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1.
Anaesthesia ; 75 Suppl 1: e46-e53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31903565

RESUMO

The increasing age and subsequent medical complexity of patients presenting for surgery grants the opportunity to examine the processes and delivery of peri-operative care. There is a need to redesign peri-operative pathways allowing room for shared decision making and personalised, evidence-based care. In times of financial constraint, this is no easy task. However, neglecting to transform services now may lead to challenges in the sustainability of the provision of peri-operative care in the long-term. Challenges in redesigning peri-operative care pathways include identification and optimisation of those at highest peri-operative risk to inform the difficult conversations surrounding the appropriateness of surgery. The moral burden of these conversations on patient and professionals alike is increasingly recognised and managing this issue requires innovative models of collaborative, multidisciplinary and interprofessional working. To operate or not can be a challenging question to answer with a number of different perspectives to consider; not least that of the patient.


Assuntos
Tomada de Decisão Clínica/métodos , Recusa do Médico a Tratar , Procedimentos Cirúrgicos Operatórios , Idoso , Idoso de 80 Anos ou mais , Humanos , Risco
2.
Anaesthesia ; 75 Suppl 1: e39-e45, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31903579

RESUMO

Shared decision-making is central to the pre-operative consent process and accurate communication of risk is dependent on a clear understanding of numerical information by both the patient and clinician. The risk of an adverse event or complication is often described using verbal probability expressions but how these are interpreted by clinicians and patients in the pre-operative setting has not been studied. We asked patients and clinicians to assign a numerical translation (as a percentage) for seven verbal probability expressions in relation to the probability of a major peri-operative complication occurring. In total, data from 290 patients and 57 clinicians were analysed. There was a wide range in percentages assigned by patients to all verbal probability expressions. Patients assigned a wider range of percentage values to each of the verbal probability expressions and these were all significantly higher than those assigned by clinicians: median (IQR [range]) negligible risk 5% (1-15 [0-100]) vs. 0% (0-0 [0-5]); minimal risk 5% (2-10) [0-100]) vs. 1% (0-1 [0-10]); low risk 10% (3-10 [0-100]) vs. 1% (0-2) [0-10]); standard risk 20% (10-40) [0-100]) vs. 1% (1-5) [0-30]); moderate risk 33% (20-50) [0-100]) vs. 5% (3-10) [0-80]); high risk 70% (30-90 [0-100]) vs. 15% (10-40) [1-75]); and very high risk 90% (50-95 [0-100]) vs. 40% (20-50 [5-100]), respectively (p < 0.005 for all comparisons). There is considerable variation in the numerical translation of verbal probability expressions by both patients and clinicians. This suggests that verbal probability expressions should not be used in isolation as part of doctor-patient discussions regarding peri-operative risk.


Assuntos
Comunicação em Saúde/métodos , Complicações Pós-Operatórias , Probabilidade , Feminino , Humanos , Masculino , Matemática , Pessoa de Meia-Idade , Risco
6.
Rev Med Suisse ; 15(673): 2195-2197, 2019 Nov 27.
Artigo em Francês | MEDLINE | ID: mdl-31778048

RESUMO

Elderly patients with urologic cancer are often undertreated because of their age. Recently, many studies showed that advanced age is not an absolute contraindication to radical surgery for bladder and prostate cancer patients. For small renal cancers, instead, active surveillance with a close follow-up may be a valid alternative to surgery because of a low risk of progression. Patients' selection remains a crucial step to define the best treatment. This article summarizes the new tendencies of urologic cancer management in elderly patients.


