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1.
Rev Fac Cien Med Univ Nac Cordoba ; 77(1): 10-14, 2020 03 12.
Artigo em Espanhol | MEDLINE | ID: mdl-32238252

RESUMO

Introduction: Presidential medical units are intended to protect the dignitary's health in multiple aspects and work in close relationship with security. There are three central areas of coverage: myocardial infarction, stroke and trauma. By 2016 we had not found information about the resources on medical centers in Argentina and their integration into healthcare networks. Objective: Describe the relevant medical centers and their available resources for the medical coverage areas mentioned. Methods: It is a descriptive, cross-sectional study between 12/2016 and 8/2019. The sampling was not probabilistic and for convenience. Variables were reported as proportions and comparisons were made using the chi-square test or Fischer. Results: 232 centers were entered, 66.8% in capital cities and 67% in the public sector. Capitals were associated with a greater presence of resources: category 3 centers (OR 7.85; 95% CI 3.66-16.84; p <0.000001), angiography (OR 5.94; 95% CI 3.24-10.28; p <0.000001 ), tomography (OR 3.41; 95% CI 1.51-7.69; p=0.002), thrombolytics (OR 3.24; 95% CI 1.37-7.76; p=0.005); except trauma surgery (OR 1.83; 95% CI 0.75-4.46; p=0.17). Private centers were associated with greater resources for reperfusion; and public centers for trauma treatment. Conclusions: There is an unbalanced distribution of key resources between capital and non-capital cities in large geographical areas that makes it impossible to develop an adequate network for the treatment of heart attack, stroke and trauma. The best quality of care requires combining public and private networks.


Assuntos
Infarto Cerebral/terapia , Instalações de Saúde/estatística & dados numéricos , Infarto do Miocárdio/terapia , Alocação de Recursos/estatística & dados numéricos , Ferimentos e Lesões/terapia , Argentina , Estudos Transversais , Geografia , Pesquisas sobre Serviços de Saúde , Humanos , Setor Privado , Estudos Prospectivos , Setor Público
2.
Int J Med Inform ; 112: 158-165, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29500015

RESUMO

BACKGROUND: Diffusion of medical innovations among physicians rests on a set of theoretical assumptions, including learning and decision-making under uncertainty, social-normative pressures, medical expert knowledge, competitive concerns, network performance effects, professional autonomy or individualism and scientific evidence. OBJECTIVES: The aim of this study was to develop and test four real data-based, agent-based computational models (ABM) to qualitatively and quantitatively explore the factors associated with diffusion and application of innovations among cardiologists. METHODS: Four ABM were developed to study diffusion and application of medical innovations among cardiologists, considering physicians' network connections, leaders' opinions, "adopters' categories", physicians' autonomy, scientific evidence, patients' pressure, affordability for the end-user population, and promotion from companies. RESULTS: Simulations demonstrated that social imitation among local cardiologists was sufficient for innovation diffusion, as long as opinion leaders did not act as detractors of the innovation. Even in the absence of full scientific evidence to support innovation, up to one-fifth of cardiologists could accept it when local leaders acted as promoters. Patients' pressure showed a large effect size (Cohen's d > 1.2) on the proportion of cardiologists applying an innovation. Two qualitative patterns (speckled and granular) appeared associated to traditional Gompertz and sigmoid cumulative distributions. CONCLUSIONS: These computational models provided a semiquantitative insight on the emergent collective behavior of a physician population facing the acceptance or refusal of medical innovations. Inclusion in the models of factors related to patients' pressure and accesibility to medical coverage revealed the contrast between accepting and effectively adopting a new product or technology for population health care.


Assuntos
Atitude do Pessoal de Saúde , Cardiologistas , Tomada de Decisões , Difusão de Inovações , Modelos Teóricos , Rede Social , Atitude , Humanos
3.
Arq. bras. cardiol ; 105(1): 11-19, July 2015. tab, ilus
Artigo em Inglês | LILACS | ID: lil-755000

RESUMO

Background:

Previous reports have inferred a linear relationship between LDL-C and changes in coronary plaque volume (CPV) measured by intravascular ultrasound. However, these publications included a small number of studies and did not explore other lipid markers.

Objective:

To assess the association between changes in lipid markers and regression of CPV using published data.

Methods:

We collected data from the control, placebo and intervention arms in studies that compared the effect of lipidlowering treatments on CPV, and from the placebo and control arms in studies that tested drugs that did not affect lipids. Baseline and final measurements of plaque volume, expressed in mm3, were extracted and the percentage changes after the interventions were calculated. Performing three linear regression analyses, we assessed the relationship between percentage and absolute changes in lipid markers and percentage variations in CPV.

Results:

Twenty-seven studies were selected. Correlations between percentage changes in LDL-C, non-HDL-C, and apolipoprotein B (ApoB) and percentage changes in CPV were moderate (r = 0.48, r = 0.47, and r = 0.44, respectively). Correlations between absolute differences in LDL-C, non‑HDL-C, and ApoB with percentage differences in CPV were stronger (r = 0.57, r = 0.52, and r = 0.79). The linear regression model showed a statistically significant association between a reduction in lipid markers and regression of plaque volume.

Conclusion:

A significant association between changes in different atherogenic particles and regression of CPV was observed. The absolute reduction in ApoB showed the strongest correlation with coronary plaque regression.

.

Fundamento:

Estudos prévios sugerem uma relação linear entre o LDL-C e mudanças no volume de placa coronariana (VPC) medido por ultrassonografia intravascular. No entanto, estas publicações incluíram um número pequeno de estudos e não exploraram outros marcadores lipídicos.

Objetivo:

Avaliar a associação entre alterações nos marcadores lipídicos e regressão no VPC com base em dados publicados.

