross-sectional survey conducted from 1stJune to 31stDecember, 2021 among caregivers of patients in a Paediatric outpatient clinic. Interviewer-administered questionnaires were used to assess knowledge, attitude, and home intervention of childhood seizures. Data were analyzed using SPSS 24 and results presented as frequency tables, percentages and charts. P-values < 0.05 were considered significant.Results: Out of 218 respondents, the commonest source of information on childhood seizures was from friends and relatives 126(73.2%). Fever was the commonest known cause. Only 15(6.9%) recognized seizure as a neurological disorder. Jerking of the body and clenchingof the teeth were the commonest recognizable symptoms. The majority said seizures were contagious (176(80.7%) and children with seizures should not go to school 187(85.8%). The overall knowledge score was poor. Negative attitudes included avoidance 19(8.7%), isolation from playing with peers (15(6.9%) and from the public 17(7.8%). Common interventions during seizures were putting palm kernel oil in the mouth while only 25(29.4%) took the child to the hospital or laid him down away from harmful objects 25(29.4%). The practice of home intervention for seizures was good in only 11(5.0%) of respondents


Subject(s)
Humans , Seizures , Attitude to Health , Cross-Sectional Studies , Outcome Assessment, Health Care , Crisis Intervention , First Aid
15.
The Nigerian Health Journal ; 23(3): 772-779, 2023. figures, tables
Article in English | AIM | ID: biblio-1512045

ABSTRACT

Neurological emergencies are life-threatening central nervous system disorders, significantly contributing to childhood morbidity and mortality. The sequelae may be irreversible and may impact negatively on the quality of life of affected children and their families. This study identified the morbidity pattern and determinants of the outcomes of children with neurological emergencies in the Children Emergency Room (CHER) of the Rivers State University Teaching Hospital (RSUTH). Method: A 4-year retrospective study was carried out in the CHER. Data on demography, diagnosis and outcomes of children with neurological disorders were extracted from the records. Data analysed with SPSS 24 were expressed in percentages and frequency tables. Results: Of the 3040 children admitted in the CHER, 364(12%) aged 0-15 years had neurological emergencies, commoner among males (59.3%) and children aged less than five years (70.9%). Meningitis (40.2%) and febrile convulsion (28.2%) were the topmost diagnoses made. Raised intracranial pressure (17.4%) and head injuries (25.5%) were significantly more prevalent among children aged five years and above. The mortality rate was 61(16.8%) and more among adolescents (30.6%). All the mortalities took place within the first 48hours of admission especially among those with head injuries (46.5%) and perinatal asphyxia (95%), (p < 0.05). Conclusion: Meningitis and febrile convulsion were the commonest neurologic emergencies seen in this study. Mortality rate was high, especially in the first 48 hours of admission and mainly from perinatal asphyxia and head injuries. Education on the prevention and management of neurologic emergencies should be strengthened


Subject(s)
Humans , Child , Emergency Service, Hospital , Outcome Assessment, Health Care , Diagnostic Techniques, Neurological , Tertiary Care Centers
16.
Article in English | AIM | ID: biblio-1512883

ABSTRACT

Prolonged Decision-to-Delivery interval (DDI) is associated with adverse maternal-foetal outcomes following emergency Caesarean section (EmCS). Objectives: To determine the DDI, predictive factors, and the foeto-maternal outcomes of patients that had EmCS in a Nigerian Teaching Hospital. Methods: A descriptive study of all EmCS performed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, from 1st June 2020 to 31st May 2021, was conducted. Relevant data were extracted from the documentations of doctors, nurses and anaesthetists using a designed proforma. The data obtained were analysed using the IBM SPSS Statistics for Windows, version 25. Results: The median (IQR) DDI was 297 (175-434) minutes. Only one patient was delivered within the recommended DDI of 30 minutes. The most common cause of prolonged DDI was delay in procuring materials for CS by patients' relatives(s)/caregiver(s) (264, 85.2%). Repeat CS (AOR = 4.923, 95% CI 1.09-22.36; p = 0.039), prolonged decision-to-operating room time (AOR = 8.22, 95% CI 1.87-8.66; p<0.001), and junior cadre of surgeon (AOR = 25.183, 95% CI 2.698-35.053; p = 0.005) were significant predictors of prolonged DDI. Prolonged DDI > 150 minutes was significantly associated with maternal morbidity (p = 0.001), stillbirth (p = 0.008) and early neonatal death (p = 0.049). Conclusion: The recommended DDI of 30 minutes for CS is challenging in the setting studied. To improve foetomaternal outcomes, efforts to reduce the DDI should be pursued vigorously, using the recommended 30 minutesas a benchmark.


