Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 257
Filtrar
1.
Psychiatry Res ; 276: 94-99, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31030006

RESUMO

The aim of this study was to evaluate the extent of internalised stigma and possible predictors in adults with a diagnosis of autism spectrum disorder (ASD). We measured internalised stigma in a sample of 149 adults with ASD and an IQ ≥70 (79.2% male, mean age 31.8 years), using the Brief Version of the Internalized Stigma of Mental Illness Scale (ISMI-10). The mean ISMI-10 score was 1.93 (SD=0.57), with 15.4% of participants reporting moderate or severe internalised stigma. Moderate or severe stigma was more frequent in persons aged ≥35 years (OR: 4.36), and in individuals with low educational level (OR: 6.00). IQ, sex and ASD diagnostic subtype (ICD-10) did not influence stigma severity. Compared to other mental disorders, the level of internalised stigma in adults with ASD without intellectual disability appears to be lower.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Mecanismos de Defesa , Estigma Social , Adolescente , Adulto , Idoso , Transtorno do Espectro Autista/diagnóstico , Feminino , Alemanha/epidemiologia , Humanos , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/psicologia , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
2.
Int J Health Plann Manage ; 34(2): e1257-e1271, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30901132

RESUMO

BACKGROUND: Because of increasing demand, hospitals in England are currently under intense pressure resulting in shortages of beds, nurses, clinicians, and equipment. To be able to effectively cope with this demand, the management needs to accurately find out how many patients are expected to use their services in the future. This applies not just to one service but for all hospital services. PURPOSE: A forecasting modelling framework is developed for all hospital's acute services, including all specialties within outpatient and inpatient settings and the accident and emergency (A&E) department. The objective is to support the management to better deal with demand and plan ahead effectively. METHODOLOGY/APPROACH: Having established a theoretical framework, we used the national episodes statistics dataset to systematically capture demand for all specialties. Three popular forecasting methodologies, namely, autoregressive integrated moving average (ARIMA), exponential smoothing, and multiple linear regression were used. A fourth technique known as the seasonal and trend decomposition using loess function (STLF) was applied for the first time within the context of health-care forecasting. RESULTS: According to goodness of fit and forecast accuracy measures, 64 best forecasting models and periods (daily, weekly, or monthly forecasts) were selected out of 760 developed models; ie, demand was forecasted for 38 outpatient specialties (first referrals and follow-ups), 25 inpatient specialties (elective and non-elective admissions), and for A&E. CONCLUSION: This study has confirmed that the best demand estimates arise from different forecasting methods and forecasting periods (ie, one size does not fit all). Despite the fact that the STLF method was applied for the first time, it outperformed traditional time series forecasting methods (ie, ARIMA and exponential smoothing) for a number of specialties. PRACTISE IMPLICATIONS: Knowing the peaks and troughs of demand for an entire hospital will enable the management to (a) effectively plan ahead; (b) ensure necessary resources are in place (eg, beds and staff); (c) better manage budgets, ensuring enough cash is available; and (d) reduce risk.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/tendências , Previsões/métodos , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Modelos Estatísticos , Ambulatório Hospitalar/estatística & dados numéricos , Ambulatório Hospitalar/tendências , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Reino Unido
3.
Int J Cardiol ; 277: 140-146, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30131230

RESUMO

BACKGROUND: Incidence and prognostic impact of heart failure (HF) progression has been not well addressed. METHODS: From 2009 until 2015, consecutive ambulatory HF patients were recruited. HF progression was defined by the presence of at least two of the following criteria: step up of ≥1 New York Heart Association (NYHA) class; decrease LVEF ≥ 10 points; association of diuretics or increase ≥ 50% of furosemide dosage, or HF hospitalization. RESULTS: 2528 met study criteria (mean age 76; 42% women). Of these, 48% had ischemic heart disease, 18% patients with LVEF ≤ 35%. During a median follow-up of 2.4 years, overall mortality was 31% (95% CI: 29%-33%), whereas rate of HF progression or death was 57% (95% CI: 55%-59%). The 4-year incidence of HF progression was 39% (95% CI: 37%-41%) whereas the competing mortality rate was 18% (95% CI: 16%-19%). Rates of HF progression and death were higher in HF patients with LVEF ≤ 35% vs >35% (HF progression: 42% vs 38%, p = 0.012; death as a competing risk: 22% vs 17%, p = 0.002). HF progression identified HF patients with a worse survival (HR = 3.16, 95% CI: 2.75-3.72). In cause-specific Cox models, age, previous HF hospitalization, chronic obstructive pulmonary disease, chronic kidney disease, anemia, sex, LVEF ≤ 35% emerged as prognostic factors of HF progression. CONCLUSIONS: Among outpatients with HF, at 4 years 39% presented a HF progression, while 18% died before any sign of HF progression. This trend was higher in patients with LVEF ≤ 35%. These findings may have implications for healthcare planning and resource allocation.


