Rivaroxabana em Pacientes Ambulatoriais com COVID-19 Leve ou Moderada: Fundamentação e Desenho do Estudo CARE (CARE - Coalition COVID-19 Brazil VIII) / Rivaroxaban in Outpatients with Mild or Moderate COVID-19: Rationale and Design of the Study CARE (CARE - Coalition COVID-19 Brazil VIII)

Resumo Fundamento Estudos anteriores revelaram alto risco de eventos tromboembólicos arteriais e venosos como consequência de danos virais diretos do SARS-CoV-2 em células endoteliais e um meio procoagulante devido ao aumento de biomarcadores como o D-dímero, fibrinogênio, fator VIII. Foram realizados ensaios controlados randomizados de terapias antitrombóticas em pacientes internados, no entanto, poucos estudos avaliaram o papel da tromboprofilaxia no ambiente ambulatorial. Objetivo Avaliar se a profilaxia antitrombótica com rivaroxabana reduz o risco de eventos trombóticos venosos ou arteriais, suporte ventilatório invasivo e morte em pacientes ambulatoriais com COVID-19. Métodos O estudo CARE é um ensaio randomizado, aberto, multicêntrico e controlado por rivaroxabana 10 mg uma vez por dia durante 14 dias ou tratamento local padrão isolado, para a prevenção de resultados adversos, registrado no Clinicaltrials.gov (NCT04757857). Os critérios de inclusão são adultos com infecção confirmada ou suspeita do SARS-CoV-2, com sintomas leves ou moderados, sem indicação de hospitalização, no prazo de 7 dias após o início dos sintomas e um fator de risco de complicação da COVID-19 (>65 anos, hipertensão, diabetes, asma, doença pulmonar obstrutiva crônica ou outras doenças pulmonares crônicas, tabagismo, imunossupressão ou obesidade). O desfecho primário composto inclui tromboembolismo venoso, necessidade de ventilação mecânica invasiva, eventos cardiovasculares agudos maiores e mortalidade no prazo de 30 dias após a randomização, sendo avaliado segundo o princípio da intenção de tratar. Todos os pacientes assinaram termo de consentimento. Foi estabelecido um nível de significância de 5% para todos os testes estatísticos. Resultados Os principais desfechos trombóticos e hemorrágicos, hospitalizações e mortes serão avaliados centralmente por um comitê de eventos clínicos independente, sob a condição cega para a alocação dos grupos de tratamento. Conclusão O estudo CARE fornecerá informação relevante e contemporânea sobre o possível papel da tromboprofilaxia em pacientes ambulatoriais com COVID-19.

Abstract Background Previous studies have demonstrated a high risk of arterial and venous thromboembolic events as a consequence of direct viral damage to endothelial cells by SARS-CoV-2 and a procoagulant milieu due to increased biomarkers, such as D-dimer, fibrinogen, and factor VIII. Although randomized controlled trials of antithrombotic therapies have been conducted in hospitalized patients, few have evaluated the role of thromboprophylaxis in an outpatient setting. Objective To assess whether antithrombotic prophylaxis with rivaroxaban reduces the risk of venous or arterial thrombotic events, invasive ventilatory support, and death in COVID-19 outpatients. Methods The COVID Antithrombotic Rivaroxaban Evaluation (CARE) study, a multicenter, randomized, open-label, controlled trial of rivaroxaban 10 mg once daily for 14 days or local standard treatment alone to prevent adverse outcomes, is registered in clinicaltrials.gov (NCT04757857). The inclusion criteria are adults with confirmed or suspected SARS-CoV-2 infection and mild or moderate symptoms without indication for hospitalization, within 7 days of symptom onset, and 1 risk factor for COVID-19 complication (> 65 years, hypertension, diabetes mellitus, asthma, chronic obstructive pulmonary disease or other chronic lung diseases, smoking, immunosuppression, or obesity). The primary composite endpoint, which includes venous thromboembolism, invasive mechanical ventilation, major acute cardiovascular events, and mortality within 30 days of randomization, will be assessed according to the intention-to-treat principle. All patients will provide informed consent. A significance level of 5% will be used for all statistical tests. Results Major thrombotic and bleeding outcomes, hospitalizations, and deaths will be centrally adjudicated by an independent clinical events committee blinded to the assigned treatment groups. Conclusion The CARE study will provide relevant and contemporary information about the potential role of thromboprophylaxis in outpatients with COVID-19.

Conocimientos sobre donación de sangre en pacientes de un hospital de Amazonas, Perú / Knowledge about blood donation in patients of a hospital in Amazonas, Peru

RESUMEN El objetivo del estudio fue determinar el nivel de conocimientos sobre donación de sangre que tienen los pacientes externos que acuden a un hospital en Bagua Grande. Se realizó un estudio descriptivo transversal durante mayo a julio del 2019. Se elaboró y aplicó un cuestionario estructurado. Se captó a 244 personas que acudieron a consultorios externos mediante un muestreo sistemático. Los participantes obtuvieron una media de respuestas correctas de 8,90 (DE: 3,25) puntos de un total de 21. Se encontró que la edad y el grado de instrucción estaban correlacionados con el puntaje (rho = -0,21; p < 0,001 y rho = 0,38; p < 0,001, respectivamente). La procedencia y ocupación afectaron al puntaje (p < 0,001). Los conocimientos hallados en la población estudiada son bajos, pero esto no estaría relacionado con el antecedente de donación. Las intervenciones que se elaboren para mejorar la donación de sangre no solo se deben enfocar en brindar conocimientos, ya que otros factores estarían más relacionados con este resultado.

