RESUMO
INTRODUCTION: Total knee arthroplasty (TKA) is a surgery that aims to restore function and relieve pain in advanced osteoarthritis. The Educational Workshop (EW) for TKA is given to patients in the pre-surgery period to inform them and facilitating their participation in their health process (empowerment). The aim of this study was developing and validating a self-administered questionnaire to evaluate the acquired knowledge after the EW by the patients who will undergo the TKA procedure. MATERIAL AND METHODS: It was a longitudinal and prospective observational study with a sample of TKA candidate patients. The phases for the construction and validation of this ad hoc questionnaire were: Phase 1: A panel of experts who agreed on a final questionnaire of 20 items; Phase 2: Pilot test administered to 47 patients; Phase 3: Final test of 11 items administered to 50 patients, before and after the EW; Phase 4: Re-test, after the EW and 2 weeks after, administered to 58 patients. RESULTS: One hundred and fifty five patients were included. The Cronbach's alpha coefficient for the item's internal consistency of the final questionnaire, 11 items, was 0.78. To reach the criterion validity, in pre-EW the mean number of hits was: 4.92 (SD=1.78) and in post-EW 10.68 (SD=0.55), a difference that had a statistical significance p<.0001, with no overlap in the 95% CI of the mean: 4.46-5.38/10.54-10.82. The test for stability and reliability, re-test, obtained a mean of right answers 10.87 (SD=0.33) and for the re-test of 10.70 (SD=0.59). The correlation of the interclass coefficient for the re-test was 0.99, which corresponds almost to a maximum concordance. CONCLUSIONS: The questionnaire developed in this study is a reliable and easy tool to evaluate the acquired knowledge in the EW for patients who will be TKA operated.
Assuntos
Artroplastia do Joelho , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To revise the recent changes which have occurred in the diagnosis of, clinical stay for, and treatment of AIDS and their repercussions in nursing care. 1997 was characterized by the clear dominance of new advances in combined therapy using antiretorvirus drugs, by the possibility to measure the degree and number of the virus infection, and an improved knowledge of the dynamics and variability of the AIDS virus. Infected persons' quality of life can benefit from nursing care to check the gradual physical, cognitive and emotional deterioration patients continue to suffer from, in spite of the tenuous hope which new scientific discoveries and advances have introduced and which are very slowly becoming a part of treatment programs. SOURCES FOR THIS STUDY INCLUDE: MEDLINE data base studies published between 1990 and 1996, regular "SEISIDA" publications; summaries from the XIth International AIDS Conference held in Vancouver in July 1996; reports published by the Centers for the Control and Prevention of Diseases (CDC); and articles published or pending publication written by the authors. ARTICLE SELECTION: Selection of original articles published from 1990 to 1996 on the MEDLINE data base dealing with nursing treatment for patients infected by HIV in hospital, community center or homecare service units.
Assuntos
Síndrome da Imunodeficiência Adquirida , Cuidados de Enfermagem/tendências , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/enfermagem , Síndrome da Imunodeficiência Adquirida/psicologia , Fármacos Anti-HIV/uso terapêutico , Progressão da Doença , Humanos , Planejamento de Assistência ao Paciente , Qualidade de Vida , Assistência TerminalRESUMO
BACKGROUND: Health resources needed by immigrants have increased steadily in the last few years. Studying health problems and social vulnerability in immigrants would help to improve the health care quality. PATIENTS AND METHODS: A case-control study performed in the Hospital Clinic of Barcelona. Immigrant patients admitted with infectious diseases from October 2002 to September 2003 were included. Controls were paired by age, gender and HIV infection. Clinical (emergency room attendance, days and number of admission to hospital, amount of clinical procedures and drugs used during the admission, etiological and microbiological diagnosis and post-admission control) and social vulnerability variables (social worker consultation, health care card, relatives or friends caregiver, drug use, language barrier and discharge document of the nurse) were analyzed. RESULTS: One hundred and two patients (51 cases and 51 controls, all of them males) were studied. A total of 56% were HIV-1 infected in both groups. The number of diagnostic or therapeutic procedures was higher in the immigrant group (p = 0.02), a lower proportion of patients had a final etiologic diagnosis (82% vs 98%, p = 0.021) and the number of post-discharge controls was lower (55% vs 77%, p = 0.04). Immigrants had a higher social vulnerability index than the Spanish population and 35% could not speak Spanish, French or English. The number of immigrants with health care card was lower (63% vs 94%, p < 0,0001) and a higher number needed to be admitted to a social-health care center after discharge (16% vs 2%, p = 0.01). DISCUSSION: Social vulnerability influences the etiological diagnosis, the number of diagnostic and therapeutic procedures during the admission to the hospital and post-discharge control of immigrant population.