Assuntos
Neoplasias Urológicas/terapia , Idoso , Progressão da Doença , Humanos , Neoplasias Renais/terapia , Seleção de Pacientes , Risco
7.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1152-1157, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683404

RESUMO

Objective: Using Meta-analysis to evaluate the association between the short-term exposure to fine particular matter (PM(2.5)) and the morbidity of ischemic heart disease (IHD). Methods: In this paper, "particulate matter" , "PM2.5" , "ischemic heart disease" , "coronary heart disease" , "coronary artery disease" , "atherosclerotic heart disease" , and "atherosclerotic cardiovascular disease" were used to systematically search for the literature on the association between the short-term exposure to PM(2.5) and the ischemic heart disease through China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure (CNKI), Wanfang, Vip as well as Pubmed and Web of Science. The time was up to January 31(st) 2019. The quality of literature was evaluated by the Newcastle-Ottawa Scale. Meta-analysis method was performed by using R3.5.0 software and was used to perform heterogeneity test, calculate combined risk of IHD with short-term exposure to PM(2.5) and carry out publication bias test. Results: A total of 1 424 literatures were retrieved. Of the 23 literatures included studies (2 literatures in Chinese and 21 literatures in English) according to the inclusion and exclusion criteria, 14 used a time-series design and 9 used a case-crossover design. The heterogeneity existed across all identified studies (I(2)=81%, P<0.05). The Random effect model showed that a 10 µg/m(3) increase in PM(2.5) was associated with estimated relative risk of IHD morbidity at 1.007 (95%CI: 1.005-1.009); Publication bias was noted in the analysis (t=2.76, P<0.05), and the combined effect values of IHD morbidity was reduced to 1.005(95%CI: 1.004-1.007) after adjusting for asymmetry. Conclusion: Short-term exposure to PM(2.5) may lead to the increase of ischemic heart disease morbidity.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Isquemia Miocárdica/epidemiologia , Material Particulado/toxicidade , Poluentes Atmosféricos/análise , China/epidemiologia , Humanos , Morbidade , Isquemia Miocárdica/etiologia , Material Particulado/análise , Risco
8.
Medicine (Baltimore) ; 98(44): e17735, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689818

RESUMO

BACKGROUND: Several studies have reported the association of Behcet disease (BD) with the risk of diverse kinds of cancers. However, its association is controversial. Therefore, we conducted a bioinformatics-analysis to explore any possible association. METHODS: We obtained relevant findings published before October 2018 through literature survey of the PubMed, EMBASE, and Web of Science databases. STATA 12.0 software was used for statistical analysis. RESULTS: After screening, the meta-analysis comprised 5 studies. We observed a significant positive association between BD and enhanced malignancy risk (pooled relative risk [RR], 1.19; 95% confidence interval [CI]: 1.09-1.30), especially for hematological cancer (pooled RR, 2.58; 95% CI: 1.61-3.55) and thyroid cancer (pooled RR, 1.25; 95% CI: 1.04-1.47). However, high heterogeneity was also observed in the results (I = 81.3%). Subgroup analysis indicated that female BD patients from Korean population are at highest predisposition to overall malignancy. Besides, publication bias was not observed with our choice of surveys. CONCLUSION: We conclude that patients suffering from BD have an overall increased risk for malignancy. Greater numbers of exhaustive temporal studies are essential for definitive inferences.


Assuntos
Síndrome de Behçet/complicações , Neoplasias Hematológicas/etiologia , Neoplasias/etiologia , Neoplasias da Glândula Tireoide/etiologia , Biologia Computacional , Feminino , Humanos , Masculino , Risco , Fatores de Risco
9.
Medicine (Baltimore) ; 98(44): e17736, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689819