Assuntos
Progressão da Doença , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Ambulatório Hospitalar/tendências , Características de Residência , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Insuficiência Cardíaca/terapia , Humanos , Masculino , Mortalidade/tendências
4.
J Oncol Pharm Pract ; 25(1): 130-139, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29938594

RESUMO

BACKGROUND: Patients receiving anticancer therapies are frequently prescribed complex and high-risk medication regimens, which at times can result in medication misadventures. The objective of this review was to assess the effect of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies, including patients undergoing radiotherapy. METHODS: A systematic review of original publications indexed in EMBASE, MEDLINE and Cochrane Library from June 2007 to June 2017. Eligible studies evaluated outpatient pharmacy clinic services for cancer patients and reported at least one medication-related quantitative outcome measure. Two authors independently reviewed full-text articles for inclusion, then extracted data and performed quality and risk of bias assessments. RESULTS: Of 908 identified publications, 13 met predefined eligibility criteria; 1 randomised control trial, 2 controlled cohort studies and 10 uncontrolled before-after studies. Many excluded studies described outpatient pharmacy services but lacked medication-related outcomes. All included studies had informative practice model designs, with interventions for drug-related problems including drug dose optimisation ( n = 8), reduced drug interaction ( n = 6) and adverse drug reaction reporting ( n = 3). Most studies ( n = 11) reported on symptom improvement, commonly nausea ( n = 7) and pain ( n = 5). Of four studies in radiotherapy cohorts, pharmacist involvement was associated with improved symptoms, satisfaction and wellbeing scores. CONCLUSION: Few studies have objectively assessed outpatient pharmacy cancer services, even fewer in the radiotherapy settings. Although the results support these services, significant heterogeneity and bias in the study designs prohibit robust conclusions and further controlled trials are required.


Assuntos
Assistência Ambulatorial/métodos , Antineoplásicos/uso terapêutico , Neoplasias/tratamento farmacológico , Ambulatório Hospitalar , Serviço de Farmácia Hospitalar/métodos , Assistência Ambulatorial/tendências , Estudos de Coortes , Humanos , Neoplasias/diagnóstico , Ambulatório Hospitalar/tendências , Farmacêuticos/tendências , Serviço de Farmácia Hospitalar/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
5.
Respir Res ; 19(1): 246, 2018 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-30541548

RESUMO

BACKGROUND: Few studies have investigated the associations between outdoor air pollution and outpatient visits for respiratory diseases (RDs) in general population. METHODS: We collected daily outpatient data of primary RDs from five hospitals in Jinan during January 2012 and December 2016, as well as daily measurements of air pollutants from the Jinan Environmental Monitoring Center and daily meteorological variables from the China Meteorological Data Sharing Service System. A generalized additive model (GAM) with quasi-Poisson regression was constructed to estimate the associations between daily average concentrations of outdoor air pollutants (PM2.5,PM10, SO2, NO2, CO and O3) and daily outpatient visits of RDs after adjusting for long-time trends, seasonality, the "day of the week" effect, and weather conditions. Subgroup analysis stratified by gender, age group and the type of RDs was conducted. RESULTS: A total of 1,373,658 outpatient visits for RDs were identified. Increases of 10 µg/m3 in PM2.5, PM10, NO2, CO and O3 were associated with0.168% (95% CI, 0.072-0.265%), 0.149% (95% CI, 0.082-0.215%), 0.527% (95% CI, 0.211-0.843%), 0.013% (95% CI, 0.003-0.023%), and 0.189% (95% CI, 0.032-0.347%) increases in daily outpatient visits for RDs, respectively. PM2.5 and PM10 showed instant and continuous effects, while NO2, CO and O3 showed delayed effects on outpatient visits for RDs. In stratification analysis, PM2.5 and PM10 were associated with acute RDs only. CONCLUSIONS: Exposure to outdoor air pollutants including PM2.5, PM10, NO2, CO and O3 associated with increased risk of outpatient visits for RDs.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Assistência Ambulatorial/tendências , Exposição Ambiental/efeitos adversos , Ambulatório Hospitalar/tendências , Transtornos Respiratórios/epidemiologia , Adolescente , Adulto , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Respiratórios/induzido quimicamente , Transtornos Respiratórios/terapia , Adulto Jovem
6.
BMC Geriatr ; 18(1): 293, 2018 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-30486785

