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1.
J Crit Care ; 52: 115-125, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31035186

RESUMO

PURPOSE: The present systematic review and meta-analysis aimed to synthesize data on subject outcomes associated with post-ICU follow-up. MATERIALS AND METHODS: MEDLINE, PsycINFO, CINAHL, Cochrane CENTRAL, and EMBASE databases were searched according to pre-specified criteria (PROSPERO- CRD42017074734). Non-randomized and randomized studies assessing patient and family outcomes associated with post-ICU follow-up were included. RESULTS: Twenty-six studies were included. Sixteen (61%) were randomized trials; of these, 15 were meta-analyzed. Non-randomized studies reported benefits in survival, functional status, anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms, and satisfaction. In randomized trials, post-ICU follow-up models focusing on physical therapy were associated with fewer depression symptoms (mean difference [MD], -1.21 (see Fig. 2); 95% confidence interval [CI], -2.31 to -0.11; I2 = 0%) and better mental health-related quality of life scores (standardized MD [SMD], 0.26; 95%CI, 0.02 to 0.51; I2 = 6%) in the short term. Post-ICU follow-up models focusing on psychological or medical management interventions were associated with fewer PTSD symptoms (SMD, -0.21; 95%CI, -0.37 to -0.05; I2 = 0%) in the medium term. CONCLUSIONS: Post-ICU follow-up may improve depression symptoms and mental health-related quality of life in the short term for models focusing on physical therapy and PTSD symptoms in the medium term for models focusing on psychological or medical management interventions.

3.
Artigo em Português | LILACS-Express | ID: lil-712277

RESUMO

JUSTIFICATIVA E OBJETIVO: No Brasil, desde a criaçãodo Sistema Único de Saúde, o acesso aos cuidados de saúde éum direito do cidadão e um dever do Estado. Atualmente, 70%da população são assistidas exclusivamente pelo Sistema Únicode Saúde, o que ocasiona a necessidade de racionalização dosrecursos. Assim, esforços para a melhoria da eficácia, garantiada segurança e qualificação da atenção dispensada aos pacientessão necessários em todos os níveis. O estudo descreveu oimpacto de uma equipe de Medicina Hospitalar no contextodo Sistema Único de Saúde no Brasil. MÉTODOS: Trata-se deestudo observacional descritivo. Em julho de 2011, uma equipede Medicina Hospitalar passou a assistir os pacientes clínicos doSistema Único de Saúde, sendo abolidos os cuidados pelo métodotradicional. Neste estudo, os autores compararam índices demorbidade hospitalar utilizados no monitoramento do desempenhodos serviços médicos obtidos pelas duas equipes médicasdiferentes, em dois períodos consecutivos de 6 meses. Os dadosdos pacientes foram coletados a partir do sistema informatizadodo hospital. RESULTADOS: Comparando os dois períodos,houve significativo aumento do escore de Charlson (2,5±2,0versus 3,3±2,1) com diminuição do tempo médio de internaçãoem dias (8,5±1,8 versus 6,0±1,1) assim como da ocorrênciade infecção hospitalar em percentual de pacientes (5,2±0,9 versus2,8±1,8). Ao se comparar a mortalidade nos dois períodos, observou-se diferença significativa ao se controlar a análise peloíndice de comorbidades de Charlson. Quando se comparou amortalidade nos dois períodos, diferença significativa pôde ser vista, controlando-se a análise pelo escore de gravidade (5/261versus 8/321; p=0,033). Ao que se referem às reinternações,não houve diferença na comparação dos períodos em 30 dias(61/261 versus 55/321; p=0,508). CONCLUSÃO: Considerandoa realidade de falta de leitos hospitalares, as iniciativas quediminuem o tempo de internação, sem prejudicar a assistência,devem ser alvo de avaliação e incentivo financeiro por parte dosgestores públicos.


BACKGROUND AND OBJECTIVE: Since the creation ofthe Unified Health System, the access to health care in Brazilhas been citizen?s right and government?s duty. Nowadays,more than 70% of the population is assisted exclusively by theUnified Health System and this leads to a need to streamline theresources. Thus, an attempt to improve efficiency, to guaranteesafety and qualified attention to patients at all levels is necessary.This study described the impact of a Hospital Medicine teamin the context of the Public Health Care System in Brazil.METHODS: This was a descriptive observational study. InJuly 2011, a Hospital Medicine team started attending theUnified Health System patients and the traditional method wasabolished. The study compared hospital morbidity rates used formonitoring the performance of the two different medical teamsin two consecutive 6-month periods. The data from all patientswere collected from the hospital computer system. RESULTS:Comparing the two periods, there was a significant increasein Charlson?s score (2.5±2.0 versus 3.3±2.1), a decrease in theaverage hospital stay in days (8.5±1.8 versus 6.0± 1.1) as well as inthe percentage of patients presenting hospital infection (5.2±0.9versus 2.8±1.8). When comparing the mortality between thetwo systems, significant statistical difference was seen usingCharlson?s score to control the analysis (5/261 versus 8/321;p=0.033). There was no difference between the two systems interms of readmissions within a thirty-day period (61/261 versus55/321; p=0.508). CONCLUSION: Considering the reality oflack of hospital beds, initiatives that allow a decrease in hospital stay must be observed and be target of financial incentives bythe public managers

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