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2.
World J Gastroenterol ; 25(36): 5403-5422, 2019 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-31576089

RESUMO

The Chinese Society of Hepatology developed the current guidelines on the management of hepatic encephalopathy in cirrhosis based on the published evidence and the panelists' consensus. The guidelines provided recommendations for the diagnosis and management of hepatic encephalopathy (HE) including minimal hepatic encephalopathy (MHE) and overt hepatic encephalopathy, emphasizing the importance on screening MHE in patients with end-stage liver diseases. The guidelines emphasized that early identification and timely treatment are the key to improve the prognosis of HE. The principles of treatment include prompt removal of the cause, recovery of acute neuropsychiatric abnormalities to baseline status, primary prevention, and secondary prevention as soon as possible.


Assuntos
Doença Hepática Terminal/complicações , Gastroenterologia/normas , Encefalopatia Hepática/terapia , Cirrose Hepática/complicações , Sociedades Médicas/normas , China , Consenso , Doença Hepática Terminal/terapia , Gastroenterologia/métodos , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/etiologia , Humanos , Cirrose Hepática/terapia , Prognóstico , Prevenção Secundária/métodos , Prevenção Secundária/normas , Fatores de Tempo
3.
J Stroke Cerebrovasc Dis ; 28(12): 104445, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31627997

RESUMO

BACKGROUND: Stroke is a leading cause of disability worldwide with a great impact on quality of life. Ain Shams University Hospital is a tertiary center for neurology and a pioneer in offering comprehensive stroke service in the region. METHODS: A cross sectional study in which an 8 domains questionnaire was applied to all cerebrovascular stroke patients who were admitted to the stroke unit of the neurology department of Ain Shams University Hospital in the period from January 2016 till May 2017, with the aim to define pitfalls in post discharge. RESULTS: From our study show that 20% of all patients discharged from acute stroke unit did not have further follow up with any stroke doctor. Moreover, 60% of patients were not seen by a physiotherapist after discharge, including almost half of patients with moderate or severe disability on discharge who are expected to have ongoing care needs. Patients who developed stroke complications were more likely to seek follow up. As expected, continuous follow up was associated with increased adherence to secondary preventive medications. CONCLUSIONS: Patient needs should be assessed before patient discharge and patient and care givers should have clear written information on required follow up with stroke doctors, and arrangements made for receiving adequate rehabilitation post discharge.


Assuntos
Continuidade da Assistência ao Paciente/normas , Hospitais Universitários , Sumários de Alta do Paciente Hospitalar/normas , Alta do Paciente/normas , Padrões de Prática Médica/normas , Prevenção Secundária/normas , Acidente Vascular Cerebral/terapia , Idoso , Estudos Transversais , Avaliação da Deficiência , Egito , Feminino , Fidelidade a Diretrizes/normas , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia/normas , Guias de Prática Clínica como Assunto/normas , Prognóstico , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Centros de Atenção Terciária
4.
Arch Cardiovasc Dis ; 112(8-9): 532-542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31378692