RESUMO

BACKGROUND: Risk factors associated with opioid-induced adverse reactions (OIARs) in the elderly population have not been well defined. The objective of this study was to determine effects of various risk factors on incidence of OIARs in male elderly patients. METHODS: A retrospective cohort study in Korea Veterans Hospital was performed. Data were analyzed in male patients aged 65 years and older who received morphine, oxycodone, or codeine. Binomial variables describing patient-related and drug-related characteristics were constructed. Associations between these variables and frequency of OIARs were determined. Odds ratio (OR) and adjusted odds ratio (AOR) were calculated from univariate and multivariable analyses, respectively. Attributable risk was obtained by (1-1/OR)*100%. RESULTS: Of 316 patients, 28% experienced at least one adverse event. The most common adverse events were gastrointestinal problems (n = 59) and central nerve system adverse effects (n = 20). The odds of OIARs in patients with opioid use ≥12 weeks was increased by 80% compared to those with opioid use < 12 weeks. Attributable risk of GABA analogues was 64~78% in constructed Models. Compared to codeine users, patients using morphine and oxycodone had 653 and 473% increased odds for OIARs, respectively. MME ≥ 60 mg/day had a 317% increased odds for OIARs (95% CI: 1.92-9.04) compared to MME < 60 mg/day. Opioid combination therapy had a 139% increased odds for OIARs compared to monotherapy. CONCLUSIONS: These findings have significant implications for clinical use of opioid in elderly patients. Our study suggests that low dose short-term use will pose less risk of OIARs for the elderly, whereas concomitant use of GABA analogues, strong opioids and dual-opioid therapy may increase the risk of OIARs. Therefore, clinician should carefully monitor patients when starting opioid therapy in older population.


Assuntos
Analgésicos Opioides/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Hospitais de Veteranos/tendências , Ambulatório Hospitalar/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Tontura/induzido quimicamente , Tontura/diagnóstico , Tontura/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Gastroenteropatias/induzido quimicamente , Gastroenteropatias/diagnóstico , Gastroenteropatias/epidemiologia , Humanos , Masculino , Oxicodona/efeitos adversos , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
7.
Respir Res ; 19(1): 182, 2018 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-30236104

RESUMO

BACKGROUND: Few data are available on the long-term effect of pulmonary rehabilitation (PR) and on long PR programs in interstitial lung diseases (ILD). We aimed to evaluate the effects of PR on exercise capacity (6-Minute Walking Distance, 6MWD; Peak Work Rate, Wmax), quality of life (St George's Respiratory Questionnaire, SGRQ), quadriceps force (QF) and objectively measured physical activity in ILD after the 6-month PR-program and after 1 year. METHODS: 60 patients (64 ± 11 years; 62% males; 23% with IPF) were randomly assigned to receive a 6 month-PR program or usual medical care. RESULTS: Exercise capacity, quality of life and muscle force increased significantly after the program as compared to control (mean,95%CI[ll to ul]; 6MWD + 72,[36 to 108] m; Wmax 19, [8 to 29]%pred; SGRQ - 12,[- 19 to - 6] points; QF 10, [1 to 18] %pred). The gain was sustained after 1 year (6MWD 73,[28 to 118] m; Wmax 23, [10 to 35]%pred; SGRQ - 11,[- 18 to - 4] points; QF 9.5, [1 to 18] %pred). Physical activity did not change. CONCLUSIONS: PR improves exercise tolerance, health status and muscle force in ILD. The benefits are maintained at 1-year follow-up. The intervention did not change physical activity. TRIAL REGISTRATION: Clinicaltrials.gov NCT00882817 .


Assuntos
Tolerância ao Exercício/fisiologia , Exercício Físico/fisiologia , Doenças Pulmonares Intersticiais/fisiopatologia , Doenças Pulmonares Intersticiais/reabilitação , Idoso , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , Fatores de Tempo , Resultado do Tratamento
8.
Psychiatry Res ; 269: 134-139, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30145295

RESUMO

This study investigated gender differences in the prevalence of sleep disturbance and related demographic and clinical characteristics, including quality of life (QOL), in Chinese outpatients. Up to 4399 adult outpatients (2896 females, 1503 males) who visited the neurological, cardiovascular, gastrointestinal, and gynaecological outpatient clinics in four general hospitals were recruited. Demographic and clinical data including QOL were collected by using self-report questionnaires. The prevalence of sleep disturbance in female outpatients (671/2896, 23.2%) was significantly higher than in male outpatients (302/1503, 20.1%) and remained significant after adjusting for significant confounders in the regression analysis. In the regression analysis, divorced/widowed and unemployed status were independently associated with a higher frequency of sleep disturbance in females, while educational level was independently associated with males only. Among these factors, depressive symptoms and older age were the most common risk factors for sleep disturbance in both genders. Sleep disturbance was not associated with the mental domains of the QOL assessments in both genders. This study suggests that sleep disturbance is more frequent in female outpatients and is associated with multiple factors in both genders. A longitudinal study is warranted to confirm the current findings.


