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1.
Einstein (Sao Paulo) ; 18: eGS4913, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31531556

RESUMO

OBJECTIVE: To evaluate indications, results and strategy of retinal exams requested at Primary Care Units. METHODS: A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than -3.00 diopters. RESULTS: A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams. CONCLUSION: Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Atenção Primária à Saúde/estatística & dados numéricos , Retina , Doenças Retinianas/diagnóstico , Idoso , Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico/economia , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Exame Físico , Estudos Retrospectivos , Telemedicina , Acuidade Visual
2.
Med Clin North Am ; 104(1): 15-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757233

RESUMO

Urticaria is a common presenting problem to the primary care provider. Acute urticaria lasting less than 6 weeks may be associated with a drug or food allergens. Chronic urticaria lasting more than 6 weeks is often associated without a known underlying cause. Inducible stimuli causing hives should be excluded using specific provocation testing. Treatment follows a standardized algorithmic approach as outlined by the Joint Task Force Practice Parameter and/or International Urticaria guidelines. Patients not responsive to steps 1 or 2 should be referred to an urticaria specialist for further evaluation and treatment. The prognosis and outcome of urticaria is generally very favorable for most patients.


Assuntos
Atenção Primária à Saúde/métodos , Urticária/diagnóstico , Doença Aguda , Comitês Consultivos/normas , Doença Crônica , Hipersensibilidade a Drogas/complicações , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/diagnóstico , Humanos , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Prognóstico , Encaminhamento e Consulta , Urticária/etiologia
3.
Rev. Esc. Enferm. USP ; 53: e03512, Jan.-Dez. 2019. graf
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1020387

RESUMO

OBJETIVO: Desvelar as práticas de Educação Permanente em Saúde desenvolvidas pelo Núcleo de Apoio à Saúde da Família na atenção ao idoso. MÉTODO: Estudo qualitativo e exploratório-descritivo, desenvolvido em um município do estado do Paraná, com profissionais do Núcleo de Apoio à Saúde da Família. Os dados foram obtidos pela técnica de Grupo Focal e submetidos à Classificação Hierárquica Descendente utilizando o software IRaMuTeQ. Os referenciais teórico-analíticos foram a Política Nacional de Educação Permanente em Saúde e a Teoria Dialógica. RESULTADOS: Participaram 46 profissionais. Surgiram cinco classes que permitiram desvelar que as práticas de educação permanente na atenção ao idoso ocorrem durante os momentos de discussão de casos, no matriciamento, nas visitas domiciliares, nos grupos operativos e no cotidiano do trabalho de modo informal. CONCLUSÃO: As práticas de educação permanente desenvolvidas pelos profissionais na atenção ao idoso ocorrem em distintos momentos da atuação profissional e são permeadas pela prática


OBJETIVO: Desvelar las prácticas de Educación Permanente en Salud desarrolladas por el Núcleo de Apoyo a la Salud de la Familia en la atención a la persona mayor. MÉTODO: Estudio cualitativo y exploratorio descriptivo, desarrollado en un municipio del Estado de Paraná, con profesionales del Núcleo de Apoyo a la Salud de la Familia. Los datos fueron obtenidos por la técnica de Grupo Focal y sometidos a la Clasificación Jerárquica Descendiente utilizando el software IRaMuTeQ. Los marcos de referencia teóricos analíticos fueron la Política Nacional de Educación Permanente en Salud y la Teoría Dialógica. RESULTADOS: Participaron 46 profesionales. Surgieron cinco clases que permitieron desvelar que las prácticas de educación permanente en la atención a la persona mayor ocurren durante los momentos de discusión de casos, en el matriciamiento, las visitas domiciliarias, los grupos operativos y el cotidiano del trabajo de modo informal. CONCLUSIÓN: Las prácticas de educación permanente desarrolladas por los profesionales en la atención a la persona mayor ocurren en distintos momentos de la actuación profesional y traen consigo la práctica