RESUMO

To explore associated risk factors and their interactions with type 2 diabetes (T2DM) among the elderly with prediabetes in rural areas in China.A nested case-control study was conducted in a fixed cohort to identify the risk factors for T2DM among the elderly with prediabetes in rural areas of Yiyang City in China. A total of 37 elderly with T2DM were included in the cases group and 111 elderly subjects with prediabetes were matched in the control group. Data related to sociodemographic characteristics, lifestyle behavior, and anthropometric variables were collected by trained staff using standard tools. The risk factors for T2DM were determined using conditional logistic regression analysis, and their additive interactions were also explored.Multivariable conditional logistic regression analysis results showed that overweight/obesity (odds ratio [OR] = 4.80, 95% confidence interval [CI]: 1.20-12.28), family history of diabetes (OR = 3.63, 95% CI: 1.03-12.81), physically inactive (OR = 3.08, 95% CI: 1.14-8.30), high waist-to-hip ratio (WHR) (OR = 3.15, 95% CI: 1.27-7.80), and inadequate diabetes-specific health literacy (DSHL) (OR = 3.92, 95% CI: 1.14-13.48) increased the risk for T2DM. Additive interactions for T2DM were observed between a family history of diabetes and high WHR with a relative excess risk of interaction (RERI) of 10.02 (95% CI: 4.25, 15.78), and between high WHR and overweight or obesity, with an RERI of 3.90 (95% CI: 0.36, 7.44).The independent risk factors for T2DM are overweight or obesity, high WHR, family history of diabetes, physically inactive, and inadequate DSHL. High WHR as a risk factor for T2DM has additive interactions with family history of diabetes and overweight or obesity.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Estado Pré-Diabético/etiologia , População Rural/estatística & dados numéricos , Idoso , Antropometria , Estudos de Casos e Controles , China/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Exercício , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/fisiopatologia , Risco , Fatores de Risco , Comportamento Sedentário , Relação Cintura-Quadril
10.
N Engl J Med ; 381(16): 1547-1556, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31618540

RESUMO

BACKGROUND: Familial hypercholesterolemia is characterized by severely elevated low-density lipoprotein (LDL) cholesterol levels and premature cardiovascular disease. The short-term efficacy of statin therapy in children is well established, but longer follow-up studies evaluating changes in the risk of cardiovascular disease are scarce. METHODS: We report a 20-year follow-up study of statin therapy in children. A total of 214 patients with familial hypercholesterolemia (genetically confirmed in 98% of the patients), who were previously participants in a placebo-controlled trial evaluating the 2-year efficacy and safety of pravastatin, were invited for follow-up, together with their 95 unaffected siblings. Participants completed a questionnaire, provided blood samples, and underwent measurements of carotid intima-media thickness. The incidence of cardiovascular disease among the patients with familial hypercholesterolemia was compared with that among their 156 affected parents. RESULTS: Of the original cohort, 184 of 214 patients with familial hypercholesterolemia (86%) and 77 of 95 siblings (81%) were seen in follow-up; among the 214 patients, data on cardiovascular events and on death from cardiovascular causes were available for 203 (95%) and 214 (100%), respectively. The mean LDL cholesterol level in the patients had decreased from 237.3 to 160.7 mg per deciliter (from 6.13 to 4.16 mmol per liter) - a decrease of 32% from the baseline level; treatment goals (LDL cholesterol <100 mg per deciliter [2.59 mmol per liter]) were achieved in 37 patients (20%). Mean progression of carotid intima-media thickness over the entire follow-up period was 0.0056 mm per year in patients with familial hypercholesterolemia and 0.0057 mm per year in siblings (mean difference adjusted for sex, -0.0001 mm per year; 95% confidence interval, -0.0010 to 0.0008). The cumulative incidence of cardiovascular events and of death from cardiovascular causes at 39 years of age was lower among the patients with familial hypercholesterolemia than among their affected parents (1% vs. 26% and 0% vs. 7%, respectively). CONCLUSIONS: In this study, initiation of statin therapy during childhood in patients with familial hypercholesterolemia slowed the progression of carotid intima-media thickness and reduced the risk of cardiovascular disease in adulthood. (Funded by the AMC Foundation.).