RESUMO

BACKGROUND: Unlike previous randomized clinical trials (RCTs), recent trials and meta-analyses have shown that transcatheter closure of patent foramen ovale (PFO) reduces stroke recurrence risk in young and middle-aged adults with an otherwise unexplained PFO-associated ischaemic stroke. AIM: To produce an expert consensus on the role of transcatheter PFO closure and antithrombotic drugs for secondary stroke prevention in patients with PFO-associated ischaemic stroke. METHODS: Five neurologists and five cardiologists with extensive experience in the relevant field were nominated by the French Neurovascular Society and the French Society of Cardiology to make recommendations based on evidence from RCTs and meta-analyses. RESULTS: The experts recommend that any decision concerning treatment of patients with PFO-associated ischaemic stroke should be taken after neurological and cardiological evaluation, bringing together the necessary neurovascular, echocardiography and interventional cardiology expertise. Transcatheter PFO closure is recommended in patients fulfilling all the following criteria: age 16-60 years; recent (≤6 months) ischaemic stroke; PFO associated with atrial septal aneurysm (>10mm) or with a right-to-left shunt>20 microbubbles or with a diameter≥2mm; PFO felt to be the most likely cause of stroke after thorough aetiological evaluation by a stroke specialist. Long-term oral anticoagulation may be considered in the event of contraindication to or patient refusal of PFO closure, in the absence of a high bleeding risk. After PFO closure, dual anti-platelet therapy with aspirin (75mg/day) and clopidogrel (75mg/day) is recommended for 3 months, followed by monotherapy with aspirin or clopidogrel for≥5 years. CONCLUSIONS: Although a big step forward that will benefit many patients has been taken with recent trials, many questions remain unanswered. Pending results from further studies, decision-making regarding management of patients with PFO-associated ischaemic stroke should be based on a close coordination between neurologists/stroke specialists and cardiologists.


Assuntos
Isquemia Encefálica/prevenção & controle , Cateterismo Cardíaco/normas , Cardiologia/normas , Forame Oval Patente/terapia , Prevenção Secundária/normas , Acidente Vascular Cerebral/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Consenso , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Medição de Risco , Fatores de Risco , Dispositivo para Oclusão Septal/normas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento , Adulto Jovem
5.
J Surg Res ; 244: 122-129, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31284141

RESUMO

BACKGROUND: The objective of this study was to evaluate clinical outcomes, costs, and clinician and parent satisfaction after implementation of a protocol to discharge patients from the emergency department (ED) after successful reduction of uncomplicated ileocolic intussusception. MATERIALS AND METHODS: In March 2017, an intussusception management protocol was implemented for children presenting with ultrasound findings of ileocolic intussusception. Those meeting inclusion criteria were observed after successful radiological reduction in the ED and discharged after 6 h with resolution of symptoms. Retrospective chart review was completed for cases before and after protocol implementation for clinical outcomes and costs. Clinicians and parents were surveyed to assess overall satisfaction. RESULTS: Charts were reviewed before (42 encounters, 37 patients) and after (30 encounters, 23 patients) protocol implementation. After implementation, admission rates decreased from 95% (40/42) to 23% (7/30; P < 0.001) and antibiotic use was eliminated (91% to 0%, P < 0.001). There was no difference in recurrence rates (17% versus 23%, P = 0.44). Median total length of stay decreased from 18.87 to 9.52 h (P < 0.001), whereas median ED length of stay increased from 4.37 to 9.87 h (P < 0.001). In addition, there was an overall hospital cost saving of over $2000 ($9595 ± 3424 to $7465 ± 3723; P = 0.009) per encounter. Clinicians and parents were overall satisfied with the protocol and parents showed no changes in patient satisfaction with protocol implementation. CONCLUSIONS: An intussusception protocol can facilitate early discharge from the ED and improve patient care without increased risk of recurrence. Additional benefits include decreased hospital- and patient-related costs, elimination of antibiotic use, and parent as well as clinician satisfaction.


Assuntos
Protocolos Clínicos/normas , Implementação de Plano de Saúde , Doenças do Íleo/terapia , Intussuscepção/terapia , Satisfação Pessoal , Pré-Escolar , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Enema , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Doenças do Íleo/economia , Lactente , Recém-Nascido , Intussuscepção/economia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Alta do Paciente/normas , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Estudos Retrospectivos , Prevenção Secundária/economia , Prevenção Secundária/organização & administração , Prevenção Secundária/normas , Inquéritos e Questionários/estatística & dados numéricos
7.
Osteoporos Int ; 30(9): 1779-1788, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31190123