Assuntos
Hospitais Gerais/tendências , Ambulatório Hospitalar/tendências , Pacientes Ambulatoriais/psicologia , Caracteres Sexuais , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida/psicologia , Transtornos do Sono-Vigília/diagnóstico , Desemprego/psicologia , Viuvez/psicologia
9.
BMC Endocr Disord ; 18(1): 53, 2018 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-30081878

RESUMO

BACKGROUND: Diabetic foot ulceration is a serious limb-threatening complication of diabetes. It is the common cause of hospital admissions and amputations. The objective of the study was to determine the prevalence of diabetic foot ulcers (DFU) and its association with age, gender, duration of diabetes, peripheral neuropathy (PN), peripheral arterial disease (PAD) and HbA1c. METHODS: A total of 1940 people (≥ 30 years of age) with type 2 diabetes coming to the Sakina Institute of Diabetes and Endocrine Research (specialist diabetes clinic) at Shalamar Hospital, Lahore, Pakistan, were recruited over a period of 1 year from January 2016 to January 2017. The foot ulcers were identified according to the University of Texas classification. PN was assessed by biothesiometer and PAD by ankle-brachial index (< 0.9). Body weight, height, body mass index (BMI), HbA1c and duration of diabetes were recorded. RESULTS: The prevalence of DFU was 7.02%, of which 4.5% of the ulcers were on the planter and 2.6% on the dorsal surface of the foot; 8.5% of the persons had bilateral foot ulcers and 0.4% subjects had Charcot deformity. There was significant association of foot ulcers with age, duration of diabetes, HbA1c, PN and PAD, whereas no association was observed with gender and BMI. PN and PAD were observed in 26.3 and 6.68% of people with diabetes respectively. Neuropathic ulcers and neuro-ischemic ulcers were identified in 74 and 19% of the study population. Logistic regression analysis revealed significant odds ratio for peripheral neuropathy 23.9 (95% confidence interval (5.41-105.6). CONCLUSIONS: Peripheral neuropathy is the commonest cause of foot ulcers. An optimum control of blood glucose to prevent neuropathy and regular feet examination of every person with diabetes may go a long way in preventing foot ulceration.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Ambulatório Hospitalar/tendências , Centros de Atenção Terciária/tendências , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 2/terapia , Pé Diabético/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia
10.
BMC Psychiatry ; 18(1): 232, 2018 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-30021544

RESUMO

BACKGROUND: Data on the prevalence of insomnia symptoms in medical outpatient clinics in China are lacking. This study examined the prevalence of insomnia symptoms and their socio-demographic correlates in patients treated at medical outpatient clinics affiliated with four general hospitals in Guangzhou, a large metropolis in southern China. METHOD: A total of 4399 patients were consecutively invited to participate in the study. Data on insomnia and its socio-demographic correlates were collected with standardized questionnaires. RESULTS: The prevalence of any type of insomnia symptoms was 22.1% (95% confidence interval (CI): 20.9-23.3%); the prevalence of difficulty initiating sleep was 14.3%, difficulty maintaining sleep was 16.2%, and early morning awakening was 12.4%. Only 17.5% of the patients suffering from insomnia received sleeping pills. Multiple logistic regression analysis revealed that male gender, education level, rural residence, and being unemployed or retired were negatively associated with insomnia symptoms, while lacking health insurance, older age and more severe depressive symptoms were positively associated with insomnia symptoms. CONCLUSIONS: Insomnia symptoms are common in patients attending medical outpatient clinics in Guangzhou. Increasing awareness of sleep hygiene measures, regular screening and psychosocial and pharmacological interventions for insomnia are needed in China. TRIAL REGISTRATION: ChiCTR-INR-16008066 . Registered 8 March 2016.


Assuntos
Hospitais Gerais/tendências , Ambulatório Hospitalar/tendências , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Adolescente , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural/tendências , Higiene do Sono/fisiologia , Inquéritos e Questionários , Adulto Jovem
11.
BMC Nephrol ; 19(1): 183, 2018 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-30025520