Subject(s)
Humans , Cesarean Section , Indicators of Morbidity and Mortality , Emergency Medical Services , Perinatal Mortality , Pregnancy Outcome , Outcome Assessment, Health Care
17.
China Journal of Orthopaedics and Traumatology ; (12): 901-904, 2023.
Article in Chinese | WPRIM | ID: wpr-1009157

ABSTRACT

There are inconsistencies in treatment outcomes, measurement instruments, and criteria for assessing clinical effectiveness in studies related to distal radius fractures (DRF), resulting in potential biases and failing to provide high-quality clinical evidence. To address these challenges, international researchers have reached a consensus on developing the core outcome indicator set for distal radius fractures(COS-DRF). However, it's important to note that the existing COS-DRF framework could not reflect the unique characteristics of Traditional Chinese Medicine (TCM) treatment. Currently, there are no established standards for treatment outcomes and measurement instruments specific to TCM clinical research, nor has a COS-DRF been established for TCM clinical studies in China. In light of these gaps, our research team aims to construct a core set of treatment outcomes for TCM clinical research on distal radius fractures. This involves compiling a comprehensive list of treatment outcomes and measurement instruments, initially derived from a thorough literature review and expert consensus, which will then undergo further refinement and updates based on real-world clinical experiences, incorporating feedback from 2 to 3 rounds of expert consensus or Delphi questionnaire surveys. Our goal is to establish a COS-DRF or CMS-DRF that aligns with the principles and practices of TCM, and provide high-quality evidence for clinical practice.


Subject(s)
Humans , China , Consensus , East Asian People , Outcome Assessment, Health Care , Wrist Fractures/therapy , Medicine, Chinese Traditional , Review Literature as Topic , Fracture Fixation/standards
18.
Article in Portuguese | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1510269

ABSTRACT

As quedas em idosos representam um importante problema de saúde pública devido à associação com a morbimortalidade. Objetivos: Descrever o perfil epidemiológico de idosos com fratura de fêmur proximal, bem como associar o tempo de espera para a cirurgia e os desfechos clínicos com as variáveis físico-funcionais. Métodos: Estudo transversal analítico, de idosos com fratura de fêmur proximal de origem traumática. Os aspectos físico-funcionais foram avaliados pelo Índice de Barthel, Escala de Lawton, Medical Research Council e Dinamometria de Força de Preensão Palmar em dois momentos distintos, admissão e alta hospitalar. Foi realizado análise estatística descritiva e inferencial adotando-se p<0,05. Resultados: A amostra foi composta por 64 indivíduos, sendo 48 (75%) do sexo feminino, com média de idade de 77,8 anos (±8,73). Os pacientes com maior dependência funcional no Índice de Barthel na admissão (U= 282,000; p<0,05) e na alta hospitalar (U= 248,000; p<0,05) aguardaram mais tempo para o procedimento cirúrgico. O principal desfecho foi a alta, de 55 pacientes (85,9%), no entanto aqueles que evoluíram a óbito apresentaram piores pontuações na Escala de Lawton (t(62)= -2,060; p<0,05) e no Índice de Barthel (U= 145,500; p<0,05) no momento da admissão. Conclusão: O perfil de idosos com fratura de fêmur proximal são mulheres, na transição para a oitava década de vida, vítimas de queda da própria altura. Idosos com maior dependência funcional aguardaram mais tempo para a cirurgia e apresentaram piores desfechos


