Neuropsychiatric Symptoms in Patients with Dementia Associated with Increased Psychological Distress in Caregivers During the COVID-19 Pandemic.

BACKGROUND: The social isolation imposed by COVID-19 pandemic can have a major impact on the mental health of dementia patients and their caregivers. OBJECTIVE: We aim to evaluate the neurological decline of patients with dementia and the caregivers' burden during the pandemic. METHODS: We performed a cross-sectional study. Caregivers of dementia patients following in the outpatient clinic were included. A structured telephone interview composed of the Neuropsychiatric Inventory Questionnaire (NPI-Q), Zarit Burden Interview (ZBI), Beck Depression (BDI) and Anxiety (BAI) Inventories to address cognitive, behavioral, and functional changes associated with social distancing during the Sars-Cov-2 outbreak. Patients were divided in two groups according to caregivers' report: with perceived Altered Cognition (AC) and Stable Cognition (SC). RESULTS: A total of 58 patients (median age: 57 years [21-87], 58.6%females) and caregivers (median age: 76.5 years [55-89], 79.3%females) were included. Cognitive decline was shown by most patients (53.4%), as well as behavioral symptoms (48.3%), especially apathy/depression (24.1%), and functional decline (34.5%). The AC group (n = 31) presented increased behavioral (67.7%versus 25.9%, p = 0.002) and functional (61.3%versus 3.7%, p < 0.001) changes when compared to the SC group. In the AC group, ZBI, BDI, NPI-Q caregiver distress, and NPI-Q patient's severity of symptoms scores were worse than the SC group (p < 0.005 for all). CONCLUSION: Patients' neuropsychiatric worsening and caregiver burden were frequent during the pandemic. Worsening of cognition was associated with increased caregivers' psychological distress.

Impact of clinical pharmacy in oncology and hematology centers: A systematic review.

BACKGROUND: Oncology and hematology is a complex and specific area that requires monitoring by a multidisciplinary team capable of personalizing the treatment of each patient. Clinical pharmacy services have the potential to contribute significantly to the effective and economical care of cancer patients. OBJECTIVE: To evaluate, synthesize and critically present the available evidence on the impact of the Clinical Pharmacy in the treatment of patients with hematological cancer. METHOD: A review was carried out on the bases PubMed/MEDLINE, LILACS and Google Scholar. The included studies were: studies that evaluated the effects of pharmaceutical interventions in clinical in oncology and hematology services and having as a population patient with hematological cancer. RESULTS: 17 studies were selected among 745 identified. 4.771 patients were included, with an average follow-up time of 15.3 months. Patients affected by some type of hematological cancer, undergoing chemotherapy treatment, showed better adherence and continuity when accompanied by a clinical pharmacist, added to this professional in carrying out interventions, provides control of symptoms such as cancer pain, nausea and constipation and, thus, contributes to decrease the length of hospital stay. CONCLUSION: The implementation of a Clinical Pharmacy service in oncology and hematology centers contributes significantly to the effectiveness of pharmacotherapeutic treatment, treatment costs reduction, safety increase in the use of medications and the patient's quality of life.

Trauma-related disorders in a low- to middle-income country: A four-year follow-up of outpatient trauma in Brazil.

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are developed from exposure to traumatic events including war, interpersonal violence and natural disasters. We investigated prevalence and trauma-related information in patients from an outpatient psychiatric unit in Brazil among 2014-2017. A prevalence of ASD/PTSD of 40.8% was found in 179 patients. Female, Caucasian, married, mostly educated during 10-12 years long and employed patients composed a main profile. The presence of any previous trauma in adulthood and childhood were related to ASD/PTSD with longer follow-up time. This study provides evidence of stress-related disorders in a heterogeneous environment.

Warfarin Safety: A Cross-Sectional Study of the Factors Associated with the Consumption of Medicinal Plants in a Brazilian Anticoagulation Clinic.

