Inflammatory bowel disease: outpatient treatment profile / Doença inflamatória intestinal: perfil do paciente em tratamento ambulatorial

ABSTRACT BACKGROUND Crohn’s disease and ulcerative colitis are the two major forms of inflammatory bowel disease. The incidence and prevalence of both conditions have increased and are progressively increasing. These diseases are frequently recurrent and clinically highly severe. In Brazil, the lack of epidemiological data related to such diseases has left these patients in a vulnerable state and contributed to increased morbidity. OBJECTIVE To describe the profiles of patients with inflammatory bowel disease treated in an outpatient service in Brazil. METHODS This descriptive, exploratory, and retrospective documentary study with a quantitative approach was performed in an outpatient treatment service for inflammatory bowel disease, at a university polyclinic located in Rio de Janeiro, Brazil, from May to July 2016. The study included 556 patients and was approved by the research ethics committee of the institution (CAAE no. 55179316.6.0000.5259/2016). RESULTS The data showed a high prevalence of inflammatory bowel disease in white female patients. Crohn’s disease was diagnosed in more patients than was ulcerative colitis; the ileocolon was the most commonly affected location in patients with Crohn’s disease. The stenotic phenotype was prevalent in patients with Crohn’s disease. CONCLUSION The prevalence of the stenotic phenotype in Crohn’s disease in relation to others demonstrates the need for further investigations in this field of study in Brazil. In conclusion, the data showed that the epidemiologic profile of the study population is similar to that published in the national and international literature.

RESUMO CONTEXTO A Doença de Crohn e a retocolite ulcerativa idiopática são as duas principais formas de doença inflamatória intestinal e possuem crescente incidência e prevalência, tendem a ser progressivas, cursam com recidivas frequentes e assumem formas clínicas de alta gravidade. No Brasil a escassez de dados epidemiológicos relacionados a tais agravos deixa essas pessoas em estado de vulnerabilidade e contribui para o aumento da morbidade. OBJETIVO Descrever o perfil dos pacientes portadores de doença inflamatória intestinal atendidos em um ambulatório de doenças inflamatórias intestinais do estado do Rio de Janeiro. MÉTODOS Trata-se de uma pesquisa documental retrospectiva, exploratória, descritiva em abordagem quantitativa, realizada de maio a julho de 2016, em uma policlínica universitária, localizada no Rio de Janeiro, em ambulatório de tratamento de doenças inflamatórias intestinais. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da instituição CAAE: 55179316.6.0000.5259 /2016, e contou com 556 participantes. RESULTADOS Os dados revelam um predomínio das doenças inflamatórias intestinais, nos pacientes do sexo feminino, de cor branca. A doença de Crohn foi diagnosticada em um maior número de indivíduos em relação a retocolite ulcerativa idiopática. Os dados do perfil de localização intestinal mostram a região ileocolônica como mais afetada na doença de Crohn. Foi evidenciado predomínio do fenótipo estenosante na doença de Crohn. CONCLUSÃO O predomínio do fenótipo estenosante na doença de Crohn, evidencia a necessidade de estudos aprofundados sobre a temática no Brasil. No mais, os dados obtidos demonstram um perfil epidemiológico da população semelhante ao divulgado em estudos nacionais e internacionais.

INFLAMMATORY BOWEL DISEASE: OUTPATIENT TREATMENT PROFILE.

BACKGROUND: Crohn's disease and ulcerative colitis are the two major forms of inflammatory bowel disease. The incidence and prevalence of both conditions have increased and are progressively increasing. These diseases are frequently recurrent and clinically highly severe. In Brazil, the lack of epidemiological data related to such diseases has left these patients in a vulnerable state and contributed to increased morbidity. OBJECTIVE: To describe the profiles of patients with inflammatory bowel disease treated in an outpatient service in Brazil. METHODS: This descriptive, exploratory, and retrospective documentary study with a quantitative approach was performed in an outpatient treatment service for inflammatory bowel disease, at a university polyclinic located in Rio de Janeiro, Brazil, from May to July 2016. The study included 556 patients and was approved by the research ethics committee of the institution (CAAE no. 55179316.6.0000.5259/2016). RESULTS: The data showed a high prevalence of inflammatory bowel disease in white female patients. Crohn's disease was diagnosed in more patients than was ulcerative colitis; the ileocolon was the most commonly affected location in patients with Crohn's disease. The stenotic phenotype was prevalent in patients with Crohn's disease. CONCLUSION: The prevalence of the stenotic phenotype in Crohn's disease in relation to others demonstrates the need for further investigations in this field of study in Brazil. In conclusion, the data showed that the epidemiologic profile of the study population is similar to that published in the national and international literature.

