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1.
BMC Health Serv Res ; 20(1): 10, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900134

RESUMO

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality in India. CVDs are to a large extent preventable with the availability of wide range of interventions focusing on primary and secondary prevention. However human resource deficit is the biggest challenge for implementing these prevention programs. Task shifting of the cardiovascular risk assessment and communication to nurses can be one of the most viable and sustainable option to run prevention programs. METHODS: The study was quasi experimental in nature with 1 year follow up to determine the effect of CVD risk assessment and communication by nurses with the help of risk communication package on primary and secondary prevention of CVDs. The study was done in the outpatient departments of a tertiary health care center of Northern India. All the nurses (n = 16) working in selected OPDs were trained in CVD risk assessment and communication of risk to the patients. A total of 402 patients aged 40 years and above with hypertension (HTN) were recruited for primary prevention of CVDs from medicine and allied OPDs, whereas 500 patients who had undergone CABG/PTCA were recruited from cardiology OPDs for secondary prevention of CVDs and were randomized to intervention (n = 250) and comparison group (n = 250) by using block randomization. CVD risk modification and medication adherence were the outcomes of interest for primary and secondary prevention of CVDs respectively. RESULTS: The results revealed high level of agreement (k = 0.84) between the risk scores generated by nurses with that of investigator. In the primary prevention group, there were significantly higher proportion of participants in the low risk category (70%) as compared to baseline assessment (60.6%) at 1 year follow up. Whereas in secondary prevention group the mean medication adherence score among intervention group participants (7.60) was significantly higher than that of the comparison group (5.96) with a large effect size of 1.1.(p < 0.01). CONCLUSION: Nurse led intervention was effective in risk modification and improving medication adherence among subjects for primary and secondary prevention of CVDs respectively. TRIAL REGISTRATION: Trial registration no CTRI/2018/01/011372 [Registered on: 16/01/2018] Trial Registered Retrospectively.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Comunicação , Relações Enfermeiro-Paciente , Prevenção Primária/organização & administração , Prevenção Secundária/organização & administração , Adulto , Idoso , Feminino , Humanos , Hipertensão/tratamento farmacológico , Índia , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Pesquisa em Avaliação de Enfermagem , Medição de Risco , Atenção Terciária à Saúde/organização & administração
2.
N Z Med J ; 132(1502): 77-83, 2019 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-31563929

RESUMO

Wald and Law, who popularised the term 'polypill' in 2003, proposed giving everyone above a certain age a polypill to reduce the burden of cardiovascular disease (CVD). A more compelling potential application, proposed in 2001 by the World Health Organization, is to use a polypill containing antiplatelet, statin and blood pressure-lowering therapy among people with established CVD, in whom the components are already indicated but in whom guideline implementation and adherence are suboptimal. This article outlines relevant international and New Zealand evidence on the likely benefits and harms of a polypill for the secondary prevention of CVD. The evidence indicates that the benefits are likely to outweigh the harms, particularly given the persistence of substantial treatment gaps and inequities in the management of and outcomes in CVD. The time is long overdue for the polypill to be funded for the secondary prevention of CVD.


Assuntos
Anti-Hipertensivos/farmacologia , Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Inibidores da Agregação de Plaquetas/farmacologia , Prevenção Secundária , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Combinação de Medicamentos , Regulamentação Governamental , Humanos , Nova Zelândia/epidemiologia , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Prevenção Secundária/economia , Prevenção Secundária/métodos , Prevenção Secundária/organização & administração , Comprimidos
3.
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
4.
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
5.
Osteoporos Int ; 30(8): 1671-1677, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31152183