Métodos:

Nós coletamos dados dos braços controle, placebo e intervenção de estudos que compararam o efeito de tratamentos hipolipemiantes no VPC, e dos braços placebo e controle de estudos que testaram medicamentos que não afetam os lipídios. Os volumes inicial e final da placa, representados em mm3, foram extraídos e as alterações percentuais após as intervenções foram calculadas. Nós realizamos três análises de regressão linear e avaliamos a relação entre alterações percentuais e absolutas dos marcadores lipídicos com as variações percentuais do VPC.

Resultados:

Vinte e sete estudos foram selecionados. As correlações entre as variações percentuais do LDL-C, não- HDL-C e apolipoproteína B (ApoB) com variações percentuais do VPC foram moderadas (r = 0,48; r = 0,47; e r = 0,44, respectivamente). As correlações entre diferenças absolutas do LDL-C, não-HDL-C e ApoB com diferenças percentuais do VPC foram mais fortes (r = 0,57; r = 0,52; e r = 0,79). O modelo de regressão linear mostrou uma associação estatisticamente significativa entre a redução nos marcadores lipídicos e regressão no volume da placa.

Conclusão:

Observamos uma associação significativa entre alterações de diferentes partículas aterogênicas e regressão do VPC. A redução absoluta da ApoB mostrou a correlação mais forte com a regressão da placa coronariana.

.


Assuntos
Humanos , Apolipoproteínas B/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Placa Aterosclerótica/sangue , Braço , Anticolesterolemiantes/uso terapêutico , Biomarcadores/sangue , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana , Placa Aterosclerótica/tratamento farmacológico , Placa Aterosclerótica , Valores de Referência , Resultado do Tratamento , Ultrassonografia de Intervenção
4.
Health Econ Rev ; 5(1): 52, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26112219

RESUMO

Apixaban, a novel oral anticoagulant which has been approved for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation, reduces both ischemic and haemorrhagic stroke and produces fewer bleedings than vitamin K antagonist warfarin. These clinical results lead to a decrease in health care resource utilization and, therefore, have a positive impact on health economics of atrial fibrillation. The cost-effectiveness of apixaban has been assessed in a variety of clinical settings and countries. However, data from emergent markets, as is the case of Argentina, are still scarce.We performed a cost-effectiveness analysis of apixaban versus warfarin in non-valvular atrial fibrillation (NVAF) in patients suitable for oral anticoagulation in Argentina. A Markov-based model including both costs and effects were used to simulate a cohort of patients with NVAF. Local epidemiological, resource utilization and cost data were used and all inputs were validated by a Delphi Panel of local experts. We adopted the payer's perspective with costs expressed in 2012 US Dollars.The study revealed that apixaban is cost-effective compared with warfarin using a willingness to pay threshold ranging from 1 to 3 per capita Gross Domestic Product (11558 - 34664 USD) with an incremental cost-effectiveness ratio of 786.08 USD per QALY gained. The benefit is primarily a result of the reduction in stroke and bleeding events.The study demonstrates that apixaban is a cost-effective alternative to warfarin in Argentina.

5.
Rev. argent. cardiol ; 83(3): 1-10, June 2015. ilus
Artigo em Inglês | LILACS-Express | ID: biblio-957610

RESUMO

background: Smoking is the leading cause of preventable morbidity and death. It is important to know the characteristics of smoking habits among physicians and their attitude toward patients who smoke. Objective: The aim of this study is to investigate the prevalence of smoking among physicians in Argentina, the factors associated with tobacco consumption and their attitude toward their patients who smoke. Methods: An observational cross- sectional study was performed between June and December 2013 in Argentine physicians of dif-ferent specialties. Using a structured survey, the following variables were analyzed: associated cardiovascular risk factors, charac-teristics of tobacco consumption, smoking cessation training and the attitude toward the patient who smokes. results: 3,033 physicians were surveyed, ; 57% were men, and mean age was 41.3±12 years; 19.7% were current smokers and 21.7% were former smokers. The probability of being a smoker was higher among surgeons (OR 1.29) or physicians working at the emergency room (OR 1.41). Undergraduate and postgraduate tobacco cessation training was achieved by 36.6% and 40.8% of physicians, respectively. Young physicians, clinical specialties or private practice were associated with higher level of training. Tobacco cessation counseling was more frequent in physicians with higher level of training than physicians who smoked or surgeons. Former smokers presented higher prevalence of risk factors and cardiovascular events. Family history of smoking habit was more common in former smokers and current smokers. Conclusions: The prevalence of smoking among Argentine physicians is high. Different factors are involved in the probability of smoking, tobacco cessation training or the possibility of medical counseling. Higher level of training in smoking cessation must be provided.

6.
Arq Bras Cardiol ; 105(1): 11-9, 2015 Jul.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26016784

RESUMO

BACKGROUND: Previous reports have inferred a linear relationship between LDL-C and changes in coronary plaque volume (CPV) measured by intravascular ultrasound. However, these publications included a small number of studies and did not explore other lipid markers. OBJECTIVE: To assess the association between changes in lipid markers and regression of CPV using published data. METHODS: We collected data from the control, placebo and intervention arms in studies that compared the effect of lipidlowering treatments on CPV, and from the placebo and control arms in studies that tested drugs that did not affect lipids. Baseline and final measurements of plaque volume, expressed in mm3, were extracted and the percentage changes after the interventions were calculated. Performing three linear regression analyses, we assessed the relationship between percentage and absolute changes in lipid markers and percentage variations in CPV. RESULTS: Twenty-seven studies were selected. Correlations between percentage changes in LDL-C, non-HDL-C, and apolipoprotein B (ApoB) and percentage changes in CPV were moderate (r = 0.48, r = 0.47, and r = 0.44, respectively). Correlations between absolute differences in LDL-C, non­HDL-C, and ApoB with percentage differences in CPV were stronger (r = 0.57, r = 0.52, and r = 0.79). The linear regression model showed a statistically significant association between a reduction in lipid markers and regression of plaque volume. CONCLUSION: A significant association between changes in different atherogenic particles and regression of CPV was observed. The absolute reduction in ApoB showed the strongest correlation with coronary plaque regression.