RESUMO

BACKGROUND: Knowing how chronic kidney disease (CKD) patients talk about their encounters with providers (i.e., their discourse) can inform the important clinical goal of engaging patients in their chronic disease self-management. The aim of this study was to analyze patient discourse on ongoing CKD monitoring encounters for health communication strategies that motivate patient engagement. METHODS: Passages regarding CKD monitoring from 6 focus group transcripts on self-management with a total of 30 participants age ≥ 70 years from the Atlanta Veterans Affairs Renal Clinic across three different CKD trajectories (stable, linear decline, and non-linear) were extracted. These passages were examined using three-stage critical discourse analysis (description, interpretation, explanation) for recurring patterns across groups. RESULTS: Focus group participants were an average age of 75.1, 96.7% male, and 60% Black. Passages relating to CKD monitoring (n = 55) yielded predominantly negative communication themes. Perceived negative communication was characterized through a patient discourse of unequal exchange, whereby engaged patients would provide bodily fluids and time for appointments and continued to wait for meaningful, contextualized monitoring information from providers and/or disengaged providers who withheld that information. However, some encounters were depicted as helpful. Perceived positive communication was characterized by a patient discourse of kidney protection, whereby patients and providers collaborate in the mutual goal of preserving kidney function. CONCLUSIONS: Patient perceived an unequal exchange in CKD monitoring encounters. This perception appears rooted in a lack of easily understandable information. By accessing the positive discourse of protecting the kidneys (e.g., through eGFR level) vs. the discourse of damage (e.g., serum creatinine level), healthcare professionals can clarify the purpose of monitoring and in ways that motivate patient engagement in self-management. Patients being monitored for CKD progression may best be supported through messaging that conceptualizes monitoring as kidney protection and provides concrete contextualized information at each monitoring encounter.


Assuntos
Hospitais de Veteranos/tendências , Ambulatório Hospitalar/tendências , Pesquisa Qualitativa , Insuficiência Renal Crônica/terapia , United States Department of Veterans Affairs/tendências , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais de Veteranos/normas , Humanos , Masculino , Ambulatório Hospitalar/normas , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/normas
12.
Epilepsy Behav ; 85: 188-194, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30032806

RESUMO

AIM: This study investigated the efficacy and safety of perampanel (PER) adjunctive therapy in pediatric patients with epilepsy whose seizures are pharmacoresistant to existing antiepileptic drugs. METHODS: A clinical retrospective study was conducted from 2016 to 2017 in the pediatric neurology clinic at a tertiary children's hospital. We reviewed the data obtained from 66 children whose seizures were pharmacoresistant to more than two antiepileptic drugs, and could be followed up for a minimum of 3 months after PER adjunctive therapy initiation. The efficacy was estimated by the PER response rate at 3-, 6-, and 12-month follow-up evaluations, and adverse events were also recorded. RESULTS: The rate of seizure reduction of >50% was 30.3%, 37.5%, and 34.7% for all seizure types at 3, 6, and 12 months, in which 7.6%, 8.9%, and 14.3% of the patients became seizure-free at these time points, respectively. No significant differences were found between enzyme-inducing and nonenzyme-inducing antiepileptic drugs in combination with PER with regard to the responder rate. Five patients with Dravet syndrome were included in the study. Four of them (80%) exhibited 50% seizure reduction at the last visit, at which point, two patients (40.0%) were seizure-free. The retention rate was 51% at 12 months. Adverse events were documented in 25 patients (35.7%) and led to PER discontinuation in eight patients (12.1%). The most common adverse events comprised irritability, skin rash, dizziness, and somnolence; however, all were transient and successfully managed after PER dose reduction or discontinuation. CONCLUSION: The current data support the value of adjunctive PER in child and adolescent patients with pharmacoresistant epilepsy in daily clinical practice. Perampanel was efficacious and generally well-tolerated as an add-on treatment for epilepsy.


Assuntos
Anticonvulsivantes/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Epilepsia Resistente a Medicamentos/epidemiologia , Ambulatório Hospitalar/tendências , Piridonas/uso terapêutico , Adolescente , Instituições de Assistência Ambulatorial/tendências , Anticonvulsivantes/efeitos adversos , Criança , Tontura/induzido quimicamente , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsias Mioclônicas/diagnóstico , Epilepsias Mioclônicas/tratamento farmacológico , Epilepsias Mioclônicas/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Neurologia/métodos , Neurologia/tendências , Pediatria/métodos , Pediatria/tendências , Piridonas/efeitos adversos , Estudos Retrospectivos , Síndrome de Rett/diagnóstico , Síndrome de Rett/tratamento farmacológico , Síndrome de Rett/epidemiologia , Resultado do Tratamento
13.
Psychiatry Res ; 267: 112-119, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29886273

RESUMO

This naturalistic study aimed to assess treatment dropout pattern, course of symptoms and outcome of depression among the elderly. This study aimed to assess the course and outcome of depression and treatment dropout pattern of patients with depression in old age. Additionally an attempt was made to study the predictors of outcome and dropout. 140 elderly patients (≥ 60 years) were followed up at 6 months and 1 year to evaluate the status of their depression and treatment pattern. Out of the 140 patients recruited at the baseline, 58 (41.4%) patients did not return to the clinic after the first visit. 65.7%, 75% and 90% patients dropped out from the clinic by 3 months, 6 months and 1 year after registration with the clinic. At 1 year, about two-third (65%) of patients achieved improvement in symptoms to the extent of 81-100% and only 10% did not show any improvement throughout the study period. To conclude present study suggests that large proportion of the elderly patients with depression attending a mental health service dropout of treatment. Despite the high dropouts rate, more than three-fourth of the patients improve to the extent of 81-100% and very few patients have worsening of symptoms or persistent symptoms.


