The impact of the COVID-19 pandemic on rates and predictors of missed hospital appointments in multiple outpatient clinics of The Royal Hospital, Sultanate of Oman: a retrospective study.

BACKGROUND: The global outbreak of the COVID-19 pandemic resulted in significant changes in the delivery of health care services such as attendance of scheduled outpatient hospital appointments. This study aimed to evaluate the impact of COVID-19 on the rate and predictors of missed hospital appointment in the Sultanate of Oman. METHODS: A retrospective single-centre analysis was conducted to determine the effect of COVID-19 on missed hospital appointments at various clinics at The Royal Hospital (tertiary referral hospital) in Muscat, Sultanate of Oman. The study population included scheduled face-to-face and virtual appointments between January 2019 and March 2021. Logistic regression models were used with interaction terms (post COVID-19) to assess changes in the predictors of missed appointments. RESULTS: A total of 34, 3149 scheduled appointments was analysed (320,049 face-to-face and 23,100 virtual). The rate of missed face-to-face hospital appointments increased from 16.9% pre to 23.8% post start of COVID-19, particularly in early pandemic (40.5%). Missed hospital appointments were more frequent (32.2%) in virtual clinics (post COVID-19). Increases in missed face-to-face appointments varied by clinic (Paediatrics from 19.3% pre to 28.2% post; Surgery from 12.5% to 25.5%; Obstetrics & Gynaecology from 8.4% to 8.5%). A surge in the frequency of missed appointments was seen during national lockdowns for face-to-face and virtual appointments. Most predictors of missed appointments did not demonstrate any appreciable changes in effect (i.e., interaction term not statistically significant). Distance of patient residence to the hospital revealed no discernible changes in the relative effect pre and post COVID-19 for both face-to-face and virtual clinic appointments. CONCLUSION: The rate of missed visits in most clinics was directly impacted by COVID-19. The case mix of patients who missed their appointments did not change. Virtual appointments, introduced after start of the pandemic, also had substantial rates of missed appointments and cannot be viewed as the single approach that can overcome the problem of missing hospital appointments.

Efficiency and Cost-Benefit Analysis of the Manual and Intelligent Venous Blood Sampling in Outpatient Area of Hospital.

To evaluate the efficiency and cost-benefit of the manual and intelligent venous blood sampling in outpatient area. The hospital selected had two branches with the outpatient area in Branch A using manual venous blood sampling as the control group and the outpatient area in Branch B using intelligent venous blood sampling as the experimental group. Analyze the differences between the two groups in operation time, cost-benefit, and service efficiency through on-site investigation and project cost methods. Compared with manual venous blood sampling, intelligent venous blood sampling project is more optimized with shorter operation time and higher nursing service efficiency. But both groups have negative returns. The intelligent venous blood sampling process is more optimized, combined with dynamic job implementation, resulting in lower labor costs and higher job service efficiency compared to manual venous blood sampling.

Client's satisfaction with healthcare services received at the hospital outpatients department and the primary healthcare facilities in Al-Qassim, Saudi Arabia: A review of service users' satisfaction.

OBJECTIVES: To assess the level of satisfaction expressed for services rendered in the public health sector to clients who were seen at outpatient departments (OPDs) and primary healthcare (PHC) facilities in Al-Qassim Health Cluster in Saudi Arabia. METHODS: This study used a comparative cross-sectional study design, and data were obtained as secondary data from The Patient's Experience Platform. Data analysis was carried out using Stata (version 16), and the significance level was 5%. RESULTS: In comparing the mean satisfaction in 9 domains, statistically significantly higher means for the PHC facilities than the OPDs were seen across 7 domains: patients navigating health facilities (p=0.008), nursing services (p<0.001), physicians' services (p=0.004), radiological services (p<0.001), personal issues (p=0.003), the pharmacy (p=0.005), and general experience (p=0.036). CONCLUSION: This study's findings are significant. They indicate that client satisfaction with services at PHC facilities was significantly higher than with services at hospital OPDs in Al-Qassim region. This underscores the need to improve the quality of services provided at OPDs to bring them to the same level as those provided by PHC facilities. Policymakers and implementers should, therefore, sustain efforts to make OPDs and PHC facilities more desirable for clients.

Atendimento psicológico ambulatorial em hospital geral: reflexões de um(a) estagiário(a) de psicologia / Ambulatory psychological care in general hospital: reflections of a psychology intern / Servicio psicológico ambulatorio en hospital general: reflexiones de una pasante de psicología

Trata-se de um relato de experiência sobre a prática de estágio curricular em psicologia realizado em um ambulatório de especialidades em um hospital geral, vinculado ao Sistema Único de Saúde. O objetivo deste artigo é apresentar reflexões sobre a prática de estágio curricular na ênfase de promoção e prevenção à saúde, a partir de um relato de experiência. Num primeiro momento, apresenta-se um delineamento histórico sobre a formação do que se conhece hoje como ambulatório em saúde mental e, posteriormente, são apresentados alguns dispositivos que podem embasar a prática do psicólogo neste contexto, fundamentados na interação entre saberes trabalhados na formação em psicologia. Os resultados apontam para a necessidade das reflexões sobre as práticas que têm sido realizadas no campo ambulatorial ­ tendo em vista a necessidade de se atualizarem as definições técnicas sobre a atuação do psicólogo nessa área ­, assim como a necessidade da criação de critérios que avaliem os métodos utilizados pelos psicólogos. Dessa forma, se constata a necessidade de atualização do ensino em psicologia e da prática profissional no atendimento em saúde mental. (AU)