RESUMO

We examined the 5-year refracture rate of 6543 patients and found an overall rate of 9.7%. Adjusted analysis showed that presenting with multiple fractures was an indicator of a higher refracture risk; while presenting with an ankle fracture was associated with a lower refracture risk. INTRODUCTION: To examine refractures among patients screened in a province-wide fracture liaison service (FLS). METHODS: We assessed the 5-year refracture rate of fragility fracture patients aged 50+ who were screened at 37 FLS fracture clinics in Ontario, Canada. Refracture was defined as a new hip, pelvis, spine, distal radius, or proximal humerus fracture. Kaplan-Meier curves and Cox proportional hazards model adjusting for age, sex, and index fracture type were used to examine refracture rates. RESULTS: The 5-year refracture rate of 6543 patients was 9.7%. Those presenting with multiple fractures at baseline (i.e., two or more fractures occurring simultaneously) had the highest refracture rate of 19.6%. As compared to the 50-65 age group, refracture risk increased monotonically with age group (66-70 years: HR = 1.3, CI 95%, 1.0-1.7; 71-80 years: HR = 1.7, CI 1.4-2.1; 81+ years: HR = 3.0, CI 2.4-3.7). Relative to distal radius, presenting with multiple fractures at screening was associated with a higher risk of refracture (HR = 2.3 CI 1.6-3.1), while presenting with an ankle fracture was associated with a lower risk of refracture (HR = 0.7 CI 0.6-0.9). Sex was not a statistically significant predictor of refracture risk in this cohort (HR = 1.2, CI 1.0-1.5). CONCLUSIONS: One in ten patients in our cohort refractured within 5 years after baseline. Presenting with multiple fractures was an indicator of a higher refracture risk, while presenting with an ankle fracture was associated with a lower refracture risk. A more targeted FLS approach may be appropriate for patients at a higher refracture risk.


Assuntos
Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Fraturas do Tornozelo/epidemiologia , Feminino , Seguimentos , Fraturas Múltiplas/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Ontário/epidemiologia , Recidiva , Medição de Risco/métodos , Fatores de Risco , Prevenção Secundária/organização & administração , Fatores de Tempo
6.
Osteoporos Int ; 30(7): 1353-1362, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30820609

RESUMO

Whether in-hospital management of patients with newly identified vertebral fractures leads to a higher rate of osteoporosis medication than delayed outpatient management remains unknown. Our study showed that early osteoporosis therapy initiation in a fracture liaison service during hospital stay was a more efficacious strategy for secondary fracture prevention. INTRODUCTION: Fracture liaison services are standard care for secondary fracture prevention. A higher rate of osteoporosis treatment initiation may be considered when introduced in the hospital rather than an outpatient recommendation to a primary care physician (PCP). Whether this applies to patients with newly detected vertebral fractures in a general internal medicine ward remains unknown. We prospectively investigated whether in-hospital management of newly identified vertebral fractures led to a higher rate of osteoporosis medication initiation and persistence at 3 and 6 months than delayed outpatient management by a PCP. METHODS: We conducted a prospective study including hospitalized patients > 60 years systematically searched for asymptomatic vertebral fractures on lateral chest and/or abdominal radiographs. Patients were included either in phase 1 (outpatient care recommendations on osteoporosis management to a PCP) or in phase 2 (inpatient care management initiated during hospitalization). The percentage of patients under osteoporosis treatment was evaluated by telephone interview at 3 and 6 months. RESULTS: Outpatients' (84 with fracture/407 assessed (21%); 75.7 ± 7.7 years) and inpatients' (100/524 (19%); 77.8 ± 9.4 years) characteristics were similar. Osteoporosis medication was more often prescribed in inpatients at 3 (67% vs. 19%, respectively; p < 0.001) and 6 months (69 vs. 27%, respectively; p < 0.001). The percentage under treatment was also higher in inpatients than in outpatients at 3 (52 vs. 19%, p < 0.001) and 6 months (54 vs. 22%, p < 0.001). Length of stay and destination post-discharge were not different between groups. CONCLUSIONS: Early patient management after a newly detected vertebral fracture during hospitalization was a more efficacious strategy of secondary fracture prevention than delayed outpatient management following discharge.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/diagnóstico por imagem , Prevenção Secundária/organização & administração , Fraturas da Coluna Vertebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Cálcio/uso terapêutico , Suplementos Nutricionais , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Feminino , Seguimentos , Hospitalização , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/prevenção & controle , Radiografia , Suíça , Vitamina D/uso terapêutico
8.
Osteoporos Int ; 30(1): 127-134, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30232538