ABSTRACT This study aimed to determine the level of knowledge about blood donation among outpatients from a hospital in Bagua Grande. A descriptive cross-sectional study was conducted from May to July 2019. We developed and applied a structured questionnaire. A total of 244 outpatients were recruited through systematic sampling. Participants obtained a mean number of correct answers of 8.90 (SD: 3.25) points out of 21. Age and educational level were found to be correlated with the score (rho = -0.21; p < 0.001 and rho = 0.38; p < 0.001, respectively). Place of origin and occupation affected the score (p < 0.001). We found a low level of knowledge in the studied population, but this would not be related to previous history of donation. Interventions to improve blood donation should not only focus on providing knowledge, since other factors would be more related to this result.

Redundant laboratory testing on referral from general practice to the outpatient clinic: a post-hoc analysis.

BACKGROUND: Inappropriately repeated laboratory testing is a commonly occurring problem. However, this has not been studied extensively in the outpatient clinic after referral by GPs. AIM: The aim of this study was to investigate how often laboratory tests ordered by the GP were repeated on referral to the outpatient clinic, and how many of the normal test results remained normal on repetition. DESIGN & SETTING: This is a post-hoc analysis of a study on laboratory testing strategies in patients newly referred to the outpatient clinic between April 2015 and April 2017. METHOD: All patients who had a referral letter including laboratory test results ordered by the GP were included. These results were compared with the laboratory test results ordered in the outpatient clinic. RESULTS: Data were available for 295 patients, 191 of which had post-visit testing done. In this group, 56% of tests ordered by the GP were repeated. Tests with abnormal results were repeated more frequently than tests with normal results (65% versus 53%; P<0.001). A longer test interval was associated with slightly smaller odds of tests being repeated (odds ratio [OR] 0.97, 95% confidence interval [CI] = 0.95 to 0.99; P = 0.003). Of the tests with normal test results that were repeated, 90% remained normal. This was independent of testing interval or testing strategy. CONCLUSION: Laboratory tests ordered by the GP are commonly repeated on referral to the outpatient clinic. The number of test results remaining normal on repetition suggests a high level of redundancy in laboratory test repetition.

O adoecimento dos trabalhadores de enfermagem e os riscos psicossociais no trabalho / Enfermedades de los trabajadores de enfermería y riesgos psicosociales en el trabajo / Work-related disorders and psychosocial risks in nursing professionals

Resumo Objetivo Analisar o adoecimento físico e psicossocial decorrente do trabalho do profissional de enfermagem que atua em ambulatório de hospital universitário e sua inter-relação com os riscos psicossociais. Métodos Estudo epidemiológico transversal, realizado com 388 profissionais de enfermagem de ambulatórios universitários, no município do Rio de Janeiro, RJ. Utilizou-se um questionário para caracterização dos participantes e a Escala de Danos Físicos e Psicossociais no Trabalho, a coleta de dados ocorreu de julho a dezembro de 2018. Realizou-se análise descritiva das variáveis e a classificação de risco dos danos. Para a análise estatística bivariada, utilizou-se a medida de associação razão de chances, com intervalo de confiança de 95%, nível de significância de 5%. Resultados O contexto de trabalho ambulatorial da enfermagem põe em risco a saúde física dos profissionais; porém, há de se considerar também o seu perfil, que, além de uma longa trajetória na enfermagem, aponta para a sua rotatividade pelos setores do hospital, finalizando no ambulatório. Partindo dessa perspectiva, esses profissionais podem já estar adoecidos fisicamente ao serem alocados nos ambulatórios, para desenvolverem suas atividades laborais. Conclusão Os danos físicos receberam as piores avaliações, dados corroborados pela literatura nacional e internacional, os quais estiveram associados aos desfechos investigados, destacando-se a presença de doenças crônicas e o absenteísmo por doenças.

Resumen Objetivo Analizar las enfermedades físicas y psicosociales resultantes del trabajo de profesionales de enfermería que trabajan en el ambulatorio de un hospital universitario y su interrelación con los riesgos psicosociales. Métodos Estudio epidemiológico transversal, realizado con 388 profesionales de enfermería de ambulatorios universitarios en el municipio de Rio de Janeiro, estado de Rio de Janeiro. Se utilizó un cuestionario para la caracterización de los participantes y la Escala de Daños Físicos y Psicosociales en el Trabajo. La recopilación de datos se llevó a cabo de julio a diciembre de 2018. Se realizó el análisis descriptivo de las variables y la clasificación de riesgo de los daños. Para el análisis estadístico bivariado, se utilizó la medida de asociación razón de momios, con intervalo de confianza del 95 %, nivel de significancia del 5 %. Resultados El contexto de trabajo en un ambulatorio de enfermería pone en riesgo la salud física de los profesionales. Sin embargo, se debe considerar también su perfil, que, además de una larga trayectoria en enfermería, indica una rotación por los sectores del hospital, que termina en el ambulatorio. Partiendo de esa perspectiva, estos profesionales pueden ya estar enfermos físicamente al ser destinados a los ambulatorios para que desarrollen sus actividades laborales. Conclusión Los daños físicos recibieron las peores evaluaciones, datos corroborados por la literatura nacional e internacional, que estuvieron asociados a los desenlaces investigados, con énfasis en la presencia de enfermedades crónicas y ausentismo por enfermedad.