RESUMO

The purpose of this study was to assess the performance of our Fracture Liaison Service (FLS) over a period of 2 years. Osteoporosis medication was prescribed for 243 patients, and zoledronic acid was the main drug prescribed (60.2%). INTRODUCTION: A Fracture Liaison Service (FLS) was implemented at Lille University Hospital in 2016. The main purpose of this study was to assess the performance of the FLS using criteria proposed by the International Osteoporosis Foundation (IOF). METHODS: The criteria used were patient identification, patient evaluation, post-fracture assessment timing, vertebral-fracture identification, blood and bone mineral density (BMD) testing, falls prevention, multifaceted health and lifestyle risk-factor assessment, and medication initiation and review. RESULTS: Between January 2016 and January 2018, 736 patients (≥ 50 years old) with a recent history of fragility fracture (≤ 12 months) were identified. The identification rate for hip fractures was 74.2%. However, patient evaluation for all type of fractures was quite low (30.3%) since many patients failed to attend the FLS unit. The reasons for non-attendance were refusal, agreed but subsequently failed to attend, and still waiting to be seen. In all, 256 patients (76.6% female, mean (SD) age 74.3 (11.0) years) were seen at the FLS. Mean (SD) post-fracture assessment timing was 13.3 (9.3) weeks. Of the 139 patients seen for a non-vertebral fracture, 103 were assessed for vertebral fractures, and at least one new vertebral fracture was found in 45 of them (43.7%). Osteoporosis medication was prescribed for 243 (94.9%) patients. The main osteoporosis drug prescribed was zoledronic acid (60.2%). CONCLUSIONS: Secondary prevention of osteoporotic fractures has improved since the implementation of the FLS. However, patient identification, patient evaluation, and post-fracture assessment timing still need to be improved.


Assuntos
Fraturas por Osteoporose/prevenção & controle , Prevenção Secundária/métodos , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/uso terapêutico , Comunicação , Procedimentos Clínicos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/normas , Feminino , França/epidemiologia , Pesquisa sobre Serviços de Saúde/métodos , Hospitais Universitários/organização & administração , Hospitais Universitários/normas , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Pacientes não Comparecentes/estatística & dados numéricos , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Medição de Risco/métodos , Prevenção Secundária/organização & administração , Prevenção Secundária/normas
8.
Diagn Interv Radiol ; 25(4): 310-319, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31199287

RESUMO

PURPOSE: Active bleeding due to abdominal trauma is an important cause of mortality in childhood. The aim of this study is to demonstrate the advantages of early percutaneous transcatheter arterial embolization (PTAE) procedures in children with intra-abdominal hemorrhage due to blunt trauma. METHODS: Children with blunt abdominal trauma were retrospectively included. Two groups were identified for inclusion: patients with early embolization (EE group, n=10) and patients with late embolization (LE group, n=11). Both groups were investigated retrospectively and statistically analyzed with regard to lengths of stay in the intensive care unit and in the hospital, first enteral feeding after trauma, blood transfusion requirements, and cost. RESULTS: The duration of stay in the intensive care unit was greater in the LE group than in the EE group (4 days vs. 2 days, respectively). The duration of hospital stay was greater in the LE group than in the EE group (14 days vs. 6 days, respectively). Blood transfusion requirements (15 cc/kg of RBC packs) were greater in the LE group than in the EE group (3 vs. 1, respectively). The total hospital cost was higher in the LE group than in the EE group (4502 USD vs. 1371.5 USD, respectively). The time before starting enteral feeding after first admission was higher in the LE group than in the EE group (4 days vs. 1 day, respectively). CONCLUSION: Early embolization with PTAE results in shorter intensive care and hospitalization stays, earlier enteral feeding, and lower hospital costs for pediatric patients with intra-abdominal hemorrhage due to blunt trauma.