Assuntos
Doenças Cardiovasculares/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Adolescente , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Espessura Intima-Media Carotídea , Criança , LDL-Colesterol/sangue , Progressão da Doença , Feminino , Seguimentos , Humanos , Hiperlipoproteinemia Tipo II/sangue , Incidência , Masculino , Intervalo Livre de Progressão , Risco , Inquéritos e Questionários , Adulto Jovem
11.
Br J Radiol ; 92(1104): 20190466, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31600090

RESUMO

OBJECTIVE: One approach to reduce treatment-related morbidity for human papilloma virus (HPV)-associated tonsil cancer is omitting radiotherapy to the contralateral neck. Pathologic risk factors for early contralateral neck disease, however, are poorly understood. We report on the risk contralateral neck failures from the time of pre-operative diagnostic imaging to time of planning for adjuvant radiation in a single institution series of HPV-associated tonsillar cancer patients undergoing surgery followed by radiotherapy (RT). METHODS: Retrospective analysis of 123 patients with T1-T3 HPV-positive tonsillar squamous cell carcinoma treated between 2010 and 2016 with transoral robotic surgery and selective ipsilateral neck dissection followed by adjuvant RT. Contralateral neck recurrence was classified as the detection of a pathologic node in the contralateral neck prior to initiation of adjuvant RT. RESULTS: Seven patients (5.7%) developed contralateral neck disease/failure between the time of pre-operative diagnostic neck imaging and time of planning of adjuvant radiation. Increased ratio of positive/resected nodes [odds ratio (OR) 1.073, p = 0.005] was significantly associated with increased risk of contralateral neck recurrence, with a trend found for close/positive margins (OR 5.355, p = 0.06), tumor size (OR 2.046, p = 0.09), and total number of nodes positive (OR 1.179, p = 0.062). CONCLUSIONS: Patients who develop very early contralateral neck disease, between completion of ipsilateral neck dissection and the initiation of radiotherapy, have a higher ratio of positive nodes to total nodes resected in the ipsilateral neck. These findings suggest that proper selection of patients for omission of treatment of the contralateral, node-negative neck should be made with this in mind, with future studies needed to document the impact on toxicity and disease outcomes from such an approach. ADVANCES IN KNOWLEDGE: Pathologic risk factors in the dissected, ipsilateral neck in patients with tonsil cancer may inform the risk of contralateral neck failure. Patient selection for future, prospective efforts to examine sparing of the contralateral neck need to be based with these risk factors in mind.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Segunda Neoplasia Primária/etiologia , Infecções por Papillomavirus/complicações , Neoplasias Tonsilares/radioterapia , Neoplasias Tonsilares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Razão de Chances , Papillomaviridae , Período Pós-Operatório , Radioterapia Adjuvante/métodos , Radioterapia de Intensidade Modulada , Análise de Regressão , Estudos Retrospectivos , Risco , Neoplasias Tonsilares/patologia , Neoplasias Tonsilares/virologia , Carga Tumoral
12.
BMJ ; 367: l5928, 2019 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604711
13.
BMC Infect Dis ; 19(1): 839, 2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31606032

RESUMO

BACKGROUND: Household contact tracing of index TB cases has been advocated as a key part of TB control for many years, but has not been widely implemented in many low-resource setting because of the current dearth of high quality evidence for effectiveness. Innovative strategies for earlier, more effective treatment are particularly important in contexts with hyper-endemic levels of HIV, where levels of TB infection remain extremely high. METHODS: We present the design of a household cluster-randomised controlled trial of interventions aimed at improving TB-free survival and reducing childhood prevalence of Mycobacterium tuberculosis infection among household contacts of index TB cases diagnosed in two provinces of South Africa. Households of index TB cases will be randomly allocated in a 1:1 ratio to receive either an intensified home screening and linkage for TB and HIV intervention, or enhanced standard of care. The primary outcome will compare between groups the TB-free survival of household contacts over 15 months. All participants, or their next-of-kin, will provide written informed consent to participate. DISCUSSION: Evidence from randomised trials is required to identify cost-effective approaches to TB case-finding that can be applied at scale in sub-Saharan Africa. TRIAL REGISTRATION: ISRCTN16006202 (01/02/2017: retrospectively registered) and NHREC4399 (11/04/2016: prospectively registered). Protocol version: 4.0 (date: 18th January 2018).