Abstract Objective To analyze the physical and psychosocial work-related disorders of nursing professionals working in the outpatient clinic of a university hospital, and its interrelationship with psychosocial risks. Methods An epidemiological and cross-sectional study was conducted with 388 nursing professionals from outpatient clinics of a university hospital in the city of Rio de Janeiro, RJ, Brazil. A questionnaire was used to characterize the participants and the Work-Related Physical and Psychosocial Disorder Scale (WRDS). Data collection occurred from July to December of 2018. Descriptive analysis of the variables and the risk classification of the disorder were performed. For the bivariate statistical analysis, the odds ratio association measure was obtained, using a 95% confidence interval, 5% significance level. Results The outpatient nursing work context jeopardizes the physical health of professionals at risk; however, it is also necessary to understand their profile, which, in addition to a long trajectory in nursing, points to their constant rotation among the sectors of the hospital, ending up in the outpatient setting. From this perspective, these professionals may already be physically unhealthy, when they are allocated to the outpatient clinics. Conclusion Physical disorders received the worst evaluations, data supported by national and international literature, which were associated with the outcomes investigated, highlighting the presence of chronic diseases and absence due to illness.

One stop neck lump clinic: a boon for quick diagnosis and early management.

INTRODUCTION: One-stop neck lump clinics (OSNLC) are gaining popularity worldwide especially in the UK hospitals following NICE recommendation. The main aim of this speciality clinic is a quick diagnosis and early management while simultaneously improving patient experience. OBJECTIVES: To analyse and compare the efficacy of OSNLC and general ENT/Head and neck clinic with specifics to a number of appointments required for formulating management plan and a number of 'one stop' visits. DESIGN: Retrospective observational study SETTING: Regional Head and Neck Cancer Center (Secondary care hospital) PARTICIPANTS: Patients referred by General practitioner with symptoms of a neck lump MAIN OUTCOME MEASURES: Patients seen in general ENT/Head and neck and OSNLC in 2 phases to understand the difference in a number of appointments, one-stop visits, the requirement of Ultrasound and efficiency of Fine needle aspiration. RESULTS AND CONCLUSIONS: Improved efficacy of OSNLC was noted as patients seen in the clinic required a lesser number of appointments, reached a faster diagnosis and management plan when compared to patients seen in general ENT clinic.

Radiological outpatient' visits to avoid inappropriate cardiac CT examinations: an 8-year experience report.

PURPOSE: The aim of this study was to evaluate the appropriateness of the cardiac computed tomography angiography (CCTA) prescriptions according to the "2010-Appropriate-Use-Criteria-for-Cardiac-Computed-Tomography-Angiography" (AUCCTA) and "Clinical-indication-for-CCTA" (CICCTA) among different specialities (Cardiologist [CA], General Practitioner [GP], Other Specialists [OS]) and prescribers' age. MATERIALS AND METHODS: This is a single-centre, single-arm, cohort study. We prospectively enrolled 815 patients (October 2012-May 2019) who underwent a radiological outpatient visit, before CCTA examination. Prescriptions to the examination were categorized as follows: Appropriate (A), Uncertain (U) and Inappropriate (Ina), according to AUCCTA and I, II, III and Inv for CICCTA. This categorization was stratified according to CA, GP and OS and prescribers' age. CCTA was performed in patients whom indications belong to A/U categories. RESULTS: Eight hundred and fifteen CCTA prescriptions were analysed. An yearly increase in prescriptions was found in the eight-year observational period (2012/2019 projection: 72 vs 223). Considering AUCCTA, indication A was 540/815 (66.3%), indication U was 113/815 (13.9%) and Ina accounted for 162/815 (19.9%; 128/162 [79.0%] indications with stress test listed as criterium of inappropriateness). Only U indications decreased over years (p = 0.003). Regarding CICCTA, 501/815 (61.5%) patients were categorized as I, 144/815 (17.7%) as II, 102/815 (12.5%) as III, 67/815 (8.2%) were INV and 1/815 (0.1%) were non-classified. Clinical referrals were CA in 495/786 (63.0%), GPs in 57/786 (7.3%) GP and OS in 234/786 (29.8%) [p < 0.01]. No statistically significant differences were observed in the appropriateness among different specialty physicians. Younger doctors have a lower chance to not meet A indication (OR 0.98 [CI 95% 0.96-0.99]; p = 0.003). CONCLUSION: Our study highlights the importance of a pre-radiological visit prior to CCTA, which prevented execution of 19.9% of inappropriate examinations. Age of prescribers had an impact on appropriateness, with younger doctors having a lower chance to not meet A indication.

Timing of Palliative Care Referral Before and After Evidence from Trials Supporting Early Palliative Care.

BACKGROUND: Evidence from randomized controlled trials has demonstrated benefits in quality of life outcomes from early palliative care concurrent with standard oncology care in patients with advanced cancer. We hypothesized that there would be earlier referral to outpatient palliative care at a comprehensive cancer center following this evidence. MATERIALS AND METHODS: Administrative databases were reviewed for two cohorts of patients: the pre-evidence cohort was seen in outpatient palliative care between June and November 2006, and the post-evidence cohort was seen between June and November 2015. Timing of referral was categorized, according to time from referral to death, as early (>12 months), intermediate (>6 months to 12 months), and late (≤6 months from referral to death). Univariable and multivariable ordinal logistic regression analyses were used to determine demographic and medical factors associated with timing of referral. RESULTS: Late referrals decreased from 68.8% pre-evidence to 44.8% post-evidence; early referrals increased from 13.4% to 31.1% (p < .0001). The median time from palliative care referral to death increased from 3.5 to 7.0 months (p < .0001); time from diagnosis to referral was also reduced (p < .05). On multivariable regression analysis, earlier referral to palliative care was associated with post-evidence group (p < .0001), adjusting for shorter time since diagnosis (p < .0001), referral for pain and symptom management (p = .002), and patient sex (p = .04). Late referrals were reduced to <50% in the breast, gynecological, genitourinary, lung, and gastrointestinal tumor sites. CONCLUSIONS: Following robust evidence from trials supporting early palliative care for patients with advanced cancer, patients were referred substantially earlier to outpatient palliative care. IMPLICATIONS FOR PRACTICE: Following published evidence demonstrating the benefit of early referral to palliative care for patients with advanced cancer, there was a substantial increase in early referrals to outpatient palliative care at a comprehensive cancer center. The increase in early referrals occurred mainly in tumor sites that have been included in trials of early palliative care. These results indicate that oncologists' referral practices can change if positive consequences of earlier referral are demonstrated. Future research should focus on demonstrating benefits of early palliative care for tumor sites that have tended to be omitted from early palliative care trials.