Assuntos
Assistência Ambulatorial/tendências , Depressão/terapia , Transtorno Depressivo/terapia , Serviços de Saúde Mental/tendências , Pacientes Desistentes do Tratamento , Adulto , Idoso , Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Ambulatório Hospitalar/tendências , Pacientes Desistentes do Tratamento/psicologia , Estudos Prospectivos
14.
Int J Clin Pharm ; 40(5): 1072-1077, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29956134

RESUMO

Background In response to the recognized difficulty in the management of patients on anticoagulation therapy, anticoagulation management services were developed in both hospital anticoagulation clinics (HACs) and an online anticoagulation clinic (OAC) by a pharmacist. Objective To compare monitoring outcomes and complications of warfarin therapy managed by pharmacists via hospital or on-line. Setting The anticoagulation clinic of Fujian Medical University Union Hospital, China. Method A retrospective, observational cohort study was used to compare patients managed via hospital  to those managed o-line between December 2015 and 2016. The primary outcome was the percentage of time in the therapeutic range (TTR). The secondary outcomes were the incidence rates of hemorrhagic events, thrombotic events and extreme international normalized ratio (INR) values. Results A total of 152 patients were evaluated; 70 patients managed in a HAC were compared to 82 patients managed via an OAC. There were no significant differences in the TTR (78.9 vs. 74.0%, P = 0.393) and adverse events [major bleeding events (0 vs. 1.2%, P = 1.000), minor bleeding events (10.0 vs. 9.8%, P = 0.960), thromboembolic events (0 vs. 0%, P = 1.000), warfarin-related emergency visits (2.9 vs. 3.7%, P = 1.000)], warfarin-related hospital admissions (0 vs. 1.2%, P = 1.000), and the incidence of subtherapeutic (3.0 vs. 3.8%, P = 0.148), and extreme total (8.4 vs. 5.8%, P = 0.135), between the groups managed via HAC and OAC. Patients managed in the HAC were more stable on warfarin, with a higher percentage of INR values within the target therapeutic range (80.2 vs. 71.9%, P = 0.005) and a lower incidence of supratherapeutic INR values (8.4 vs. 18.5%, P = 0.001) compared to patients managed via OAC. Conclusion The management of oral anticoagulation therapy on-line yielded similar clinical outcomes compared to that achieved by management via the hospital, although the incidence of supra-therapeutic INR values was increased.


Assuntos
Anticoagulantes/administração & dosagem , Internet , Ambulatório Hospitalar , Farmacêuticos , Serviço de Farmácia Hospitalar/métodos , Varfarina/administração & dosagem , Adulto , Anticoagulantes/efeitos adversos , Estudos de Coortes , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/tendências , Feminino , Seguimentos , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Humanos , Coeficiente Internacional Normatizado/métodos , Coeficiente Internacional Normatizado/tendências , Internet/tendências , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , Farmacêuticos/tendências , Serviço de Farmácia Hospitalar/tendências , Estudos Retrospectivos , Terapia Assistida por Computador/métodos , Terapia Assistida por Computador/tendências , Resultado do Tratamento , Varfarina/efeitos adversos
15.
Spine (Phila Pa 1976) ; 43(22): 1566-1571, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29664812

RESUMO

STUDY DESIGN: A cross-sectional study. OBJECTIVE: This study aimed to investigate the health-related quality of life (HRQOL) and body image disturbance of adolescents with untreated severe idiopathic early-onset scoliosis (IEOS) in a developing country. SUMMARY OF BACKGROUND DATA: IEOS has the potential to progress rapidly and may lead to significant disability if left untreated. Moreover, it can lead to significant body image changes that may lead to social and psychological stresses on developing adolescents. In developing countries, untreated severe IEOS among adolescents is common. METHODS: The Scoliosis Research Society 22 revision (SRS-22r) Arabic version questionnaire and Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S) were used to investigate the HRQOL and body image disturbance of these patients. RESULTS: A total of 137 patients with untreated severe IEOS (mean age, 15.5 years; range, 12-21 years) were included: group 1 (76 patients) with major curve angles of 90° to 120°, group 2 (61 patients) with major curve angles above 120°, and group 3 comprising 50 healthy controls were used for comparison. No significant differences were found regarding age, sex, and body mass index among the groups. Group 1 had significantly lower scores than group 3 in all SRS-22r domains (P < 0.001). Group 2 had significantly lower scores than group 1 in all SRS-22r domains, except for satisfaction (P < 0.005); the satisfaction domain had 100% worst answers in groups 1 and 2. Group 2 had worse scores than group 1 in all BIDQ-S questions (P < 0.001). No significant differences were found between males and females in all SRS-22r domains and BIDQ-S questions (P > 0.05). Further, 13% to 100% and 25% to 71% of the patients provided the worst answers to the SRS-22r and BIDQ-S questions, respectively. CONCLUSION: The HRQOL and body image of the adolescents with untreated severe IEOS in a developing country were severely impaired. LEVEL OF EVIDENCE: 3.