Assuntos
Busca de Comunicante/métodos , Tuberculose/prevenção & controle , Adulto , Criança , Análise Custo-Benefício , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Estudos Retrospectivos , Risco , África do Sul/epidemiologia , Padrão de Cuidado , Resultado do Tratamento , Teste Tuberculínico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Carga Viral
14.
Nursing ; 49(10): 49-52, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31568083

RESUMO

Urethral characterization can be difficult for patients and providers alike. This article describes an evidence-based protocol for difficult urethral catheter insertions in male patients.


Assuntos
Prática Clínica Baseada em Evidências , Guias de Prática Clínica como Assunto , Cateterismo Urinário/enfermagem , Algoritmos , Humanos , Masculino , Segurança do Paciente , Risco , Uretra/anatomia & histologia , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos
15.
Chemotherapy ; 64(2): 94-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31569090

RESUMO

BACKGROUND: The combination of transarterial chemoembolization (TACE) and apatinib has been used in the treatment of intermediate or advanced hepatocellular carcinoma (HCC). However, its effectiveness and safety are also argued. METHODS: Eligible studies were collected from a computer search of literatures published from the database establishment to May 2019 in PubMed, Web of Science, EMBASE, Ovid, the Cochrane Library, Wanfang Database, China National Knowledge Infrastructure, and China Biology Medicine Disc. The objective response rate (ORR), the disease control rate (DCR), survival rate (SR), and the incidences of treatment-related adverse effects (AEs) were collected as the relevant outcomes. Data were analyzed through fixed/random effects of meta-analysis models with RevMan 5.3 software. RESULTS: Eight randomized controlled clinical trials comprising 528 patients and 4 cohort studies comprising 226 patients were eventually included. Compared to the control group treated with TACE solely, combination therapy group, in which intermediate or advanced HCC patients were treated with TACE and apatinib, significantly enhanced ORR (relative risk [RR] 2.06, 95% CI 1.63-2.61, p < 0.001), DCR (RR 1.65, 95% CI 1.24-2.20, p < 0.001), and whole SRs of 6-month (RR 1.52, 95% CI 1.08-2.14, p = 0.02), 1-year (RR 1.52, 95% CI 1.25-1.84, p < 0.001), and 2-year (RR 1.84, 95% CI 1.34-2.54, p < 0.001). The incidence of hand foot syndrome, proteinuria, hypertension, and diarrhea was significantly increased in the combination therapy group compared with the control group (p < 0.05), and the incidence of nausea and vomiting, fever, and myelosuppression, respectively, was similar in 2 groups (p > 0.05). CONCLUSIONS: The combination therapy of TACE and apatinib can enhance the clinical effectiveness better than TACE solely in patients with intermediate or advanced HCC, while increase in the AEs is usually tolerable.


Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Inibidores de Proteínas Quinases/uso terapêutico , Piridinas/uso terapêutico , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica , Humanos , Neoplasias Hepáticas/mortalidade , Risco , Taxa de Sobrevida , Resultado do Tratamento
16.
Psychiatr Hung ; 34(3): 266-279, 2019.
Artigo em Húngaro | MEDLINE | ID: mdl-31570658