This paper describes a Psychology curricular internship experience at a specialty clinic managed by the Brazilian Public Health System. The goal of this paper is to discuss the practice of curricular internship required by the curricular emphasis on health promotion and prevention, based on expe-rience report. Initially, the paper explores the historical constitution of what is currently known as mental health clinic. Then, we present some tools that may support the psychologist's practice in this context, based on the interac-tion between the distinct knowledges which students must acquire to obtain a Psychology degree. The results show a need to reflect on the practices that are currently being carried out in mental health clinics ­ given the necessity to update the technical definitions that guide psychologists' work in this field ­ as well as a need to specify criteria for the evaluation of the methods employed by psychologists. Thus, we see that there is a need to update teaching in Psychology and professional practices in the field of mental health. (AU)

Este artículo presenta un relato de experiencia sobre la pasantía curricular realizada en un ambulatorio de especialidades vinculado al Sistema Único de Salud. Tiene el fin de presentar reflexiones sobre la pasantía con énfasis en la promoción a la salud y prevención basado en un informe de experiencia. En un primer momento, el artículo presenta un diseño histórico sobre la formación de lo que hoy se conoce como ambulatorio de salud mental y, posteriormente, se presentan algunos dispositivos que pueden apoyar la práctica del psicólogo en este contexto, a partir de la interacción entre conocimientos trabajados en la formación en psicología. Los resultados apuntan la necesidad de reflexionar sobre las prácticas que se han realizado en el ámbito ambulatorio - ante la necesidad de actualizar las definiciones técnicas sobre el desempeño del psicó-logo en esta área - así como la necesidad de generar criterios que evalúen las metodologías utilizadas por los psicólogos. Por lo tanto, queda evidente la necesidad de actualizar la docencia en psicología y la práctica profesional en el cuidado de la salud mental. (AU)

Outpatient pharmaceutical office: access to medicines in public health

Abstract We evaluated the implementation of the outpatient pharmaceutical office in a teaching hospital regarding the access to medicines available in the Unified Health System - SUS. This is a descriptive-analytical study, based on secondary data analysis of 735 appointments performed by the pharmacist from 2015 to 2017. Of the drugs prescribed to patients attended at the outpatient pharmacist office, 86.39% were listed in the National List of Essential Medicines - RENAME, of which 95.43% belonged to the Specialized Component of Pharmaceutical Assistance. Evaluating the patient's diagnosis against the inclusion criteria of the Clinical Protocols and Therapeutic Guidelines (PCDT), that the most frequent pharmaceutical interventions were: adequacy of the medication request documents (56.4%) and examination requests for pharmacotherapeutic follow up (28.5%). When the prescribed drugs were not included in RENAME/PCDT, the intervention was accepted in 90.3% of the proposals for exchange with available drug in SUS. Still, it was possible to refer the patient to primary care for renewal of continuity of treatment in 95.1% of cases. In conclusion, the role of the clinical pharmacist contributes to the resolution of untreated health problems by promoting access to medicines within the scope of SUS and their rational use in accordance with the PCDT.

Atención farmacéutica en pacientes con inmunodeficiencia adquirida y/o tuberculosis en el área ambulatoria de un hospital pediátrico / Pharmacovigilance in patients with acquired immunodeficiency and/or tuberculosis in the outpatient area of a pediatric hospital

La Atención farmacéutica (AF) ayuda a los pacientes a alcanzar objetivos terapéuticos reduciendo los problemas relacionados al medicamento (PRM). Objetivos: analizar los PRM en la práctica de la AF a pacientes con inmunodeficiencia adquirida (IDA) y/o tuberculosis (TBC) y evaluar su impacto. Método: estudio, descriptivo, observacional, en el área ambulatoria de Farmacia. Se incluyeron pacientes con IDA y/o TBC con: inicio de tratamiento, polifarmacia, reinternaciones frecuentes, regular/mala adherencia, reacciones adversas a medicamentos (RAM) previas y/o comorbilidades. Se entrevistaron pacientes o cuidadores y se registraron PRM, errores, grados de adherencia y conocimiento farmacoterapéutico, retiro oportuno de medicamentos y parámetros clínicos. Se registró la intervención farmacéutica y entregó material educativo. Se repitieron las mediciones en una segunda entrevista. Resultados: Se estudiaron 54 pacientes (28 con IDA y 26 con TBC). Se realizaron 93 intervenciones (29.9% dirigidas al prescriptor, 27.8% a otros profesionales) y se detectaron 8 RAM y 53 errores (28 IDA y 25 TBC), el principal PRM fue la mala/regular adherencia con bajo porcentaje de conocimiento farmacoterapéutico completo. Después de la AF, en IDA el grado de adherencia tuvo una mejora estadísticamente significativa (p= 0.012), también fue significativa la mejora en el retiro oportuno de la medicación (28.6% a 71.4% p=0.005 IDA). Se obtuvieron resultados favorables de carga viral (CV) en 72% pacientes con IDA y aumento de peso en 92% pacientes con TBC, aunque no fueron estadísticamente significativos. Conclusiones: mediante AF se mejoró la adherencia y la comunicación en pacientes pediátricos con IDA y/o TBC (AU)