Assuntos
Traumatismos Abdominais/complicações , Embolização Terapêutica/métodos , Prevenção Secundária/normas , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/economia , Adolescente , Transfusão de Sangue/estatística & dados numéricos , Transfusão de Sangue/tendências , Criança , Pré-Escolar , Nutrição Enteral/estatística & dados numéricos , Nutrição Enteral/tendências , Feminino , Hemorragia/etiologia , Hemorragia/mortalidade , Humanos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Masculino , Estudos Retrospectivos , Prevenção Secundária/estatística & dados numéricos , Tomografia Computadorizada por Raios X
9.
Value Health Reg Issues ; 18: 151-158, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31082795

RESUMO

OBJECTIVES: To systematically review and assess the quality of the economic evidence of adjuvant trastuzumab usage in early breast cancer in Asian countries. METHODS: Literature search was performed using 6 electronic databases (PubMed, Scopus, Ovid MEDLINE, EconLit, National Health Service Economic Evaluation Database, and ISI Web of Knowledge). The final search was performed in October 2018. All potential economic studies were then checked for eligibility. The reporting and methodological qualities of each study were independently assessed by 2 authors of this review, using the Consolidated Health Economic Evaluation Reporting Standards, Drummond, and Philips checklists. To compare the different currencies used in these studies, all costs were converted into US dollars (2016). RESULTS: A total of 6 studies were included; most of them were performed from the healthcare provider perspective. The incremental cost-effectiveness ratio for evaluation performed for a lifetime horizon were reported at $8573 and $20 816 per quality-adjusted life-year in 2 studies. The model outcome was generally sensitive to the changes in trastuzumab drug acquisition cost and discount rate, as well as its clinical effectiveness. For the quality assessment, all studies fulfilled more than 50% of the requirements in the Consolidated Health Economic Evaluation Reporting Standards, Drummond, and Philips checklists. CONCLUSIONS: Adjuvant trastuzumab therapy is considered a cost-effective option for early breast cancer in Asian countries including China, Iran, Japan, Singapore, and Taiwan. All studies were generally well conducted. Economic evaluations from the societal perspective, with inclusion of indirect and informal care costs, are warranted to facilitate informed decision making among policy makers.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Análise Custo-Benefício/normas , Prevenção Secundária/métodos , Trastuzumab/economia , Neoplasias da Mama/economia , Feminino , Humanos , Prevenção Secundária/normas , Trastuzumab/uso terapêutico
10.
Acta Neurol Scand ; 140(2): 107-115, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31017305

RESUMO

OBJECTIVES: The clinical benefits of use of secondary preventive pharmacotherapy in ischemic stroke/TIA have been previously demonstrated. A potential target for facilitating the use of recommended medications is primary care physicians. Therefore, we carried out an audit and feedback intervention aimed at primary care centers. The aim was to improve the use of secondary preventive stroke medications and diagnosis recording in ischemic stroke/TIA. MATERIALS AND METHODS: The intervention consisted of structured, healthcare database-derived quality reports on secondary preventive medication use and diagnosis recording, sent in 2015 to half of the primary care centers in Stockholm County, with information specific to each primary care center. Medication dispensation (primary outcome) for statins, antihypertensives, antiplatelets, and anticoagulants, as well as diagnosis recording (secondary outcome), was compared between intervention centers and control centers in the 18 months following the intervention. Outcome data were derived from the healthcare databases of Stockholm County (VAL). RESULTS: Dispensation of medications to the 12 766 patients analyzed in the study was high. Over 77% of patients used antihypertensives and antithrombotics, and 65%-68% used statins. After the intervention, no differences in medication dispensation were seen between the intervention and control centers, even after adjusting for potential confounders. CONCLUSIONS: A simple audit and feedback intervention directed toward physicians in primary care did not improve medication dispensation to ischemic stroke/TIA patients 18 months later. Any future audit and feedback intervention aimed at improving adherence to guidelines for secondary prevention in primary care should consider multiple and continuous reminders, the graphical appeal, and widening the recipients to include patients.