RESUMO

Despite their proven efficacy for secondary fracture prevention, long-term adherence with oral bisphosphonates is poor. INTRODUCTION: To compare the effectiveness of two interventions on long-term oral bisphosphonate adherence after an upper extremity fragility fracture. METHODS: Community-dwelling participants 50 years or older with upper extremity fragility fractures not previously treated with bisphosphonates were randomized to either a multi-faceted patient and physician educational intervention (the active control arm) vs. a nurse-led case manager (the study arm). Primary outcome was adherence (taking > 80% of prescribed doses) with prescribed oral bisphosphonates at 12 months postfracture between groups; secondary outcomes included rates of primary non-adherence and 24-month adherence. We also compared quality of life between adherent and non-adherent patients. RESULTS: By 12 months, adherence with the initially prescribed bisphosphonate was similar (p = 0.96) in both groups: 38/48 (79.2%) in the educational intervention group vs. 66/83 (79.5%) in the case manager arm. By 24 months, adherence rates were 67% (32/48) in the educational intervention group vs. 53% (43/81) in case managed patients (p = 0.13). Primary non-adherence was 6% (11 patients) in the educational intervention group and 12% (21 patients) in the case managed group (p = 0.07). Prior family history of osteoporosis (aOR 2.1, 95% CI 1.0 to 4.4) and being satisfied with current medical care (aOR 2.3, 95% CI 1.1 to 4.8) were associated with better adherence while lower income (aOR 0.2, 95% CI 0.1 to 0.6, for patients with income < $30,000 per annum) was associated with poorer rates of adherence. There were no differences in health-related quality of life scores at baseline or during follow-up between patients who were adherent and those who were not. CONCLUSION: While both interventions achieved higher oral bisphosphonate adherence compared to previously reported adherence rates in the general population, primary non-adherence and long-term adherence to bisphosphonates were similar in both arms. Adherence was influenced by family history of osteoporosis, satisfaction with current medical care, and income. TRIAL REGISTRATION: ClinicalTrials.gov : NCT01401556.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Difosfatos/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Fraturas por Osteoporose/prevenção & controle , Extremidade Superior/lesões , Administração Oral , Idoso , Alberta , Administração de Caso/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/tratamento farmacológico , Educação de Pacientes como Assunto/métodos , Psicometria , Qualidade de Vida , Recidiva , Prevenção Secundária/métodos , Prevenção Secundária/organização & administração , Fatores Socioeconômicos
9.
Am Heart J ; 207: 27-39, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30408621

RESUMO

BACKGROUND: Despite the significant burden of stroke in rural China, secondary prevention of stroke is suboptimal. This study aims to develop a SINEMA for the secondary prevention of stroke in rural China and to evaluate the effectiveness of the model compared with usual care. METHODS: The SINEMA model is being implemented and evaluated through a 1-year cluster-randomized controlled trial in Nanhe County, Hebei Province in China. Fifty villages from 5 townships are randomized in a 1:1 ratio to either the intervention or the control arm (usual care) with a target to enroll 25 stroke survivors per village. Village doctors in the intervention arm (1) receive systematic cascade training by stroke specialists on clinical guidelines, essential medicines and behavior change; (2) conduct monthly follow-up visits with the support of a mobile phone application designed for this study; (3) participate in virtual group activities with other village doctors; 4) receive performance feedback and payment. Stroke survivors participate in a health education and project briefing session, receive monthly follow-up visits by village doctors and receive a voice message call daily as reminders for medication use and physical activities. Baseline and 1-year follow-up survey will be conducted in all villages by trained staff who are blinded of the randomized allocation of villages. The primary outcome will be systolic blood pressure and the secondary outcomes will include diastolic blood pressure, medication adherence, mobility, physical activity level and quality of life. Process and economic evaluation will also be conducted. DISCUSSION: This study is one of very few that aim to promote secondary prevention of stroke in resource-constrained settings and the first to incorporate mobile technologies for both healthcare providers and patients in China. The SINEMA model is innovative as it builds the capacity of primary healthcare workers in the rural area, uses mobile health technologies at the point of care, and addresses critical health needs for a vulnerable community-dwelling patient group. The findings of the study will provide translational evidence for other resource-constrained settings in developing strategies for the secondary prevention of stroke.


Assuntos
Agentes Comunitários de Saúde/educação , População Rural , Prevenção Secundária/organização & administração , Acidente Vascular Cerebral/prevenção & controle , Terapia Comportamental/educação , Lista de Checagem , China , Continuidade da Assistência ao Paciente/organização & administração , Medicamentos Essenciais/uso terapêutico , Avaliação de Desempenho Profissional/métodos , Avaliação de Desempenho Profissional/organização & administração , Exercício Físico , Humanos , Adesão à Medicação , Aplicativos Móveis , Educação de Pacientes como Assunto/métodos , Guias de Prática Clínica como Assunto , Qualidade de Vida , Sistemas de Alerta , Prevenção Secundária/métodos , Sobreviventes/estatística & dados numéricos
11.
Heart ; 105(7): 516-523, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30470725

