Postdischarge telephone follow-up among chronic disease patients discharged from a vascular surgery service: a best practice implementation project.

OBJECTIVES: To improve postdischarge telephone follow-up in the context of chronic disease management (peripheral artery disease), in a vascular surgery service. INTRODUCTION: Patients with chronic diseases, such as peripheral artery disease, present a higher risk of complications and greater constraints regarding their adherence to treatment, leading to an increasing mortality rate and decreased functional capacity. Comprehensive discharge planning plus postdischarge telephone follow-up may reduce 30-day re-hospitalization rates. METHODS: The project used the JBI audit and feedback methodological approach to implement the best available evidence into practice. Two audit criteria were used: existence of comprehensive discharge planning and timely telephone follow-up. A baseline audit was conducted, followed by analysis of barriers, which led to the implementation of several strategies, namely, a targeted training program, the development of educational resources and standardized procedures for the discharge process, and postdischarge telephone follow-up. RESULTS: Results from the baseline and first follow-up audits showed improvement for both criteria. Compliance for criterion 1 (comprehensive discharge planning, including postdischarge telephone follow-up) increased from 0% to 40.7%, and for criterion 2 (patient is followed up by telephone within 2 weeks of discharge) increased from 0% to 44.4%. These two criteria sustained improvements in the second follow-up audit: compliance increased to 45% (criterion 1) and 60% (criterion 2). CONCLUSIONS: This implementation project contributed to the optimization of the chronic disease management, including improved compliance with discharge planning and early postdischarge telephone follow-up.

AUTISM SPECTRUM DISORDER: A SYSTEMATIC REVIEW ABOUT NUTRITIONAL INTERVENTIONS.

OBJECTIVE: To identify and analyze the scientific evidence of nutritional interventions performed in children and adolescents with Autism Spectrum Disorder. DATA SOURCES: A systematic review was conducted in the MEDLINE, Cochrane Library, Embase, LILACS, Google Scholar, PubMed, PsycINFO and Periódicos CAPES databases, using a search strategy to identify studies published between January 2003 and March 2018, in Portuguese, English and Spanish. Were included studies that described nutritional interventions in children and adolescents with autism spectrum disorders and assessed autistic behavior and/or gastrointestinal symptoms. We excluded other review articles and studies that did not include a control group in the research design. The studies were reviewed for descriptive information, and the quality of evidence was assessed through the GRADE system. DATA SYNTHESIS: 18 studies were included in the review, being 16 randomized clinical trials, 1 case-control study and 1 open-label trial. As a result, the implementation of a gluten-free and casein-free diet was the most used intervention among the studies. Of the total, 10 studies showed a positive association of intervention with the evaluated results, while 8 did not find of a significant association. CONCLUSIONS: Although some authors report progress in the symptoms associated with autism in individuals with Autistic Spectrum Disorder undergoing nutritional interventions, there is little scientific evidence to support the use of nutritional supplements or dietary therapies in children and adolescents with autism.

Comparison of the energy and metabolic nutritional profile of women with central obesity of socioeconomic classes A/B vs C/D/E.

INTRODUCTION: Objective: to describe the characteristics of food consumption and energy intake of women with central obesity of socioeconomic classes A/B vs C/D/E. Methodology: a cross-sectional study in which a structured questionnaire was answered containing data on socioeconomics and physical activities. Weight and waist circumference (WC) were measured and the 24-hour recall was assessed (24hR) in relation to food consumption. Biochemical exams were analyzed. The dietary analysis was performed on the Nutwin software and statistical analysis on the SPSS 23.0. Results: there were 89 women assessed in each group and no significant differences were observed in relation to age, with averages of 51.2 ± 12.2 years vs 49 ± 14.4 years for classes C/D/E vs A/B, respectively. A sedentary lifestyle was predominant for class C/D/E 82 (92.13%) vs 22 (24.71%) (p < 0.001).Significant differences were observed between the groups for variables of hypertriglyceridemia (p < 0.001), predominant in the C/D/E socioeconomic group, and HDL-C (p < 0.001), predominant in the A/B socioeconomic group. Total energy consumption of women from class C/D/E vs A/B presented mean values of 1,528.72 kcal (1,128.8-1,697.3) vs 2,267.48 kcal (1,670.3-2,625.84), respectively. Significant differences were observed in the consumption of fiber between groups C/D/E vs A/B (p < 0.001), with less consumption in class C/D/E. With reference to income and schooling levels, we observed heterogeneity in the results and emphasize the marked contrast between low and high income that could influence the choice of food, contributing in the lower income to monotonous diets, less energy consumption and, furthermore, low quality in the ingested food. Conclusion: in this study, all of the women presented metabolic profiles in different manners among the groups and, also, women of class C/D/E, who presented insufficient fiber consumption, directly contributing to this condition of obesity, also presented worse lipid (total cholesterol and triglycerides) and glycemic profiles.