Assuntos
Apolipoproteínas B/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Placa Aterosclerótica/sangue , Anticolesterolemiantes/uso terapêutico , Braço , Biomarcadores/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/tratamento farmacológico , Humanos , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/tratamento farmacológico , Valores de Referência , Resultado do Tratamento , Ultrassonografia de Intervenção
7.
Rev. argent. cardiol ; 83(1): 21-27, feb. 2015. graf, tab
Artigo em Espanhol | LILACS-Express | ID: lil-757115

RESUMO

Introducción: El Cuestionario sobre la Dieta Restrictiva de Sodio [Dietary Sodium Restriction Questionnaire (DSRQ)] está basado en la teoría del comportamiento planificado. Originalmente desarrollado en inglés, este instrumento, compuesto por tres subescalas (en 16 ítems que evalúan los parámetros vinculados con la actitud en relación con el comportamiento, la norma subjetiva y el control comportamental percibido), identifica los factores que afectan la adhesión a la dieta hiposódica en pacientes con insuficiencia cardíaca congestiva (ICC). Objetivos: Realizar la adaptación transcultural del DSRQ en idioma español para su utilización en la Argentina y evaluar las propiedades psicométricas (validez y confiabilidad). Material y métodos: La adaptación transcultural se realizó con la metodología recomendada (traducción, síntesis, revisión y retrotraducción). La validez se determinó mediante análisis de forma y factorial de componentes principales con la extracción de factores y rotación Varimax. El análisis de la confiabilidad se efectuó mediante el cálculo de la consistencia interna (alfa de Cronbach) y la correlación ítem-total de la escala. Resultados: En la adaptación transcultural se adaptaron los encabezados y solamente una pregunta tuvo alteraciones semánticas relevantes. Para el análisis de las propiedades psicométricas se incluyeron 230 pacientes con ICC. La proporción de datos faltantes fue muy baja (0,20%). En el análisis de componentes principales se extrajeron tres factores. Luego de la rotación Varimax, los ítems se agruparon con los factores seleccionados, coincidiendo con las tres subescalas originales. En el análisis ítem-total, ninguna correlación mostró un valor < 0,30. El alfa de Cronbach global fue de 0,86 (0,89, 0,71 y 0,89 para las tres subescalas, de actitud en relación con el comportamiento, norma subjetiva y control comportamental percibido, respectivamente). Conclusiones: En nuestro trabajo se realizó por primera vez la adaptación transcultural del DSRQ al español para su utilización en la Argentina; la confiabilidad y la validez de esta versión del instrumento fueron adecuadas.


Background: The Dietary Sodium Restriction Questionnaire (DSRQ) is based on the theory of planned behavior. Originally developed in English, this instrument, consisting of three subscales (divided in 16 items evaluating the parameters associated with attitude relative to behavior, the subjective norm and the perceived behavioral control), identifies the factors affecting adherence to low-sodium diet in patients with congestive heart failure (CHF). Objectives: The purpose of this study was to perform the DSRQ transcultural adaptation into Spanish to be used in Argentina and assess its psychometric properties (validity and reliability). Methods: The transcultural adaptation was done with the recommended methodology (translation, synthesis, revision and back translation). Its validity was explored by principal component structure and factor analysis with factor extraction and Varimax rotation. Reliability was analyzed by internal consistency calculation (Cronbach's alpha) and the item-total scale correlation. Results: Headlines were adjusted and one question only had relevant semantic changes in the transcultural adaptation. A total of 230 CHF patients were included for the psychometric analysis. The proportion of missing data was very low (0.20%). Three factors were extracted from the main component analysis. After Varimax rotation, the items were grouped with the selected factors, matching the three original subscales. In the item-total analysis, no correlation showed a value < 0.30. Global Cronbach's alpha was 0.86 (0.89, 0.71 and 0.89 for the three subscales, of attitude relative to behavior, subjective norm and perceived behavioral control, respectively). Conclusions: We performed for the first time the DSRQ transcultural adaptation into Spanish for its use in Argentina. This version of the instrument showed adequate validity and reliability.

8.
Rev. argent. cardiol ; 83(1): 21-27, feb. 2015. graf, tab
Artigo em Espanhol | BINACIS | ID: bin-133930

RESUMO

Introducción: El Cuestionario sobre la Dieta Restrictiva de Sodio [Dietary Sodium Restriction Questionnaire (DSRQ)] está basado en la teoría del comportamiento planificado. Originalmente desarrollado en inglés, este instrumento, compuesto por tres subescalas (en 16 ítems que evalúan los parámetros vinculados con la actitud en relación con el comportamiento, la norma subjetiva y el control comportamental percibido), identifica los factores que afectan la adhesión a la dieta hiposódica en pacientes con insuficiencia cardíaca congestiva (ICC). Objetivos: Realizar la adaptación transcultural del DSRQ en idioma español para su utilización en la Argentina y evaluar las propiedades psicométricas (validez y confiabilidad). Material y métodos: La adaptación transcultural se realizó con la metodología recomendada (traducción, síntesis, revisión y retrotraducción). La validez se determinó mediante análisis de forma y factorial de componentes principales con la extracción de factores y rotación Varimax. El análisis de la confiabilidad se efectuó mediante el cálculo de la consistencia interna (alfa de Cronbach) y la correlación ítem-total de la escala. Resultados: En la adaptación transcultural se adaptaron los encabezados y solamente una pregunta tuvo alteraciones semánticas relevantes. Para el análisis de las propiedades psicométricas se incluyeron 230 pacientes con ICC. La proporción de datos faltantes fue muy baja (0,20%). En el análisis de componentes principales se extrajeron tres factores. Luego de la rotación Varimax, los ítems se agruparon con los factores seleccionados, coincidiendo con las tres subescalas originales. En el análisis ítem-total, ninguna correlación mostró un valor < 0,30. El alfa de Cronbach global fue de 0,86 (0,89, 0,71 y 0,89 para las tres subescalas, de actitud en relación con el comportamiento, norma subjetiva y control comportamental percibido, respectivamente). Conclusiones: En nuestro trabajo se realizó por primera vez la adaptación transcultural del DSRQ al español para su utilización en la Argentina; la confiabilidad y la validez de esta versión del instrumento fueron adecuadas.(AU)