Assuntos
Emigrantes e Imigrantes , Infecções/epidemiologia , Adulto , Estudos de Casos e Controles , Nível de Saúde , Humanos , Masculino , Fatores Socioeconômicos , Populações VulneráveisRESUMO
Introducción. La necesidad de recursos sanitarios de la población inmigrante ha aumentado en los últimos años. El estudio de los problemas de salud y la vulnerabilidad social planteados durante el ingreso hospitalario de estos pacientes ayudaría a mejorar su cuidado. Pacientes y métodos. Estudio caso-control realizado en el Hospital Clínic de Barcelona. Se incluyeron pacientes inmigrantes ingresados con patología infecciosa de octubre de 2002 a septiembre de 2003. Los casos fueron apareados por edad, sexo e infección por virus de la inmunodeficiencia humana (VIH). Se evaluaron variables clínicas (visitas a Urgencias, días y número de ingresos, cantidad de procedimientos y fármacos, diagnóstico etiológico y control post alta) y de vulnerabilidad social (utilización de trabajo social, tarjeta sanitaria, cuidador de referencia, consumo de tóxicos, barrera idiomática y alta de enfermería). Resultados. Se estudiaron 102 pacientes (51 casos y 51 controles, todos varones). El 56% estaban infectados por VIH en ambos grupos. El número de procedimientos diagnósticos o terapéuticos fue mayor en el grupo de inmigrantes (p = 0,02), se llegó en menor proporción a un diagnóstico etiológico (el 82% frente al 98%, p = 0,021) y el número de visitas post alta fue inferior (el 55% frente al 77%, p = 0,04). Los pacientes inmigrantes tuvieron unos índices de vulnerabilidad social mayores que la población autóctona y en un 35% de ellos existía una barrera idiomática. Un menor número tenían tarjeta sanitaria (el 63% frente al 94%, p < 0,0001) y un número mayor tuvieron necesidad de traslado a un centro sociosanitario (el 16% frente al 2%, p = 0,01). Discusión. La vulnerabilidad social de los pacientes inmigrantes influye en una menor obtención del diagnóstico etiológico, mayor número de procedimientos durante la hospitalización y un menor seguimiento posterior al alta (AU)
Health problems and social vulnerability in immigrants admitted for an infectious disease: a case-control study Patients and methods. A case-control study performed in the Hospital Clínic of Barcelona. Immigrant patients admitted with infectious diseases from October 2002 to September 2003 were included. Controls were paired by age, gender and HIV infection. Clinical (emergency room attendance, days and number of admission to hospital, amount of clinical procedures and drugs used during the admission, etiological and microbiological diagnosis and post-admission control) and social vulnerability variables (social worker consultation, health care card, relatives or friends caregiver, drug use, language barrier and discharge document of the nurse) were analyzed. Results. One hundred and two patients (51 cases and 51 controls, all of them males) were studied. A total of 56% were HIV-1 infected in both groups. The number of diagnostic or therapeutic procedures was higher in the immigrant group (p = 0.02), a lower proportion of patients had a final etiologic diagnosis (82% vs 98%, p = 0.021) and the number of post-discharge controls was lower (55% vs 77%, p = 0.04). Immigrants had a higher social vulnerability index than the Spanish population and 35% could not speak Spanish, French or English. The number of immigrants with health care card was lower (63% vs 94%, p < 0,0001) and a higher number needed to be admitted to a social-health care center after discharge (16% vs 2%, p = 0.01). Discussion. Social vulnerability influences the etiological diagnosis, the number of diagnostic and therapeutic procedures during the admission to the hospital and post-discharge control of immigrant population (AU)