RESUMO

INTRODUCTION: The Inventory of Callous-Unemotional Traits (ICU) is one of the most widely used measures of psychopathic traits in children. Callous-unemotional (CU) traits designate an important subgroup of antisocial youth characterized by lack of empathy, guilt and remorse. The aim of the present study was to test the applicability and reliability of the self-reported ICU in a high-risk sample of adolescent boys. METHODS: Participants were 202 adolescent boys (mean age: 16.63 years; SD = 1.71) from institutional care facilities and juvenile detention centres. Confirmatory factor analyses (CFA) were conducted to investigate the factor structure of the ICU. In addition, MIMIC modelling (CFA with covariates) was applied to test the convergent validity of the ICU scores by examining relationships with externalizing symptoms (including conduct problems, hyperactivity-inattention, proactive-reactive aggression), and prosocial behaviour. RESULTS: We observed that the bifactor model with three correlated specific factors (callousness, uncaring and unemotional) and one general CU traits factor provided the best fit to the data. However, similar to previous studies, low internal consistency was found for the unemotional scale. In line with our expectations, CU traits showed positive associations with externalizing symptoms, and negative associations with prosocial behaviour. CONCLUSION: The ICU is a reliable and valid measure of callous-unemotional traits. Our results support the application of the Hungarian version of the questionnaire.


Assuntos
Transtorno da Personalidade Antissocial/diagnóstico , Transtorno da Personalidade Antissocial/psicologia , Emoções , Psicometria , Adolescente , Humanos , Hungria , Masculino , Inventário de Personalidade/normas , Psicometria/normas , Reprodutibilidade dos Testes , Risco , Autorrelato
18.
J Glob Health ; 9(2): 020405, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31656604

RESUMO

Background: A growing body of evidence suggests the impact of maternal nutrition plays a role in determining offspring's risk of non-communicable diseases (NCDs), including heart disease (CVD), type 2 diabetes (T2DM), cancer and chronic obstructive pulmonary diseases (COPD). We conducted a systematic review to investigate this relationship. Methods: We systematically searched CINAHL, Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, Database of Abstracts of Reviews of Effects, MEDLINE, EMBASE, Web of Science Core Collection and Global Health for papers published before May 2016 (PROSPERO: CRD42016039244, CRD42016039247). Included studies examined the impact of maternal nutrition (diet, vitamin status and weight) on adult offspring's NCD outcomes. Results: Of 23 501 identified citations, 20 met our inclusion criteria. Heterogeneity of papers required narrative synthesis. Included studies involved 1 939 786 participants. CVD: Four papers examined maternal exposure to famine during gestation, 3 identified a resulting increased risk of CVD in offspring. Five identified an increased risk of offspring CVD with increasing maternal weight. T2DM: Six studies investigated maternal exposure to famine during gestation; three identified an increase in offspring's T2DM risk. Three found no increased risk; two of these were in circumstances where famine states persisted beyond pregnancy. Three papers found an increased risk of T2DM in offspring with increasing maternal BMI. CANCER: Four papers investigated maternal famine exposure during pregnancy - two identified a reduced risk of cancer in male offspring, and two an increased risk in female offspring. COPD: One study found low maternal vitamin D status was associated with reduced use of asthma medication. Conclusions: While there are indications that exposure to both famine (particularly when coupled with exposure to nutritional excess after birth) and maternal overweight during pregnancy is associated with offspring's risk of CVD, T2DM and cancer, currently there is a lack of evidence to confirm this relationship. Despite the lack of conclusive evidence, these finding hold important research and policy implications for a lifecycle approach to the prevention of NCDs.


Assuntos
Fenômenos Fisiológicos da Nutrição Materna , Doenças não Transmissíveis/epidemiologia , Adulto , Feminino , Humanos , Gravidez , Risco
19.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1353-1359, out.-dez. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022039

RESUMO

Objective: The study's main purpose has been to analyze scientific articles on the world scenario about nursing interventions in the process of preparation and administration of intravenous drugs, risks inherent in professional practice and actions integrated with medical prescription. Methods: It is a research of literary nature that was carried out through the main databases of online indexed studies. For the development of this research, books related to the practice of intravenous therapy and current legislation were consulted. Results: This investigation describes the main urgent and emerging pathologies in the hospital service, nursing actions aimed at intravenous therapy and pain relief. Conclusion: Finally, it is needed to improve the instruments used to measure acute pain, because they have limitations in its implementation, either for evaluating the size of a single aspect or to be extensive in its application in the level of hospital care