OBJECTIVE: The aim of this study was to analyze factors associated with the consumption of medicinal plants by patients being treated with warfarin in a Brazilian anticoagulation clinic and to study the safety of medicinal plant use in patients on warfarin therapy. METHODS: The study was performed as an observational cross-sectional analysis. Study participants were outpatients on long-term warfarin therapy for at least 2 months for atrial fibrillation or prosthetic cardiac valves. Interviews were carried out concerning information about the habits of medicinal herb consumption, and logistic regression analysis was performed to identify factors associated with the consumption of herbs. The scientific names of the medicinal plants were identified to search for information on the effects on the hemostasis of the interactions between the medicinal herbs reported and warfarin. RESULTS: The mean age of the 273 patients included was 60.8 years; 58.7% were women. Medicinal plants were used by 67% of the participants. No association between demographic and clinical data and the use of medicinal plants was identified. Patients reported a total of 64 different plants, primarily consumed in the form of tea. The plants were mainly used to treat respiratory tract and central nervous system disorders. About 40% of the plants cited have been reported to potentially interfere with the anticoagulation therapy, principally by potentiating the effects of warfarin, which could, increase the risk of bleeding. CONCLUSION: The use of medicinal plants was highly common and widespread in patients receiving warfarin as an anticoagulation therapy. Univariate analysis of variables associated with the consumption of herbs showed no statistically significant difference in the consumption of medicinal plants for any of the sociodemographic and clinical data. The medicinal plants that were reportedly consumed by the patients could affect hemostasis. This study reinforces the need for further studies evaluating the habits of patients consuming medicinal plants and their clinical implications, and will help to design strategies to manage the risks associated with warfarin-herbal interactions.

Atividade educativa na sala de espera com pacientes com insuficiência cardíaca / An educational activity in the waiting room with heart failure patients

Fundamentos: A insuficiência cardíaca (IC) é uma síndrome crônica, de tratamento complexo; de tal modo permite que estratégias de educação em saúde tenham importante impacto na qualidade de vida dos pacientes. Objetivo: Avaliar a eficácia de palestra realizada na sala de espera de um ambulatório para pacientes com IC. Métodos: Palestra educativa foi realizada para pacientes que aguardavam o atendimento, com duração média de 40 minutos. Antes e após a palestra, os pacientes responderam ao mesmo questionário, composto por 10 perguntas objetivas, concernentes à IC. Dados sociodemográficos foram coletados na ocasião do preenchimento do questionário e os dados clínicos durante a consulta. Resultados: 187 pacientes responderam ao questionário inicial e 114 ao questionário final. Foi encontrada uma melhora significativa no desempenho dos pacientes após a palestra (79,3% vs. 92,8%, p<0,001). Conclusões: Palestras constituem uma importante estratégia educacional, são de simples execução e apresentam impacto imediato e significativo no conhecimento dos pacientes sobre IC.

Background: Heart failure (HF) is a chronic syndrome and of complex treatment. So that, it allows health education strategies to have important impact on the management of these patients. Objective: To evaluate the efficacy of educational activities on the waiting room of a specialized clinic for patients with HF. Methods: While waiting for their appointments at the clinic, the patients took part on an educational activity with main duration of 40 minutes. They answered questionnaire (consisting of 10 questions) both before and after the lectures about HF. Sociodemographic data were collected during the questionnaire application and the clinical data during the medical appointment. Results: 187 patients answered the initial questionnaire and 114 answered both of them. There was a significant improvement of the questionnaire's results after the lectures (79.3% vs 92.8%, p<0.001). Conclusions: Lectures performed at the waiting room of a specialized clinic represent an important educational strategy of simple execution and with a significant immediate impact on the patient's knowledge about HF.