Pharmacovigilance (PV) helps patients achieve therapeutic goals by reducing drug-related problems (DRP). Objectives: to analyze DRPs in the practice of PV in patients with acquired immunodeficiency (AIDS) and/or tuberculosis (TB) and to evaluate its impact. Methods: A descriptive, observational study was conducted in the outpatient pharmacy area. Patients with AIDS and/or TB with: treatment initiation, polypharmacy, frequent readmissions, regular/poor adherence, previous adverse drug reactions (ADR) and/or comorbidities were included. Patients or caregivers were interviewed, and DRP, errors, adherence and pharmacotherapeutic knowledge, timely drug withdrawal, and clinical parameters were recorded. The pharmaceutical intervention was recorded and educational material was delivered. Measurements were repeated in a second interview. Results: We studied 54 patients (28 with AIDS and 26 with TB). Ninety-three interventions were performed (29.9% addressed to the drug prescriber, 27.8% to other professionals) and 8 ADRs and 53 errors were detected (28 AIDS and 25 TB). The main DRP was poor/regular adherence together with a low level of complete pharmacotherapeutic knowledge. After PV, in patients with AIDS the degree of adherence statistically significantly improved (p= 0.012). The improvement in timely medication withdrawal was also significant (28.6% vs. 71.4% p=0.005 AID). Favorable viral load results were obtained in 72% of patients with AIDS and weight gain in 92% of patients with TB, although they were not statistically significant. Conclusions: PV improved adherence and communication in pediatric patients with AIDS and/or TB (AU)

Conocimientos sobre donación de sangre en pacientes de un hospital de Amazonas, Perú / Knowledge about blood donation in patients of a hospital in Amazonas, Peru

RESUMEN El objetivo del estudio fue determinar el nivel de conocimientos sobre donación de sangre que tienen los pacientes externos que acuden a un hospital en Bagua Grande. Se realizó un estudio descriptivo transversal durante mayo a julio del 2019. Se elaboró y aplicó un cuestionario estructurado. Se captó a 244 personas que acudieron a consultorios externos mediante un muestreo sistemático. Los participantes obtuvieron una media de respuestas correctas de 8,90 (DE: 3,25) puntos de un total de 21. Se encontró que la edad y el grado de instrucción estaban correlacionados con el puntaje (rho = -0,21; p < 0,001 y rho = 0,38; p < 0,001, respectivamente). La procedencia y ocupación afectaron al puntaje (p < 0,001). Los conocimientos hallados en la población estudiada son bajos, pero esto no estaría relacionado con el antecedente de donación. Las intervenciones que se elaboren para mejorar la donación de sangre no solo se deben enfocar en brindar conocimientos, ya que otros factores estarían más relacionados con este resultado.

ABSTRACT This study aimed to determine the level of knowledge about blood donation among outpatients from a hospital in Bagua Grande. A descriptive cross-sectional study was conducted from May to July 2019. We developed and applied a structured questionnaire. A total of 244 outpatients were recruited through systematic sampling. Participants obtained a mean number of correct answers of 8.90 (SD: 3.25) points out of 21. Age and educational level were found to be correlated with the score (rho = -0.21; p < 0.001 and rho = 0.38; p < 0.001, respectively). Place of origin and occupation affected the score (p < 0.001). We found a low level of knowledge in the studied population, but this would not be related to previous history of donation. Interventions to improve blood donation should not only focus on providing knowledge, since other factors would be more related to this result.

Patología asociada al consumo de metanfetamina cristalizada (shabú) en un centro hospitalario de tercer nivel / Emergencies associated with shabu — crystal methamphetamine — in a tertiary care hospital

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Perfil de mães adolescentes no ambulatório de aleitamento materno de um hospital-escola do noroeste paulista / Profile of adolescent mothers in the breastfeeding outpatient clinic of a northwestern school hospital / Perfil de madres adolescentes en el ambulatorio de lactancia de un hospital-escuela del noroeste de paulista

Introdução: A prática do Aleitamento Materno Exclusivo é uma eficaz intervenção para a redução da morbimortalidade infantil, uma vez que o leite humano possui todas as substâncias necessárias para promover a proteção e nutrição de crianças até os seis meses de vida. O aleitamento materno também traz benefícios à mãe ao contribuir para a recuperação no pós-parto imediato; maior rapidez na involução uterina e consequente prevenção à anemia. Objetivos: Identificar a adesão do aleitamento materno exclusivo e as orientações recebidas no pré-natal, em mães adolescentes. Métodos: Estudo descritivo transversal realizado de abril a agosto de 2019, no ambulatório de aleitamento materno do Hospital-Escola Emílio Carlos. Resultados: Com relação à faixa etária: 6 mães (32%) tinham 18 anos; 5 (26%) tinham 19 anos. A maioria das adolescentes tinha companheiro 14 (74%) e 5 (26%) solteiras. Em relação à escolaridade, apenas 5 (26%) concluíram o ensino médio. Das adolescentes, 13 (69%) não tinham profissão; 14 (74%) não planejaram a gravidez e 12 (63%) não usavam contraceptivo. Realizaram o pré-natal 17 (89%); não receberam orientações sobre o aleitamento materno pré-natal 15 (79%). A maioria das adolescentes na consulta do aleitamento materno estava em Aleitamento Materno Exclusivo; 7 (37%) não usavam chupeta. Conclusão: Evidências científicas comprovam que a melhor maneira de ajudar as mães adolescentes a estabelecer e manter o aleitamento é o aconselhamento, apoio pessoal e contínuo por um profissional de saúde com conhecimentos adequados sobre amamentação.(AU)

Introduction: The practice of Exclusive Breastfeeding is an effective intervention to reduce infant morbidity and mortality, since human milk has all the necessary substances to promote the protection and nutrition of children up to six months of life. Breastfeeding also brings benefits to the mother by contributing to recovery in the immediate postpartum period; faster uterine involution and consequent prevention of anemia. Objectives: To identify the adherence to exclusive breastfeeding and the guidelines received during prenatal care in adolescent mothers. Methods: A cross-sectional descriptive study was conducted from April to August 2019, at the Emílio Carlos School-Hospital outpatient clinic. Results: Regarding the age group: 6 mothers (32%) were 18 years old; 5 (26%) were 19 years old. The majority of adolescents had 14 (74%) and 5 (26%) unmarried partners. In relation to schooling, only 5 (26%) completed high school. Of the adolescents, 13 (69%) had no profession; 14 (74%) did not plan pregnancy and 12 (63%) did not use contraceptives. They underwent prenatal care 17 (89%); received no guidance on prenatal breastfeeding 15 (79%). The majority of adolescents in the breastfeeding consultation were in Exclusive Breastfeeding; 7 (37%) did not use pacifiers. Conclusion: Scientific evidence proves that the best way to help teenage mothers establish and maintain breastfeeding is counseling, personal and continuous support by a health professional with adequate knowledge about breastfeeding.(AU)

