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1.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 962-967, jul.-set. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005814

RESUMO

Objetivos: Descrever as características dos casos de abandono do tratamento de tuberculose em pacientes que desenvolveram tuberculose multirresistente (TBMR). Métodos: Estudo descritivo de abordagem quantitativa, desenvolvido em uma instituição terciária de referência para tratamento de TBMR localizada na cidade do Rio de Janeiro. Foi utilizado instrumento estruturado com informações de quarenta prontuários entre os meses de agosto a dezembro de 2016. A análise dos dados foi realizada por meio do software SPSS. Resultados: Dos pacientes estudados, 35% abandonaram tratamento anterior de tuberculose. Conclusão e implicação para a prática: É necessária a identificação precoce de pacientes que apresentam maior risco para abandono do tratamento, bem como a criação de um modelo de assistência voltado ao perfil dos usuários que abandonam o tratamento, com uma prática participativa, com grupos educativos que promovam ações preventivas, identificando e estudando estratégias para a superação de barreiras ligadas à realidade de vida individual e coletiva


Objective: To describe the characteristics of cases of tuberculosis treatment abandonment in patients who developed MDR-TB. Methods: a descriptive study of a quantitative approach developed in a tertiary referral institution for the treatment of MDR-TB, located in the city of Rio de Janeiro. A structured instrument was used with information from forty medical records between August and December 2016. Data analysis was performed using SPSS software. Results: Of the patients studied, 35% abandoned previous treatment of tuberculosis. Conclusion and implication for the practice: early identification of patients who are at greater risk for treatment abandonment is required, as well as the creation of a model of assistance aimed at the profile of users who abandon treatment, with a participatory practice with educational groups That promote preventive actions, identifying, studying strategies for overcoming barriers linked to reality, individual and collective life


Objetivos: Describir las características de los casos de abandono del tratamiento de tuberculosis en pacientes que desarrollaron TBMR. Métodos: estudio descriptivo de abordaje cuantitativo, desarrollado en una institución terciaria de referencia para tratamiento de TBMR, ubicado en la ciudad de Río de Janeiro. Se utilizó instrumento estructurado con informaciones de cuarenta prontuarios entre los meses de agosto a diciembre de 2016. El análisis de los datos fue realizado a través del software SPSS. Resultados: de los pacientes estudiados, el 35% abandonó el tratamiento anterior de la tuberculosis.Conclusión e implicación para la práctica: es necesaria la identificación precoz de pacientes que presentan mayor riesgo para el abandono del tratamiento, así como la creación de un modelo de asistencia orientado al perfil de los usuarios que abandonan el tratamiento, con una práctica participativa, con grupos educativos Que promuevan acciones preventivas, identificando, estudiando estrategias para la superación de barreras ligadas a la realidad, de vida individual y colectiva


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Adesão à Medicação/estatística & dados numéricos
2.
An. psicol ; 35(2): 175-180, mayo 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-181686

RESUMO

Objetivos: Analizar la incidencia de diferentes variables en el padecimiento de reiterados episodios en la situación sin hogar. Método: El trabajo se realizó a partir de los datos obtenidos de una muestra representativa de las personas en situación sin hogar en Madrid (España) (n=188). Resultados: El padecimiento de una enfermedad grave o crónica ejerce un efecto en la "puerta giratoria" a la situación sin hogar mediado por una percepción subjetiva muy negativa de la propia salud que, a su vez, se encuentra mediada por el padecimiento de alguna discapacidad. El consumo excesivo de alcohol ejerce un efecto en la "puerta giratoria" a la situación sin hogar mediado por el acceso a tratamiento por problemas derivados de dicho consumo. Padecer una enfermedad grave o crónica correlaciona con tener o haber tenido problemas derivados de un consumo excesivo de alcohol. El padecimiento de múltiples sucesos vitales estresantes ejerce un efecto directo en la "puerta giratoria" a la situación sin hogar. Conclusiones: Para prevenir la "puerta giratoria" a la situación sin hogar hay que eliminar las barreras que dificultan el acceso a los recursos normalizados de salud a las personas en exclusión social, a la vez que implementar programas continuados de apoyo para las personas sin hogar o en riesgo que incluyan prioritariamente cuestiones de salud


Objectives: To analyse the impact of different variables on repeated episodes of homelessness. Method: The study was conducted based on data obtained from a representative sample of homeless people in Madrid (Spain) (n=188). Results: Suffering from a serious or chronic illness has an effect on the revolving door to homelessness, which is mediated by a highly negative subjective perception of the individual's own health, which is in turn mediated by suffering from a disability. Excessive alcohol consumption has an effect on the revolving door to homelessness, mediated by access to treatment for problems caused by alcohol consumption. Suffering from a serious or chronic illness correlates with having problems caused by excessive alcohol consumption. Experiencing multiple stressful life events has a direct effect on the revolving door to homelessness. Conclusions: To prevent the revolving door to homelessness, it is necessary to remove the barriers that hinder access to normal health resources which are experienced by people suffering from social exclusion, while implementing on going support programmes for homeless people or those at risk of homelessness, which primarily deal with health issues


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Pessoas em Situação de Rua/psicologia , Alcoolismo/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Mentais/epidemiologia , Pessoas em Situação de Rua/estatística & dados numéricos , Pacientes Desistentes do Tratamento/psicologia , Problemas Sociais/psicologia , Acesso aos Serviços de Saúde/tendências
3.
BMC Res Notes ; 12(1): 232, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30999924