Tratamiento ambulatorio de infecciones severas: Hospital de Pediatría Prof. Dr. Juan P. Garrahan / Ambulatory treatment of severe infections: Hospital de Pediatría Prof. Dr. Juan P. Garrahan

En 1995 se desarrolló en el Hospital Garrahan un programa de tratamiento ambulatorio de infecciones severas (TAIS) con el objeto de evaluar la factibilidad de su realización en un hospital público. Para su implementación se utilizó la modalidad de hospital de día. La selección de pacientes se realizó en base a aspectos relacionados con la infeccióny a las características socioambientales del niño y su familia. Se estudiaron 2poblaciones: pacientes internados, que luego de la estabilidad clínica egresaron del hospital y fueron derivados al programa TAIS (grupo A) y pacientes que se atendieron exclusivamente en forma ambulatoria (grupo B). Durante un período de 924 días se atendieron 1000 pacientes, cuya mediana de edad fue 45 meses. Las infecciones más frecuentes fueron: neutropenia febril, bacteriemias, neumonía, celulitis periorbitaria, infecciones relacionadas a catéteres implantables y meningitis bacterianas. Los antimicrobianos más utilizados fueron: ceftriaxona, teicoplanina, aminoglucósidos y anfotericinia B. El 93 por ciento de los pacientes tuvo éxito terapéutico; en el 6 por ciento hubo fallo terapéutico (relacionado con la infección tratada); en el 0.6 por ciento fallo médico (no relacionado con la infección tratada); en el 0.3 por ciento fallo por causa social. La mortalidad fue del 0.1 por ciento. El ahorro de días/cama fue de 6586 lo que representa 7.1 camas/día. Concluímos que este programa es factible de realizar en hospitales públicos de nuestro país. Para ello es imprescindible formar grupos de trabajo y realizar una adecuada selección de pacientes. Evitar internaciones innecesarias para el niño y su familia y disminuír costos con mayor disponibilidad de camas, se cuentan entre las ventajas más importantes del programa. (AU)

Tratamiento ambulatorio de infecciones severas: Hospital de Pediatría Prof. Dr. Juan P. Garrahan / Ambulatory treatment of severe infections: Hospital de Pediatría Prof. Dr. Juan P. Garrahan

En 1995 se desarrolló en el Hospital Garrahan un programa de tratamiento ambulatorio de infecciones severas (TAIS) con el objeto de evaluar la factibilidad de su realización en un hospital público. Para su implementación se utilizó la modalidad de hospital de día. La selección de pacientes se realizó en base a aspectos relacionados con la infeccióny a las características socioambientales del niño y su familia. Se estudiaron 2poblaciones: pacientes internados, que luego de la estabilidad clínica egresaron del hospital y fueron derivados al programa TAIS (grupo A) y pacientes que se atendieron exclusivamente en forma ambulatoria (grupo B). Durante un período de 924 días se atendieron 1000 pacientes, cuya mediana de edad fue 45 meses. Las infecciones más frecuentes fueron: neutropenia febril, bacteriemias, neumonía, celulitis periorbitaria, infecciones relacionadas a catéteres implantables y meningitis bacterianas. Los antimicrobianos más utilizados fueron: ceftriaxona, teicoplanina, aminoglucósidos y anfotericinia B. El 93 por ciento de los pacientes tuvo éxito terapéutico; en el 6 por ciento hubo fallo terapéutico (relacionado con la infección tratada); en el 0.6 por ciento fallo médico (no relacionado con la infección tratada); en el 0.3 por ciento fallo por causa social. La mortalidad fue del 0.1 por ciento. El ahorro de días/cama fue de 6586 lo que representa 7.1 camas/día. Concluímos que este programa es factible de realizar en hospitales públicos de nuestro país. Para ello es imprescindible formar grupos de trabajo y realizar una adecuada selección de pacientes. Evitar internaciones innecesarias para el niño y su familia y disminuír costos con mayor disponibilidad de camas, se cuentan entre las ventajas más importantes del programa.

Características clínicas y epidemiológicas de la consulta ambulatoria en la práctica privada en el área Gran La Plata / Clinical characteristics and epidemiology of the private ambulatory consult in the private practice in the area of Greater La Plata

In a protocol previously designed, were analysed the 1000 patients characteristics who assisted to an ambulatory consult. They were seen by internist in three doctors offices placed in a diferent areas of the local city. It whose observed that the patients consulted about hypertension, diabetes and lipid disorders. Besides, it whose notice and important number of patients without any kind of disease. (AU)