Assuntos
Ataque Isquêmico Transitório/tratamento farmacológico , Prevenção Secundária/normas , Acidente Vascular Cerebral/tratamento farmacológico , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Ataque Isquêmico Transitório/prevenção & controle , Masculino , Auditoria Médica , Prevenção Secundária/métodos , Acidente Vascular Cerebral/prevenção & controle
12.
BMC Cardiovasc Disord ; 19(1): 71, 2019 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-30922234

RESUMO

BACKGROUND: Patients with established coronary artery disease (CAD) have an increased risk of new cardiovascular events. An underuse of secondary preventive drugs has been observed, and many patients may not attain the treatment goals for secondary prevention. The aims of the present nationwide register-based cohort study were to assess the degree of risk factor control and long-term outcomes in patients < 80 years with Type 1 myocardial infarction (MI) with and without prior CAD. METHODS: Data concerning all patients with MI admitted to hospitals in Norway from 2013 to 2016 were retrieved from the Norwegian Myocardial Infarction Register (NORMI). Long-term mortality was obtained through linkage with the Norwegian Cause of Death Registry. RESULTS: In total, 47,204 patients were registered in the NORMI from 2013 to 2016. Prior CAD was recorded in 7219 (25.2%) of the 28,607 patients < 80 years old with Type 1 MIs. On average, 3 of the 6 defined treatment targets for secondary preventive therapy were attained, and only 1% of the patients achieved all targets. Patients with MI and prior CAD had increased risk of death or new MI compared to patients without prior CAD during long-term follow-up (adjusted HR 1.6, 95% CI 1.5-1.7). CONCLUSIONS: Prior CAD was frequent in patients with acute MI. The attainment of secondary preventive treatment targets in patients with MI and prior CAD was not optimal, and the long-term outcomes were reduced compared to patients without prior CAD. Increased efforts to improve risk factor control are needed.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Doença da Artéria Coronariana/terapia , Fidelidade a Diretrizes/normas , Infarto do Miocárdio/terapia , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Comportamento de Redução do Risco , Prevenção Secundária/normas , Idoso , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Noruega/epidemiologia , Recidiva , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
J Orthop Surg Res ; 14(1): 72, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30841897

RESUMO

INTRODUCTION: Osteoporosis is often not recognized until one or more fractures occur, yet post-fracture screening remains uncommon. Orthopedic surgeons are well situated to address this care gap. Both a protocol-based approach and fracture liaison services (FLS) have been proposed. The present surveys assess orthopedists' attitudes to these alternative models for addressing this care gap. METHODS: Two digital surveys were sent to all orthopedic surgeons and orthopedic midlevel providers at a large level 1 trauma center 1.5 years apart. RESULTS: Thirty-six of 47 survey recipients (77%) responded to the first survey; all 55 recipients (100%) responded to the second. Respondents recognized the importance of osteoporosis care, the inadequacy of current measures, and the potential of orthopedic surgeons to help address this gap. Respondents reported regular encounters with fragility fracture patients but limited familiarity with core aspects of osteoporosis screening and treatment, especially pharmacotherapy. While some respondents (40%) reported willingness to attempt a protocol-based approach to addressing this care gap, many others expressed reservations (60%) and support for a FLS-based approach was much higher (95%). CONCLUSIONS: A fracture liaison service model best fits the observed attitudes of orthopedic surgeons at this level 1 trauma center relative to a protocol-based approach. Protocol-based approaches may be preferable in alternate settings.


Assuntos
Cirurgiões Ortopédicos/normas , Osteoporose/terapia , Fraturas por Osteoporose/terapia , Qualidade da Assistência à Saúde/normas , Inquéritos e Questionários , Humanos , Cirurgiões Ortopédicos/psicologia , Osteoporose/diagnóstico , Osteoporose/prevenção & controle , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/prevenção & controle , Prevenção Secundária/métodos , Prevenção Secundária/normas , Vitamina D/administração & dosagem
15.
JMIR Mhealth Uhealth ; 7(3): e11568, 2019 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-30924789