OBJECTIVE: To unveil the Permanent Education in Health practices developed by the Family Health Support Center in the care provided to older adults. METHOD: A qualitative and exploratory-descriptive study developed in a municipality in the state of Paraná with professionals from the Family Health Support Center. Data were obtained by the Focus Group technique and submitted to the Descending Hierarchical Classification using IRaMuTeQ software. The implemented theoretical-analytical references were the National Policy of Permanent Education in Healthcare and the Dialogical Theory. RESULTS: Forty-six (46) professionals participated. Five classes emerged which revealed that the practices of permanent education in care provided to older adults occur during the moments of discussion of cases, in collaborative care planning (matriciamento ), in the home visits, in the operative groups and in the daily life of the informal work. CONCLUSION: The permanent education practices developed by the professionals in the care provided to older adults occur at different moments of professional performance and are permeated by the practice


Assuntos
Humanos , Masculino , Feminino , Idoso , Atenção Primária à Saúde/normas , Educação Continuada/métodos , Enfermagem de Atenção Primária/normas , Serviços de Saúde para Idosos/normas , Pessoal de Saúde , Grupos Focais , Pesquisa Qualitativa
4.
Rev. cuba. angiol. cir. vasc ; 20(2): e385, jul.-dic. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1003858

RESUMO

Introducción: La coordinación entre niveles asistenciales centrada en las enfermedades frecuentes, graves y vulnerables, constituye un elemento esencial para incrementar la eficiencia del sistema sanitario con la ayuda del uso de instrumentos diagnósticos. Objetivo: Validar el Cuestionario de Edimburgo modificado para el diagnóstico de la claudicación arterial periférica en la atención primaria de salud. Métodos: Estudio de evaluación de instrumentos diagnósticos a través de un estudio explicativo observacional de corte transversal, en una muestra de 100 pacientes provenientes de la atención primaria de salud. El período de estudio fue el segundo semestre (julio-diciembre) de 2016. A todos los participantes se les realizó un examen físico vascular, se midieron los índices de presiones tobillo-brazo, se identificó la topografía de las lesiones arteriales de los miembros inferiores, se les aplicó el Cuestionario de Edimburgo modificado y se calculó su sensibilidad, especificidad, valores predictivos positivos y negativos y exactitud diagnóstica. Resultados: El examen físico vascular constató un predominio de la afección fémoro-poplítea (54,8 por ciento) seguido de la aorta-ilíaco (29,9 por ciento). Se obtuvo en la validación del Cuestionario una sensibilidad de 98 por ciento, una especificidad de 31,5 por ciento con alta probabilidad de tener falsos negativos. El valor predictivo positivo fue de 70 por ciento y el negativo de 92 por ciento. La exactitud de las pruebas diagnósticas fue de 73 por ciento, para cada prueba. Conclusiones: El uso del Cuestionario de Edimburgo modificado en la atención primaria de salud es de gran utilidad para establecer el diagnóstico clínico positivo de una claudicación intermitente por enfermedad arterial periférica(AU)


Introduction: Coordination between care levels centered in the severe, frequently and vulnerable diseases constitutes an essential element to increase the efficiency of the health system with the help of diagnostic means. Objective: To validate the modified Edinburgh Questionnaire for the diagnostic of arterial claudication in the primary health care. Methods: An assessment study of diagnostic instruments was done through of a cross-sectional, observational explicative study in a sample of 100 patients from primary health care. The study was conducted in the second semester (July-December) of 2016. A vascular physical exam was performed to all the participants where ankle- brachial pressure index was measured, the topography of the arterial occlusions of the lower limbs was identified, the modified Edinburgh Questionnaire was carried out; and the sensitivity, specificity, positive and negative predictive values and the diagnostic exactitude were calculated. Results: The vascular physical exam exhibited a predominant femoro-popliteal affectation (54,8 percent) followed of the aorta-iliac (29,9 percent). In the validation of the modified Edinburgh Questionnaire it was obtained a sensitivity of 98 percent and an specificity of 31,5 percent with high probabilities of false negative. The positive predictive value was 70 percent and the negative 92 percent. The exactitude of the diagnostic test was 73 percent for each test. Conclusions: The use of the modified Edinburgh Questionnaire in the primary health care is useful to establish the positive clinical diagnostic of an intermittent arterial claudication by Peripheral Arterial Disease(AU)