Introducción: La práctica de la Lactancia Materna Exclusiva es una intervención eficaz para reducir la morbilidad y mortalidad infantil, ya que la leche materna posee todas las sustancias necesarias para promover la protección y nutrición de los niños hasta los seis meses de edad. La lactancia materna también beneficia a la madre al contribuir a la recuperación en el período posparto inmediato; mayor rapidez en la involución uterina y consecuente prevención de la anemia. Objetivos: Identificar la adherencia a la lactancia materna exclusiva y las pautas recibidas durante la atención prenatal en madres adolescentes. Métodos: Estudio descriptivo transversal realizado de abril a agosto de 2019, en el ambulatorio de lactancia materna del Hospital-Escola Emílio Carlos. Resultados: Respecto al grupo de edad: 6 madres (32%) tenían 18 años; 5 (26%) tenían 19 años. La mayoría de los adolescentes tenían pareja 14 (74%) y 5 (26%) soltera. En cuanto a educación, solo 5 (26%) completaron la escuela secundaria. De los adolescentes, 13 (69%) no tenían profesión; 14 (74%) no planificaron el embarazo y 12 (63%) no usaron anticonceptivos. Realizaron atención prenatal 17 (89%); no recibieron orientación sobre lactancia materna...(AU)

Evaluación del dolor en consultas de reumatología españolas: Estudio EVADOR / Pain assessment in Spanish rheumatology outpatient clinics: EVADOR Study

Introducción: Las enfermedades reumáticas son la causa más frecuente de dolor crónico no maligno. En los últimos años el dolor y su manejo han cobrado mayor relevancia en reumatología. Objetivos: Establecer la prevalencia y las características del dolor asociado a enfermedad reumática atendido en consultas de reumatología de nuestro país, así como de su tratamiento y la respuesta a este. Métodos: Estudio multicéntrico observacional con 2 fases, una transversal y otra prospectiva. Se recogieron variables del médico, paciente, dolor y su manejo, comorbilidades, respuesta terapéutica y aspectos psicosociales relacionados. Se analizaron las diferencias entre pacientes nuevos y en revisión (PR). Resultados: Se incluyeron 34 centros y 1.084 pacientes, 32% pacientes nuevos y 68% PR. En general, el dolor estaba presente en el 86% de los pacientes, era crónico en el 81% y neuropático en un 12%. El 50% de los pacientes consideraría el dolor aceptable cuando la intensidad en la escala visual numérica fuese≤2. Entre los PR existía mayor percepción de dolor controlado (65,5% vs. 49,4%) y satisfacción con el tratamiento (53,3% vs. 35,6%). El 23,5% estaba en tratamiento con opioides en el mes previo. Conclusiones: En la última década la prevalencia de dolor en el ámbito reumatológico en nuestro país persiste elevada, aunque ha disminuido. El empleo de opioides, por otra parte, ha aumentado.(AU)

Introduction: rheumatic diseases are the most frequent cause of non-malignant chronic pain. In recent years, pain and its management have become more important in rheumatology. Objectives: to estimate the prevalence and characteristics of pain associated with rheumatic pathology treated in rheumatology clinics in Spain, as well as their treatment and response to it. Methods: Multicentre observational study with two phases (cross-sectional and prospective). Variables were collected from the doctor, patient, pain and its management, comorbidities, therapeutic response and related psychosocial aspects. The differences between de novo (NP) vs follow-up (FP) patients were analyzed. Results: 34 centres and 1084 patients were included, 32% NP and 68% FP. Pain was present in 86%, was chronic in 81% and neuropathic in 12% of the surveyed population. Fifty percent of the patients would regard their pain as tolerable if its intensity according to the visual numeric scale (VNS) was≤2. Among the FP it was more frequent to have the perception of controlled pain (65.5% vs 49.4%) and to be satisfied with the treatment (53.3% vs. 35.6%). Of these patients, 23.5% had been treated with opioids in the previous month. Conclusions: In the last decade, the prevalence of pain in rheumatology in Spain remains high, although it has diminished. The use of opioids, on the other hand, has increased.(AU)

Information on antibiotics in an Indonesian hospital outpatient setting: What is provided by pharmacy staff and recalled by patients?