RESUMO

AIM: To investigate sex differences in acute myocardial infarction (AMI) guideline-indicated care as defined by the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) quality indicators. METHODS: Nationwide cohort study comprising 691 290 AMI hospitalisations in England and Wales (n=233 hospitals) from the Myocardial Ischaemia National Audit Project between 1 January 2003 and 30 June 2013. RESULTS: There were 34.5% (n=238 489) women (median age 76.7 (IQR 66.3-84.0) years; 33.9% (n=80 884) ST-elevation myocardial infarction (STEMI)) and 65.5% (n=452 801) men (median age 67.1 (IQR 56.9-77.2) years; 42.5% (n=192 229) STEMI). Women less frequently received 13 of the 16 quality indicators compared with men, including timely reperfusion therapy for STEMI (76.8% vs 78.9%; p<0.001), timely coronary angiography for non-STEMI (24.2% vs 36.7%; p<0.001), dual antiplatelet therapy (75.4% vs 78.7%) and secondary prevention therapies (87.2% vs 89.6% for statins, 82.5% vs 85.6% for ACE inhibitor/angiotensin receptor blockers and 62.6% vs 67.6% for beta-blockers; all p<0.001). Median 30-day Global Registry of Acute Coronary Events risk score adjusted mortality was higher for women than men (median: 5.2% (IQR 1.8%-13.1%) vs 2.3% (IQR 0.8%-7.1%), p<0.001). An estimated 8243 (95% CI 8111 to 8375) deaths among women could have been prevented over the study period if their quality indicator attainment had been equal to that attained by men. CONCLUSION: According to the ESC ACCA AMI quality indicators, women in England and Wales less frequently received guideline-indicated care and had significantly higher mortality than men. Greater attention to the delivery of recommended AMI treatments for women has the potential to reduce the sex-AMI mortality gap.


Assuntos
Infarto do Miocárdio , Administração dos Cuidados ao Paciente , Serviços Preventivos de Saúde , Indicadores de Qualidade em Assistência à Saúde/normas , Prevenção Secundária/estatística & dados numéricos , Idoso , Estudos de Coortes , Feminino , Fidelidade a Diretrizes , Hospitalização/estatística & dados numéricos , Humanos , Mortalidade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Determinação de Necessidades de Cuidados de Saúde , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/normas , Guias de Prática Clínica como Assunto , Serviços Preventivos de Saúde/normas , Serviços Preventivos de Saúde/estatística & dados numéricos , Prevenção Secundária/organização & administração , Fatores Sexuais , Reino Unido/epidemiologia
12.
Encephale ; 45 Suppl 1: S32-S34, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30554771

RESUMO

In France, one adolescent out of ten has already attempted suicide. In this population, suicide reattempts are frequent and significantly impact the vital, morbid and functional long-term prognosis. For about fifteen years, surveillance and brief contact intervention systems (SBCIS) have been used to complete the French suicide reattempt prevention arsenal for youth. The relevance of such strategy appears once the mental health service gap observed at this period of life is considered. In addition to prompting better coordination between the different professional stakeholders, the SBCIS help to alleviate the adolescent's help-seeking barriers, especially the ambivalence between conquest of autonomy and need for help. The first results from the French SBCIS dedicated to children and adolescents are encouraging. Although they have to deal with specific challenges, we argue that they relevantly complement and potentiate the already available prevention resources, thus optimizing the whole prevention system for suffering youth.


Assuntos
Monitorização Fisiológica , Psiquiatria Preventiva , Psicoterapia Breve , Prevenção Secundária , Tentativa de Suicídio/prevenção & controle , Adolescente , Adulto , Criança , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Psiquiatria Preventiva/métodos , Psiquiatria Preventiva/organização & administração , Psiquiatria Preventiva/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Psicologia do Adolescente/métodos , Psicologia do Adolescente/organização & administração , Psicologia do Adolescente/normas , Psicologia da Criança/métodos , Psicologia da Criança/organização & administração , Psicologia da Criança/normas , Psicoterapia Breve/métodos , Psicoterapia Breve/organização & administração , Psicoterapia Breve/normas , Psicoterapia Breve/estatística & dados numéricos , Recidiva , Estudos Retrospectivos , Prevenção Secundária/métodos , Prevenção Secundária/organização & administração , Prevenção Secundária/normas , Prevenção Secundária/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Resultado do Tratamento
14.
Rev. latinoam. enferm. (Online) ; 27: e3072, 2019. tab
Artigo em Inglês | LILACS | ID: biblio-985655