Assuntos
Transtornos Dismórficos Corporais/diagnóstico , Países em Desenvolvimento , Qualidade de Vida , Escoliose/diagnóstico , Índice de Gravidade de Doença , Adolescente , Transtornos Dismórficos Corporais/epidemiologia , Transtornos Dismórficos Corporais/psicologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Ambulatório Hospitalar/tendências , Qualidade de Vida/psicologia , Escoliose/epidemiologia , Escoliose/psicologia , Adulto Jovem
16.
Diabetes Metab Syndr ; 12(5): 689-692, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29685824

RESUMO

BACKGROUND: The purpose of this study was to evaluate the outcome of DM2 patients with nephropathy when they are under surveillance of a joined clinic run by endocrinologists & nephrologists. PATIENTS AND METHODS: A cohort of 106 patients with DM2, 42-83 years of age, and eGFR < 60 ml/min/m2 were included. Age, sex, duration of diabetes, duration of attending our clinic, smoking habits, BMI, data regarding ischemic heart disease and induction of hemodialysis, urine albumin excretion (UAE) levels, eGFR (MDRD equation) and values of various biochemical parameters were recorded too. Follow-up period ranged from one to 25 years. Paired samples t-test and non-parametrical Kruskal-Wallis test were used for the analyses of the data. RESULTS: Fifty percent of patients had no further progression, 25.9% improvement, while 24.1% had worsening of the UAE levels. During the follow-up in the joined clinic, there was a smaller than the expected from the medical literature decrease in median eGFR, i.e. 2,3 ml/min/m2 and a statistically significant improvement in glycosylated hemoglobin levels from 8.0% to 7.4% (p = 0.016). Time in years of follow-up in the joined clinic of our hospital appeared to be the most significant factor in the improvement or stabilization against deterioration of the UAE levels (p = 0.018). CONCLUSIONS: Close follow-up of DM2 patients with eGFR < 60 ml/min/m2 has resulted in a minor annual eGFR decrease. Monitoring of these patients in a specialized diabetic nephropathy clinic is beneficial for this group of patients for delaying the occurrence of end-stage renal disease.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/fisiopatologia , Monitorização Fisiológica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Albuminúria/diagnóstico , Albuminúria/epidemiologia , Albuminúria/fisiopatologia , Pressão Sanguínea/fisiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/epidemiologia , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/tendências , Ambulatório Hospitalar/tendências , Estudos Retrospectivos
17.
Pediatrics ; 141(4)2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29540572

RESUMO

BACKGROUND AND OBJECTIVES: Human papillomavirus (HPV) vaccination rates lag behind vaccination rates for other adolescent vaccines; a bundled intervention may improve HPV vaccination rates. Our objective is to evaluate the impact of quality improvement (QI) training plus a bundled practice-based intervention (provider prompts plus communication skills training plus performance feedback) on improving HPV vaccinations in pediatric resident continuity clinics. METHODS: Staff and providers in 8 resident clinics participated in a 12-month QI study. The intervention included training to strengthen provider communication about the HPV vaccine. Clinics also implemented provider prompts, received monthly performance feedback, and participated in learning collaborative calls. The primary outcome measure was eligible visits with vaccination divided by vaccine-eligible visits (captured HPV vaccination opportunities). Practices performed chart audits that were fed into monthly performance feedback on captured HPV vaccination opportunities. We used conditional logistic regression (conditioning on practice) to assess captured vaccination opportunities, with the time period of the study (before and after the QI intervention) as the independent variable. RESULTS: Overall, captured opportunities for HPV vaccination increased by 16.4 percentage points, from 46.9% to 63.3%. Special cause was demonstrated by centerline shift, with 8 consecutive points above the preintervention mean. On adjusted analyses, patients were more likely to receive a vaccine during, versus before, the intervention (odds ratio: 1.87; 95% confidence interval: 1.54-2.28). Captured HPV vaccination rates improved at both well-child and other visits (by 11.7 and 13.0 percentage points, respectively). CONCLUSIONS: A bundled intervention of provider prompts and training in communication skills plus performance feedback increased captured opportunities for HPV vaccination.