BACKGROUND: The provision of information by pharmacy staff is a key factor to ensure patients' understanding and quality use of medications, including antibiotics. However, little is known regarding the transmission of information between pharmacy staff and patients in Indonesia. OBJECTIVE: This study aimed to identify information on antibiotics provided by pharmacy staff and recalled by patients in an Indonesian outpatient setting. METHODS: The study was conducted in a hospital outpatient clinic in Malang, Indonesia, in 2019. A checklist was used to obtain the data on information provided by pharmacy staff, while interviews were conducted to determine information recalled by patients (only presenting patients were included); a total of 15 information items - i.e. 14 essential and one secondary - were observed. Descriptive analysis was used to summarise data on the checklists ('given' versus 'not given') as well as responses from the interviews ('recalled' versus 'missed'). RESULTS: Eleven pharmacy staff (two pharmacists and nine pharmacy technicians) were involved in providing information for patients obtaining oral antibiotics during the study period. Of 14 essential information items, only about half was given by pharmacy staff, with pharmacists significantly providing on average more information items than pharmacy technicians (7.96 versus 7.67 respectively; p < 0.001). The most frequently information items provided (>90%) included "antibiotic identification", "indication", administration directions (i.e. "dosage", "frequency", "hour of administration", "administration before/after meal", "route of administration"), and "duration of use". A total of 230 patients consented to the study, giving 79.9% response rate. The average number of information items recalled by patients was 7.09 (SD 1.45). Almost all patients could recall information on administration directions [i.e. "route of administration" (97.0%), "frequency" (95.2%), "dosage" (92.6%), "hour of administration" (85.7%), "administration before/after meal" (89.1%)] and "duration of use" (90.9%). Fewer patients were able to recall "antibiotic identification" (76.5%) and "indication" (77.0%). CONCLUSIONS: Pharmacy staff provided antibiotic information in a limited fashion, while patients showed adequate ability to recall the information given to them. Further study is needed to better understand the effective process of information transmission between pharmacy staff and patients, especially if more information was provided, to better optimise the use of antibiotics in outpatient settings in Indonesia

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Frequência e características dos respondedores a uma intervenção educacional para redução de testes cardíacos inapropriados: um subestudo do Echo WISELY Trial / Frequency and characteristics of responders to an educational intervention to reduce inappropriate heart testing: a sub-study of the Echo WISELY Trial

Introdução: O Echo WISELY Trial é um estudo controlado, randomizado, multicêntrico, cego pelo investigador, que avaliou uma intervenção educacional com base nos critérios de uso apropriado para ecocardiografia para redução da proporção de ecocardiogramas raramente apropriados realizados ambulatorialmente. Objetivo: Descrever a prevalência e identificar preditores de responsividade de médicos respondedores submetidos à intervenção educacional no Echo WISELY Trial. Métodos: Médicos do grupo intervenção receberam um programa educacional multifacetado. O médico respondedor foi definido como aquele que apresentou redução >2,5% na média proporcional de exames raramente apropriados solicitados entre o primeiro trimestre (linha de base) e qualquer um dos seguintes trimestres (segundo ao sexto). Foram comparadas as características do médico (sexo, tempo de formação, especialidade médica e local de trabalho) com as classificações dos ecocardiogramas (apropriado, talvez apropriado e raramente apropriado) e razões clínicas para ecocardiogramas solicitados utilizando teste do qui-quadrado. A significância estatística foi indicada por p < 0,05 bicaudal. Resultados: Foram analisados 4.605 exames solicitados nos seis hospitais participantes de Ontário e randomizados para o braço intervenção. Dentre os 36 médicos incluídos, 26 (72%) foram classificados como respondedores. Entre as variáveis analisadas, não houve diferença significativa entre médicos respondedores e não respondedores à intervenção educacional. O número de exames raramente apropriados solicitados pelos respondedores foi significativamente menor que o de não respondedores (234; 8,67% versus 261; 13,8%; p < 0,0001). Conclusão: A prevalência de médicos respondedores é alta, porém não foram identificados preditores de responsividade à intervenção educacional entre as variáveis analisadas. Isso pode decorrer de aspectos psicológicos e características pessoais dos médicos, que não foram incluídos nesta pesquisa.(AU)

Introduction: The Echo WISELY Trial is a controlled randomized multicenter investigator-blinded study that evaluated an educational intervention based on the criteria for appropriate use of echocardiography to reduce the proportion of rarely appropriate outpatient echocardiograms performed. Objective: To describe the prevalence and identify predictors of the responsiveness of responding physicians subjected to an educational intervention in the Echo WISELY Trial. Methods: The intervention group physicians received a multifaceted educational program. A responding physician was defined as one who had a >2.5% reduction in the proportional mean of rarely appropriate tests requested between the first trimester (baseline) and any of the following trimesters (second to sixth). Physician characteristics (sex, time since graduation, medical specialty, and workplace) were compared to the echocardiogram ratings (appropriate, maybe appropriate, and rarely appropriate) and clinical reasons for the requested echocardiograms using the chi-square test. Statistical significance was indicated by a two-tailed p < 0.05. Results: A total of 4,605 tests requested at the six participating hospitals in Ontario were analyzed and randomized for the intervention arm Of the 36 included physicians, 26 (72%) were classified as responders. Of the variables analyzed, there was no significant difference in the outcomes of the responders versus non-responders to the educational intervention. The number of rarely appropriate tests requested by the responders was significantly lower than that of the non-responders (234 [8.67%] versus 261 [13.8%]; p < 0.0001). Conclusion: The prevalence of responder physicians was high, but predictors of responsiveness to educational intervention were not identified among the analyzed variables. This may be a result of the psychological aspects and personal characteristics of the physicians, which were not included in this research. (AU)

Retrospective study of polytrauma patients's medical records that presented abdominal trauma, comperad to abdominal trauma and extra-abdominal injuries

This study sought to retrospectively assess the relationship between intra and extra-abdominal injuries in polytrauma patients undergoing laparotomy at the Regional University Hospital of Maringá between 2017 and 2018.This study was based on 111 electronic medical records from the Brazilian public health system "SUS", admitted to the hospital due to trauma and undergoing laparotomy, comparing two groups: abdominal injury without extra-abdominal injury (WoEI) and abdominal injury with extra-abdominal injury (WiEI).A total of 111 medical records were analyzed, 57 from 2017 and 54 from 2018. Of these 111records, 43 (39%) were trauma victims with only abdominal injuries and 68 (61%) trauma victims with abdominal and extra-abdominalinjuries. Most patients were male (85%), with an average age of 33 years, ranging from 14 to 87 years. In statistical analysis, according to the T-test, there was significance (p > 0.05) between the WoEI and WiEI groups for data collected regarding death rates and hospitalization days. As for the morbidity rate and difference between genders (male and female), there was no statistical significance (p < 0.05).Polytraumapatients are exposed to greater kinetic energy, with more severe conditions and therefore required more in-hospital care.