RESUMO

BACKGROUND: Schizophrenia relapses are common, have profound, adverse consequences for patients and are costly to health services. Early signs interventions aim to use warning signs of deterioration to prevent full relapse. Such interventions show promise but could be further developed. This study addresses 2 developments: adding basic symptoms to checklists of conventional early signs and using a mobile phone app ExPRESS to aid early signs monitoring. OBJECTIVE: This study aimed to (1) design a pool of self-report items assessing basic symptoms (Basic Symptoms Checklist, BSC); (2) develop and beta test a mobile phone app (ExPRESS) for monitoring early signs, basic symptoms, and psychotic symptoms; and (3) evaluate the long-term acceptability of ExPRESS via qualitative feedback from participants in a 6-month feasibility study. METHODS: The BSC items and ExPRESS were developed and then adjusted following feedback from beta testers (n=5) with a schizophrenia diagnosis. Individuals (n=18) experiencing a relapse of schizophrenia within the past year were asked to use ExPRESS for 6 months to answer weekly questions about experiences of early signs, basic symptoms, and psychotic symptoms. At the end of follow-up, face-to-face qualitative interviews (n=16; 2 were uncontactable) explored experiences of using ExPRESS. The topic guide sought participants' views on the following a priori themes regarding app acceptability: item content, layout, and wording; app appearance; length and frequency of assessments; worries about app use; how app use fitted with participants' routines; and the app's extra features. Interview transcripts were analyzed using the framework method, which allows examination of both a priori and a posteriori themes, enabling unanticipated aspects of app use experiences to be explored. RESULTS: Participants' mean age was 38 years (range 22-57 years). Responses to a priori topics indicated that long-term use of ExPRESS was acceptable; small changes for future versions of ExPRESS were suggested. A posteriori themes gave further insight into individuals' experiences of using ExPRESS. Some reported finding it more accessible than visits from a clinician, as assessments were more frequent, more anonymous, and did not require the individual to explain their feelings in their own words. Nevertheless, barriers to app use (eg, unfamiliarity with smartphones) were also reported. Despite ExPRESS containing no overtly therapeutic components, some participants found that answering the weekly questions prompted self-reflection, which had therapeutic value for them. CONCLUSIONS: This study suggests that apps are acceptable for long-term symptom monitoring by individuals with a schizophrenia diagnosis across a wide age range. If the potential benefits are understood, patients are generally willing and motivated to use a weekly symptom-monitoring app; most participants in this study were prepared to do so for more than 6 months. TRIAL REGISTRATION: ClinicalTrials.gov NCT03558529; https://clinicaltrials.gov/ct2/show/NCT03558529 (Archived by WebCite at http://www.webcitation.org/70qvtRmZY).


Assuntos
Aplicativos Móveis/normas , Transtornos Psicóticos/diagnóstico , Prevenção Secundária/instrumentação , Síndrome , Fatores de Tempo , Adulto , Estudos de Viabilidade , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Desenvolvimento de Programas/métodos , Transtornos Psicóticos/complicações , Pesquisa Qualitativa , Prevenção Secundária/métodos , Prevenção Secundária/normas , Autorrelato/estatística & dados numéricos , Smartphone/instrumentação
16.
Urologe A ; 58(9): 1019-1028, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-30623216

RESUMO

BACKGROUND: Several studies have shown that nonadherence to guidelines is pretty common in the treatment of urinary tract infections (UTI). However, no urological study has raised the question, what are barriers or reasons for this nonadherence, yet. OBJECTIVES: Consequently, we performed a survey among German urologists with the primary endpoint identification of barriers for nonadherence to German guidelines on UTI. MATERIALS AND METHODS: A 19-item questionnaire was developed and transferred to the online portal "Survey Monkey®" (Private Equity, San Mateo, CA, USA) and tested for usability by our study group. The link for the survey was sent twice to the members of the German Society of Urology (DGU). RESULTS: Overall, 307 questionnaires were completed. The mean age of the study population was 46.7 years (standard deviation 11.5). The majority (34.9%) followed guidelines in 80% of the cases. Main reasons for nonadherence on the physicians' side were 23.4% personal experience and lacking practicality of UTI guidelines on the individual complex patient. On the open questions urologists mostly stated (11.7%) that the main reason on the physician side for nonadherence is ignorance. Therefore they, in open questions, suggest to promote guidelines more in meetings and more designed practically with shortcuts and simple layout. Patient-associated factors mentioned were mostly in 26.7%. Furthermore, German urologists stated that guidelines should also have a patient section, where the main recommendations are explained in plain language. CONCLUSION: We performed the first survey on identifying barriers for nonadherence to guidelines in urology. Despite some limitations, our results are very important for the further design of guidelines. This has the potential to improve guideline adherence.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Bacteriúria/epidemiologia , Infecções Comunitárias Adquiridas/terapia , Fidelidade a Diretrizes , Médicos/psicologia , Guias de Prática Clínica como Assunto , Prevenção Secundária/normas , Infecções Urinárias/diagnóstico , Infecções Urinárias/terapia , Adulto , Infecções Bacterianas/epidemiologia , Bacteriúria/diagnóstico , Infecções Comunitárias Adquiridas/diagnóstico , Medicina Baseada em Evidências , Alemanha , Humanos , Padrões de Prática Médica , Inquéritos e Questionários , Infecções Urinárias/epidemiologia , Urologia/normas
17.
Am J Ther ; 26(5): 593-599, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29757761

RESUMO

BACKGROUND: Aspirin (ASA) is the most used medication on the globe. ASA is a primary pillar of the secondary prevention of cardiovascular atherothromboembolic events. However, a fraction of the population does not respond to ASA as expected in a unique phenomenon called ASA resistance. Multiple mechanisms were described and studied in the literature to explain this phenomenon. AREA OF UNCERTAINTY: ASA resistance is an interesting phenomenon that is worth studying and reviewing. Mechanisms behind this resistance are various and although the rarity of some, it is crucial for the modern health provider to be aware of such phenomenon and its possible explanations to provide more efficient preventive cardiology practice. Our study aimed to review and conclude the evidence behind ASA resistance and its implication on the cardiovascular health. DATA SOURCES: We searched databases like PubMed, EMBASE, Ovid by midline, and Google Scholar for published articles and abstracts. RESULTS: Our systemic search revealed more than 100 articles in relation to ASA resistance. We selected 40 articles, which were relevant for this review. Various mechanisms were described in the literature, with few of them very well documented and understood. Main mechanisms include medication nonadherence, interaction with proton pump inhibitors, esterase-mediated ASA inactivation, post-coronary artery bypass grafting (CABG) MRP-4-mediated ASA consumption, cyclooxygenase-1 (COX-1) polymorphisms, high platelet turnover-associated regeneration of platelet COX-1, and the documented platelet ability of de novo COX-1 synthesis in response to thrombin and fibrinogen. CONCLUSION: Multiple mechanisms of ASA resistance were described in the literature. Awareness of such interaction is important for medical practitioners. Bottom line, further studies and reviews are needed to further study this phenomenon and its implication on the cardiovascular health and hence reaching a valid evidence-based conclusion that might change the practice and improve the patient preventive health care.


Assuntos
Aspirina/farmacologia , Doenças Cardiovasculares/prevenção & controle , Inibidores da Agregação de Plaquetas/farmacologia , Prevenção Secundária/normas , Aspirina/uso terapêutico , Resistência a Medicamentos , Medicina Baseada em Evidências/normas , Humanos , Inibidores da Agregação de Plaquetas/uso terapêutico , Guias de Prática Clínica como Assunto , Fatores de Risco
18.
Heart Lung Circ ; 28(2): 257-262, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29523466