RESUMO

OBJECTIVE: The aim of this study was to determine the major risk factors of antiretroviral therapy dropout. The retrospective cohort research design was applied. 1512 HIV patients were included from Mettu Karl Hospital in Illubabor Zone, southwest part of Ethiopia from September 2005 to January 2018. Kaplan-Meier comparison and log-logistic regression accelerated failure time model were used. RESULTS: From the log-logistic regression result, the risk of dropout for patients with primary education status was 10.58% greater as compared to illiterate (p < 0.0110). The probability of dropout for patients with marital status separated was about 16.82% higher than those patients with marital status divorced (p < 0.0070). Being merchant, farmer and daily labour had a greater risk of dropout as compared to a housewife. Most of the HIV/AIDS patients on ART were dropout in a short period due to patients separated marital status, primary education, CD4, being merchants, farmer and daily labour. Investigation on the cause of antiretroviral therapy dropout from a number of AIDS clinics in the country is highly appreciated.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/psicologia , Adesão à Medicação/estatística & dados numéricos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Adulto , Terapia Antirretroviral de Alta Atividade , Escolaridade , Etiópia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Hospitais , Humanos , Modelos Logísticos , Masculino , Estado Civil , Adesão à Medicação/psicologia , Pacientes Desistentes do Tratamento/psicologia , Estudos Retrospectivos , Fatores de Risco , Classe Social
4.
BMC Res Notes ; 12(1): 111, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819236

RESUMO

OBJECTIVES: The aim of this study was to estimate the incidence of lost to follow up from anti-retroviral therapy (ART) care and identify the associated factors among human immunodeficiency virus (HIV) infected patients after first-line ART initiation at University of Gondar comprehensive specialized hospital, Northwest Ethiopia between January 2012 and January 2018. RESULTS: The overall incidence rate of lost to follow up was 12.26 per 100 person years (95% CI (10.61-14.18)). Being underweight (< 18.5 kg/m2) (AHR, 1.52, 95% CI 1.01-2.28), jobless (AHR, 2.22, 95% CI 1.2-4.11), substance abuser (AHR, 1.84 95% CI 1.19-2.86), having sub-optimal adherence (fair/poor) (AHR 6.33, 95% CI (3.90-10.26)), not receiving isoniazid prophylaxis (AHR 2.47, 95% CI (1.36-4.48)), ambulatory functional status (AHR 1.94, 95% CI (1.23-3.06)), having opportunistic infections (AHR, 1.74 95% CI 1.11-2.72), having CD4 count 201-349 cells/µL (AHR 0.58, 95% CI (0.38-0.88)) were found to be significant predictors of lost to follow up from ART service.


Assuntos
Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Hospitais Especializados/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Adolescente , Adulto , Etiópia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
5.
Z Evid Fortbild Qual Gesundhwes ; 141-142: 76-88, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30910624

RESUMO

BACKGROUND: User acceptance is a key indicator and driver for the use and implementation of telemonitoring applications (TMA) in healthcare. Despite various positive effects that previous studies have revealed for users of TMA, there are always patients who discontinue their participation in a telemedicine study or even decline participation. There is little evidence for the reasons for non-acceptance and non-use of TMA, especially in multimorbid patients at the age of 65 and over in their home environment. To close this research gap, this sub-study focuses on patient-reported reasons for non-acceptance and non-use of TMA in the home environment. METHODS: This study follows a mixed-method approach and focuses on patients' perspective. Quantitative data collection took place via computer-assisted telephone interviews among all drop-outs and non-participants. Qualitative data were collected via semi-structured interviews with drop-out patients and non-users. Eligible patients were recruited consecutively by general practitioners, informed and included in the study according to the inclusion criteria. Amongst others, patients measured their vital signs (blood pressure, heart frequency, oxygen saturation, weight) via telemedical measures and sent them via tablet to a Care Coordination Center to ascertain the need for intervention. Collected data on non-acceptance and non-use of TMA were analyzed quantitatively and qualitatively. RESULTS: Nine general practices in two German cities included a total of 177 patients according to the inclusion criteria. During the study, 61 study participants (34.5 %) dropped out, 80 patients (31.1 %) declined participation in the study. Drop-outs and non-participants were significantly older than active participants (p=.004 and p=.001, respectively). Predominant reasons for drop-out were the lack of the perceived added value and the content-related variety of the program on the patient's tablet, the missing interest/need for telemedical monitoring as well as the time spent participating in the study. Patients living alone, single and widowed patients reported significantly more difficulties in handling the hardware (tablet) (p=.040) and the program (Motiva) (p=.013) than married and cohabiting patients. These reasons were also reported mainly by female patients, patients aged 75 years and over, and those with a low level of education. CONCLUSION: In order to increase the acceptance and the added value of TMA for patients, the individual needs of the future target group should be analyzed at the beginning of the development. To ensure maximum user centricity, individual development steps should be continuously evaluated by the target group. TMA should be adapted to the functional abilities of elderly, multimorbid patients through, e. g., an appropriate design of the content, which is tailored to patients' individual needs. TMA should be used to an appropriate degree to avoid overburdening and should fit unobtrusively into patients' usual daily routine. For patient-specific acceptance of TMA, easy handling of the telemedical measuring and input devices is as important as the variety of offers on the platform and personal contact for technical queries. Special attention should be paid to patients who live alone, women, elderly patients over 75 years of age, and poorly educated patients in order to ensure full and easy access to technology-based telemonitoring for their own healthcare.