Assuntos
Humanos , Masculino , Feminino , Atenção Primária à Saúde , Inquéritos e Questionários/normas , Estudos Transversais , Doença Arterial Periférica/diagnóstico , Estudo Observacional , Claudicação Intermitente/diagnóstico
5.
Orv Hetil ; 160(48): 1904-1914, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31760778

RESUMO

Introduction: The attitude to immunization and the issue of vaccine hesitancy in health care workers (HCWs) have been studied in a former survey performed by ECDC (European Centre for Disease Prevention and Control). Aim: Our aim was to study the immunization attitude of primary care paediatricians, general practitioners and primary care nurses in Hungary. Method: We studied vaccine hesitancy in HCWs by way of a questionnaire, developed on the basis of a recent similar survey by ECDC in four countries. The online survey has been performed between May and July 2017. Altogether 765 questionnaires have been returned: 189 primary care paediatricians, 375 general practitioners working in adult or mixed practices, and 201 primary care nurses. The sample has been weighted to the country-specific features - e.g., location of the practice, residence and age of the HCWs - within each of the three groups, so from this aspect it can be considered representative. Results: Our results did not differ substantially from the international ECDC data. Approximately 2/3 of the primary care doctors and about 50% of the primary care nurses were convinced of the benefit and value of vaccines. Data on vaccine hesitancy were consolingly low, though the data on recommended vaccines were somewhat higher compared to the age related/NIP (National Immunization Plan) vaccines. The well-known vaccine scares - e.g., autism-MMR, etc., known also from the literature - could hardly been detected, and it can be explained by the voluntary participation in the study. The least supported vaccine is BCG, while the highest hesitancy rates are related to MMR in Hungary. Conclusion: The need to improve immunization-related communication among primary HCWs could clearly been detected - both in gradual and in post-gradual training programs. Orv Hetil. 2019; 160(48): 1904-1914.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Vacinação/psicologia , Vacinas , Adulto , Humanos , Hungria , Atenção Primária à Saúde , Segurança , Confiança
6.
Lima; Perú. Ministerio de Salud; 20191100. 45 p. ilus, tab.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1024810

RESUMO

Contribuir con la mejora de la gestión en el uso eficiente de los recursos públicos que son utilizados por la IPRESS para brindar servicios de salud a la población usuaria


Assuntos
Atenção Primária à Saúde , Alocação de Custos , Instalações de Saúde , Serviços de Saúde
7.
Pan Afr Med J ; 33: 292, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692903

RESUMO

Face presentation is a rare obstetric event and most practitioners will go through their carriers without ever meeting one. Face presentation can be delivered vaginally only if the foetus is in the mentum anterior position. More than half of the cases of face presentation are delivered by caesarean section. Newborn infants with face presentation usually have severe facial oedema, facial bruising or ecchymosis. These syndromic facial features usually resolved within 24-48 hours.


Assuntos
Parto Obstétrico/métodos , Edema/patologia , Apresentação no Trabalho de Parto , Camarões , Face , Feminino , Humanos , Recém-Nascido , Lábio , Masculino , Gravidez , Atenção Primária à Saúde , Adulto Jovem
8.
Br J Gen Pract ; 69(688): 536-537, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31672800
12.
Pan Afr Med J ; 33: 209, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692730

RESUMO

Introduction: management of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) within primary health care (PHC) facilities involve nursing students as part of them integrating theory to practice. Clinical learning for nursing students requires adequate support from the Nursing Education Institution (NEI) and nursing professionals. Given the dearth of literature regarding clinical support for nursing students in the management of TB/HIV in PHC setting, this study is aimed at exploring and describing nursing students' experiences regarding clinical support. Methods: a phenomenological design was used to explore and describe the experiences of nursing students using an individual, unstructured, in-depth interview. Audio-taped interviews were transcribed verbatim and analysed using Atlas TI software. Results: themes derived from the study were factors inhibiting clinical support which incorporated shortage of professional nurses (PNs), lack of accompaniment, fear of managing TB/HIV patients and negative attitudes of PNs; outcomes of poor clinical support included inability to integrate TB/HIV theory to practice and lack of confidence among nursing students; nursing students' desired outcomes through clinical support included becoming a competent TB/HIV nurse and the ability to integrate TB/HIV theory to practice; and strategies to strengthen and promote clinical support in TB/HIV management through strengthened occupational health and safety learning, provision of knowledge regarding post-exposure prophylaxis and infection control, and appointed clinical PN for students in each facility. Conclusion: the development of policies for clinical support, increasing supervision, appointment of clinical preceptors and accompanists in facilities where nursing students are placed would promote clinical learning within the NEI and the production of competent and confident nurses.


