Complicações em Serviços de Hemodinâmica ­ como agir / Complications in Cath Lab ­ how to bail out

Vários fatores, incluindo intervenções terapêuticas aprimoradas e tecnologias avançadas, levaram a melhores desfechos clínicos nas intervenções coronárias percutâneas complexas. No entanto, ainda podem ocorrer complicações capazes de impactar negativamente na sobrevida do paciente e nos custos de saúde. O risco dessas complicações pode ser reduzido, por meio de operadores experientes e procedimentos preventivos. Este artigo discute uma série de casos de cinco pacientes com problemas específicos relacionados aos procedimentos, como perfuração coronária, dissecções, fechamento abrupto das coronárias e fenômeno de no-reflow.

Various factors, including improved therapeutic interventions and advanced technologies, have led to better clinical outcomes for complex percutaneous coronary interventions. However, complications can still occur and have a negative impact on patient survival and healthcare costs. The risk of these complications can be reduced through experienced operators and preventative procedures. This article discusses a case series of five patients with specific periprocedural issues, such as coronary perforation, dissections, abrupt closure of the coronaries, and no-reflow phenomenon.

Factores asociados a la no-adherencia al tratamiento farmacológico antihipertensivo en pacientes de un hospital del seguro social / Factors associated with non-adherence to antihypertensive treatment in patients with social security

Introducción: La falta de adherencia a la terapia antihipertensiva contribuye directamente a que los pacientes coexistan con hipertensión, desencadenando mayor riesgo de morbilidad y mortalidad. Así, la falta de adherencia al tratamiento se convierte en una de las principales causas de hipertensión no controlada en la población. Evaluamos los factores asociados a la no-adherencia al tratamiento antihipertensivo en pacientes de cardiología de un hospital de EsSalud en San Juan de Lurigancho-Lima, durante el 2017. Material y Métodos: Estudio analítico-transversal, se incluyeron pacientes que acudieron a consultorio externo de cardiología con historia previa de hipertensión esencial y se excluyeron hipertensión secundaria por otras causas biológicas. Se utilizó el Test de Morisky-Green Morisky Medication Adherence Scale (MMAS-4) para evaluar la no-adherencia al tratamiento antihipertensivo. Resultados: De los 270 participantes de estudio, el 69% (n=185) eran adultos mayores de 65 años, 46% (n=124) varones y el 76% (n=118) tenían pareja estable. Entre los antecedentes clínicos, el 60% (n=122) reportó diagnóstico clínico de hipertensión arterial, el 30% (n=80) de diabetes mellitus tipo II y el 27% (n=73) no-adherencia al tratamiento. Los factores asociados a la no-adherencia de tratamiento fueron sexo masculino (ORa: 0,45, IC95% 0,20-1,04), trabajador independiente (ORa:3,88, IC95% 1,51-9,97), IMC mayor de 30 (ORa:0,23, IC95% 0,07-0,70). Conclusiones: en los pacientes con diagnóstico de hipertensión esencial existen factores de riesgo modificables y no modificables asociados a la no-adherencia al tratamiento. Se deben considerar estos factores para implementar estrategias de tamizaje y focalizar las intervenciones para adherir a los pacientes renuentes a su tratamiento.

Background:Lack of adherence to antihypertensive therapy contributes directly to patients coexisting with hypertension, triggering increased risk of morbidity and mortality. Thus, nonadherence to treatment becomes one of the main causes of uncontrolled hypertension in the population. We evaluated the factors associated with non-adherence to antihypertensive treatment in cardiology patients of an EsSalud hospital in San Juan de Lurigancho-Lima, during 2017. Material and Methods: Analytical-crossover study, patients attending cardiology outpatient clinic with previous history of essential hypertension were included and secondary hypertension due to other biological causes were excluded. The Morisky-Green Morisky Medication Adherence Scale (MMAS-4) was used to assess non-adherence to antihypertensive treatment. Results: Of the 270 study participants, 69% (n=185) were adults older than 65 years, 46% (n=124) were male and 76% (n=118) had a stable partner. Among the clinical history, 60% (n=122) reported clinical diagnosis of arterial hypertension, 30% (n=80) of type II diabetes mellitus and 27% (n=73) non-adherence to treatment. Factors associated with non-adherence to treatment were male sex (ORa: 0.45, 95%CI 0.20-1.04), self-employed (ORa:3.88, 95%CI 1.51-9.97), BMI greater than 30 (ORa:0.23, 95%CI 0.07-0.70). Conclusions: in patients with a diagnosis of essential hypertension there are modifiable and non-modifiable risk factors associated with non-adherence to treatment. These factors should be considered in order to implement screening strategies and target interventions to adhere to treatment in reluctant patients.