Assuntos
Multimorbidade , Aceitação pelo Paciente de Cuidados de Saúde , Pacientes Desistentes do Tratamento , Telemedicina , Idoso , Feminino , Alemanha , Humanos , Masculino , Assistência Individualizada de Saúde
6.
Cochrane Database Syst Rev ; 3: CD010677, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30921478

RESUMO

BACKGROUND: Panic disorder is characterised by recurrent unexpected panic attacks consisting of a wave of intense fear that reaches a peak within a few minutes. Panic disorder is a common disorder, with an estimated lifetime prevalence of 1% to 5% in the general population and a 7% to 10% prevalence in primary care settings. Its aetiology is not fully understood and is probably heterogeneous.Panic disorder is treated with psychological and pharmacological interventions, often used in combination. Although benzodiazepines are frequently used in the treatment of panic disorder, guidelines recommend antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs), as first-line treatment for panic disorder, particularly due to their lower incidence of dependence and withdrawal reaction when compared to benzodiazepines. Despite these recommendations, benzodiazepines are widely used in the treatment of panic disorder, probably because of their rapid onset of action. OBJECTIVES: To assess the efficacy and acceptability of benzodiazepines versus placebo in the treatment of panic disorder with or without agoraphobia in adults. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR Studies and References), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950-), Embase (1974-), and PsycINFO (1967-) up to 29 May 2018. We handsearched reference lists of relevant papers and previous systematic reviews. We contacted experts in the field for supplemental data. SELECTION CRITERIA: All double-blind (blinding of patients and personnel) controlled trials randomising adults with panic disorder with or without agoraphobia to benzodiazepine or placebo. DATA COLLECTION AND ANALYSIS: Two review authors independently checked the eligibility of studies and extracted data using a standardised form. Data were then entered data into Review Manager 5 using a double-check procedure. Information extracted included study characteristics, participant characteristics, intervention details, settings, and outcome measures in terms of efficacy, acceptability, and tolerability. MAIN RESULTS: We included 24 studies in the review with a total of 4233 participants, of which 2124 were randomised to benzodiazepines and 1475 to placebo. The remaining 634 participants were randomised to other active treatments in three-arm trials. We assessed the overall methodological quality of the included studies as poor. We rated all studies as at unclear risk of bias in at least three domains. In addition, we judged 20 of the 24 included studies as having a high risk of bias in at least one domain.Two primary outcomes of efficacy and acceptability showed a possible advantage of benzodiazepines over placebo. The estimated risk ratio (RR) for a response to treatment was 1.65 (95% confidence interval (CI) 1.39 to 1.96) in favour of benzodiazepines, which corresponds to an estimated number needed to treat for an additional beneficial outcome (NNTB) of 4 (95% CI 3 to 7). The dropout rate was lower among participants treated with benzodiazepines (RR 0.50, 95% CI 0.39 to 0.64); the estimated NNTB was 6 (95% CI 5 to 9). We rated the quality of the evidence as low for both primary outcomes. The possible advantage of benzodiazepine was also seen for remission (RR 1.61, 95% CI 1.38 to 1.88) and the endpoint data for social functioning (standardised mean difference (SMD) -0.53, 95% CI -0.65 to -0.42), both with low-quality evidence. We assessed the evidence for the other secondary outcomes as of very low quality. With the exception of the analyses of the change score data for depression (SMD -0.22, 95% CI -0.48 to 0.04) and social functioning (SMD -0.32, 95% CI -0.88 to 0.24), all secondary outcome analyses showed an effect in favour of benzodiazepines compared to placebo. However, the number of dropouts due to adverse effects was higher with benzodiazepines than with placebo (RR 1.58, 95% CI 1.16 to 2.15; low-quality evidence). Furthermore, our analyses of adverse events showed that a higher proportion of participants experienced at least one adverse effect when treated with benzodiazepines (RR 1.18, 95% CI 1.02 to 1.37; low-quality evidence). AUTHORS' CONCLUSIONS: Low-quality evidence shows a possible superiority of benzodiazepine over placebo in the short-term treatment of panic disorders. The validity of the included studies is questionable due to possible unmasking of allocated treatments, high dropout rates, and probable publication bias. Moreover, the included studies were only short-term studies and did not examine the long-term efficacy nor the risks of dependency and withdrawal symptoms. Due to these limitations, our results regarding the efficacy of benzodiazepines versus placebo provide only limited guidance for clinical practice. Furthermore, the clinician's choice is not between benzodiazepines and placebo, but between benzodiazepines and other agents, notably SSRIs, both in terms of efficacy and adverse effects. The choice of treatment should therefore be guided by the patient's preference and should balance benefits and harms from treatment in a long-term perspective.


Assuntos
Benzodiazepinas/uso terapêutico , Transtorno de Pânico/tratamento farmacológico , Adulto , Idoso , Agorafobia/complicações , Agorafobia/tratamento farmacológico , Buspirona/uso terapêutico , Humanos , Imipramina/uso terapêutico , Pessoa de Meia-Idade , Números Necessários para Tratar , Transtorno de Pânico/complicações , Paroxetina/uso terapêutico , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Placebos/uso terapêutico , Propranolol/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão , Adulto Jovem
7.
Cochrane Database Syst Rev ; 3: CD011501, 2019 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-30920649