Background: The Dietary Sodium Restriction Questionnaire (DSRQ) is based on the theory of planned behavior. Originally developed in English, this instrument, consisting of three subscales (divided in 16 items evaluating the parameters associated with attitude relative to behavior, the subjective norm and the perceived behavioral control), identifies the factors affecting adherence to low-sodium diet in patients with congestive heart failure (CHF). Objectives: The purpose of this study was to perform the DSRQ transcultural adaptation into Spanish to be used in Argentina and assess its psychometric properties (validity and reliability). Methods: The transcultural adaptation was done with the recommended methodology (translation, synthesis, revision and back translation). Its validity was explored by principal component structure and factor analysis with factor extraction and Varimax rotation. Reliability was analyzed by internal consistency calculation (Cronbachs alpha) and the item-total scale correlation. Results: Headlines were adjusted and one question only had relevant semantic changes in the transcultural adaptation. A total of 230 CHF patients were included for the psychometric analysis. The proportion of missing data was very low (0.20%). Three factors were extracted from the main component analysis. After Varimax rotation, the items were grouped with the selected factors, matching the three original subscales. In the item-total analysis, no correlation showed a value < 0.30. Global Cronbachs alpha was 0.86 (0.89, 0.71 and 0.89 for the three subscales, of attitude relative to behavior, subjective norm and perceived behavioral control, respectively). Conclusions: We performed for the first time the DSRQ transcultural adaptation into Spanish for its use in Argentina. This version of the instrument showed adequate validity and reliability.(AU)

9.
Medicina (B Aires) ; 74(4): 326-32, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-25188663

RESUMO

Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology's Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as "appropriate" "uncertain" or "inappropriate" ,for the procedure in accordance with the panelists' median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.


Assuntos
Síndrome Coronariana Aguda/terapia , Cardiologia , Cateterismo de Swan-Ganz , Consenso , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/normas , Medicina Baseada em Evidências , Insuficiência Cardíaca/terapia , Humanos , Medição de Risco
10.
Medicina (B.Aires) ; 74(4): 326-332, ago. 2014. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-734394

RESUMO

Actualmente existen dudas sobre la seguridad del uso del catéter de Swan Ganz (CSG). Para definir la opinión de los cardiólogos de nuestro país, el Consejo de Emergencias Cardiovasculares de la Sociedad Argentina de Cardiología (SAC) realizó una reunión para evaluar la opinión de expertos en diferentes escenarios (cirugía no cardíaca, cardíaca, síndromes coronarios e insuficiencia cardíaca), usando el método RAND-UCLA appropiateness. Se envió la evidencia bibliográfica previa a la reunión en la SAC y en la misma los panelistas seleccionaron las variables para conformar las situaciones clínicas que luego fueron enviadas para que individualmente, en una segunda etapa, determinaran si consideraban beneficioso o perjudicial la utilización del catéter con una escala de 1 a 9 (1 significaba que los potenciales perjuicios superaban a los beneficios, 9 que los beneficios eran mayores y 5 que podía considerarse indistintamente beneficioso o perjudicial). Dos expertos analizaron los resultados, describiendo la tasa de acuerdo/desacuerdo. Finalmente, cada indicación se clasificó como “apropiada”, “dudosa” o inapropiada de acuerdo a la mediana definida por los panelistas: 1-3 se clasificó como inapropiado, 4-6 dudoso y 7-9 como indicación apropiada. Observamos gran discrepancia en la opinión sobre la indicación de CSG entre los expertos. Sin embargo, los panelistas estuvieron a favor de su utilización en situaciones que incluían shock y disfunción miocárdica, especialmente cuando se asoció disfunción orgánica. Hubo situaciones en las que los panelistas consideraron inapropiada la indicación del CSG, en pacientes sin disfunción orgánica.


Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology’s Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as “appropriate,” “uncertain” or “inappropriate” for the procedure in accordance with the panelists’ median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.


Assuntos
Humanos , Síndrome Coronariana Aguda/terapia , Cardiologia , Cateterismo de Swan-Ganz , Consenso , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/normas , Medicina Baseada em Evidências , Insuficiência Cardíaca/terapia , Medição de Risco
11.
Medicina (B.Aires) ; 74(4): 326-332, ago. 2014. ilus, tab
Artigo em Espanhol | BINACIS | ID: bin-131433

RESUMO

Actualmente existen dudas sobre la seguridad del uso del catéter de Swan Ganz (CSG). Para definir la opinión de los cardiólogos de nuestro país, el Consejo de Emergencias Cardiovasculares de la Sociedad Argentina de Cardiología (SAC) realizó una reunión para evaluar la opinión de expertos en diferentes escenarios (cirugía no cardíaca, cardíaca, síndromes coronarios e insuficiencia cardíaca), usando el método RAND-UCLA appropiateness. Se envió la evidencia bibliográfica previa a la reunión en la SAC y en la misma los panelistas seleccionaron las variables para conformar las situaciones clínicas que luego fueron enviadas para que individualmente, en una segunda etapa, determinaran si consideraban beneficioso o perjudicial la utilización del catéter con una escala de 1 a 9 (1 significaba que los potenciales perjuicios superaban a los beneficios, 9 que los beneficios eran mayores y 5 que podía considerarse indistintamente beneficioso o perjudicial). Dos expertos analizaron los resultados, describiendo la tasa de acuerdo/desacuerdo. Finalmente, cada indicación se clasificó como “apropiada”, “dudosa” o inapropiada de acuerdo a la mediana definida por los panelistas: 1-3 se clasificó como inapropiado, 4-6 dudoso y 7-9 como indicación apropiada. Observamos gran discrepancia en la opinión sobre la indicación de CSG entre los expertos. Sin embargo, los panelistas estuvieron a favor de su utilización en situaciones que incluían shock y disfunción miocárdica, especialmente cuando se asoció disfunción orgánica. Hubo situaciones en las que los panelistas consideraron inapropiada la indicación del CSG, en pacientes sin disfunción orgánica.(AU)


Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology’s Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as “appropriate,” “uncertain” or “inappropriate” for the procedure in accordance with the panelists’ median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.(AU)

12.
Rev. argent. cardiol ; 82(1): 26-33, feb. 2014. graf, tab
Artigo em Espanhol | LILACS-Express | ID: lil-734490

RESUMO

Introducción La inactividad física se asocia con mayor morbimortalidad cardiovascular y está en aumento en la población general. Los médicos serían los mejor preparados para brindar asesoramiento sobre actividad física a los pacientes; no obstante ello, no existen datos locales validados relativos a los hábitos y las actitudes de los médicos frente al ejercicio. Objetivos Analizar las características de la actividad física en una población de médicos, determinar la actitud del médico frente al paciente con respecto al ejercicio, estudiar la relación entre la actividad física y la edad, el sexo y la especialidad y evaluar los factores de riesgo de esta población. Material y métodos Se realizó una encuesta a médicos de la Ciudad Autónoma de Buenos Aires y del Conurbano bonaerense. Se utilizó el International Physical Activity Questionnaire (Cuestionario Internacional de Actividad Física). Para evaluar el nivel de actividad física se empleó una escala basada en los MET semanales ( 3.000 MET = actividad física vigorosa). Resultados Se incluyeron 550 médicos (53% hombres, edad media 38 años). El 37,5%, el 57,5% y el 5% realizan actividad física baja, moderada o vigorosa, respectivamente. Al 80% de la población le gusta hacer ejercicio, el 92% recomienda hacer ejercicio a sus pacientes y el 97% lo considera beneficioso para la salud. El principal motivo para no realizar ejercicio es la falta de tiempo. Los hombres realizan más actividad física vigorosa 3 o más veces por semana (20% vs. 15%; p < 0,01) que las mujeres. La especialidad cardiología es en la que se indica más frecuentemente realizar ejercicio (75%). Conclusiones En esta población médica, independientemente del sexo, el grupo etario o la especialidad analizada, se observó una prevalencia menor de actividad física baja en comparación con la población general. La recomendación de ejercicio a los pacientes fue globalmente elevada, aunque mayor en las especialidades clínicas.


Background Sedentarism is associated with higher cardiovascular morbidity and mortality and is increasing in the general population. Physicians should have the best preparation to instruct patients on physical activity. There are, however, no validated local data regarding physician’s habits and attitudes towards physical exercise. Objectives The aim of the study was to analyze the characteristics of physical activity in a medical population, determine the attitude towards patients regarding exercise, study the relationship between physical activity and age, gender and specialty and evaluate the risk factors of this population. Methods We surveyed physicians from the Autonomous City of Buenos Aires and the Greater Buenos Aires using the International Physical Activity Questionnaire (IPAQ). To assess the physical activity level a scale based on weekly METS ( 3000 METS = vigorous physical activity) was applied. Results Five hundred and fifty physicians were included (53% male, mean age 38 years). Physical activity levels were low, moderate or vigorous in 37.5%, 57.5%, and 5% of cases, respectively. Eighty percent of the medical population liked to exercise, 92% recommended exercise to their patients and 97% saw it as beneficial for health. The main reason for not performing exercise was lack of time. Men performed more vigorous physical activity than women (20 vs. 15%, p <0.01). Cardiology was the specialty which recommended exercise more frequently to patients (75%). Conclusions In this medical population there was a lower prevalence of low physical activity than in the general population, independently of gender, age group or specialty analyzed. Exercise recommendation to patients was generally high, though more elevated in clinical specialties.