Sodium-Glucose Cotransporter-2 Inhibitors at Discharge from Cardiology Hospitalization Department: Decoding A New Clinical Scenario.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) are new glucose-lowering drugs (GLDs) with demonstrated cardiovascular benefits in patients with heart disease and type-2 diabetes mellitus (T2DM). However, their safety and efficacy when prescribed at hospital discharge are unexplored. This prospective, observational, longitudinal cohort study included 104 consecutive T2DM patients discharged from the cardiology department between April 2018 and February 2019. Patients were classified based on SGLT-2 inhibitor prescription and adjusted by propensity-score matching. The safety outcomes included discontinuation of GLDs; worsening renal function; and renal, hepatic, or metabolic hospitalization. The efficacy outcomes were death from any cause, cardiovascular death, cardiovascular readmission, and combined clinical outcome (cardiovascular death or readmission). The results showed that, the incidence rates of safety outcomes were similar in the SGLT-2 inhibitor or non-SGLT-2 inhibitor groups. Regarding efficacy, the SGLT-2 inhibitors group resulted in a lower rate of combined clinical outcomes (18% vs. 42%; hazard ratio (HR), 0.35; p = 0.02), any cause death (0% vs. 24%; HR, 0.79; p = 0.001) and cardiovascular death (0% vs. 17%; HR, 0.83; p = 0.005). No significant differences were found in cardiovascular readmissions. SGLT-2 inhibitor prescription at hospital discharge in patients with heart disease and T2DM was safe, well tolerated, and associated with a reduction in all-cause and cardiovascular deaths.

Material de apoyo para la docencia "Cuidados postoperatorios cardiovasculares en adultos y niños" / Teaching aid for teaching "Cardiovascular postoperative cares in adults and children"

RESUMEN Fundamento: el desarrollo vertiginoso de la ciencia y la técnica incorpora constantemente nuevos adelantos al quehacer diario del ejercicio médico, lo cual reclama una continua capacitación. Esta necesidad se acentúa cuando se trata de la atención a pacientes graves en el contexto del postoperatorio de cirugía cardiovascular, donde la mayoría son atendidos en unidades de terapia intensiva. Objetivos: diseñar un material docente de apoyo bibliográfico para los temas incluidos en el Módulo 25: Cuidados postoperatorios cardiovasculares en el adulto y el niño, del programa de estudio de tercer año de la residencia de Cardiología. Métodos: se realizó una investigación de desarrollo en el Cardiocentro "Ernesto Che Guevara", de Villa Clara, durante diciembre 2017-mayo 2018. Se emplearon métodos teóricos: análisis-síntesis, inducción-deducción y sistémico-estructural; empíricos: análisis documental y cuestionario a docentes médicos especialistas; y matemáticos estadísticos para los valores absolutos y relativos. Resultados: la literatura sobre los temas del módulo se encuentra dispersa, es extensa y posee acceso parcialmente limitado, el cuestionario de satisfacción sobre el material diseñado, obtuvo en todas las variables analizadas la categoría 4, lo que avala su actualización, pertinencia, integración, estructura y organización de los contenidos. Conclusiones: el material de apoyo resultó adecuado, con buena aceptación, y se tuvieron en cuenta las recomendaciones emitidas por los especialistas en su elaboración final.

ABSTRACT Background: the vertiginous development of science and technology constantly incorporates new advances to the daily task of medical practice, which calls for continuous training. This need is accentuated when dealing with the care of serious patients in the context of postoperative cardiovascular surgery, where the most of them are treated in intensive care units. Objectives: to design a teaching aid for bibliographic support for the subjects included in Module 25: Cardiovascular post-operative care in adults and children, of the third year study program of the cardiology residency. Methods: a development research was carried out in the "Ernesto Che Guevara" Cardiologic center, in Villa Clara, from December 2017 to 2018. Theoretical methods were used: analysis-synthesis, induction-deduction and systemic-structural; empirical ones: documentary analysis and questionnaire to specialized medical teachers; and statistical mathematics for absolute and relative values. Results: the literature on the subjects of the module is scattered, it is extensive and has partially limited access, the satisfaction questionnaire on the teaching aid designed, obtained in the entire variables analyzed category 4, which supports its updating, relevance, integration, structure and organization of the contents. Conclusions: the teaching aid was adequate, with good acceptance, and the recommendations issued by the specialists in its final elaboration were taken into account.