RESUMO

BACKGROUND: Epilepsy is one of the most common neurological disorders. It is estimated that up to 30% of patients with epilepsy continue to have epileptic seizures despite treatment with an antiepileptic drug. These patients are classified as drug-resistant and require treatment with a combination of multiple antiepileptic drugs. Brivaracetam is a third-generation antiepileptic drug that is a high-affinity ligand for synaptic vesicle protein 2A. This review investigates the use of brivaracetam as add-on therapy for epilepsy. OBJECTIVES: To evaluate the efficacy and tolerability of brivaracetam when used as add-on treatment for people with drug-resistant epilepsy. SEARCH METHODS: We searched the following databases on 9 October 2018: the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL); Medline (Ovid) 1946 to 8 October 2018; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). Originally we also searched SCOPUS as a substitute for Embase, but this is no longer necessary, because randomised and quasi-randomised controlled trials in Embase are now included in CENTRAL. SELECTION CRITERIA: We sought randomised controlled trials with parallel-group design, recruiting people of any age with drug-resistant epilepsy. We accepted studies with any level of blinding (double-blind, single-blind, or unblind). DATA COLLECTION AND ANALYSIS: In accordance with standard methodological procedures expected by the Cochrane Collaboration, two review authors independently assessed trials for inclusion before evaluating trial quality and extracting relevant data. The primary outcome to be assessed was 50% or greater reduction in seizure frequency. Secondary outcomes were: seizure freedom, treatment withdrawal for any reason, treatment withdrawal due to adverse events, the proportion of participants who experienced any adverse events, and drug interactions. We used an intention-to-treat (ITT) population for all primary analyses, and we presented results as risk ratios (RRs) with 95% confidence intervals (CIs). MAIN RESULTS: The review included six trials representing 2411 participants. Only one study included participants with both focal and generalised onset seizures; the other five trials included participants with focal onset seizures only. All six studies included adult participants between 16 and 80 years old, and treatment periods ranged from 7 to 16 weeks. We judged two studies to have low risk of bias and four to have unclear risk of bias. One study failed to provide details on the method used for allocation concealment, and one did not report all outcomes prespecified in the trial protocol. One study did not describe how blinding was maintained, and another noted discrepancies in reporting.Participants receiving brivaracetam add-on were significantly more likely to experience a 50% or greater reduction in seizure frequency than those receiving placebo (RR 1.81, 95% CI 1.53 to 2.14; 6 studies; moderate-quality evidence). Participants receiving brivaracetam were also significantly more likely to attain seizure freedom (RR 5.89, 95% CI 2.30 to 15.13; 6 studies; moderate-quality evidence). The incidence of treatment withdrawal for any reason (RR 1.27, 95% CI 0.94 to 1.74; 6 studies; low-quality evidence), as well as the risk of participants experiencing one or more adverse events (RR 1.08, 95% CI 1.00 to 1.17; 5 studies; moderate-quality evidence), was not significantly different following treatment with brivaracetam compared to placebo. However, participants receiving brivaracetam did appear to be significantly more likely to withdraw from treatment specifically because of adverse events compared with those receiving placebo (RR 1.54, 95% CI 1.02 to 2.33; 6 studies; low-quality evidence). AUTHORS' CONCLUSIONS: Brivaracetam, when used as add-on therapy for patients with drug-resistant epilepsy, is effective in reducing seizure frequency and can aid patients in achieving seizure freedom. However, add-on brivaracetam is associated with a greater proportion of treatment withdrawals due to adverse events compared with placebo. It is important to note that only one of the eligible studies included participants with generalised epilepsy. None of the studies included participants under the age of 16, and all studies were of short duration. Consequently, these findings are mainly applicable to adult patients with drug-resistant focal epilepsy. Future research should thus focus on investigating the tolerability and efficacy of brivaracetam during longer-term follow-up, and should also assess the efficacy and tolerability of add-on brivaracetam in managing other types of seizures and its use in other age groups.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Pirrolidinonas/uso terapêutico , Anticonvulsivantes/efeitos adversos , Interações de Medicamentos , Quimioterapia Combinada , Humanos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Pirrolidinonas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
J Consult Clin Psychol ; 87(3): 246-256, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30777776

RESUMO

OBJECTIVE: One in 3 veterans will dropout from trauma-focused treatments for posttraumatic stress disorder (PTSD). Social environments may be particularly important to influencing treatment retention. We examined the role of 2 support system factors in predicting treatment dropout: social control (direct efforts by loved ones to encourage veterans to participate in treatment and face distress) and symptom accommodation (changes in loved ones' behavior to reduce veterans' PTSD-related distress). METHOD: Veterans and a loved one were surveyed across 4 VA hospitals. All veterans were initiating prolonged exposure therapy or cognitive processing therapy (n = 272 dyads). Dropout was coded through review of VA hospital records. RESULTS: Regression analyses controlled for traditional, individual-focused factors likely to influence treatment dropout. We found that, even after accounting for these factors, veterans who reported their loved ones encouraged them to face distress were twice as likely to remain in PTSD treatment than veterans who denied such encouragement. CONCLUSIONS: Clinicians initiating trauma-focused treatments with veterans should routinely assess how open veterans' support systems are to encouraging veterans to face their distress. Outreach to support networks is warranted to ensure loved ones back the underlying philosophy of trauma-focused treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Implosiva , Pacientes Desistentes do Tratamento/psicologia , Meio Social , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adulto , Terapia Cognitivo-Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
9.
Cochrane Database Syst Rev ; 1: CD007834, 2019 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-30609006

RESUMO

BACKGROUND: Restless legs syndrome (RLS) is a common neurologic disorder that is associated with peripheral iron deficiency in a subgroup of patients. It is unclear whether iron therapy is effective treatment for RLS. OBJECTIVES: To evaluate the efficacy and safety of oral or parenteral iron for the treatment of restless legs syndrome (RLS) when compared with placebo or other therapies. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycNFO, and CINAHL for the time period January 1995 to September 2017. We searched reference lists for additional published studies. We searched Clinicaltrials.gov and other clinical trial registries (September 2017) for ongoing or unpublished studies. SELECTION CRITERIA: Controlled trials comparing any formulation of iron with placebo, other medications, or no treatment, in adults diagnosed with RLS according to expert clinical interview or explicit diagnostic criteria. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality, with discussion to reach consensus in the case of any disagreement. The primary outcome considered in this review was restlessness or unpleasant sensations, as experienced subjectively by the patient. We combined treatment/control differences in the outcomes across studies using random-effects meta-analyses. We analysed continuous data using mean differences (MDs) where possible and performed standardised mean difference (SMD) analyses when different measurements were used across studies. We calculated risk ratios (RRs) for dichotomous data using the Mantel-Haenszel method and 95% confidence intervals (CIs). We analysed study heterogeneity using the I2 statistic. We used standard methodological procedures expected by Cochrane. We performed GRADE analysis using GRADEpro. MAIN RESULTS: We identified and included 10 studies (428 total participants, followed for 2-16 weeks) in this review. Our primary outcome was restlessness or uncomfortable leg sensations, which was quantified using the International Restless Legs Scale (IRLS) (range, 0 to 40) in eight trials and a different RLS symptom scale in a ninth trial. Nine studies compared iron to placebo and one study compared iron to a dopamine agonist (pramipexole). The possibility for bias among the trials was variable. Three studies had a single element with high risk of bias, which was lack of blinding in two and incomplete outcome data in one. All studies had at least one feature resulting in unclear risk of bias.Combining data from the seven trials using the IRLS to compare iron and placebo, use of iron resulted in greater improvement in IRLS scores (MD -3.78, 95% CI -6.25 to -1.31; I2= 66%, 7 studies, 345 participants) measured 2 to 12 weeks after treatment. Including an eighth study, which measured restlessness using a different scale, use of iron remained beneficial compared to placebo (SMD -0.74, 95% CI -1.26 to -0.23; I2 = 80%, 8 studies, 370 participants). The GRADE assessment of certainty for this outcome was moderate.The single study comparing iron to a dopamine agonist (pramipexole) found a similar reduction in RLS severity in the two groups (MD -0.40, 95% CI -5.93 to 5.13, 30 participants).Assessment of secondary outcomes was limited by small numbers of trials assessing each outcome. Iron did not improve quality of life as a dichotomous measure (RR 2.01, 95% CI 0.54 to 7.45; I2=54%, 2 studies, 39 participants), but did improve quality of life measured on continuous scales (SMD 0.51, 95% CI 0.15 to 0.87; I2= 0%, 3 studies, 128 participants), compared to placebo. Subjective sleep quality was no different between iron and placebo groups (SMD 0.19, 95% CI -0.18 to 0.56; I2 = 9%, 3 studies, 128 participants), nor was objective sleep quality, as measured by change in sleep efficiency in a single study (-35.5 +/- 92.0 versus -41.4 +/- 98.2, 18 participants). Periodic limb movements of sleep were not significantly reduced with iron compared to placebo ( SMD -0.19, 95% CI -0.70 to 0.32; I2 = 0%, 2 studies, 60 participants). Iron did not improve sleepiness compared to placebo, as measured on the Epworth Sleepiness Scale (data not provided, 1 study, 60 participants) but did improve the daytime tiredness item of the RLS-6 compared to placebo (least squares mean difference -1.5, 95% CI -2.5 to -0.6; 1 study, 110 participants). The GRADE rating for secondary outcomes ranged from low to very low.Prespecified subgroup analyses showed more improvement with iron in those trials studying participants on dialysis. The use of low serum ferritin levels as an inclusion criteria and the use or oral versus intravenous iron did not show significant subgroup differences.Iron did not result in significantly more adverse events than placebo (RR 1.48, 95% CI 0.97 to 2.25; I2=45%, 6 studies, 298 participants). A single study reported that people treated with iron therapy experienced fewer adverse events than the active comparator pramipexole. AUTHORS' CONCLUSIONS: Iron therapy probably improves restlessness and RLS severity in comparison to placebo. Iron therapy may not increase the risk of side effects in comparison to placebo. We are uncertain whether iron therapy improves quality of life in comparison to placebo. Iron therapy may make little or no difference to pramipexole in restlessness and RLS severity, as well as in the risk of adverse events. The effect on secondary outcomes such as quality of life, daytime functioning, and sleep quality, the optimal timing and formulation of administration, and patient characteristics predicting response require additional study.


Assuntos
Ferro/uso terapêutico , Síndrome das Pernas Inquietas/terapia , Oligoelementos/uso terapêutico , Agonistas de Dopamina/efeitos adversos , Agonistas de Dopamina/uso terapêutico , Compostos Férricos/efeitos adversos , Compostos Férricos/uso terapêutico , Óxido de Ferro Sacarado/efeitos adversos , Óxido de Ferro Sacarado/uso terapêutico , Compostos Ferrosos/efeitos adversos , Compostos Ferrosos/uso terapêutico , Humanos , Ferro/efeitos adversos , Maltose/efeitos adversos , Maltose/análogos & derivados , Maltose/uso terapêutico , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Pramipexol/efeitos adversos , Pramipexol/uso terapêutico , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Oligoelementos/efeitos adversos , Resultado do Tratamento
11.
Behav Ther ; 50(1): 189-199, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30661559

RESUMO

Dropout from psychotherapy is frequent and limits the benefits patients can receive from treatment. The study of factors associated with dropout has the potential to yield strategies to reduce it. This study analyzed data from a large sample of adults (N = 1,092) receiving naturalistic cognitive behavioral therapy (CBT) to test the hypotheses that dropouts, as compared to completers, had (1) higher symptom severity at treatment termination, (2) a slower rate of symptom change during treatment, and (3) a higher odds that the therapist rated treatment as ending for reasons related to poor outcome. Results showed that although dropouts ended treatment with higher symptom severity than completers, dropouts and completers did not differ in their rate of symptom change during treatment, suggesting that dropouts had higher symptom severity at termination because they received fewer sessions of treatment, not because their symptoms changed at a slower rate. Dropout was also associated with a higher odds of having a therapist-rated termination reason indicating a poor outcome, suggesting that dropout is more likely if patients are dissatisfied with some aspect of the therapy outcome or process. These findings suggest that strategies for monitoring and enhancing patient satisfaction with the process and outcome of treatment may help patients stay in treatment longer and end treatment with fewer symptoms than if they had dropped out.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Pacientes Desistentes do Tratamento/psicologia , Satisfação do Paciente , Adulto , Terapia Cognitivo-Comportamental/tendências , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Pulm Pharmacol Ther ; 54: 87-89, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30597278

RESUMO

Mepolizumab (anti IL-5, monoclonal antibody) is commercially available in Italy since more than one year for the treatment of severe hypereosinophilic asthma. Its efficacy and safety were evaluated in several regulatory trials. The characteristics of this drug in real life began to be assessed only recently. We describe herein the drop-out rate observed with mepolizumab in real life, because this datum can indirectly reflect the safety and tolerability aspects. The demographic and clinical data of patients receiving mepolizumab for severe asthma were collected, and the number and reasons for discontinuation of the treatment were analyzed. The database involves 143 patients (67 male, age range 19-80 year) who received at least one dose of mepolizumab. The observed discontinuation rate was 6/143 (4.2%). Five out of 6 discontinuations were due to lack of response, and one was an adverse event (urticaria) probably related to the treatment. There was no clinical difference between the drop-out group and the patients still ongoing. As compared to the clinical trials published the discontinuation rate was lower in our population, especially for adverse events (7% vs 23.7%). Thus, the tolerability of mepolizumab, as derived from discontinuations, seems to be better in real-life than in clinical trials.


Assuntos
Antiasmáticos/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Asma/tratamento farmacológico , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiasmáticos/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Asma/fisiopatologia , Bases de Dados Factuais , Eosinofilia/tratamento farmacológico , Eosinofilia/fisiopatologia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto Jovem
13.
BMC Emerg Med ; 19(1): 5, 2019 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-30634924

RESUMO

BACKGROUND: Though substance use is a known risk factor for self-discharge, patients self-discharging during treatment for acute poisoning have not previously been described. We charted characteristics of patients self-discharging during treatment for acute poisoning by substances of abuse looking for associations between self-discharge, repeated poisoning, and death. METHODS: All patients 12 years and older treated for acute poisoning by substances of abuse at an emergency outpatient clinic in Oslo, Norway, were included consecutively from October 2011 through September 2012. We collected data on gender, age, main toxic agent, suicidal intention, homelessness, history of severe mental illness, and self-discharge. Information on deaths was retrieved from the National Cause of Death Register. We did a multiple logistic regression analysis to look for associations between self-discharge and repeated poisoning and a Cox regression analysis for associations between self-discharge and death. RESULTS: During one year, 1731 patients were treated for 2343 episodes of acute poisoning by substances of abuse. Two-hundred-and-sixty-six (15%) patients self-discharged during at least one poisoning episode. Self-discharging patients were older, median age 39 years vs 32 years (p <  0.001), more frequently homeless, 20/266 (8%) vs 63/1465 (4%) (p = 0.035), and the main toxic agent more frequently was an opioid, 82/266 (31%) vs 282/1465 (19%) (p <  0.001). Self-discharge was an independent risk factor for repeated poisoning. The adjusted odds ratio for two or more poisoning episodes during one year among self-dischargers was 3.0 (95% CI 2.2-4.1). The association was even stronger for three or more poisoning episodes, adjusted odds ratio 5.0 (3.3-7.5). In total, there were 34 deaths, 9/266 (3.4%) among self-discharging patients and 25/1465 (1.7%) among patients not self-discharging (p = 0.12). The adjusted hazard ratio for death among self-discharging patients was 1.6 (0.75-3.6). CONCLUSIONS: Self-discharge was associated with frequent poisonings by substances of abuse. Short-term mortality was doubled among self-discharging patients, though this increase was not statistically significant. Still, the increased risk of repeated poisoning marks self-discharging patients as a vulnerable group who might benefit from targeted post-discharge follow-up measures.


Assuntos
Analgésicos Opioides/envenenamento , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Adulto , Fatores Etários , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Estudos Prospectivos , Recidiva , Fatores de Risco , Adulto Jovem
14.
Rev. enferm. UFPE on line ; 13(1): 118-125, jan. 2019. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1006081

RESUMO

Objetivo: identificar os motivos que levam o cliente idoso com hipertensão arterial sistêmica a abandonar o tratamento anti-hipertensivo. Método: trata-se de estudo qualitativo, descritivo, exploratório, em uma Estratégia Saúde da Família. Compôs-se a pesquisa por idosos cadastrados no programa HIPERDIA que deixaram de frequentar a unidade de saúde. Realizou-se, para a coleta de dados, um grupo focal e, posteriormente, no mês de agosto de 2017, em seguida, analisaram-se as falas por meio do Discurso do Sujeito Coletivo. Resultados: percebeu-se, após a aplicação da pesquisa, que os principais motivos que levaram os idosos com HAS a abandonarem seu tratamento foram o esquecimento em tomar a medicação, os efeitos colaterais dos medicamentos e, ainda, a ausência de sintomas como os principais fatores. Conclusão: faz-se necessária a utilização de métodos, por parte dos profissionais da ESF, para a captação de idosos hipertensos, para a continuidade do seu tratamento, em ações de promoção da saúde que visem à redução de danos e à manutenção de uma melhor qualidade de vida, destacando-se a importância na utilização adequada da medicação anti-hipertensiva.(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pacientes Desistentes do Tratamento , Idoso , Estratégia Saúde da Família , Adesão à Medicação , Promoção da Saúde , Hipertensão , Hipertensão/tratamento farmacológico , Saúde Pública , Epidemiologia Descritiva , Pesquisa Qualitativa
15.
Med. oral patol. oral cir. bucal (Internet) ; 24(1): e20-e25, ene. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-180402

RESUMO

Background: To improve eradication strategies of health-compromising behaviors between oral cancer survivors, this study aimed to explore the extent of clustering of risk behaviors and to assess possible factors associated. Material and Methods: A cross-sectional study was carried out among oral cancer patients at least 6 months after treatment. They completed a questionnaire about smoking, alcohol consumption, oral hygiene habits and dental visits. Presence of clusters was evaluated through pairwise Pearson correlations and principal component analysis. Factors associated with each identified cluster were analyzed with multivariate models. Results: Among 142 patients, 14.8% smoked, 51.7% consumed alcohol, 52.1% performed oral hygiene less than twice a day, and 74.6% visited to dentist when there was a problem or never. There were two distinct clusters: smoking-alcohol consumption (general risk behaviors cluster) and oral hygiene-dental attendance (oral risk behaviors cluster). Multivariate analysis showed significant associations between males and both clustering patterns of health compromising behaviors, patients with clinical stage I or with longer follow-up and the presence of general risk behaviors cluster and worse social class and the presence of oral risk behaviors cluster. Conclusions: A high proportion of patients treated for oral cancer presented health-compromising behaviors occurring in clusters which reinforce the need for health promotion strategies to target multiple behaviors. Factors analyzed suggest that chances of having detrimental behavioral clustering are higher in male, patients with clinical stage I, with lower social class and those with longer follow-up after treatment


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Bucais/terapia , Cooperação do Paciente/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Neoplasias Bucais/epidemiologia , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos
16.
BMC Public Health ; 19(1): 58, 2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642314

RESUMO

BACKGROUND: Following the Syrian crisis, a substantial influx of Syrian refugees into Lebanon posed new challenges to optimal vaccination coverage for all children residing in the country. In 2016, the district-based immunization coverage evaluation survey (CES) assessed routine immunization coverage at the district level in Lebanon among children aged 12-59 months. METHODS: A cross-sectional multistage cluster survey was conducted in all of Lebanon (with the exception of the Nabatieh district) using the World Health Organization (WHO) recommended Expanded Programme on Immunization (EPI) methodology adapted to the local context. A survey questionnaire consisting of closed and open-ended questions concerning demographic information and the child's immunization status was administered to collect immunization status information. RESULTS: Among surveyed children aged 12-59 months, irrespective of nationality, vaccination coverage at the national level for any recommended last dose was below the targeted 95%. Generally, vaccination coverage levels increased with age and were higher among Lebanese than Syrian children. However, large variations were revealed when coverage rates were analyzed at the district level. Vaccination was significantly associated with nationality, age, mother's educational status and the place of vaccination. Common reasons for undervaccination included the child's illness at the time of vaccine administration, vaccination fees, lack of awareness or a doctor's advice not to vaccinate during campaigns. CONCLUSIONS: Substantial variability exists in vaccination coverage among children aged 12-59 months residing in different districts in Lebanon. Immunization coverage reached 90% or above only for the first doses of polio and pentavalent vaccines. A considerable dropout rate from the first dose of any vaccine is observed. Efforts to optimize coverage levels should include increased vaccination initiatives targeting both refugee children and children from vulnerable host communities, increased cooperation between public and private vaccine providers, improved training for vaccine providers to adhere to complete vaccine administration recommendations, and increased awareness among caregivers.


Assuntos
Conflitos Armados , Imunização , Refugiados , Cobertura Vacinal , Vacinação/estatística & dados numéricos , Vacinas/administração & dosagem , Cuidadores , Pré-Escolar , Estudos Transversais , Grupos Étnicos , Feminino , Humanos , Programas de Imunização , Lactente , Líbano , Masculino , Pacientes Desistentes do Tratamento , Poliomielite , Vacinas contra Poliovirus/administração & dosagem , Vacinas contra Rotavirus/administração & dosagem , Inquéritos e Questionários , Síria , Vacinas Atenuadas/administração & dosagem
17.
Med Glas (Zenica) ; 16(1): 45-52, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30589240

RESUMO

Aim To assess efficacy of omalizumab in moderate to severe asthma and notable factors affecting it, such as treatment compliance during the period of ten years. This retrospective, observational real life study is the first of this kind in the Gulf region and one of the worldwide rare long term omalizumab treatment studies. Methods The treatment for 35 patients started in 2008. Twenty patients (ongoing group) proceeded with treatment and were assessed annually until 2017. Reasons for treatment discontinuation in 15 patients (drop-out group) were also assessed. Results Before starting omalizumab the ongoing group of patients had history of ≥2 asthma exacerbations per year, which significantly decreased during the first year of the treatment (p<0.001), and for 14 (70%) patients ≤1 exacerbation stayed during the next 10 years. Since 2014 six (30%) patients had had ≥2 annual asthma exacerbations (p<0.05 in 2013; p<0.05 in 2014; p<0.001 in 2015; p<0.01 in 2016; p<0.001 in 2017). At the same time there was a significant drop in compliance index (CI) (p<0.0001). Conclusion To our knowledge this is the first 10-year study of compliance and effectiveness, which may help finalize some practical suggestions to improve CI in clinical practice and to note acceptable variation in CI. It is important to recognize factors that can possibly affect effectiveness of the treatment and identify the patients who will have the best benefit from a long term omalizumab treatment.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Adesão à Medicação , Omalizumab/uso terapêutico , Índice de Gravidade de Doença , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento , Estudos Retrospectivos , Resultado do Tratamento
18.
Psychiatry Res ; 271: 484-501, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30551081

RESUMO

Understanding variables predicting drop-out or unfavourable outcome following treatment for anorexia nervosa (AN) may help to improve upon intervention efforts. However, the current literature has demonstrated sparse and inconsistent significant findings. The current systematic review and meta-analysis summarised the evidence base examining baseline predictors of drop-out and outcome in AN treatment. A literature search was conducted to identify research investigating predictors of drop-out and outcome in individuals treated for AN. Four online databases were searched, and predictors were organised by category and dependent variable (outcome versus drop-out). 27 studies were included. Lower motivation, lower BMI, and having the binge-purge subtype of AN predicted drop-out. Greater ED pathology and poorer motivation predicted poorer outcome. Clinical recommendations include taking particular care during assessment stages to identify patients at risk of drop-out and/or poor outcome based on their clinical profile and level of motivation for recovery. At-risk patients should be receiving tailored treatment to enhance engagement and reduce risk of drop-out. In conclusion, there's some evidence that motivation, BMI, subtype, and ED pathology predicts drop-out and/or outcome in individual and family-based therapy for AN amongst adolescents and adults; however, research incorporating carefully designed multi-site studies is required to further examine these findings.


Assuntos
Anorexia Nervosa/terapia , Terapia Familiar/estatística & dados numéricos , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Psicoterapia/estatística & dados numéricos , Adolescente , Adulto , Humanos
19.
Am J Orthod Dentofacial Orthop ; 155(1): 19-27.e3, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30591159

RESUMO

INTRODUCTION: Intention-to-treat (ITT) analysis is an approach to managing dropouts and missing data in randomized controlled trials (RCTs). In this study, we systematically reviewed orthodontic RCTs to assess the frequency that an ITT analysis was carried out, to compare the number of trials that reported using ITT analyses with those that had truly used it, and to evaluate how dropouts and missing data were managed. METHODS: Systematic searches were conducted in electronic databases including Cochrane Oral Health's Trials Register (searched on November 30, 2016) and Cochrane Central Register of Controlled Trials (2016) in the Cochrane Library (searched on November 30, 2016), with no restrictions on language, publication year, or publication status. RCTs comparing orthodontic or orthopedic treatments, or comparing orthodontic or orthopedic treatment with a control group without intervention were included. A customized data collection form was created, piloted, and used to gather information from the selected studies. The data extraction was performed by 2 authors independently and in duplicate, with disagreements resolved by discussion with the third author. The studies were assessed for attrition bias. The data were grouped and classified according to 2 categorical variables: sample analyzed and missing data strategy. The results were reported in percentages and descriptively. RESULTS: From the 55 RCTs identified, 6 reported using an ITT approach. From these, only 1 study carried out a true ITT analysis (2%). From the 49 RCTs that did not report using an ITT analysis, 12 had used it (22%). The most used method of analyzing missing data was "completer sample" with 19 studies using this method (28%). "Full random sample" and "sufficient dose" were similar, with 13 and 11 studies, respectively (16% and 14%). The most frequently used missing data strategy for studies that did not conduct a true ITT analysis was "sample followed" with 30 studies (81%). For the studies that conducted a true ITT analysis, the most observed missing data strategy was "no dropouts" with 11 studies (79%). CONCLUSIONS: Less than a third of the RCTs in orthodontics used an ITT analysis. There is a potential lack of understanding on dropouts and missing data management in research on orthodontic treatment.


Assuntos
Análise de Intenção de Tratamento , Ortodontia , Pacientes Desistentes do Tratamento , Humanos
20.
J Neurosurg Anesthesiol ; 31(2): 212-217, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30557230

RESUMO

BACKGROUND: Cognitive training is beneficial in various clinical settings, although its perioperative feasibility and impact remain unknown. The objective of this pilot study was to determine the feasibility of home-based cognitive prehabilitation before major surgery in older adults. MATERIALS AND METHODS: Sixty-one patients were enrolled, randomized, and allocated to either a home-based preoperative cognitive training regimen or no training before surgery. Outcomes included postoperative delirium incidence (primary outcome; assessed with the 3D-Confusion Assessment Method), perioperative cognitive function based on NIH Toolbox measures, hospital length of stay, and physical therapy session participation. Reasons for declining enrollment were reported, as were reasons for opting out of the training program. RESULTS: Postoperative delirium incidence was 6 of 23 (26%) in the prehabilitation group compared with 5 of 29 (17%) in the control group (P=0.507). There were no significant differences between groups in NIH Toolbox cognitive function scoring, hospital length of stay, or physical therapy participation rates. Study feasibility data were also collected and reported. The most common reasons for declining enrollment were lack of computer access (n=19), time commitment (n=9), and feeling overwhelmed (n=9). In the training group, only 5 of 29 (17%) included patients were able to complete the prescribed 7 days of training, and 14 of 29 (48%) opted out of training once home. Most common reasons were feeling overwhelmed (n=4) and computer difficulties (n=3). CONCLUSIONS: Short-term, home-based cognitive training before surgery is unlikely to be feasible for many older patients. Barriers to training include feeling overwhelmed, technical issues with training, and preoperative time commitment.


Assuntos
Transtornos Cognitivos/prevenção & controle , Delírio/prevenção & controle , Serviços de Assistência Domiciliar , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Idoso , Transtornos Cognitivos/psicologia , Delírio/psicologia , Estudos de Viabilidade , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Pacientes Desistentes do Tratamento , Modalidades de Fisioterapia , Projetos Piloto , Complicações Pós-Operatórias/psicologia , Método Simples-Cego , Resultado do Tratamento
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