Objetivo: Objetivo do estudo consiste em analisar artigos científicos no cenário mundial acerca das intervenções de enfermagem no processo de preparo e administração de medicamentos por via venosa, riscos inerentes a pratica profissional e ações integradas à prescrição médica. Método: pesquisa de natureza literária, realizada através dos principais bancos de dados online de pesquisas indexadas. Para desenvolvimento do estudo foram consultados livros relacionados à prática da terapia intravenosa e legislações vigentes. Resultados: descrição das principais patologias urgentes e emergentes no serviço hospitalar, ações de enfermagem voltadas para terapia intravenosa e alivio da dor. Conclusão: necessidade de aprimoramento dos instrumentos utilizados para mensurar a dor aguda, pois possuem limitações em sua implementação, seja por avaliar a dimensão de um único aspecto ou serem extenso em sua aplicação em nível de atendimento hospitalar


Objetivo: El objetivo del estudio consiste en analizar artículos científicos en el escenario mundial acerca de las intervenciones de enfermería en el proceso de preparación y administración de medicamentos por vía venosa, riesgos inherentes a la práctica profesional y acciones integradas a la prescripción médica. Método: investigación de naturaleza literaria, realizada a través de las principales bases de datos en línea de investigaciones indexadas. Para el desarrollo del estudio se consultó libros relacionados con la práctica de la terapia intravenosa y las legislaciones vigentes. Resultados: descripción de las principales patologías urgentes y emergentes en el servicio hospitalario, acciones de enfermería dirigidas a terapia intravenosa y alivio del dolor. Conclusión: necesidad de perfeccionamiento de los instrumentos utilizados para medir el dolor agudo, pues poseen limitaciones en su implementación, sea por evaluar la dimensión de un solo aspecto o ser extenso en su aplicación a nivel de atención hospitalaria


Assuntos
Humanos , Dor Aguda/enfermagem , Dor Aguda/prevenção & controle , Segurança do Paciente , Risco , Redução do Dano , Administração Intravenosa/enfermagem
20.
MMWR Morb Mortal Wkly Rep ; 68(38): 819-824, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31557148

RESUMO

Rheumatic diseases are a leading cause of chronic, noncancer pain. Systemic lupus erythematosus (SLE) is a chronic autoimmune rheumatic disease characterized by periodic flares that can result in irreversible target organ damage, including end-stage renal disease. Both intermittent and chronic musculoskeletal pain, as well as fibromyalgia (considered a centralized pain disorder due to dysregulation of pain processing in the central nervous system), are common in SLE. Opioids are generally not indicated for long-term management of musculoskeletal pain or centralized pain (fibromyalgia) because of lack of efficacy, safety issues ranging from adverse medical effects to overdose, and risk for addiction (1,2). In this study of 462 patients with SLE from the population-based Michigan Lupus Epidemiology and Surveillance (MILES) Cohort and 192 frequency-matched persons without SLE, nearly one third (31%) of SLE patients were using prescription opioids during the study period (2014-2015), compared with 8% of persons without SLE (p<0.001). Among the SLE patients using opioids, 97 (68%) were using them for >1 year, and 31 (22%) were concomitantly on two or more opioid medications. Among SLE patients, those using the emergency department (ED) were approximately twice as likely to use prescription opioids (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3-3.6; p = 0.004). In SLE, the combined contributions of underlying disease and adverse effects of immunosuppressive and glucocorticoid therapies already put patients at higher risk for some known adverse effects attributed to long-term opioid use. Addressing the widespread and long-term use of opioid therapy in SLE will require strategies aimed at preventing opioid initiation, tapering and discontinuation of opioids among patients who are not achieving treatment goals of reduced pain and increased function, and consideration of nonopioid pain management strategies.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Vigilância da População , Adulto , Idoso , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Humanos , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Manejo da Dor/métodos , Risco
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