Infarto agudo de miocardio en mujeres ingresadas en el servicio de Cardiología del Hospital Joaquín Albarrán / Acute myocardial infarction in women admitted to the Cardiology service of the Joaquín Albarrán Hospital

RESUMEN Fundamento: la cardiopatía isquémica es la principal causa de muerte en mujeres, representa un tercio de las muertes del sexo femenino a nivel mundial. Objetivo: caracterizar el infarto agudo de miocardio en pacientes femeninas. Métodos: se realizó un estudio descriptivo de corte transversal, con una muestra de 47 pacientes del sexo femenino, que cumplían los criterios de inclusión y exclusión. Resultados: el 80,7 % de las pacientes eran mayores de 60 años, el grupo etario predominante fueron las comprendidas entre los 61 a 70 años. El antecedente personal de hipertensión arterial estuvo presente en el 70 %, de las pacientes ingresadas, seguidas de la hipertrigliceridemia. Entre las manifestaciones clínicas más frecuentes se observó el dolor precordial en el 85 % de la población. El 51,06 % de las pacientes estudiadas presentaron un infarto agudo de miocardio con elevación del segmento ST. Las complicaciones más frecuentes fueron la arritmia cardíaca seguido de la insuficiencia cardíaca y la sepsis intrahospitalaria. Conclusiones: se demostró que el sexo femenino es predictor de peores resultados entre los pacientes con infarto agudo de miocardio es todavía un tema en discusión ya que existe una gran heterogeneidad en los datos publicados.

ABSTRACT Background: ischemic heart disease is the leading cause of death in women, one third of female deaths worldwide. Objective: to characterize myocardial infarction in female patients. Methods: a descriptive cross-sectional study was carried out, with a sample of 47 female patients, who met the inclusion and exclusion criteria. Results: 80.7 % of patients older than 60 years, the predominant age group were those between 61 and 70 years. The personal history of hypertension was present in 70% of the patients admitted, followed by hypertriglyceridemia. Among the most frequent manifestations, precordial pain is treated in 85 % of the population. 51.06 % of the patients studied had a myocardial infarction with ST segment elevation. The most frequent complications are cardiac arrhythmia followed by heart failure and intrahospital sepsis. Conclusions: it was shown that the female sex is a predictor of worse outcomes among patients with acute myocardial infarction is still a topic in the discussion and that there is great heterogeneity in the published data.

Potential drug-food interactions in patients hospitalized in the Cardiology Unit / Potenciais interações fármaco-alimento em pacientes internados no Setor de Cardiologia

ABSTRACT Objective To analyze potential Drug-Food Interactions identified in prescriptions of patients admitted to the Cardiology Unit of a university hospital. Methods This is a descriptive, cross-sectional quantitative study carried out in the Cardiology Unit of a university hospital in the city of Rio de Janeiro, Brazil. Data collection took place in archived medical records of hospitalized patients between August and September, 2016. Results In each prescription, there were on average 7.5 drugs mentioned (Standard Deviation of 2.1). Most were tablets (93%) and antihypertensive drugs (40%). Two hundred and fifty two potential Drug-Food Interactions were identified. Acetylsalicylic acid and omeprazole were the most potentially interactive drugs. Conclusion Drug-Food Interactions occur with commonly used drugs, for example omeprazole and acetylsalicylic acid. However, health teams do not know or identify a substantial part of interactions. This factor leads to an exposure to risks related to changes in drug response and patient safety.

RESUMO Objetivo Analisar as potenciais interações fármaco-alimento identificadas a partir das prescrições medicamentosas de pacientes internados no Serviço de Cardiologia de um Hospital Universitário. Métodos Trata-se de um estudo quantitativo, descritivo e transversal, realizado em uma unidade de internação cardiológica de um Hospital Universitário localizado no município do Rio de Janeiro. A coleta de dados ocorreu em prontuários arquivados de pacientes internados entre agosto e setembro de 2016. Resultados Em cada prescrição haviam em média 7,5 medicamentos, desvio padrão de 2,1, sendo a maioria comprimidos (93%) e da classe dos anti-hipertensivos (40%). Identificou-se 252 potenciais interações fármaco-alimento, sendo o ácido acetilsalicílico e omeprazol os medicamentos de maior potencialidade de interação. Conclusão As interações fármaco-alimento ocorrem com medicamentos comumente utilizados, a exemplo do omeprazol e ácido acetilsalicílico. No entanto, parte substancial das interações não são conhecidas ou identificadas pela equipe de saúde, colaborando para exposições aos riscos de alterações na resposta medicamentosa e na segurança do paciente.