Assuntos
Infecções por HIV/enfermagem , Atenção Primária à Saúde/organização & administração , Estudantes de Enfermagem/estatística & dados numéricos , Tuberculose/enfermagem , Adulto , Competência Clínica , Feminino , Humanos , Entrevistas como Assunto , Masculino , Adulto Jovem
14.
Nurs Clin North Am ; 54(4): 457-471, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703773

RESUMO

Depression management in primary care settings is the norm, in the United States and globally. As incidence and prevalence of depression continue to mount, there are innovative models of treatment, newer understandings, more open philosophies, and evidence-informed treatments that may address this troubling public health issue. This article attempts to succinctly examine the evidence in identifying and treating this in the United States in an expedient, evidence-informed manner to assist those in need of have care that is patient centered, of high quality, affordable, and readily accessible across the lifespan.


Assuntos
Depressão/diagnóstico , Depressão/terapia , Assistência Centrada no Paciente , Atenção Primária à Saúde/organização & administração , Humanos , Telemedicina , Estados Unidos
15.
Nurs Clin North Am ; 54(4): 473-493, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703774

RESUMO

Although anxiety disorders are extremely prevalent in primary care settings, barriers such as a lack of knowledge, time constraints, and lack of common presentation can lead to misdiagnosis and ineffective treatment. Optimal treatment of anxiety disorders includes both pharmacologic and behavioral interventions. The purpose of this article is to assist primary care providers in quick identification of anxiety disorders so that proper treatment can be initiated and appropriate referrals can be made.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Atenção Primária à Saúde/organização & administração , Transtornos de Ansiedade/tratamento farmacológico , Humanos , Prevalência , Inquéritos e Questionários
16.
Nurs Clin North Am ; 54(4): 495-501, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703775

RESUMO

This article offers a brief review geared toward primary care providers of the most critical aspects of the management of opiate use disorder, including screening, brief intervention, and referral to treatment as well as medication-assisted treatment and the alarming trends and dangers of illicitly produced fentanyl.


Assuntos
Analgésicos Opioides/efeitos adversos , Overdose de Drogas/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Atenção Primária à Saúde , Overdose de Drogas/tratamento farmacológico , Fentanila/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/terapia
17.
Nurs Clin North Am ; 54(4): 517-532, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703777

RESUMO

Management of attention-deficit/hyperactivity disorders require provider skill, rapport, and referral acumen to treat patients across the life span. Incidence and prevalence have increased in the United States and globally. There are innovative models of evidence-informed screening techniques, treatment strategies to help providers work with patients and their families. Diplomatic management of highly charged treatment controversies, drug diversion, and risk factor reduction helps to ethically address this growing public health phenomenon. This article examines risk factors and treatment considerations in the United States for evidence-informed care, with a focus on affordable and readily accessible treatment in primary care settings.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/genética , Predisposição Genética para Doença , Farmacogenética , Atenção Primária à Saúde , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Humanos , Prevalência , Fatores de Risco , Estados Unidos
19.
Rev Med Suisse ; 15(671): 2074-2079, 2019 Nov 13.
Artigo em Francês | MEDLINE | ID: mdl-31742937

RESUMO

The international recommendations of the management of asthma have been modified last years. Several therapies used since long time have no place in the management of moderate asthma today. The use of targeted immunotherapies against phenotypes of asthma are used more and more. Inhalant therapies are becoming more targeted towards the patient's wishes. This article specifies the novelties in management of asthma for de general practitioner, including the use of short acting beta2-agonists, which are no longer to be used without inhaled corticosteroid.


Assuntos
Asma/terapia , Atenção Primária à Saúde , Administração por Inalação , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Agonistas Adrenérgicos beta/administração & dosagem , Agonistas Adrenérgicos beta/uso terapêutico , Asma/tratamento farmacológico , Humanos , Imunoterapia
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