RESUMO

BACKGROUND: We assessed the effect of a pre-discharge medication checklist on discharge prescription rates of guideline recommended medications following myocardial infarction. In addition, we assessed what proportion of the residual prescribing gap following implementation of the checklist was due to the presence of contraindications. METHODS: We examined baseline prescription rates of guideline recommended medications in 100 patients discharged from our institution following acute myocardial infarction. We then introduced a pre-discharge checklist and reassessed discharge medications and reasons for non-prescription of guideline recommended medications in 447 patients with acute myocardial infarction. RESULTS: We demonstrated a significant gap in the prescription of guideline recommended secondary prevention medications at the time of discharge in our pre-intervention cohort. Introduction of a pre-discharge checklist resulted in a significant improvement in the prescription rates of all guideline recommended secondary prevention medications, with aspirin increasing from 90% to 97% (p=0.004), Adenosine diphosphate (ADP) receptor antagonist from 84% to 96% (p=0.0001), B-blocker from 79% to 87% (p=0.03), statin from 88% to 96% (p=0.002) and angiotensin converting enzyme (ACE) inhibitor from 58% to 70% (p=0.03). The residual gap in prescribing was largely explained by the presence of contraindications or absence of an indication in the case of ACE-inhibitors. Once these were taken into account there was a residual gap of 0-4% which represents genuine non-adherence to the guidelines. CONCLUSIONS: Introduction of a pre-discharge checklist led to significant improvement in prescription rates of all five guideline recommended secondary prevention medications. The residual gap in medication prescription following introduction of the checklist was largely due to the presence of contraindications rather than non-adherence.


Assuntos
Síndrome Coronariana Aguda/prevenção & controle , Fármacos Cardiovasculares/uso terapêutico , Prescrições de Medicamentos/normas , Fidelidade a Diretrizes , Infarto do Miocárdio/complicações , Prevenção Secundária/normas , Síndrome Coronariana Aguda/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Prospectivos
19.
Transplantation ; 103(1): 57-67, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30335694

RESUMO

Nonalcoholic steatohepatitis (NASH) is a growing indication for liver transplant whether the primary or secondary cause of liver disease, and it is expected to be the leading indication in the years to come. Nonalcoholic steatohepatitis recurs after transplant but the impact of the recurrence on allograft and patient outcomes is unclear. A group of multidisciplinary transplant practice providers convened at the International Liver Transplantation Society NASH consensus conference with the purpose of determining the current knowledge and future directions for understanding the recurrence rates, risk and management of NASH in the transplant allograft. Specific questions relating to posttransplant NASH were proposed and reviewed in detail with recommendations on future actions to fill the knowledge gaps.


Assuntos
Conferências de Consenso como Assunto , Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Hepatopatia Gordurosa não Alcoólica/cirurgia , Prevenção Secundária/normas , Aloenxertos/patologia , Biópsia/normas , Comorbidade , Humanos , Fígado/patologia , Cirrose Hepática/epidemiologia , Cirrose Hepática/patologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/patologia , Guias de Prática Clínica como Assunto , Recidiva , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Can J Cardiol ; 35(5): 590-597, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30454967

RESUMO

Treatment guidelines have proliferated in cardiology, although most guideline recommendations are not supported by clinical trial evidence. What is considered to be a normal cholesterol level has progressively declined over the past 50 years, with the increasing realization that "normal" is far from optimal and that lower is better. The first important United States and Canadian cholesterol guidelines were published in 1988, and recommended diet for 6 months to be followed by consideration of bile acid sequestrants or nicotinic acid. Over the ensuing 25 years guidelines have changed rapidly and dramatically in response to a large number of definitive clinical trials, usually with statins. Low-density lipoprotein cholesterol targets have moved progressively lower, and in some guidelines, have been abandoned entirely. The concept of selecting patients for treatment according to the absolute risk reduction expected from treatment on the basis of clinical trial data seems to be a rational approach. For secondary prevention, some patients are still untreated or undertreated, presenting an opportunity for improving outcomes.


Assuntos
Anticolesterolemiantes/farmacologia , Doenças Cardiovasculares/prevenção & controle , Prevenção Secundária , Humanos , Guias de Prática Clínica como Assunto , Prevenção Secundária/métodos , Prevenção Secundária/normas
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