Avaliação do clima de segurança em um hospital público especializado em cardiologia no Município do Rio de Janeiro / Evaluation of the safety climate in a public hospital specialized in cardiology in the City of Rio de Janeiro

Introdução: No ambiente do cuidado em saúde os atributos qualidade e segurança são imperativos para promover uma assistência segura, sendo necessário o fortalecimento de uma cultura de segurança. Objetivo geral: Avaliar o clima de segurança na perspectiva de profissionais de saúde nas unidades de internação e terapia intensiva, em um hospital público especializado em cardiologia, no Município do Rio de Janeiro. Método: Estudo quantitativo, exploratório-descritivo, com a participação de 391 profissionais de saúde. Os dados foram coletados entre abril e junho de 2018, empregando-se o instrumento Safety Attitudes Questionnaire (SAQ), traduzido e validado para a língua portuguesa/Brasil. Os achados foram analisados por intermédio da estatística descritiva e inferencial, com nível de significância de 5% e a confiabilidade do questionário pelo valor de de Cronbach. Resultados: O instrumento mostrou-se confiável com valor total de 0,92, variando entre 0,70 e 0,80 nos domínios. Quanto à caracterização dos sujeitos, predominou o gênero mulher (75%) e os profissionais da equipe de enfermagem (53,88%). A média de idade correspondeu a 40,89 anos (dp=10,06), a maior parte (75,89%) atuava na especialidade de adultos, com média de tempo de trabalho na unidade de 9,77 anos (dp=6,98) e 64,09% mantinham o vínculo de estatuários. Em relação ao clima de segurança do SAQ, a média geral foi 66,6 (dp=15); entre os domínios o de Satisfação no trabalho apresentou o maior escore, média 80,79 (dp=19,56) e os menores escores foram observados nos domínios Condições de trabalho, média 61,19 (dp=27,69), Percepção da gerência da unidade 60,02 (dp=27,62) e Percepção da gerência do hospital 52,54 (dp=22,29). Na comparação entre os domínios e as variáveis sociodemográficas, houve diferença estatisticamente significante, em relação à categoria profissional, gênero, vínculo trabalhista, unidade de trabalho e idade. Conclusão: Os achados evidenciaram que o clima de cultura de segurança apresenta fragilidades, especialmente, no que tange às questões gerenciais e às condições de trabalho, todavia os profissionais encontram-se satisfeitos com o trabalho executado. Foi possível apreender que as variáveis sociodemográficas influenciaram na percepção do clima de segurança, sobretudo, as relativas à categoria profissional, ao gênero e vínculo trabalhista. Outrossim, acredita-se que a compreensão do clima constitua-se em elemento propulsor para implementar ações de melhorias para uma assistência segura.

Introduction: In the health care environment, the quality and safety attributes are imperative for promoting safe care, which requires the strengthening of a safety culture. General objective: To evaluate the safety climate in the perspective of health professionals in the hospitalization and intensive care units, in a public hospital specialized in cardiology, located in the City of Rio de Janeiro. Method: This is a quantitative and exploratory-descriptive study that included 391 health professionals. Data were collected between April and June 2018, using the Safety Attitudes Questionnaire (SAQ) instrument, translated and validated for the Portuguese language/ Brazil. The findings were analyzed through descriptive and inferential statistics, with a significance level of 5%, and the reliability of the questionnaire by the Cronbach value. Results: The instrument proved to be reliable, with a total value of 0.92, ranging from 0.70 to 0.80 in the surveyed domains. As for the characterization of the individuals, the female gender (75%) and the professionals of the nursing team (53.88%) were prevalent. The average age corresponded to 40.89 years (sd=10.06), most (75.89%) worked in the adult specialty, with an average work time in the unity of 9.77 years (sd=6.98), and 64.09% maintained thestatutory bond. Regarding the SAQ safety climate, the overall average was 66.6 (sd=15); among the domains, Work satisfaction showed the highest score, average of 80.79 (sd=19.56), and the lowest scores were observed in the domains of Work conditions, average of 61.19 (sd=27.69), Perception of unit management, 60.02 (sd=27.62), and Perception of hospital management, 52.54 (sd=22.29). In the comparison between the domains and the sociodemographic variables, there was a statistically significant difference with regard to professional category, gender, employment bond, unit of work and age. Conclusion: The findings highlighted that the safety climate culture has weaknesses, especially with respectto managerial issues and work conditions, but professionals are satisfied with work performed. It was possible to understand that the sociodemographic variables influenced the perception of the safety climate, especially those related to professional category, gender and employment bond. Moreover, it is believed that the understanding of the climate constitutes a driving element to help us implement improvement actions for safe care.

Descoberta da doença cardiovascular: associando causas e vivenciando o contexto da instituição hospitalar de referência / Discovery of cardiovascular disease: associating causes and experiencing the context of a referral hospital / Descubrimiento de la enfermedad cardiovascular: asociando causas y viviendo el contexto de la institución hospitalaria de referencia

Objetivo: compreender como os pacientes experienciam a descoberta da doença cardiovascular e como ocorre o processo desde o diagnóstico da doença até a reabilitação cardíaca em uma instituição hospitalar, referência em cardiologia. Método: estudo descritivo de abordagem qualitativa, com uso da Teoria Fundamentada nos Dados, envolvendo 29 sujeitos (pacientes, familiares, profissionais). Realizada entrevista semiestruturada, entre outubro/2010 e maio/ 2012, tendo sido o projeto aprovado por Comitê de Ética em Pesquisa sob o nº 001/2010. Resultados: a instituição de referência apresenta fragilidades estruturais e no âmbito das ações dos profissionais de saúde, mas possui um programa de reabilitação cardíaca que oferece acompanhamento multiprofissional, equipamentos para condicionamento físico, além de favorecer a interação social e a promoção da saúde psíquica dos pacientes. Conclusão: para além de investimentos em estrutura física e em recursos humanos, a capacitação dos profissionais para o cuidado ao paciente cardíaco cirúrgico, é fundamental para atender àss demandas dos usuários do serviço.

Objective: to understand how patients experience the discovery of cardiovascular disease and how the process occurs, from diagnosis to these patients' cardiac rehabilitation in a cardiology referral hospital. Method: in this qualitative, descriptive study, using Grounded Theory, 29 subjects (patients, relatives and health personnel) underwent semi-structured interviews between October 2010 and May 2012. The study was approved by the research ethics committee (No. 001/2010). Results: the referral institution displays weaknesses in its structure and in the sphere of the health personnel's actions, but has a cardiac rehabilitation program, which offers multi-professional care, physical fitness equipment, favors social interaction and promotes patients' mental health. Conclusion: in addition to investing in physical infrastructure and human resources, training for health personnel to care for surgical cardiac patients is key to meeting service users' demands.

Objetivo: entender cómo los pacientes experimentan el descubrimiento de la enfermedad cardiovascular y la forma cómo el proceso se produce desde el diagnóstico hasta la rehabilitación cardiaca en una institución hospitalaria, referencia en cardiología. Método: estudio descriptivo de enfoque cualitativo, utilizando la Teoría Fundamentada en los datos, involucrando a 29 sujetos (pacientes, familiares, profesionales). Las entrevistas semiestructuradas se llevaron a cabo entre octubre / 2010 y mayo / 2012 y el proyecto ha sido aprobado por el Comité Ético en Investigación bajo el No. 001/2010. Resultados: la institución de referencia tiene debilidades estructurales y también en lo que respecta a las acciones de los profesionales de la salud, pero posee un programa de rehabilitación cardiaca que ofrece seguimiento multiprofesional, equipos para preparación física y, además, favorece la interacción social y la promoción de salud psíquica de los pacientes. Conclusión: además de la inversión en infraestructura física y en recursos humanos, la formación de profesionales para el cuidado de la paciente del corazón quirúrgica, la capacitación de los profesionales para el cuidado al paciente cardiaco quirúrgico es esencial para atender a las demandas de los usuarios del servicio.