Pain and Satisfaction Levels upon Removal of External Fixator at an Outpatient Facility.

Objective To quantify the levels of satisfaction and pain of patients submitted to external fixation removal without anesthesia at an outpatient facility. Methods The present was a prospective study involving 28 patients using external fixators who answered 3 questionnaires associated with the Visual Analogue and Numerical Pain Scale during different moments of the removal. Results The average pain prior to fixator removal was of 3.61. Shortly after the procedure, the patients reported that, on average, the most intense pain scored 6.68, and the least intense pain, 2.25 points. The average pain variation was of 4.43 points, and pain after 1 week scored, on average, 2.03 points. The recollection of the pain after fixator removal scored lower than the pain reported immediately after the procedure (mean value: 5.29). Most patients were middle-aged men, and 89.3% used circular external fixators. The main limb segment involved was the leg, and most patients (71.4%) had never used an external fixator before; they preferred the removal at an outpatient facility because it was faster (75%), and to avoid hospitalization (25%). The most intense pain was felt during the removal of Schanz pins (60.7%), being worse in the extremities of the limbs for 75% of the patients. An absolute majority of 85.7% was satisfied with the removal, and 82.1% stated that they would undergo the procedure again. Conclusion External fixator removal at an outpatient facility without anesthesia is a well-tolerated option for patients, with good levels of approval and satisfaction.

Pain and Satisfaction Levels upon Removal of External Fixator at an Outpatient Facility / Nível de satisfação e dor na retirada de fixador externo em um ambulatório

Abstract Objective To quantify the levels of satisfaction and pain of patients submitted to external fixation removal without anesthesia at an outpatient facility. Methods The present was a prospective study involving 28 patients using external fixators who answered 3 questionnaires associated with the Visual Analogue and Numerical Pain Scale during different moments of the removal. Results The average pain prior to fixator removal was of 3.61. Shortly after the procedure, the patients reported that, on average, the most intense pain scored 6.68, and the least intense pain, 2.25 points. The average pain variation was of 4.43 points, and pain after 1 week scored, on average, 2.03 points. The recollection of the pain after fixator removal scored lower than the pain reported immediately after the procedure (mean value: 5.29). Most patients were middle-aged men, and 89.3% used circular external fixators. The main limb segment involved was the leg, and most patients (71.4%) had never used an external fixator before; they preferred the removal at an outpatient facility because it was faster (75%), and to avoid hospitalization (25%). The most intense pain was felt during the removal of Schanz pins (60.7%), being worse in the extremities of the limbs for 75% of the patients. An absolute majority of 85.7% was satisfied with the removal, and 82.1% stated that they would undergo the procedure again. Conclusion External fixator removal at an outpatient facility without anesthesia is a well-tolerated option for patients, with good levels of approval and satisfaction.

Resumo Objetivo Quantificar os níveis de satisfação e dor dos pacientes submetidos a retirada ambulatorial de fixadores externos sem anestesia. Métodos Estudo prospectivo envolvendo 28 pacientes usando fixadores externos submetidos a três questionários associados à Escala Visual Analógica e Numérica da dor durante diferentes etapas da retirada. Resultados A média de dor prévia à retirada foi de 3,61. Logo após o término do procedimento, encontramos média de 6,68 para a dor mais intensa, e de 2,25 para a dor menos intensa. A variação da dor média foi de 4,43, e a dor após uma semana teve média de 2,03. A lembrança dolorosa da retirada foi menor do que a dor referida imediatamente após a retirada (média de 5,29). A predominância no estudo foi de pacientes do sexo masculino de meia-idade, e 89,3% usavam fixador externo do tipo circular. O principal segmento dos membros envolvido foi a perna, e a maior parte dos pacientes não havia feito uso de fixador externo previamente (71,4%); eles optaram pela retirada ambulatorial por se tratar de opção mais rápida (75%), e para evitar internação hospitalar (25%). O momento de dor mais intensa ocorreu durante a retirada dos pinos de Schanz (60,7%), sendo pior nas extremidades dos membros para 75% dos entrevistados. Uma maioria absoluta de 85,7% mostrou-se satisfeita após a retirada, e 82,1% afirmaram que se submeteriam novamente ao procedimento. Conclusão A retirada ambulatorial de fixadores externos sem anestesia é uma opção bem tolerada pelos pacientes, tratando-se de um procedimento com bons níveis de aceitabilidade e satisfação.

Sociodemographic, personal, and disease-related determinants of referral to patient-reported outcome-based follow-up of remote outpatients: a prospective cohort study.

PURPOSE: We examined the association between sociodemographic, personal, and disease-related determinants and referral to a new model of health care that uses patient-reported outcomes (PRO) measures for remote outpatient follow-up (PRO-based follow-up). METHODS: We conducted a prospective cohort study among outpatients with epilepsy at the Department of Neurology at Aarhus University Hospital, Denmark. Included were all persons aged ≥ 15 years visiting the department for the first time during the period from May 2016 to May 2018. Patients received a questionnaire containing questions about health literacy, self-efficacy, patient activation, well-being, and general health. We also collected data regarding sociodemographic status, labour market affiliation, and co-morbidity from nationwide registers. Associations were analysed as time-to-event using the pseudo-value approach. Missing data were handled using multiple imputations. RESULTS: A total of 802 eligible patients were included in the register-based analyses and 411 patients (51%) responded to the questionnaire. The results based on data from registers indicated that patients were less likely to be referred to PRO-based follow-up if they lived alone, had low education or household income, received temporary or permanent social benefits, or if they had a psychiatric diagnosis. The results based on data from the questionnaire indicated that patients were less likely to be referred to PRO-based follow-up if they reported low levels of health literacy, self-efficacy, patient activation, well-being, or general health. CONCLUSION: Both self-reported and register-based analyses indicated that socioeconomically advantaged patients were referred more often to PRO-based follow-up than socioeconomically disadvantaged patients.

Prevention and control strategies of new coronavirus pneumonia in general hospitals / 重庆医学

The new coronavirus pneumonia has been listed as one of the Class B infectious disease but is managed as Class A infectious disease. To prevent and control its spread in hospitals, the outpatient department is the first key gate. Based on the relevant diagnosis and treatment strategies of the National Health Commission of the People's Republic of China, combined with the actual situation of the hospital's epidemic prevention and control work, this article formulated comprehensive prevention and control strategies from the perspective of the patients and staffs. From the aspects of organization and leadership, medical epidemic prevention, pre-screening and screening, process formulation, admission management, cleaning and disinfection, epidemic report, prevention and control supervision, personnel and material deployment, patient education, comprehensive management, personnel management and psychological support and so on, advice and guidance on prevention and control of this infectious disease in outpatient department of hospital were provided.

Perfil da equipe de enfermagem de unidades ambulatoriais universitárias: considerações para a saúde do trabalhador / Perfil del equipo de enfermería de unidades ambulatorias universitarias: consideraciones para la salud del trabajador / Profile of the nursing team of university outpatient units: worker health considerations

RESUMO Objetivo identificar o perfil sociodemográfico, laboral e de saúde da equipe de enfermagem de unidades ambulatoriais especializadas. Método Estudo quantitativo, descritivo, realizado com 388 profissionais de enfermagem de ambulatórios de universidades públicas no município do Rio de Janeiro. Os dados foram coletados por equipe de auxiliares capacitados. A análise foi realizada por meio do software SPSS. Resultados houve predomínio do sexo feminino, idade acima de 50 anos, profissionais casados e com filhos. Percentual maior de trabalhadores possuía Pós-Graduação Lato Sensu, vínculo permanente, um vínculo empregatício e carga horária laboral de 31 a 60 horas semanais. Prevaleceram aqueles que autoavaliaram o estado de saúde como bom. Dentre as doenças crônicas com diagnóstico médico, destacaram-se o estresse, as doenças osteoarticulares e as varizes. Conclusões e implicações para a prática os resultados mostraram, além de dados que corroboram com a realidade nacional e internacional, uma realidade que não é prerrogativa apenas da enfermagem, como o duplo vínculo e uma alta prevalência de estresse associado a outros problemas de saúde. Observa-se um cenário preocupante no mundo do trabalho da equipe de enfermagem ambulatorial, o qual traz à tona concepções e práticas negativas potencialmente causadoras de insatisfações, riscos, danos, inseguranças e adoecimentos no trabalho.

RESUMEN Objetivo identificar el perfil sociodemográfico, laboral y de salud del equipo de enfermería de unidades ambulatorias especializadas. Método estudio cuantitativo, descriptivo, realizado con 388 profesionales de enfermería de ambulatorios de universidades públicas del município de Rio de Janeiro. Los datos fueron recolectados por auxiliares capacitados. El análisis se realizó utilizando software SPSS. Resultados se observó predominio del sexo feminino, edad superior a 50 años, profesionales casados ​​y con hijos. Un porcentaje mayor de trabajadores poseía Posgrado Lato Sensu, vínculo permanente, vínculo de empleo y carga horaria laboral de 31 a 60 horas semanales. Prevalecerán aquellos que auto validarán el estado de salud como bueno. Entre las enfermedades crónicas con diagnóstico médico se destacan estrés, las enfermedades osteoarticulares y varices. Conclusiones e implicaciones para la práctica los resultados mostraron, además de datos que corroboran con la realidad nacional e internacional, una realidad que no es prerrogativa apenas de la enfermería, como el doble vínculo y alta prevalencia de estrés asociados a otros problemas de salud. Esto demuestra un escenario preocupante en el mundo del trabajo del equipo de enfermería ambulatoria, el cual trae a tono concepciones y prácticas negativas potencialmente causantes de insatisfacciones, riesgos, daños, inseguridades y enfermedades en el trabajo.

ABSTRACT Objective to identify the sociodemographic, occupational and health profile of nursing staff working at specialized outpatient units. Method a descriptive study with a quantitative approach, conducted with 388 nursing professionals from outpatient clinics of public universities in the city of Rio de Janeiro. Data were collected by trained auxiliary team. Analysis was performed using SPSS software. Results there was a predominance of females, aged over 50 years, married professionals, and with children. A higher percentage of workers had Lato Sensu Graduate studies, permanent employment, an employment relationship and workload of 31 to 60 hours per week. Those who self-rated health prevailed as good. Chronic diseases with medical diagnosis, that stand out, include stress, osteoarticular diseases and varicose veins. Conclusions and implications for the practice the results showed, in addition to data that corroborate the national and international reality, a reality that is not only prerogative of nursing, such as the double bond and a high prevalence of stress associated with other health problems. This shows a worrying setting in the outpatient nursing staff work world, which brings out negative conceptions and practices potentially causing dissatisfaction, risk, damage, insecurity, and illness at work.

Patient-initiated versus fixed-interval patient-reported outcome-based follow-up in outpatients with epilepsy: a pragmatic randomized controlled trial.

BACKGROUND: The use of patient-reported outcome (PRO) could potentially contribute to the reorganization of the health care system. AmbuFlex is a PRO system used in remote patient monitoring, in which questionnaires are sent to patients at fixed intervals. The PRO data are used by clinicians to decide whether patients need clinical attention. Better self-management and cost-saving follow-up activities may be achieved by letting patients initiate need of contact. We evaluated the effects of patient-initiated PRO-based outpatient follow-up on health care resource utilization, quality of care, and the patient perspective. METHODS: We conducted a parallel two-arm pragmatic randomized controlled trial at the Department of Neurology, Aarhus University Hospital, Denmark. Outpatients with epilepsy (≥ 15 years old), attending fixed-interval PRO-based follow-up with web-based questionnaires, were randomly assigned in a ratio of 0.55:0.45 to either 1) patient-initiated PRO-based follow-up (open access telePRO) or 2) fixed-interval PRO-based follow-up (standard telePRO). The primary outcome was the number of outpatient hospital contacts related to epilepsy retrieved from a regional registry. Hospitals admissions and emergency room visits were also assessed. Secondary self-reported outcomes including general health, well-being, health literacy, self-efficacy, number of seizures, side effects, confidence, safety, and satisfaction were retrieved from questionnaires. Data were analyzed by the intention-to-treat and per-protocol approaches. RESULTS: Between January 2016 and July 2016, 593 patients were randomized to either open access telePRO (n = 346) or standard telePRO (n = 247). At 18 months, no statistically significant differences were found between the arms regarding number of telephone consultations or outpatient visits. Patients in the open access arm had a slightly lower, statistically significant number of emergency room visits than patients in the standard arm. Self-reported mental well-being in the open access arm was slightly, statistically significantly lower than in the standard arm. Other secondary outcomes did not differ statistically significantly between arms. CONCLUSION: This study did not find, as hypothesized, less use of health care resources or improved patient self-management or satisfaction in the patient-initiated PRO-based initiative compared to fixed-interval PRO-based follow-up. Patient-initiated PRO-based follow-up may be used as an alternative to fixed-interval PRO-based follow-up in patients who prefer this approach, but there is insufficient evidence for recommending a system-wide shift to patient-initiated PRO-based follow-up. TRIAL REGISTRATION: Registered 4 February 2016 with ClinicalTrials.gov: NCT02673580 .

Capacidade funcional e eventos estressores em idosos / Functional capacity and stressful events in elderly population / Capacidad funcional y acontecimientos estresantes en personas mayores

OBJETIVO: relacionar a capacidade funcional e os eventos estressores em pessoas idosas. MÉTODO: trata-se de estudo transversal, com abordagem quantitativa, realizado com 80 idosos atendidos no ambulatório de um hospital universitário em João Pessoa, Paraíba, Brasil. A coleta de dados foi realizada por meio de entrevista, um instrumento semiestruturado para obtenção de dados sociodemográficos, além do índice de Barthel e do inventário de eventos de vida estressantes para idosos. RESULTADOS: foram observadas correlações negativas e com significância estatística (p ≤ 0,05) entre os escores da capacidade funcional e o número e intensidade dos eventos estressantes vivenciados pelos idosos. CONCLUSÃO: a vivência de eventos estressores pelos idosos atuou de forma negativa sobre a capacidade funcional, causando prejuízos para a autonomia e a independência desses indivíduos.(AU)

Objective: to relate the functional capacity and stressor events in older adults. Method: cross-sectional study with a quantitative approach conducted with 80 elderly patients treated at the outpatient clinic of a university hospital in João Pessoa, Paraíba, Brazil. Data collection was performed through interviews, and we used a semi-structured instrument for obtaining socio-demographic data, and the Barthel index and the inventory of stressful life events for the older adults. Results: we observed negative and statistically significant correlations (p ≤ 0.05) between the functional capacity scores and the number and intensity of stressful events experienced by the elderly patients. Conclusion: the experience of stressful events by the elderly patients acted negatively on functional capacity, causing damage to the autonomy and independence of these individuals.(AU)

Objetivo: relacionar la capacidad funcional y los acontecimientos estresantes en ancianos. Método: estudio transversal con enfoque cuantitativo, realizado con 80 pacientes de edad avanzada tratados en la clínica ambulatoria de un hospital universitario de João Pessoa, Paraíba, Brasil. La recogida de datos se realizó a través de entrevistas, un instrumento semiestructurado para obtener datos sociodemográficos, así como el índice de Barthel y el inventario de acontecimientos vitales estresantes para los ancianos. Resultados: se observaron correlaciones negativas y estadísticamente significativas (p ≤ 0,05) entre los puntajes de capacidad funcional y el número e intensidad de acontecimientos estresantes vividos por los ancianos. Conclusión: la experiencia de acontecimientos estresantes por parte de los adultos mayores actuó negativamente en la capacidad funcional, causando daños a la autonomía y a la independencia de estos individuos.(AU)

Advanced Practice Nursing in Pediatric Urology: experience report in the Federal District / Práctica de Enfermería Avanzada en Uropediatría: relato de experiencia en el Distrito Federal / Prática Avançada de Enfermagem em Uropediatria: relato de experiência no Distrito Federal

ABSTRACT Objective: To describe the creation and implementation of the extension program Advanced Practice Nursing in Pediatric Urology, developed in the outpatient clinic of a teaching hospital in the Federal District. Method: This is an experience report regarding the implementation of an outpatient service aimed at children and adolescents with symptoms of bladder and bowel dysfunction. Results: Because it is an extension program linked to the university, it follows a different model of care, valuing empowerment, informed and shared decision making, which results in a stronger bond between patients, family and the Pediatric Urology nursing team. It has also become a privileged space for the production and use of scientific knowledge, associated with the principles of evidence-based practice. Conclusion: This project shows a different performance of the nurse-specialist-professor-researcher in Pediatric Urology Nursing, and it has become a reference in the Federal District, mainly for undergraduate and graduate nursing students.

RESUMEN Objetivo: Relatar sobre la creación e implantación del proyecto de extensión, titulado Práctica de Enfermería Avanzada en Uropediatría, desarrollado en el ambulatorio de un hospital de enseñanza del Distrito Federal. Método: Se trata de un relato de experiencia sobre la implantación de un servicio ambulatorio dirigido a niños y adolescentes portadores de síntomas de disfunción vesical e intestinal. Resultados: Por tratarse de un proyecto de extensión vinculado a la universidad, sigue un modelo diferenciado de atención que valora el empoderamiento y la toma de decisión informada y compartida, lo que fortalece el vínculo entre paciente, familia y equipo de enfermería de Uropediatría. Se ha vuelto, en consecuencia, un espacio privilegiado para la producción y aplicación de conocimientos científicos, articulado al referencial de la práctica basada en evidencias. Conclusión: Este proyecto demuestra una actuación diferenciada del enfermero-especialista-investigador-docente en el área de Enfermería en Uropediatría, y está siendo visto como referencia en el Distrito Federal, principalmente para alumnos de graduación y posgrado de Enfermería.

RESUMO Objetivo: Relatar a criação e implementação do projeto de extensão, intitulado Prática Avançada de Enfermagem em Uropediatria, desenvolvido no ambulatório de um hospital de ensino do Distrito Federal. Método: Trata-se de um relato de experiência sobre a implantação de um serviço ambulatorial direcionado a crianças e adolescentes portadores de sintomas de disfunção vesical e intestinal. Resultados: Por se tratar de um projeto de extensão vinculado à universidade, segue um modelo diferenciado de atendimento, que valoriza empoderamento e tomada de decisão informada e compartilhada, resultando no fortalecimento do vínculo entre pacientes, família e equipe de enfermagem de Uropediatria. Também se tornou um espaço privilegiado para produção e aplicação de conhecimentos científicos, articulado ao referencial da prática baseada em evidências. Conclusão: Este projeto mostra uma atuação diferenciada do enfermeiro-especialista-pesquisador-docente, na área de Enfermagem em Uropediatria, e vem se tornando referência no Distrito Federal, principalmente para alunos de graduação e pós-graduação em Enfermagem.

Caracterização de aspectos fonoaudiológicos segundo as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para Crianças e Jovens (CIF-CJ) / Characterization of communication disorders according to the categories of the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY)

RESUMO Objetivo Caracterizar o desempenho em aspectos fonoaudiológicos de pacientes ambulatoriais segundo as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para Crianças e Jovens (CIF-CJ). Método Trata-se de estudo observacional descritivo, baseado em análise retrospectiva de dados secundários coletados em serviço fonoaudiológico ambulatorial da rede pública, com prontuários de pacientes com idades entre 5 e 16 anos avaliados entre 2010 e 2014. Foram analisados elementos dos relatórios de anamnese e avaliação, sendo identificadas categorias da CIF-CJ referentes aos componentes Funções do Corpo, Atividades e Participação e Fatores Ambientais. As categorias presentes foram definidas como as variáveis do estudo. Todas foram armazenadas como variáveis categóricas, sendo realizada análise descritiva por meio da distribuição de frequências. Resultados Foram incluídos 180 prontuários e das 168 categorias pré-selecionadas, 65 foram identificadas. Para as Funções do Corpo, 13 itens foram verificados, sendo a categoria com mais frequência referida em que se observa deficiência a funções mentais da linguagem. Para as 34 categorias identificadas pertencentes às Atividades e Participação, as mais frequentemente apontadas como dificuldade foram: aprender a ler - desempenho e realização das tarefas domésticas - desempenho. Das 18 categorias dos Fatores Ambientais, a descrita na maior parte dos relatórios como Barreira foi a atitudes individuais de conhecidos, pares, colegas, vizinhos e membros da comunidade. Conclusão Foram verificadas alterações em categorias dos três componentes da CIF-CJ analisados, indicando a existência de questões que afetaram o desempenho funcional em aspectos fonoaudiológicos de crianças e jovens atendidos em ambiente ambulatorial.

ABSTRACT Purpose Characterize the performance of outpatients regarding aspects of communication disorders according to the categories of the International Classification of Functioning, Disability and Health - Children and Youth Version (ICF-CY). Methods This is a descriptive, observational study based on a retrospective analysis of secondary data collected at a Speech-language Pathology outpatient clinic of the public health network, from records of patients aged 5-16 years, evaluated between 2010 and 2014. Elements of anamnesis and assessment reports were analyzed with identification of ICF-CY categories related to the following components: Body Functions, Activities and Participation, and Environmental Factors. These categories were defined as the study variables, stored as categorical variables, and had their frequency distribution investigated by descriptive statistical analysis. Results One hundred eighty medical records were included in the study, and 65 of the 168 pre-selected categories were identified. As for the component Body Functions, 13 items were verified, with the category related to impairment in Mental functions of language as the most frequently mentioned. Of the 34 categories identified in the component Activities and Participation, Learning to read - Performance and Doing housework - Performance were the ones that most frequently presented difficulties. Of the 18 categories of the component Environmental Factors, the one described in most reports as Barrier was Individual attitudes of acquaintances, peers, colleagues, neighbors, and community members. Conclusion Changes were found in categories of the three components of the ICF-CY analyzed, indicating the existence of issues that affected the functional performance regarding aspects of communication disorders of children and adolescents assisted at an outpatient environment.

Factores asociados a la no utilización de los servicios formales de prestación en salud en la población peruana: análisis de la encuesta nacional de hogares (ENAHO) 2015 / Associated Factors to non-use of Formal Health Services in the Peruvian Population: Analysis of the National Household Survey (ENAHO) 2015

RESUMEN El objetivo del estudio fue estimar la prevalencia de la no utilización de los servicios formales de prestación de salud (NUSFPS) y sus factores asociados en Perú. Se realizó un análisis secundario de datos de la Encuesta Nacional de Hogares (ENAHO) del año 2015. Se definió como NUSFPS a aquellos participantes que, pese a haber presentado algún síntoma, malestar, enfermedad, recaída de enfermedad crónica o accidente durante el último mes, no acudieron a los servicios de salud. Se analizaron 35 036 participantes; la prevalencia de NUSFPS fue de 53,9% (IC95%:52,9-54,8). La NUSFPS fue superior en la costa (razón de prevalencia ajustada [RPa] = 1,24;IC95%:1,17-1,31), sierra (RPa =1,38;IC95%:1,31-1,46) y selva (RP = 1,25;IC95%:1,181,33) en comparación a Lima Metropolitana. Hubo mayor prevalencia de NUSFPS en los participantes sinseguro (RPa = 1,59; IC95%: 1,52-1,66) y afiliados al seguro integral de salud (RPa = 1,16; IC95%: 1,11-1,22) comparados con los afiliados a la Seguridad Social. En conclusión, más de la mitad de los participantes padecieron NUSFPS, lo cual se asoció con condiciones geográficas y de aseguramiento. Se sugieren políticas públicas informadas en la evidencia para mejorar esta situación.

ABSTRACT The aim of the study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors using the National Household Survey (ENAHO 2015). The participants were defined as NUHS if they have presented any symptoms, discomfort, illness, relapse of chronic illness or accident during the last month and did not go to the health services. 35036 participants were analyzed; the prevalence of NUHS was 53,9%. NUHS was higher in the coastal region (adjusted Prevalence Ratio [aPR]=1.24;95%CI:1.17-1.31), highlands (aPR=1.38; 95%CI: 1.31-1.46) and jungle (aPR=1.25,95%CI:1.18-1.33) compared to Lima. Likewise, there were a higher prevalence of NUHS in participants without health insurance (aPR=1.59;95%CI:1.52-1.66) and those affiliated to Ministry of Health insurance (aPR=1.16;95%CI:1.11-1.22) compared to those affiliated to Social Security. More than half of the participants suffered from NUHS, which was associated with geographical and health system conditions. It is required evidenced-informed public policies to improve this situation.

Organization and management of Whisper Consulting Room in sexually transmitted diseases clinic / 中华护理杂志

Objective To explore the effects of establishing Whisper Consulting Room in sexually transmitted diseases (STD) clinic on knowledge and sexual behavior of STD patients.Methods Whisper Consulting Room was established in sexually transmitted diseases clinic,and 360 STD patients were selected by convenience sampling method.One-on-one,face-to-face health education and cognitive behavior intervention was conducted by seven professionally trained and qualified nurses.Results After intervention,understanding of STD-related knowledge,relapserelated risk factors,preventive measures and serious consequences were significantly improved(P＜0.001);condom use during sexual behavior was increased from 8.9％ to 51.9％ after intervention,and there was significant difference before and after intervention (P＜0.001).Conclusion Establishing Whisper Consulting Room in STD clinic and allowing nurses to perform psychological and cognitive behavior intervention,can help patients fully understand the harm of STDs,improve their knowledge of STD prevention and control,effectively promote their safe sexual behavior,improve condom use,and prevent recurrence of STD.

Characteristics and satisfaction of outpatients in walk-in clinic of a Grade A tertiary hospital / 中华全科医师杂志

Objective To assess the characteristics and satisfaction of outpatients in walk-in clinic of a grade A tertiary hospital.Methods A total of 1 100 outpatients visiting walk-in clinic of the Second Hospital of Hebei Medical University during March 2016 and June 2016 were randomly selected for the questionnaire survey.The self-designed questionnaire included the general information of patients,the satisfaction degree to the walk-in clinic,to special clinics of the hospital or to community clinics and related reasons,and suggestions for further improvement.Results Total 947 valid questionnaires were received with a retrieval rate of 86.09％.Most of participants had one chronic disease (594,62.72％).The satisfaction degree of walk-in clinic (1.78) was higher than that of hospital special clinics (1.93) (P =0.010),in turn the latter(2.33)was higher than that of conmmnity clinics (P ＜ 0.001).The reasons for patient to choose the walk-in clinic were wide range of medications (389,41.08％),reliable quality (285,27.98％),short waiting time (249,26.29％) and so on.Suggestions for improvement of the walk-in clinic were further reducing the waiting time (428,45.20％),need specialists for chronic disease management (210,22.18％),raising reimbursement rate (172,18.16％) and so on.The reasons for patients to choose special clinic were need readjusting prescription (587,61.99％),special disease or drug (427,45.09％).The reasons of dissatisfaction with special clinic were long waiting time (476,50.26％),frequent transfer to multiple departments (221,23.34％),high registration fee (221,23.34％).The reasons for patients to choose community clinic were short distance (350,36.96％),better environment (350,36.96％),short waiting time (184,19.43％).The reason of dissatisfaction with community clinic were low qualification of medical staff (405,42.77％),insufficient medications (392,42.39％);distrusting the quality of drugs (263,27.77％).Suggestions for improvement of the community clinics were upgrading the qualification of medical staff (317,33.47％),enlarging drug variety (298,31.47％),improving medical environment (94,9.93％) and so on.Conclusion Most outpatients visiting walk-in clinic of grade A tertiary hospital are highly satisfied the clinic.To meet the patients' needs the primary medical unit should further improve their overall service.