O telecuidado no tratamento das doenças inflamatórias intestinais: ensaio clínico randomizado / Telecution in the treatment of inflammatory bowel diseases: a randomized clinical trial

As doenças inflamatórias intestinais (DII), apresentam uma crescente incidência mundial, são crônicas, progressivas, podendo se tornar graves. Esse estudo objetivou: Avaliar a efetividade do telecuidado dos pacientes portadores de Doenças Inflamatórias Intestinais, comparado ao tratamento ambulatorial convencional; Realizar telecuidado a um grupo de pacientes a partir do Índice Simples de Harvey-Bradshaw para Doença de Crohn (DC), e do Índice Clínico Simples de Atividade da Colite para Retocolite ulcerativa (RCU), acompanhando a flutuação de score, assim como; Avaliar a incidência de complicações relacionadas a DII, no grupo telecuidado pelo enfermeiro e no grupo controle dos pacientes atendidos no Ambulatório de Doenças Inflamatórias Intestinais da Policlínica Piquet Carneiro. Método: Ensaio clínico controlado e randomizado com tempo de seguimento de 24 semanas. A amostra foi de 176 voluntários. A coleta de dados ocorreu de abril a outubro de 2016. O desfecho primário do estudo foi a redução do índice de atividades da DII dos pacientes telecuidados e os desfechos secundários foram a redução de complicações relacionadas a doença. A pesquisa foi submetida, aprovada e registrada no Comitê de Ética em Pesquisa do Hospital Universitário Pedro Ernesto parecer 1.598990, e pelo Registro Brasileiro de Ensaios Clínicos com registro RBR-7t8fv7. Resultados: Os grupos foram homogêneos quanto às características sociodemográficas e clínicas. A população é tipicamente de mulheres (61,4%), brancas (47,26%), com idade média 44,7 anos. Quanto ao diagnóstico (54,5%) DC e (45,5%) RCU. As principais comorbidades foram hipertensão arterial sistêmica (36,4%) e diabetes mellitus (10,3%). E quanto à evolução ao longo de 24 semanas de tratamento, o grupo telecuidado apresentou maiores taxas de remissão da doença (97,7%), e menor escore de atividade da doença (1,7). Assim como maior adesão as condutas orientadas pela equipe multiprofissional do que o grupo controle. Os experimentados com baixo peso, tiveram sua classificação aproximada a faixa de normalidade. Conclusão: o telecuidado apresentou maior efetividade que o tratamento convencional no controle de atividade das DII

The inflammatory bowel diseases (IBD), a growing global impact, are progressive, chronic and may become severe. This study aimed to: Assess the effectiveness of the telenursing of patients with inflammatory bowel diseases, compared to the conventional outpatient treatment; Perform telenursing to a group of patients from the Simple Index of Harvey-Bradshaw to Crohn's disease (ad), and Simple Clinical index of activity of colitis for ulcerative rectocolitis (RCU), following the score, as well as fluctuation; To evaluate the incidence of complications related to IBD in the telecuidado group by the nurse and in the control group of patients seen in inflammatory bowel disease clinic of Piquet Carneiro Polyclinic. Method: randomized controlled trial with follow-up time of 24 weeks. The sample was of 176 volunteers. Data collection occurred from April to October 2016. The primary outcome of the study was the reduction in the index of activities of the IBD of telecare patients and the secondary outcomes were the reduction of complications related to the disease. The research was submitted, approved and registered in the Committee of Ethics in Research of the Hospital Universitário Pedro Ernesto opinion 1.598990, and by the Brazilian Registry of Clinical Trials with registry RBR-7t8fv7. Results: The groups were homogeneous regarding sociodemographic and clinical characteristics. The population is typically female (61.4%), white (47.26%), with a mean age of 44.7 years. Regarding the diagnosis (54.5%), DC and (45.5%) RCU. The main comorbidities were systemic arterial hypertension (36.4%) and diabetes mellitus (10.3%). Regarding the evolution over 24 weeks of treatment, the telecution group presented higher rates of disease remission (97.7%), and lower disease activity score (1.7). As well as greater adhesion the conducts guided by the multiprofessional team than the control group. Those with low weight, had their classification close to the normal range. Conclusion: telenursing was more effective than conventional treatment in the control of IBD activity

Quality improvement and cost savings with multicomponent delirium interventions: replication of the Hospital Elder Life Program in a community hospital.

OBJECTIVE: Delirium is a common problem associated with increased morbidity, mortality, and healthcare costs in the hospitalized elderly, yet there is little research outside of academic medical centers exploring methods to prevent its onset. The authors adapted the Hospital Elder Life Program (HELP) for use in a community hospital and assessed its impact on delirium rate, length of stay (LOS) and healthcare costs in elderly patients. METHODS: Delirium episodes and duration, total patient-days with delirium and LOS were assessed in 595 patients 70 years of age or older admitted to a general medical floor at a community hospital. Pre-intervention outcomes were assessed on the medical floor for 4 months. Interventions adapted from HELP occurred over 9 months and included daily visits, therapeutic activities, and assistance with feeding, hydration, sleep, and vision/hearing impairment. Delirium was assessed on a daily basis with the Confusion Assessment Method (CAM). RESULTS: The rate of episodes of delirium decreased from 20% in the pre-intervention group to 12% in the intervention group, a relative 40% reduction (P = 0.019). Total patients days with delirium decreased from 8% in the usual care group to 6% in the intervention group (P = 0.005). LOS among all patients enrolled in the intervention group decreased by 2 days (P < 0.001). Interventions resulted in $841,000 cost savings over 9 months. CONCLUSIONS: HELP can be successfully adapted for implementation in a community hospital setting to decrease delirium episodes, total patient-days with delirium and LOS, and generate substantial cost savings.