Assuntos
Retroalimentação Psicológica , Pessoal de Saúde/tendências , Ambulatório Hospitalar/tendências , Vacinas contra Papillomavirus/uso terapêutico , Relações Profissional-Paciente , Vacinação/tendências , Adolescente , Comunicação , Feminino , Pessoal de Saúde/educação , Humanos , Masculino , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/psicologia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Vacinação/psicologia
19.
BMC Psychiatry ; 18(1): 46, 2018 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-29433452

RESUMO

BACKGROUND: Despite the significant impact of migraine on patients and societies, few studies in low- and middle-income countries (LMICs) have investigated the association between migraine and suicidal behavior. The objective of our study is to examine the extent to which migraines are associated with suicidal behavior (including suicidal ideation, plans, and attempts) in a well-characterized study of urban dwelling Ethiopian adults. METHODS: We enrolled 1060 outpatient adults attending St. Paul hospital in Addis Ababa, Ethiopia. Standardized questionnaires were used to collect data on socio-demographics, and lifestyle characteristics. Migraine classification was based on the International Classification of Headache Disorders-2 diagnostic criteria. The Composite International Diagnostic Interview (CIDI) was used to assess depression and suicidal behaviors (i.e. ideation, plans and attempts). Multivariable logistic regression models were used to estimate adjusted odds ratio (AOR) and 95% confidence intervals (95% CIs). RESULTS: The prevalence of suicidal behavior was 15.1%, with a higher suicidal behavior among those who had migraines (61.9%). After adjusting for confounders including substance use and socio-demographic factors, migraine was associated with a 2.7-fold increased odds of suicidal behavior (AOR = 2.7; 95% CI 1.88-3.89). When stratified by their history of depression in the past year, migraine without depression was significantly associated with suicidal behavior (AOR: 2.27, 95% Cl: 1.49-3.46). The odds of suicidal behavior did not reach statistical significance in migraineurs with depression (AOR: 1.64, 95% CI: 0.40-6.69). CONCLUSION: Our study indicates that migraine is associated with increased odds of suicidal behavior in this population. Given the serious public health implications this has, attention should be given to the treatment and management of migraine at a community level.


Assuntos
Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/psicologia , Ideação Suicida , População Urbana/tendências , Adulto , Grupo com Ancestrais do Continente Africano , Estudos Transversais , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Ambulatório Hospitalar/tendências , Inquéritos e Questionários
20.
Am J Cardiovasc Drugs ; 18(3): 231-243, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29476459

RESUMO

OBJECTIVE: The aim of this study was to analyze factors associated with the consumption of medicinal plants by patients being treated with warfarin in a Brazilian anticoagulation clinic and to study the safety of medicinal plant use in patients on warfarin therapy. METHODS: The study was performed as an observational cross-sectional analysis. Study participants were outpatients on long-term warfarin therapy for at least 2 months for atrial fibrillation or prosthetic cardiac valves. Interviews were carried out concerning information about the habits of medicinal herb consumption, and logistic regression analysis was performed to identify factors associated with the consumption of herbs. The scientific names of the medicinal plants were identified to search for information on the effects on the hemostasis of the interactions between the medicinal herbs reported and warfarin. RESULTS: The mean age of the 273 patients included was 60.8 years; 58.7% were women. Medicinal plants were used by 67% of the participants. No association between demographic and clinical data and the use of medicinal plants was identified. Patients reported a total of 64 different plants, primarily consumed in the form of tea. The plants were mainly used to treat respiratory tract and central nervous system disorders. About 40% of the plants cited have been reported to potentially interfere with the anticoagulation therapy, principally by potentiating the effects of warfarin, which could, increase the risk of bleeding. CONCLUSION: The use of medicinal plants was highly common and widespread in patients receiving warfarin as an anticoagulation therapy. Univariate analysis of variables associated with the consumption of herbs showed no statistically significant difference in the consumption of medicinal plants for any of the sociodemographic and clinical data. The medicinal plants that were reportedly consumed by the patients could affect hemostasis. This study reinforces the need for further studies evaluating the habits of patients consuming medicinal plants and their clinical implications, and will help to design strategies to manage the risks associated with warfarin-herbal interactions.


Assuntos
Anticoagulantes/efeitos adversos , Interações Ervas-Drogas/fisiologia , Ambulatório Hospitalar , Plantas Medicinais/efeitos adversos , Varfarina/efeitos adversos , Idoso , Anticoagulantes/metabolismo , Brasil/epidemiologia , Estudos Transversais , Feminino , Hemostasia/efeitos dos fármacos , Hemostasia/fisiologia , Humanos , Coeficiente Internacional Normatizado/tendências , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , Plantas Medicinais/metabolismo , Varfarina/metabolismo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA