Validation of the Grace Risk Score to Predict In-Hospital and 6-Month Post-Discharge Mortality in Patients with Acute Coronary Syndrome

Abstract Background The wide range of clinical presentations of acute coronary syndrome (ACS) makes it indispensible to use tools for risk stratification and for appropriate risks management; thus, the use of prognosis scores is recommended in the immediat clinical decision-making. Objective To validate the Global Registry of Acute Coronary Events (GRACE) score as a predictor of in-hospital and 6-month post-discharge mortality in a population diagnosed with ACS. Methods This is a prospective cohort study of consecutive patients diagnosed with ACS between May and December 2018. GRACE scores were calculated, as well as their predictive value for in-hospital and 6-month post-discharge mortality. The validity of the model was assessed by two techniques: discriminative power using the area under the receiver operating characteristic curve (AUC) and goodness-of-fit, using the Hosmer-Lemeshow (HL) test, at the 5% level of significance. Results A total of 160 patients were included, mean age 64 (±10.9) years; of which 60% were men. The risk model showed to have satisfactory ability to predict both in-hospital mortality, with an area under the curve (AUC) of 0.76 (95% confidence interval [CI], 0.57-0.95; p = 0.014), and 6-month post-discharge mortality, with AUC of 0.78 (95%CI, 0.62-0.94), p = 0.002. The HL test indicated good-fit for both models of the GRACE score. Conclusion In this study, the GRACE risk score for predicting mortality was appropriately validated in patients with ACS, with good discriminative power and goodness-of-fit. The results suggest that the GRACE score is appropriate for clinical use in our setting.

An Electronic Health Platform for Monitoring Health Conditions of Patients With Hypertension in the Brazilian Public Health System: Protocol for a Nonrandomized Controlled Trial.

BACKGROUND: Chronic noncommunicable diseases such as arterial hypertension have a high impact in the context of public health. Previous studies have shown improvements in blood pressure due to simple lifestyle changes, which were supported by electronic health (eHealth) solutions. OBJECTIVE: The aim of this study is to develop an eHealth platform and assess the effects of its use on the health conditions of patients with hypertension, with assistance from health professionals in the public health system of a Brazilian city. METHODS: The platform will include a server that centralizes all the data and business rules, a website dashboard for health professionals, and a mobile app for patients. We will analyze the effects of its use through a controlled, nonrandomized, nonblind, prospective, monocentric clinical trial. We will enroll 68 participants diagnosed with arterial hypertension and under medical follow-up and categorize them into two groups. The participants of the intervention group will use the platform as a monitoring method, whereas the participants of the control group will use conventional methods. In both groups, we will assess and compare the evolution of blood pressure and treatment adherence before, during, and after the intervention. RESULTS: The project was funded at the end of 2018. We have been developing the software since 2019 with plans to complete it in 2020, and we will enroll patients between 2020 and 2021. We expect to submit the first results for publication in 2020. CONCLUSIONS: For the primary outcome, we expect a reduction and stabilization of blood pressure. For the secondary outcomes, we hope to see improvements in treatment adherence, physical activities and dietary practices, and acceptance of the eHealth platform. In public health, the technology that favors disease control also helps reduce complications and, consequently, treatment costs. The platform might encourage the adaptation of medical assistance to incorporate this technology into patient monitoring. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/15299.

Significados dos episódios maníacos para pacientes com transtorno bipolar em remissão: um estudo qualitativo / Meanings of manic episodes in patients with bipolar disorder in remission: a qualitative study

Objetivo Discutir os significados da vivência de episódios maníacos para pacientes com transtorno bipolar (TAB). Métodos Trata-se de uma pesquisa qualitativa, feita por meio de entrevistas semidirigidas em profundidade, em uma amostra fechada pelo critério de saturação com oito pacientes com TAB em remissão. A técnica de tratamento de dados foi feita por meio da análise de conteúdo das entrevistas transcritas na íntegra e categorização. Os resultados foram submetidos à validação externa, no Laboratório de Pesquisa Clínico-Qualitativa do Departamento de Psicologia Médica e Psiquiatria da Unicamp, composto por 37 pesquisadores do método, entre eles mestrandos, doutorandos, pós-doutorados e pesquisadores seniores. Resultados Foram identificadas três categorias – Ambivalência e vergonha: pensar ou não pensar sobre os episódios maníacos; Organizando sentimentos pessoais: a remissão como um momento de autoconsciência; Episódios maníacos estruturando relações interpessoais versus projeções da angústia. Conclusão Os achados da presente pesquisa contribuem para a maior compreensão dos quadros maníacos no TAB, que podem auxiliar nas reflexões acerca da relação profissional-paciente, para elaborar estratégias para aderência e para as medidas terapêuticas e preventivas da recorrência dos episódios. Podem auxiliar a equipe de saúde envolvida no acompanhamento desses casos e também os pesquisadores na investigação da contribuição dos significados aqui discutidos nos fenômenos de aderência ao tratamento e de um melhor prognóstico. .

Objective To discuss the meanings of the experiences of manic episodes in patients with bipolar disorder (BD). Methods This is a qualitative research, done through semi-structured in-depth interviews in a sample closed by saturation criterion with eight patients with BD in remission. The technical data processing was done through qualitative content analysis of the transcribed interviews and categorization. The results were validated by peer-reviewers from the Laboratory of Clinical-Qualitative Research of the Department of Medical Psychology and Psychiatry, Unicamp consisting of 37 researchers of the method, including, masters, doctoral, postdoctoral and senior researchers. Results Three categories were identified – Ambivalence and shame: to think or not to think about the manic episodes; Organizing personal feelings: remission as a moment of self-consciousness; Maniac episodes: structuring interpersonal relationships versus projections of self-criticism. Conclusion The findings of this research contribute to a greater understanding of manic frames in BD that can assist in the reflections on the doctor-patient relationship, to develop strategies for adherence and the therapeutic and preventive measures of recurrent. Can assist the health team involved in monitoring these cases and also the researchers in investigation of the contribution of these meanings discussed here in the phenomena of adherence to treatment and a better prognosis. .