Meanings attributed by nursing staff about permanent education in cardiovascular institution / Significados atribuídos pela equipe de enfermagem sobre educação permanente em umainstituição cardiovascular

Objective: to understand the meanings attributed by the nursing staff to permanent educational practices in a reference cardiovascular hospital. Methods: this is a qualitative study, which used the Grounded Theory in Data for collecting and analyzing data. The sample consisted of 22 nursing professionals. Results: the study presents two categories that highlight the need for further clarification of the nursing staff about the concept of permanent education in health, as well as reinforce the permanent education of nurses as a management practice which needs to be incorporated into other assignments in daily work. Conclusion: it is admitted the need to work the concepts of permanent education in health even in professional qualification, as well as place greater emphasis on managerial training of nurses, so they acquire the power to take their assignment as a nursing care manager and the nursing staff education contribute to the necessary changes in the health services.

Objetivo: compreender os significados atribuídos pela equipe de enfermagem às práticas de educaçãopermanente em um hospital referência cardiovascular. Métodos: estudo qualitativo, o qual utilizou a TeoriaFundamentada nos Dados para coleta e análise dos dados. Participaram do estudo 22 profissionais deenfermagem. Resultados: apresenta duas categorias que evidenciam a necessidade de maior esclarecimento daequipe de enfermagem sobre o conceito da educação permanente em saúde, assim como reforçam a educaçãopermanente como prática gerencial do enfermeiro a qual precisa ser incorporada às demais atribuições nocotidiano de trabalho. Conclusão: admite-se a necessidade de trabalhar os conceitos da educação permanenteem saúde ainda na formação profissional, assim como dar maior ênfase a formação gerencial do enfermeiro demodo que este adquira competência para assumir sua atribuição como gestor do cuidado de enfermagem e daeducação da equipe de enfermagem contribuindo para as mudanças necessárias nos serviços de saúde.Descritores: Enfermagem; Gestão em Saúde; Educação Continuada; Serviço Hospitalar de Cardiologia.

Percepções e necessidades dos familiares de pacientes internados em uma unidade cardiológica intensiva / Perceptións and needs of relatives of cardiac intensive care unit patients / Percepicion y necesidade de familiares de pacientes internados en una unidad de cuidados intensivos cardiólogicos

OBJETIVO: conhecer as percepções e as necessidades dos familiares dos pacientes internados em uma unidade cardiológica intensiva.MÉTODOS: investigação do tipo descritiva com abordagem qualitativa, desenvolvida com 10 familiares de pacientes internados na Unidade Cardiológica Intensiva de um hospital universitário do Rio Grande do Sul. Aprovado pelo Comitê de Ética em Pesquisa em 11 de outubro de 2011, sob o parecer n° 23081.013113/2011-89. A coleta de dados ocorreu entre novembro de 2011 e abril de 2012, por meio de entrevista semiestruturada, as quais foram analisadas conforme a análise de conteúdo de Bardin.RESULTADOS: os achados foram agrupados em duas categorias, destacando-se os sentimentos ambíguos despertados, a vivência de um momento singular de desamparo e de crença. Além disso, evidenciam como principais necessidades: a importância do acolhimento dos familiares, adequação dos horários de visita, melhora na comunicação com a equipe de saúde e fornecimento de informações precisas aos familiares.CONCLUSÃO: a equipe multiprofissional precisa considerar o binômio paciente-familiar em suas atividades no contexto das unidades cardiológicas intensivas, buscando desenvolver estratégias de acolhimento que possibilitem a humanização da assistência e a otimização da recuperação dos pacientes.

Objective: to know the perceptions and needs of family members of patients admitted to a cardiac intensive care unit. Methods: Descriptiveresearch with qualitative approach developed with 10 family members of patients admitted to the cardiac intensive care unit of a universityhospital in Rio Grande do Sul. The study was approved by the Research Ethics Committee on 11 October, 2011, under Opinion nº 23081.013113 /2011-89. Data collection took place between November 2011 and April 2012 through semi-structured interviews, which were analyzed according toBardin’s content analysis. Results: The findings were distributed in two categories and highlighted the mixed feelings aroused by the experience ofa unique moment of helplessness and belief. In addition, the study revealed as main needs: the importance of hosting the family, adjusting visitinghours, improving communication with the health team and providing accurate information to the relatives. Conclusion: The multidisciplinaryteam needs to consider the patient-family binomial in their activities while in the context of cardiac intensive care units, seeking to develop strategiesthat may enable the humanization of care and optimization of the recovery of patients.