13.
Rev. argent. cardiol ; 82(1): 34-41, feb. 2014. tab
Artigo em Espanhol | LILACS-Express | ID: lil-734491

RESUMO

Introducción En numerosos ensayos clínicos se demostró que las estatinas reducen los eventos cardiovasculares, tanto en prevención primaria como secundaria. Sin embargo, existe una variación individual considerable en la respuesta esperada para cada dosis y tipo de estatina, por lo que detectar al paciente hiporrespondedor a las estatinas permitiría considerar un tratamiento hipolipemiante adicional. Objetivos Evaluar la respuesta a las estatinas en pacientes en prevención cardiovascular y analizar las características de los sujetos hiporrespondedores. Material y métodos Se incluyeron en forma consecutiva pacientes ambulatorios con indicación de estatinas. El médico tratante definía la estatina y la dosis utilizada. Se analizaron los valores basales y postratamiento (6-24 semanas) del perfil lipídico. Se analizó la distribución de la reducción del C-LDL para cada tipo y dosis de estatina y se definió “baja respuesta” según dos estrategias: si el porcentaje de reducción se encontraba por debajo de la mediana o por debajo del percentil 25. Se realizaron análisis univariados y multivariados. Resultados Se incluyeron 446 pacientes (52% mujeres, 25% diabéticos, 80% prevención primaria, edad 58 ± 11 años). La reducción del C-LDL promedio fue del 27%, 38% y 43% para simvastatina 10 mg, 20 mg y 40 mg, respectivamente, del 36% y 43% para atorvastatina 10 mg y 20 mg, respectivamente, y del 44% y 49% para rosuvastatina 10 mg y 20 mg, respectivamente. Definiendo hiporrespuesta por ambas estrategias (mediana y percentil 25), el sexo masculino (OR 2,54 y 2,31), la diabetes (OR 2,0 y 3,85), la edad (cada 5 años, OR 0,87 y 0,83) y el nivel basal de C-LDL (cada 10 mg/dl, OR 0,78 y 0,77) se asociaron independientemente con una chance mayor de ser hiporrespondedor. Conclusiones La reducción del C-LDL por las diferentes estatinas fue similar a lo previamente publicado. Los hombres, los diabéticos, los sujetos más jóvenes o con niveles basales más bajos de C-LDL tuvieron mayor probabilidad de mostrar baja respuesta a las estatinas.


Introduction Numerous clinical trials have shown that statins reduce cardiovascular events, both in primary and secondary prevention. There is, however, considerable individual variation in the expected response for each dose and type of statin; therefore, detection of hypo-responder patients would allow considering additional hypolipidemic treatment. Objectives The aims of this study were to evaluate the response to statins in cardiovascular prevention patients and to analyze the characteristics of hyporesponder subjects. Methods Consecutive outpatients receiving statins were included. The treating physician defined the type and dose of statin used. The lipid profile was assessed at baseline and post-treatment (6-24 weeks). The distribution of LDL-C reduction for each type and dose of statin was analyzed and “low response” was defined according to two strategies: if the percent reduction was below the median or below the 25th percentile. Univariate and multivariate analyses were performed. Results A total of 446 patients (52% female, 25% diabetic, 80% primary prevention, age 58 ± 11 years) were included in the study. Mean LDL-C reduction was 27%, 38% and 43% for simvastatin 10, 20 and 40 mg, respectively, 36% and 43% for atorvastatin 10 and 20 mg, respectively, and 44% and 49% for rosuvastatin 10 and 20 mg, respectively. Hypores-ponsiveness defined by both strategies (median and 25th percentile) showed that male gender (OR 2.54 and 2.31), diabetes (OR 2.0 and 3.85), age (every 5 years, OR 0.87 and 0.83) and baseline LDL-C (every 10 mg/dL, OR 0.78 and 0.77) were independently associated with greater chance of being hypo-responder. Conclusions LDL-C reduction by different statins was similar to previous reports. Men, diabetics, younger subjects or with lower baseline LDL-C were more likely to show poor response to statins.

14.
Rev. argent. cardiol ; 82(1): 26-33, feb. 2014. graf, tab
Artigo em Espanhol | BINACIS | ID: bin-131352

RESUMO

Introducción La inactividad física se asocia con mayor morbimortalidad cardiovascular y está en aumento en la población general. Los médicos serían los mejor preparados para brindar asesoramiento sobre actividad física a los pacientes; no obstante ello, no existen datos locales validados relativos a los hábitos y las actitudes de los médicos frente al ejercicio. Objetivos Analizar las características de la actividad física en una población de médicos, determinar la actitud del médico frente al paciente con respecto al ejercicio, estudiar la relación entre la actividad física y la edad, el sexo y la especialidad y evaluar los factores de riesgo de esta población. Material y métodos Se realizó una encuesta a médicos de la Ciudad Autónoma de Buenos Aires y del Conurbano bonaerense. Se utilizó el International Physical Activity Questionnaire (Cuestionario Internacional de Actividad Física). Para evaluar el nivel de actividad física se empleó una escala basada en los MET semanales ( 3.000 MET = actividad física vigorosa). Resultados Se incluyeron 550 médicos (53% hombres, edad media 38 años). El 37,5%, el 57,5% y el 5% realizan actividad física baja, moderada o vigorosa, respectivamente. Al 80% de la población le gusta hacer ejercicio, el 92% recomienda hacer ejercicio a sus pacientes y el 97% lo considera beneficioso para la salud. El principal motivo para no realizar ejercicio es la falta de tiempo. Los hombres realizan más actividad física vigorosa 3 o más veces por semana (20% vs. 15%; p < 0,01) que las mujeres. La especialidad cardiología es en la que se indica más frecuentemente realizar ejercicio (75%). Conclusiones En esta población médica, independientemente del sexo, el grupo etario o la especialidad analizada, se observó una prevalencia menor de actividad física baja en comparación con la población general. La recomendación de ejercicio a los pacientes fue globalmente elevada, aunque mayor en las especialidades clínicas.(AU)


Background Sedentarism is associated with higher cardiovascular morbidity and mortality and is increasing in the general population. Physicians should have the best preparation to instruct patients on physical activity. There are, however, no validated local data regarding physicianÆs habits and attitudes towards physical exercise. Objectives The aim of the study was to analyze the characteristics of physical activity in a medical population, determine the attitude towards patients regarding exercise, study the relationship between physical activity and age, gender and specialty and evaluate the risk factors of this population. Methods We surveyed physicians from the Autonomous City of Buenos Aires and the Greater Buenos Aires using the International Physical Activity Questionnaire (IPAQ). To assess the physical activity level a scale based on weekly METS ( 3000 METS = vigorous physical activity) was applied. Results Five hundred and fifty physicians were included (53% male, mean age 38 years). Physical activity levels were low, moderate or vigorous in 37.5%, 57.5%, and 5% of cases, respectively. Eighty percent of the medical population liked to exercise, 92% recommended exercise to their patients and 97% saw it as beneficial for health. The main reason for not performing exercise was lack of time. Men performed more vigorous physical activity than women (20 vs. 15%, p <0.01). Cardiology was the specialty which recommended exercise more frequently to patients (75%). Conclusions In this medical population there was a lower prevalence of low physical activity than in the general population, independently of gender, age group or specialty analyzed. Exercise recommendation to patients was generally high, though more elevated in clinical specialties.(AU)