Contribuições da enfermagem na reestruturação do serviço de cirurgia de joelho de um ambulatório escola / Contributions of nursing to restructure the knee surgery service of a school ambulatory / Contribuciones de la enfermería a la reestructuración del servicio de cirugía de rodilla en un hospital escuela

Objetivo: relatar a experiência de reestruturação do serviço de cirurgia de joelho, de um ambulatório escola, tendo em vista a sistematização da assistência de enfermagem prestada aos usuários que serão submetidos à artroplastia de joelho. Método: relato de experiência das ações do planejamento estratégico realizado, no período de 2016 a 2018, em um ambulatório localizado em Belo Horizonte. Resultados: Os principais resultados foram: elaboração coletiva de uma linha de cuidado; implementação de um grupo educativo multidisciplinar e elaboração de materiais didáticos. As estratégias de educação em saúde utilizadas fornecem informações pertinentes à segurança e recuperação do paciente no período perioperatório de cirurgia de joelho, estimulando o autocuidado. Conclusão: a continuidade deste trabalho é de fundamental importância para a consolidação destas conquistas, além da realização de outros estudos e pesquisas, a fim de contribuir para o avanço do conhecimento na área da saúde e na enfermagem ortopédica no ambulatório de especialidades (Au).

Objective: to report the experience of restructuring the knee surgery service in a school clinic, with a view to systematizing the nursing care delivered to people who will be submitted to total Knee replacement. Method: experience report of the strategic planning actions carried out from 2016 to 2018, in an outpatient clinic in Belo Horizonte. Result: The main results were: collective elaboration of a line of care; implementation of a multidisciplinary educational group and courseware development. Health education strategies provided relevant information about patient safety and recovery in knee surgery perioperative period, encouraging self-care. Conclusion: the continuity of this work is of fundamental importance for the consolidation of these achievements, in addition to other studies and research, in order to contribute to the advancement of knowledge in the area of health and in orthopedic nursing in outpatient clinic (Au).

Objetivo: relatar la experiencia de reestructuración del servicio de cirugía de rodilla de un hospital escuela, a fin de sistematizar la atención de enfermería brindada a los usuarios que serán sometidos a artroplastia total de rodilla. Metodología: relato de experiencia sobre las acciones de planificación estratégica realizadas de 2016 a 2018. Resultados: los principales resultados fueron: elaboración colectiva de esquema de atención, implementación de un grupo educativo multidisciplinario y elaboración de material didáctico. Las estrategias de educación para la salud utilizadas brindan información relevante para la seguridad y recuperación del paciente durante el período perioperatorio de cirugía de rodilla, estimulando el autocuidado. Conclusión: la continuidad de este trabajo es fundamental para consolidar estos logros y para realizar otros estudios e investigaciones, a fin de contribuir al avance del conocimiento en el área de la salud y de la enfermería ortopédica en el servicio ambulatorio de especialidades (Au).

Integração com a Atenção Primária à Saúde: Experiência de uma Unidade de Referência em Cuidados Paliativos Oncológicos / Integration with Primary Health Care: Experience of a Referral Unit in Palliative Oncology Care / Integración con Atención Primaria de Salud: Experiencia de una Unidad de Derivación en Atención Oncológica Paliativa

O Sistema Único de Saúde (SUS) brasileiro se baseia na universalidade, equidade e integralidade, com foco na participação popular, na regionalização e hierarquização, bem como na descentralização, como seus princípios. Visa dessa forma a garantir o acesso da população à saúde em todos os níveis de atenção. O Hospital do Câncer IV (HC IV), unidade de Cuidados Paliativos do Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), tem como perfil assistencial os pacientes com câncer avançado sem possibilidade de tratamento modificador da doença oriundos das outras unidades do INCA. O HC IV/INCA tem como missão "promover e prover cuidados paliativos oncológicos da mais alta qualidade, com habilidade técnica e humanitária". Dessa maneira, pretende-se minimizar o sofrimento humano proveniente das esferas física, psíquica, social e espiritual e promover qualidade de vida

The principles of the National Health System (SUS) are based in the universality, equity, and integrality, targeted to the participation of the individuals, regionalization and hierarchy and decentralization. It attempts to ensure the population the access to health across all levels of attention . The "Hospital do Câncer IV (HC IV)" Palliative Care Unit of the National Cancer Institute José Alencar Gomes da Silva (INCA), provides care to patients with advanced cancer without possibility of disease modifying treatment referred from other INCA units. HC IV/ INCA's mission is to "promote and provide high quality palliative oncologic care with technical and humanitarian proficiency" . Following this logic, it endeavors to minimize the human suffering of physical, psychic, social and spiritual nature, and improve the quality of life

Perfil da equipe de enfermagem de unidades ambulatoriais universitárias: considerações para a saúde do trabalhador / Perfil del equipo de enfermería de unidades ambulatorias universitarias: consideraciones para la salud del trabajador / Profile of the nursing team of university outpatient units: worker health considerations