Falls in the elderly represent an important public health problem due to the association with morbidity and mortality. Objectives: To describe the epidemiological profile of elderly people with proximal femur fractures, as well as to associate the waiting time for surgery and clinical outcomes with physical-functional variables. Methods: Analytical cross-sectional study of elderly patients with fractures of the proximal femur of traumatic origin. Sociodemographic, trauma and clinical information were obtained via electronic medical records. The physical-functional aspects were assessed using the Barthel Index, Lawton Scale, Medical Research Council and Hand Grip Strength at two different times, admission and hospital discharge. Descriptive and inferential statistical analysis was performed, adopting p<0.05. Results: The sample consisted of 64 individuals, 48 (75.0%) of which were female, with a mean age of 77.8 years (±8.73). The median waiting time for surgery was 12 (8-15) days. Patients with greater functional dependence on the Barthel Index at admission (U= 282.000; p<0.05) and at hospital discharge (U= 248.000; p<0.05) waited longer for the surgical procedure. The main outcome was discharge 55 (85.9%), however, patients who evolved to death had worse scores on the Lawton Scale (t(62)= -2.060; p<0.05) and on the Barthel Index (U = 145.500; p<0.05) at admission. Conclusion: The profile of elderly people with proximal femur fractures are women, in the transition to the eighth decade of life, victims of a fall from their own height. Elderly people with greater functional dependence waited longer for surgery and had worse outcomes


Subject(s)
Humans , Male , Female , Aged , Outcome Assessment, Health Care , Fractures, Bone/epidemiology , Functional Status , General Surgery/organization & administration , Health Profile , Accidental Falls , Cross-Sectional Studies
19.
Environmental Health and Preventive Medicine ; : 7-7, 2023.
Article in English | WPRIM | ID: wpr-971197

ABSTRACT

BACKGROUND@#Many previous studies have reported COVID-19 vaccine effectiveness, but there are few studies in Japan. This community-based, retrospective observational study investigated the association between vaccination status and COVID-19-related health outcomes in COVID-19 patients by SARS-CoV-2 variant type.@*METHODS@#The study participants were 24,314 COVID-19 patients aged 12 or older whose diagnoses were reported to the Nara Prefecture Chuwa Public Health Center from April 2021 to March 2022, during periods when the alpha, delta, and omicron variants of COVID-19 were predominant. The outcome variables were severe health consequences (SHC) (i.e., ICU admission and COVID-19-related death), hospitalization, and extension of recovery period. The explanatory variable was vaccination status at least 14 days prior to infection. Covariates included gender, age, population size, the number of risk factors for aggravation, and the number of symptoms at diagnosis. The generalized estimating equations of the multivariable Poisson regression models were used to estimate the adjusted incidence proportion (AIP) and 95% confidence interval (CI) for each health outcome. We performed stratified analyses by SARS-CoV-2 variant type, but the association between vaccination status and COVID-19-related health outcomes was stratified only for the delta and omicron variants due to the small number of vaccinated patients during the alpha variant.@*RESULTS@#Of the 24,314 participants, 255 (1.0%) had SHC; of the 24,059 participants without SHC, 2,102 (8.7%) were hospitalized; and of the 19,603 participants without SHC, hospitalization, and missing data on recovery period, 2,960 (15.1%) had extension of recovery period. Multivariable Poisson regression models showed that regardless of SARS-CoV-2 variant type or health outcome, those who received two or more vaccine doses had significantly lower risk of health outcomes than those who did not receive the vaccine, and there was a dose-response relationship in which the AIP for health outcomes decreased with an increased number of vaccinations.@*CONCLUSION@#A higher number of vaccinations were associated with lower risk of COVID-19-related health outcomes, not only in the delta variant but also in the omicron variant. Our findings suggest that increasing the number of COVID-19 vaccine doses can prevent severe disease and lead to early recovery of patients not requiring hospitalization.


Subject(s)
Humans , COVID-19/prevention & control , SARS-CoV-2 , COVID-19 Vaccines , Japan/epidemiology , Independent Living , Outcome Assessment, Health Care
20.
Chinese Journal of Surgery ; (12): 562-566, 2023.
Article in Chinese | WPRIM | ID: wpr-985809

ABSTRACT

Pancreatic surgery is the most complex type of abdominal surgery,with high technical requirements and long learning curve,and the quality of surgery is directly related to the prognosis of the patients. In recent years,more and more indicators have been used to evaluate the quality of pancreatic surgery,such as operation time,intraoperative blood loss,morbidity,mortality, prognosis and so on,and different evaluation systems have been established,including benchmarking,auditing,outcome evaluation based on risk factor adjustment and textbook outcomes. Among them,the benchmark is the most widely used to evaluate surgical quality and is expected to become the standard for comparison among peers. This article reviews existing quality evaluation indicators and benchmarks for pancreatic surgery and anticipates its future application prospects.


Subject(s)
Humans , Benchmarking , Digestive System Surgical Procedures , Outcome Assessment, Health Care , Blood Loss, Surgical , Risk Factors
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