Objetivo: conocer la percepción y las necesidades de familiares de pacientes internados en una unidad de cuidados intensivos cardiológicos.Métodos: investigación descriptiva de enfoque cualitativo realizada con 10 familiares de pacientes internados en la unidad de cuidados intensivoscardiológicos de un hospital universitario de Rio Grande do Sul. Aprobado por el Comité de Ética de la institución el 11 de octubre de 2011bajo dictamen nº23081.013113/2011-89. La recogida de datos se llevó a cabo entre noviembre de 2011 y abril de 2012, por medio de entrevistassemiestructuradas analizadas según el análisis de contenido de Bardin. Resultados: los hallazgos se agruparon en dos categorías, destacándose lossentimientos ambiguos, la vivencia de un momento singular de desamparo y de creencia. Además, se evidencian, como principales necesidades:considerar la importancia de la acogida de los familiares, adecuar los horarios de visita, mejorar la comunicación con el equipo de salud yproporcionar información precisa a los familiares. Conclusión: el equipo multiprofesional debe considerar el binomio paciente- familiar en susactividades en el contexto de la unidad de cuidados intensivos cardiológicos e implementar estrategias de acogida que permitan humanizar laatención y optimar la recuperación de los pacientes.

Feasibility and outcome of the implementation of a screening program for panic disorder in noncardiac chest pain patients in cardiac emergency department routine care.

OBJECTIVE: This study assesses the feasibility and outcome of the implementation of a screening program for classifying panic disorder (PD) in patients presenting with noncardiac chest pain (NCCP(1)), when integrated in routine cardiac emergency department (CED(2)) care. METHODS: Barrier analyses were made during the pilot phase and implementation period. NCCP patients aged 18-70 years presenting at the CED (n=252) were eligible for screening with the Hospital Anxiety and Depression Scale (HADS). Those scoring above cutoff on the HADS were referred to the psychiatric department and received the Composite International Diagnostic Interview. RESULTS: Screening was initiated in 60 patients (23.8%), of whom nine refused participation. Staff adherence remained low despite implementing several improvements in the screening procedure. In total, 39 patients completed the program; 8 were diagnosed with a psychiatric disorder, including 2 patients with PD. CONCLUSION: Feasibility of implementation of this screening program for PD in NCCP patients in routine CED care was limited because offering screening frequently conflicted with provision of acute care and because patients showed relatively high refusal rates. Contrasting our assumption, various other psychiatric disorders besides PD were classified.

Evaluation of cardiovascular diseases and their risk factors in hospitalized patients in East azerbaijan province, northwest iran: a review of 18323 cases.

BACKGROUND: Coronary artery disease (CAD) is accountable for more than 30% of deaths worldwide and is, thus, deemed the most important factor in terms of disease burden around the globe. This study aimed to evaluate CAD and its risk factors in hospitalized patients in the East Azerbaijan Province, northwest Iran, from 2006 to 2007. METHODS: Data on 18.323 patients hospitalized due to cardiovascular diseases were collected to evaluate the diseases and their risk factors in 15 hospitals in the East Azerbaijan Province, northwest Iran. We assessed the main diagnosis of cardiovascular disease on admission in each hospital. Also, types of interventional and surgical procedures were assessed and all these variables were compared between men and women. RESULTS: The study population consisted of 56.6% male and 43.4% female patients. The median and range between quartile 1 and 3 (Q1-Q3) ages of the males and females were 59 (49-70) and 62 (51-71) years, respectively. Ischemic heart diseases were diagnosed in 68.4%, electrophysiological disorders in 6.5%, and valvular heart diseases in 4.5% of the patients. The frequencies of the studied risk factors were as follows: cigarette smoking (47.5%); hypertension (66.95%); diabetes mellitus (35.9%); and history of cerebrovascular accident (16.4%) and renal disease (13.4%). Medical therapy was performed in 79.23%, surgery in 6.28%, and cardiovascular interventional therapy in 13.99% of the patients. The in-hospital mortality rate was 1.57% (1.42% in the males and 1.76% in the females; p value = 0.009). CONCLUSION: The most frequent known risk factors in the hospitalized patients were smoking, alcohol consumption, and diabetes. In the northwest of Iran, age at hospitalization due to cardiovascular diseases is slightly lower than that in the Western populations; however, sex distribution, diagnoses, and treatment modalities are not significantly different from those reported in Western countries.