15.
Rev. argent. cardiol ; 82(1): 34-41, feb. 2014. tab
Artigo em Espanhol | BINACIS | ID: bin-131351

RESUMO

Introducción En numerosos ensayos clínicos se demostró que las estatinas reducen los eventos cardiovasculares, tanto en prevención primaria como secundaria. Sin embargo, existe una variación individual considerable en la respuesta esperada para cada dosis y tipo de estatina, por lo que detectar al paciente hiporrespondedor a las estatinas permitiría considerar un tratamiento hipolipemiante adicional. Objetivos Evaluar la respuesta a las estatinas en pacientes en prevención cardiovascular y analizar las características de los sujetos hiporrespondedores. Material y métodos Se incluyeron en forma consecutiva pacientes ambulatorios con indicación de estatinas. El médico tratante definía la estatina y la dosis utilizada. Se analizaron los valores basales y postratamiento (6-24 semanas) del perfil lipídico. Se analizó la distribución de la reducción del C-LDL para cada tipo y dosis de estatina y se definió ôbaja respuestaö según dos estrategias: si el porcentaje de reducción se encontraba por debajo de la mediana o por debajo del percentil 25. Se realizaron análisis univariados y multivariados. Resultados Se incluyeron 446 pacientes (52% mujeres, 25% diabéticos, 80% prevención primaria, edad 58 ± 11 años). La reducción del C-LDL promedio fue del 27%, 38% y 43% para simvastatina 10 mg, 20 mg y 40 mg, respectivamente, del 36% y 43% para atorvastatina 10 mg y 20 mg, respectivamente, y del 44% y 49% para rosuvastatina 10 mg y 20 mg, respectivamente. Definiendo hiporrespuesta por ambas estrategias (mediana y percentil 25), el sexo masculino (OR 2,54 y 2,31), la diabetes (OR 2,0 y 3,85), la edad (cada 5 años, OR 0,87 y 0,83) y el nivel basal de C-LDL (cada 10 mg/dl, OR 0,78 y 0,77) se asociaron independientemente con una chance mayor de ser hiporrespondedor. Conclusiones La reducción del C-LDL por las diferentes estatinas fue similar a lo previamente publicado. Los hombres, los diabéticos, los sujetos más jóvenes o con niveles basales más bajos de C-LDL tuvieron mayor probabilidad de mostrar baja respuesta a las estatinas.(AU)


Introduction Numerous clinical trials have shown that statins reduce cardiovascular events, both in primary and secondary prevention. There is, however, considerable individual variation in the expected response for each dose and type of statin; therefore, detection of hypo-responder patients would allow considering additional hypolipidemic treatment. Objectives The aims of this study were to evaluate the response to statins in cardiovascular prevention patients and to analyze the characteristics of hyporesponder subjects. Methods Consecutive outpatients receiving statins were included. The treating physician defined the type and dose of statin used. The lipid profile was assessed at baseline and post-treatment (6-24 weeks). The distribution of LDL-C reduction for each type and dose of statin was analyzed and ôlow responseö was defined according to two strategies: if the percent reduction was below the median or below the 25th percentile. Univariate and multivariate analyses were performed. Results A total of 446 patients (52% female, 25% diabetic, 80% primary prevention, age 58 ± 11 years) were included in the study. Mean LDL-C reduction was 27%, 38% and 43% for simvastatin 10, 20 and 40 mg, respectively, 36% and 43% for atorvastatin 10 and 20 mg, respectively, and 44% and 49% for rosuvastatin 10 and 20 mg, respectively. Hypores-ponsiveness defined by both strategies (median and 25th percentile) showed that male gender (OR 2.54 and 2.31), diabetes (OR 2.0 and 3.85), age (every 5 years, OR 0.87 and 0.83) and baseline LDL-C (every 10 mg/dL, OR 0.78 and 0.77) were independently associated with greater chance of being hypo-responder. Conclusions LDL-C reduction by different statins was similar to previous reports. Men, diabetics, younger subjects or with lower baseline LDL-C were more likely to show poor response to statins.(AU)

16.
Medicina (B.Aires) ; 74(4): 326-32, 2014.
Artigo em Espanhol | BINACIS | ID: bin-133491

RESUMO

Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiologys Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as "appropriate" "uncertain" or "inappropriate" ,for the procedure in accordance with the panelists median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.

17.
Ther Adv Cardiovasc Dis ; 7(4): 189-96, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23723254

RESUMO

BACKGROUND: Hypertension (HTN) is one of the major risk factors for cardiovascular disease in Western countries, and disease control is of major relevance in order to reduce cardiovascular morbidity and mortality. Different approaches have shown efficacy, and one of the proven therapies for HTN control is the blockade of the renin-angiotensin-aldosterone system, which may be accomplished by means of various drugs with different modes of action. Aliskiren is a novel direct renin inhibitor that reduces both angiotensin I and II blood levels. Different randomized clinical trials (phase II and III) have shown its safety and efficacy either alone or in combination with hydrochlorothiazide. However, although aliskiren has been on the market for some years, reports on the post-marketing experience with aliskiren in the real-world setting are lacking. METHODS: The Aliskiren in Latin America Study (ALAS) was designed with the aim of describing the effectiveness of aliskiren at reducing blood pressure (BP) values by prospectively assessing BP control in outpatient clinics in different countries in Latin America. A total of 435 sites in 5 Latin American countries (Mexico, Ecuador, Colombia, Argentina, and Venezuela) enrolled 4588 patients who had just been initiated on aliskiren (either alone or in combination with hydrochlorothiazide) based on their treating physicians' discretion, and they were followed for a 6-month period. Prior antihypertensive drugs could be continued if their doses were not modified along the study. RESULTS: At the end of the follow-up period, a statistically significant reduction in BP values was observed, with a mean systolic BP reduction of 29.2 mmHg and a mean diastolic BP reduction of 13.78 mmHg from baseline at the 6-month visit. CONCLUSION: The BP reduction levels and the low adverse event rate demonstrate the adequate efficacy and safety profile of aliskiren (alone or with hydrochlorothiazide).