RESUMO Objetivo identificar o perfil sociodemográfico, laboral e de saúde da equipe de enfermagem de unidades ambulatoriais especializadas. Método Estudo quantitativo, descritivo, realizado com 388 profissionais de enfermagem de ambulatórios de universidades públicas no município do Rio de Janeiro. Os dados foram coletados por equipe de auxiliares capacitados. A análise foi realizada por meio do software SPSS. Resultados houve predomínio do sexo feminino, idade acima de 50 anos, profissionais casados e com filhos. Percentual maior de trabalhadores possuía Pós-Graduação Lato Sensu, vínculo permanente, um vínculo empregatício e carga horária laboral de 31 a 60 horas semanais. Prevaleceram aqueles que autoavaliaram o estado de saúde como bom. Dentre as doenças crônicas com diagnóstico médico, destacaram-se o estresse, as doenças osteoarticulares e as varizes. Conclusões e implicações para a prática os resultados mostraram, além de dados que corroboram com a realidade nacional e internacional, uma realidade que não é prerrogativa apenas da enfermagem, como o duplo vínculo e uma alta prevalência de estresse associado a outros problemas de saúde. Observa-se um cenário preocupante no mundo do trabalho da equipe de enfermagem ambulatorial, o qual traz à tona concepções e práticas negativas potencialmente causadoras de insatisfações, riscos, danos, inseguranças e adoecimentos no trabalho.

RESUMEN Objetivo identificar el perfil sociodemográfico, laboral y de salud del equipo de enfermería de unidades ambulatorias especializadas. Método estudio cuantitativo, descriptivo, realizado con 388 profesionales de enfermería de ambulatorios de universidades públicas del município de Rio de Janeiro. Los datos fueron recolectados por auxiliares capacitados. El análisis se realizó utilizando software SPSS. Resultados se observó predominio del sexo feminino, edad superior a 50 años, profesionales casados ​​y con hijos. Un porcentaje mayor de trabajadores poseía Posgrado Lato Sensu, vínculo permanente, vínculo de empleo y carga horaria laboral de 31 a 60 horas semanales. Prevalecerán aquellos que auto validarán el estado de salud como bueno. Entre las enfermedades crónicas con diagnóstico médico se destacan estrés, las enfermedades osteoarticulares y varices. Conclusiones e implicaciones para la práctica los resultados mostraron, además de datos que corroboran con la realidad nacional e internacional, una realidad que no es prerrogativa apenas de la enfermería, como el doble vínculo y alta prevalencia de estrés asociados a otros problemas de salud. Esto demuestra un escenario preocupante en el mundo del trabajo del equipo de enfermería ambulatoria, el cual trae a tono concepciones y prácticas negativas potencialmente causantes de insatisfacciones, riesgos, daños, inseguridades y enfermedades en el trabajo.

ABSTRACT Objective to identify the sociodemographic, occupational and health profile of nursing staff working at specialized outpatient units. Method a descriptive study with a quantitative approach, conducted with 388 nursing professionals from outpatient clinics of public universities in the city of Rio de Janeiro. Data were collected by trained auxiliary team. Analysis was performed using SPSS software. Results there was a predominance of females, aged over 50 years, married professionals, and with children. A higher percentage of workers had Lato Sensu Graduate studies, permanent employment, an employment relationship and workload of 31 to 60 hours per week. Those who self-rated health prevailed as good. Chronic diseases with medical diagnosis, that stand out, include stress, osteoarticular diseases and varicose veins. Conclusions and implications for the practice the results showed, in addition to data that corroborate the national and international reality, a reality that is not only prerogative of nursing, such as the double bond and a high prevalence of stress associated with other health problems. This shows a worrying setting in the outpatient nursing staff work world, which brings out negative conceptions and practices potentially causing dissatisfaction, risk, damage, insecurity, and illness at work.

Differentiating irritable mood and disruptive behavior in adults

Abstract Introduction Irritability has both mood and behavioral manifestations. These frequently co-occur, and it is unclear to what extent they are dissociable domains. We used confirmatory factor analysis and external validators to investigate the independence of mood and behavioral components of irritability. Methods The sample comprised 246 patients (mean age 45 years; 63% female) from four outpatient programs (depression, anxiety, bipolar, and schizophrenia) at a tertiary hospital. A clinical instrument rated by trained clinicians was specifically designed to capture irritable mood and disruptive behavior dimensionally, as well as current categorical diagnoses i.e., intermittent explosive disorder (IED); oppositional defiant disorder (ODD); and an adaptation to diagnose disruptive mood dysregulation disorder (DMDD) in adults. Confirmatory factor analysis (CFA) was used to test the best fitting irritability models and regression analyses were used to investigate associations with external validators. Results Irritable mood and disruptive behavior were both frequent, but diagnoses of disruptive syndromes were rare (IED, 8%; ODD, 2%; DMDD, 2%). A correlated model with two dimensions, and a bifactor model with one general dimension and two specific dimensions (mood and behavior) both had good fit indices. The correlated model had root mean square error of approximation (RMSEA) = 0.077, with 90% confidence interval (90%CI) = 0.071-0.083; comparative fit index (CFI) = 0.99; and Tucker-Lewis index (TLI) = 0.99, while the bifactor model had RMSEA = 0.041; CFI = 0.99; and TLI = 0.99 respectively). In the bifactor model, external validity for differentiation of the mood and behavioral components of irritability was also supported by associations between irritable mood and impairment and clinical measures of depression and mania, which were not associated with disruptive behavior. Conclusions Psychometric and external validity data suggest both overlapping and specific features of the mood vs. disruptive behavior dimensions of irritability.