RESUMO

ABSTRACT Objective: to identify the occurrence of warning signs and changes in vital signs in individuals who experienced in-hospital cardiorespiratory arrest and correlate them with the occurrence of this event. Method: this is a retrospective, analytical and quantitative study that included 218 medical records of patients who suffered in-hospital cardiorespiratory arrest and identified warning signs and alterations in vital signs. Mean, standard deviation, median, minimum and maximum values were calculated for the continuous variables, and frequency and percentage for the categorical variables. We compared the age and occurrence of cardiorespiratory arrest with the occurrence of warning signs using the Chi-Square Test and the Mann Whitney non-parametric test (p-value < 0.05). Results: 62.1% of the patients presented signs and symptoms of shock, 44.9% of neurological alteration, 40.4% of malaise, 15.2% presented signs suggestive of acute coronary syndrome, and 25.9% presented mental confusion. In the last measurement of vital signs before cardiorespiratory arrest, the majority of patients had altered abnormal (32.6%) and severely abnormal (23.9%) heart rate, and abnormal (37.1%) and severely abnormal (27.0%) respiratory rate. Conclusion: the warning signs identified were: shock, neurological signs, malaise and acute coronary syndrome. The prevalent changes in vital signs were: heart rate, respiratory rate and O2 saturation. Patients with severely abnormal systolic blood pressure were not discharged and those with abnormal respiratory rate did not survive 6 months after cardiorespiratory arrest.


RESUMO Objetivo: identificar ocorrência dos sinais de alerta e alterações nos sinais vitais em indivíduos com parada cardiorrespiratória intra-hospitalar e correlacioná-los à ocorrência desse evento. Método: estudo retrospectivo, analítico e quantitativo que incluiu 218 prontuários de pacientes que sofreram parada cardiorrespiratória intra-hospitalar e identificados sinais de alerta e alterações nos sinais vitais. Para variáveis contínuas, calculou-se média, desvio padrão, mediana, mínimo e máximo; para as categóricas, frequência e percentual. Comparou-se a idade e ocorrência de parada cardiorrespiratória com ocorrência de sinais de alerta pelo Teste Qui-Quadrado e Teste não paramétrico de MannWhitney (p-valor<0,05). Resultados: 62,1% dos pacientes apresentaram sinais e sintomas de choque, 44,9% neurológicos, 40,4% mal-estar, 15,2% sugestivos de síndrome coronariana aguda e 25,9% confusão mental. Na última mensuração dos sinais vitais antes da parada cardiorrespiratória, a maioria apresentou frequência cardíaca alterada, anormal (32,6%) e severamente anormal (23,9%), frequência respiratória anormal (37,1%) e severamente anormal (27,0%). Conclusão: identificou-se como sinais de alerta: sinais de choque, neurológicos, mal-estar e síndrome coronariana aguda. Alterações nos sinais vitais prevalentes foram: frequência cardíaca, respiratória e saturação de O2. Pacientes com pressão arterial sistólica severamente anormal não receberam alta e aqueles com frequência respiratória anormal não sobreviveram em 6 meses após a parada cardiorrespiratória.


RESUMEN Objetivo: identificar la presencia de señales de alerta y alteraciones en los signos vitales en individuos con parada cardiorrespiratoria intrahospitalaria y correlacionarlos a la ocurrencia de ese evento. Método: estudio retrospectivo, analítico y cuantitativo que incluyó 218 prontuarios de pacientes que sufrieron paro cardiorrespiratorio intrahospitalario e identificados signos de alerta y alteraciones en los signos vitales. Para variables continuas, se calculó la media, desviación estándar, mediana, mínima y máxima; para las categóricas, se calculó la frecuencia y el porcentaje. Se comparó la edad y ocurrencia de parada cardiorrespiratoria con ocurrencia de señales de alerta por el Test Chi-cuadrado y Test no paramétrico de MannWhitney (p-valor <0,05). Resultados: 62,1% de los pacientes presentaron signos y síntomas de shock, 44,9% neurológicos, 40,4% malestar, 15,2% sugestivos de síndrome coronario agudo y 25,9% confusión mental. En la última medición de los signos vitales antes de la parada cardiorrespiratoria, la mayoría presentó frecuencia cardiaca alterada, anormal (32,6%) y severamente anormal (23,9%), frecuencia respiratoria anormal (37,1%) y severamente anormal (27,0%). Conclusión: como signos de alerta se identificaron: signos de shock, neurológicos, malestar y síndrome coronario agudo. Los cambios en los signos vitales prevalentes fueron: frecuencia cardíaca, respiratoria y saturación de O2. Los pacientes con presión arterial sistólica severamente anormal no recibieron alta y aquellos con frecuencia respiratoria anormal no sobrevivieron en 6 meses después de la parada cardiorrespiratoria.


Assuntos
Humanos , Enfermagem em Emergência/organização & administração , Assistência Hospitalar/organização & administração , Prevenção Secundária/organização & administração , Sinais Vitais , Parada Cardíaca
15.
Indian Heart J ; 70(6): 907-910, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30580864

RESUMO

A significant socioeconomic inequality is the main barrier to achieve primordial prevention of rheumatic heart disease (RHD) in the developing countries. An effective vaccine with affordable cost against Streptococcus yet to be identified. The subclinical nature of rheumatic fever (RF) is the main hurdle for effective primary prevention of RHD. When RF and RHD are recognized at the earliest, treated adequately and SP with penicillin is strictly followed, then this disease can be kept under control though cannot be eradicated.


Assuntos
Países em Desenvolvimento , Cardiopatia Reumática/prevenção & controle , Prevenção Secundária/organização & administração , Saúde Global , Humanos , Incidência , Cardiopatia Reumática/epidemiologia , Fatores Socioeconômicos , Taxa de Sobrevida/tendências
16.
BMC Dermatol ; 18(1): 12, 2018 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-30541516

RESUMO

BACKGROUND: In Germany, work-related skin diseases are predominant within the spectrum of reported occupational diseases. Metal workers are among the high-risk professions. Offering effective prevention programs to affected patients is of utmost importance to avoid deterioration of the disease and job loss. We conducted a 1-year follow-up in patients who participated in a multidisciplinary, complex outpatient prevention program representing a standard procedure of patient care by the respective statutory accident insurance. METHODS: The multi-component prevention program consists of multiprofessional individual patient counseling, a structured skin protection seminar in a group, as well as workplace visits and on-site counseling in terms of appropriate skin protection (e.g. gloves). An observational study with a 1-year follow-up and four measurements (T1-T4, longitudinal pre/post-test design) including dermatological examinations and standardized written questionnaires was conducted between 2013 and 2016 to assess changes over time regarding job loss and disease severity. RESULTS: Data from 94 patients (87 male, mean age: 45.4 years) were included in the analysis. One year after the skin protection seminar (T4), 83 patients (88.3%) remained in their original professional metalworking activity and four patients (4.3%) had given up their profession because of their skin disease. At baseline (T1), irritant contact dermatitis of the hands was the most frequent diagnosis (80.7%). Methods for self-reported disease severity showed good correlation with the clinical gold standard at T1 and T2 (dermatological examination with the Osnabrück Hand Eczema Severity Index / OHSI), and a significant decrease of the self-reported disease severity was found over time from T1 to T4 (p < 0.001). Further results indicate an improved self-perceived disease control and an overall satisfaction with the prevention program. CONCLUSIONS: The results of this observational study demonstrate that the comprehensive prevention program positively influences the course of work-related skin diseases, increases the possibility to continue working in a "high-risk" profession and improves the disease management of metal workers. In the long term, the prevention program may lead to cost savings by preventing high therapy costs or professional retraining.


Assuntos
Dermatite de Contato/prevenção & controle , Dermatite Ocupacional/prevenção & controle , Luvas Protetoras , Dermatoses da Mão/prevenção & controle , Metalurgia , Educação de Pacientes como Assunto , Prevenção Secundária/métodos , Higiene da Pele , Adulto , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Procedimentos Clínicos , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/organização & administração , Avaliação de Programas e Projetos de Saúde , Roupa de Proteção , Prevenção Secundária/organização & administração , Índice de Gravidade de Doença , Creme para a Pele , Testes Cutâneos
17.
Ann Cardiol Angeiol (Paris) ; 67(5): 339-344, 2018 Nov.
Artigo em Francês | MEDLINE | ID: mdl-30327135

RESUMO

Secondary prevention is paramount in patients who are survivors of an acute coronary syndrome. Cardiac rehabilitation has proven to be effective for several decades in the long-term implementation of preventive measures. Despite this evidence, prescription and real participation in these programs remain limited for a many reasons, including the patient, physician, health care system. Recent statistics are a major regional disparity in prescription that leads to inequality in access to care. A reflection is therefore necessary on the organization of the course of care of the patient after an acute coronary syndrome. The secondary prevention plan that we are proposing here is based on a secondary prevention assessment that allows the patient to be guided in rehabilitation or in an alternative proposal.


Assuntos
Reabilitação Cardíaca , Doença da Artéria Coronariana/prevenção & controle , Prevenção Secundária/organização & administração , França , Acesso aos Serviços de Saúde , Humanos , Medição de Risco , Telemedicina
18.
BMJ Open ; 8(10): e021326, 2018 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-30341114

RESUMO

INTRODUCTION: Smoking remains the leading risk factor for disease burden and mortality worldwide. Heavy Smoking is often associated with poor Nutrition, Alcohol abuse and Physical inactivity (known as 'SNAP'). Australia's first prison smoking ban was introduced in the Northern Territory in July 2013. However, relapse to smoking after release from prison is normative. Holistic and cost-effective interventions are needed to maintain post-release abstinence to realise the potential public health impact of smoke-free prison policies. Rigorous, large-scale trials of innovative and scalable interventions are crucial to inform tobacco control policies in correctional settings. METHODS AND ANALYSIS: This multicentre, investigator-blinded, randomised parallel superiority trial will evaluate the effectiveness of a brief intervention on SNAP versus usual care in preventing smoking relapse among people released from smoke-free prisons in the Northern Territory, Australia. A maximum of 824 participants will be enrolled and randomly assigned to either SNAP intervention or usual care at a 1:1 ratio at baseline. The primary endpoint is self-reported continuous smoking abstinence three months after release from prison, verified by breath carbon monoxide test. Secondary endpoints include seven-day point prevalence abstinence, time to first cigarette, number of cigarettes smoked post release, Health Eating Index for Australian Adults, Alcohol Use Disorder Identification Test-Consumption and International Physical Activity Questionnaire scores. The primary endpoint will be analysed on an intention-to-treat basis using a simple log binomial regression model with multiple imputation for missing outcome data. A cost-effectiveness analysis of the brief intervention will be conducted subsequently. ETHICS AND DISSEMINATION: This study was approved by the University of New South Wales Human Research Ethics Committee (HREC), Menzies HREC and Central Australia HREC. Primary results of the trial and each of the secondary endpoints will be submitted for publication in a peer-review journal. TRIAL REGISTRATION NUMBER: ACTRN12617000217303; Pre-results.


Assuntos
Protocolos de Ensaio Clínico como Assunto , Prisioneiros/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/organização & administração , Tabagismo/terapia , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Prevenção Secundária/organização & administração
19.
Can J Cardiol ; 34(10 Suppl 2): S240-S246, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30201255

RESUMO

Following stroke, people are at high risk for repeat strokes and for complications related to coronary artery disease (CAD). Indeed, stroke and CAD share many of the same risk factors. Unfortunately, patients become sedentary after stroke, which leads to cardiorespiratory deconditioning as well as muscle atrophy and weakness that in turn leads to deterioration in metabolic, cardiorespiratory, and functional health. Access to intensive secondary prevention programs with structured exercise components that include both aerobic and resistance training can help to prevent and reverse these health hazards. Traditional stroke rehabilitation programs face many barriers to providing exercise programming early post-stroke, such as lack of available therapy time and short length of stay, lack of equipment for exercise and assessments, and concerns for patient safety related to cardiac status. Building a partnership between traditional stroke rehabilitation programs and cardiac rehabilitation by operationalizing an automatic referral process has the potential to affect secondary prevention of stroke and cardiovascular risk significantly. It could also mitigate the tremendous burden on patients and their family members. This is an easily identified group that can achieve significant gains over multiple domains of recovery with the targeted exercise and risk-factor modification components offered by comprehensive cardiac rehabilitation programs.


Assuntos
Reabilitação Cardíaca/métodos , Doenças Cardiovasculares/prevenção & controle , Continuidade da Assistência ao Paciente/organização & administração , Prevenção Secundária , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/epidemiologia , Canadá/epidemiologia , Doenças Cardiovasculares/epidemiologia , Comorbidade , Prestação Integrada de Cuidados de Saúde , Terapia por Exercício/métodos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Prevenção Secundária/métodos , Prevenção Secundária/organização & administração
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