Assuntos
Amidas/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Fumaratos/uso terapêutico , Hipertensão/tratamento farmacológico , Renina/antagonistas & inibidores , Adulto , Idoso , Assistência Ambulatorial , Amidas/administração & dosagem , Amidas/efeitos adversos , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Estudos de Coortes , Quimioterapia Combinada , Feminino , Seguimentos , Fumaratos/administração & dosagem , Fumaratos/efeitos adversos , Humanos , Hidroclorotiazida/administração & dosagem , Hidroclorotiazida/efeitos adversos , Hidroclorotiazida/uso terapêutico , América Latina , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
18.
Rev Med Chil ; 141(1): 49-57, 2013 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-23732414

RESUMO

BACKGROUND: Medicine is changing rapidly and diagnostic and therapeutic innovations are common. Not all professionals adopt these innovations in the same way. AIM: To survey the physicians' opinions on adopting innovations in cardiovascular health care, to classify individuals from an innovative to a conservative behavior, and to individualize opinion leaders among them, in order to build a social network of influence. MATERIAL AND METHODS: Between November and December 2008, 765 Argentine cardiologists were surveyed via e-mail in Argentina, to assess the way they adopt and disseminate innovations in cardiovascular health care. RESULTS: The survey was answered by 537 professionals (70.2%). Fifty three percent of respondents were "Early adopters". However, 63 to 79.3% of respondents preferred to wait for a full demonstration of the usefulness of innovation before adopting it. The opinion leaders' distribution adopted a scale-free network pattern, where few leaders had many connections and influence on the whole network. The giant component of the network included 41% of physicians; growth simulation of the network showed that the four most popular leaders influenced over 44% of the giant component. CONCLUSIONS: Among surveyed physicians there was an attitude towards rapid acceptance of innovations in health care. However, when analyzing the direct opinion of physicians, most cases preferred usefulness demonstrated before accepting innovations. The social network including respondents and opinion leaders showed a scale-free topology with a big influence of a few over the whole network.


Assuntos
Atitude do Pessoal de Saúde , Cardiologia , Difusão de Inovações , Argentina , Pesquisas sobre Serviços de Saúde , Humanos , Rede Social
19.
Rev. méd. Chile ; 141(1): 49-57, ene. 2013. ilus
Artigo em Espanhol | LILACS | ID: lil-674045

RESUMO

Background: Medicine is changing rapidly and diagnostic and therapeutic innovations are common. Not all professionals adopt these innovations in the same way. Aim: To survey the physicians' opinions on adopting innovations in cardiovascular health care, to classify individuals from an innovative to a conservative behavior, and to individualize opinion leaders among them, in order to build a social network of influence. Material and Methods: Between November and December 2008, 765 Argentine cardiologists were surveyed via e-mail in Argentina, to assess the way they adopt and disseminate innovations in cardiovascular health care. Results: The survey was answered by 537professionals (70.2%). Fifty three percent of respondents were "Early adopters". However, 63 to 79.3% of respondents preferred to wait for a full demonstration of the usefulness of innovation before adopting it. The opinion leaders' distribution adopted a scale-free network pattern, where few leaders had many connections and influence on the whole network. The giant component of the network included 41% ofphysicians; growth simulation of the network showed that the four most popular leaders influenced over 44% of the giant component. Conclusions: Among surveyed physicians there was an attitude towards rapid acceptance of innovations in health care. However, when analyzing the direct opinion ofphysicians, most cases preferred usefulness demonstrated before accepting innovations. The social network including respondents and opinion leaders showed a scale-free topology with a big influence of a few over the whole network.


Assuntos
Humanos , Atitude do Pessoal de Saúde , Cardiologia , Difusão de Inovações , Argentina , Pesquisas sobre Serviços de Saúde , Rede Social
20.
Medicina (B Aires) ; 72(5): 393-8, 2012.
Artigo em Espanhol | MEDLINE | ID: mdl-23089115

RESUMO

A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely. A trend to trust only in the doctor's knowledge to obtain information (81.7%), in wanting to know the options of treatment and express one's point of view (85.9%), and to involve the family in the decisions (63.2%) was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (or: 0.64), giving less freedom to family involvement (or: 1.31). people with a lower social and economical level claim fewer options (or: 0.48) and gave less family participation (or = 1.79). Natives from other South American countries had a minor tendency to demand for options and express their thoughts (or: 0.60); and the ones with lower education level trusted less in the doctor's knowledge (or: 1.81), demanded fewer options (or: 0.45) and chose not to know the severity of the disease (or: 0.56). the analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patient's autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.


Assuntos
Tomada de Decisões , Cardiopatias/psicologia , Preferência do Paciente/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Feminino , Humanos , Comportamento de Busca de Informação , Internet , Masculino , Pessoa de Meia-Idade , Razão de Chances , Preferência do Paciente/estatística & dados numéricos , Autonomia Pessoal , Relações Médico-Paciente , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
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