Frecuencia de consulta médica por problemas osteoarticulares en población general adulta en España. Estudio EPISER2016 / Frequency of medical visits due to osteoarticular problems of the adult general population in Spain. EPISER2016 Study

OBJETIVO: Estimar la prevalencia de consultas médicas por problemas osteoarticulares en población general adulta en España y su asociación con variables sociodemográficas, antropométricas y de hábitos de vida. MÉTODO: Estudio transversal de base poblacional. Muestra de 4916 sujetos de 20 o más años de edad. Se realizó un cuestionario telefónico que incluía una pregunta sobre consulta médica por problemas osteoarticulares. Para la estimación de la prevalencia y su intervalo de confianza del 95% (IC95%) se calcularon los pesos en función de la probabilidad de selección en cada una de las etapas del muestreo. RESULTADOS: El 28,9% (IC95%: 27,6-30,2) de las personas encuestadas refirieron haber consultado a algún médico por problemas osteoarticulares en el último año. Se ha observado una asociación con la edad, el sexo, el nivel de estudios y el índice de masa corporal

OBJECTIVE: To estimate the prevalence of medical visits due to osteoarticular problems by the adult general population in Spain and its association with sociodemographic, anthropometric and lifestyle variables. METHOD: Cross-sectional population-based study. Sample with 4916 subjects aged 20 years and over. A telephone questionnaire, with a question about medical visits due to osteoarticular problems, was used. To estimate the prevalence and its 95% confidence interval (95%CI), weights were calculated according to the probability of selection in each of the sampling stages. RESULTS: 28.9% (95%CI: 27.6-30.2) of the people reported having consulted a doctor in the last year because of osteoarticular problems. We observed an association with age, sex, level of education, and body mass index

Fatores associados à demência em idosos / Factors associated with dementia in elderly

Resumo Analisar os fatores associados à demência em idosos atendidos em um ambulatório de memória da Universidade do Sul de Santa Catarina (Unisul). Estudo transversal com análise de dados de prontuário no período de 01/2013 a 04/2016. O desfecho foi o diagnóstico clínico de demência. As variáveis de controle foram: nível sérico de vitamina D na época do diagnóstico, sexo, cor da pele, escolaridade, idade, diabetes tipo 2, hipertensão arterial e depressão. Foi realizada análise bruta e ajustada com regressão logística. Amostra de 287 idosos, com predominância de idade entre 60 e 69 anos (48,78%), sexo feminino (79,09%), cor da pele branca (92,33%). A média de anos de estudo foi de 6,95 anos (DP ± 4,95) e da vitamina D 26,09 ng/mL (DP ± 9,20). A prevalência de idosos com demência foi de 16,72%. Dentre as morbidades a depressão foi a de maior prevalência seguida pela hipertensão arterial. Estiveram independentemente associadas à demência: vitamina D (OR = 0,92 IC 95% 0,88;0,97), depressão (OR = 4,09 IC95% 1,87;8,94), hipertensão arterial (OR = 2,65 IC95% 1,15;6,08) e indivíduos com idade igual e maior que 80 anos. A prevalência de demência foi alta, e houve associação de níveis mais baixos de vitamina D com diagnóstico de demência. Sendo a vitamina D um fator modificável, abrindo importantes perspectivas para políticas de saúde pública.

Abstract We analyzed the factors associated with dementia in the elderly attended at a memory outpatient clinic of the University of Southern Santa Catarina (UNISUL). This is a cross-sectional study with data analysis of medical records from January 2013 to April 2016. The outcome was the clinical diagnosis of dementia. The control variables were: serum vitamin D level at the time of diagnosis, gender, skin color, schooling, age, type 2 diabetes, hypertension, and depression. We performed a crude and adjusted analysis with logistic regression. The sample consisted of 287 elderly, with the predominance of age between 60 and 69 years (48.78%), female (79.09%) and white (92.33%). The mean number of years of study was 6.95 years (SD ± 4.95) and mean vitamin D was 26.09 ng/mL (SD ± 9,20). The prevalence of elderly with dementia was 16.72%. Depression was the most prevalent (42.50%) among the morbidities, followed by hypertension (31.71%). The following were independently associated with dementia: vitamin D (OR = 0.92, 95%CI, 0.88;0.97), depression (OR = 4.09, 95%CI, 1.87;8.94), hypertension (OR = 2.65, 95%CI, 1.15;6.08) and individuals aged 80 years and over (OR = 3.97 95%CI, 1.59;9.91). Dementia prevalence was high and diagnosed dementia was associated with lower levels of vitamin D. Vitamin D is a modifiable factor, opening up essential perspectives for public health policies.

Sala de espera: educação em saúde em um ambulatório de gestação de alto risco / The waiting room: health education in a high risk pregnancy clinic

O objetivo deste trabalho foi identificar as necessidades das gestantes referentes a assuntos que possam ser abordados em atividades de educação em saúde, no momento de espera, em um ambulatório de referência de gestação de alto risco. Trata-se de um estudo descritivo, qualitativo e de campo, utilizando a análise de conteúdo temática de Bardin. Participaram 35 gestantes presentes no dia da consulta de pré-natal. Emergiram então seis categorias: Percepção de desconforto durante o momento de espera; Sentimento de abandonado no momento de espera e preocupação com o retorno ao trabalho; Referência a sintomas de ordem física e emocional; Participação (ou não) de educação em saúde; Sugestão de desenvolvimento de atividades educativas no momento de espera; Proposição de oferta oportuna de lanches durante o momento de espera. Assim, a partir das necessidades identificadas, sugere-se a prática de educação em saúde como forma de otimizar o tempo de espera para a consulta de pré-natal deste serviço.

Current paper identifies the needs of pregnant females with regard to themes within health education when they are waiting in a high-risk hospital outpatient clinic. Through a descriptive, qualitative and field studies and employing Bardin´s thematic contents, thirty-five pregnant females participated on the occasion of their pre-natal visit to the doctor. Six categories emerged: perception of discomfort while waiting; feeling of abandonment while waiting; concern on return to work; reference to physical and emotional symptoms; participation or not in health education; suggestion to the development of educational activities while waiting; offering of meals while waiting. When needs are identified, health education should optimize waiting time prior to pre-natal service.