INTRODUCCIÓN: Objetivo: describir las características del consumo alimentario e ingestión energética de mujeres con obesidad central de clase socioeconómica A/B vs C/D/E. Metodología: estudio transversal en el que respondieron a un cuestionario estructurado que contenía datos socioeconómicos y actividad física. Se evaluaron el peso, circunferencia de la cintura (CC), y se hizo un recordatorio de 24 horas (R24h) en relación al consumo alimentario y los exámenes bioquímicos. Los análisis dietéticos se realizaron en el software Nutwin y los análisis estadísticos en el SPSS 23.0. Resultados: se valoraron 89 mujeres en cada grupo y no se observó diferencia significativa para la edad, con una media de 51,2 ± 12,2 años frente a 49 ± 14,4 años clase C/D/E vs A/B, respectivamente. El sedentarismo fue predominante en la clase C/D/E 82 (92,13%) vs 22 (24,71%), (p < 0,001). Se observaron diferencias significativas entre los grupos para las variables de hipertrigliceridemia (p < 0,001), predominantes en el grupo de clase socioeconómico C/D/E y HDL-C (p < 0,001), predominante en el grupo de clase socioeconómico A/B. El consumo energético total de las mujeres de clase C/D/E vs A / B, presentó medianas de 1528,72 kcal (1128,8-1697,3) frente a 2267,48 kcal (1670,3-2625,84), respectivamente. Se observó una diferencia significativa del consumo de fibra entre los grupos C/D/E vs A/B (p < 0,001), siendo el consumo menor en la clase C / D / E. En lo que se refiere a la renta y escolaridad, observamos la heterogeneidad de los resultados y destacamos el marcado contraste entre la baja y elevada renta lo que podría influir en la elección de los alimentos, contribuyendo en la menor renta para la monotonía alimentaria, menor consumo energético y, además, baja calidad de los alimentos ingeridos. Conclusión: en este estudio, todas las mujeres presentaron perfiles metabólicos de maneras distintas entre los grupos. Las mujeres de la clase C/D/E presentaron consumo insuficiente de fibra, lo que ciertamente contribuyó al cuadro de obesidad encontrado y paralelamente presentan peor perfil lipídico (colesterol total y triglicéridos) y glucémico.

Autism spectrum disorder: a systematic review about nutritional interventions / Transtorno do espectro autista: uma revisão sistemática sobre intervenções nutricionais

ABSTRACT Objective: To identify and analyze the scientific evidence of nutritional interventions performed in children and adolescents with Autism Spectrum Disorder. Data sources: A systematic review was conducted in the MEDLINE, Cochrane Library, Embase, LILACS, Google Scholar, PubMed, PsycINFO and Periódicos CAPES databases, using a search strategy to identify studies published between January 2003 and March 2018, in Portuguese, English and Spanish. Were included studies that described nutritional interventions in children and adolescents with autism spectrum disorders and assessed autistic behavior and/or gastrointestinal symptoms. We excluded other review articles and studies that did not include a control group in the research design. The studies were reviewed for descriptive information, and the quality of evidence was assessed through the GRADE system. Data synthesis: 18 studies were included in the review, being 16 randomized clinical trials, 1 case-control study and 1 open-label trial. As a result, the implementation of a gluten-free and casein-free diet was the most used intervention among the studies. Of the total, 10 studies showed a positive association of intervention with the evaluated results, while 8 did not find of a significant association. Conclusions: Although some authors report progress in the symptoms associated with autism in individuals with Autistic Spectrum Disorder undergoing nutritional interventions, there is little scientific evidence to support the use of nutritional supplements or dietary therapies in children and adolescents with autism.

RESUMO Objetivo: Identificar e analisar as evidências científicas de intervenções nutricionais realizadas em crianças e adolescentes com Transtorno do Espectro Autista. Fontes de dados: Realizou-se uma revisão sistemática nas bases de dados MEDLINE, Cochrane Library, Embase, LILACS, Google Acadêmico, PubMed, PsycINFO e Periódicos CAPES utilizando estratégia de busca abrangente para identificar estudos publicados entre janeiro de 2003 e março de 2018, em língua portuguesa, inglesa e espanhola. Foram incluídos estudos que descreveram intervenções nutricionais em crianças e adolescentes com Transtorno do Espectro Autista e avaliaram sintomas comportamentais e/ou sintomas gastrintestinais, sendo excluídos artigos de revisão e estudos que não incluíram um grupo controle em seu delineamento. Os estudos foram examinados para obter informações descritivas, e a qualidade de evidência foi avaliada por meio do Sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Síntese dos dados: Dezoito estudos foram incluídos na revisão (16 ensaios clínicos randomizados, um estudo de caso-controle e um ensaio clínico aberto). As intervenções e os resultados variaram, entretanto a implementação de uma dieta livre de glúten e caseína foi a intervenção mais utilizada entre os estudos. Do total, dez estudos encontraram associação positiva entre intervenção e resultados avaliados, enquanto oito não encontraram associação significativa. Conclusões: Embora alguns autores exponham progressos nos sintomas associados ao autismo em indivíduos com esse transtorno submetidos a intervenções nutricionais, há poucas evidências científicas para apoiar o uso destas em crianças e adolescentes com autismo.

Humoral immune response after kidney transplantation is enhanced by acute rejection and urological obstruction and is down-regulated by mycophenolate mofetil treatment.

The anti-allograft immune response may have a cellular and a humoral component. Lymphocytotoxic antibodies (Ab) and anti-human leucocyte antigen (HLA) Ab present before kidney transplantation carry an enhanced risk of acute rejection. Current immunosuppressive drugs act predominantly upon the cellular immune pathway which may leave unopposed the humoral mechanisms of anti-allograft response. We studied the production of lymphocytotoxic Ab and anti-HLA Ab after kidney transplantation under different drug therapies. Two hundred and sixty-four consecutive kidney transplant recipients treated with different immunosuppressive drugs, either stable and or with previous acute rejection or acute urologic obstruction, entered this study. Lymphocytotoxic Ab and anti-HLA Ab were evaluated by complement-dependent cytotoxicity and by ELISA. Ab donor-specificity was determined by flow cytometry. Both lymphocytotoxic Ab and anti-HLA Ab were significantly increased in acute rejection whatever the immunosuppressive regimen and almost significantly in urologic obstruction treated with azathioprine (AZA) groups. The presence of antidonor-specific Ab was associated with a significantly higher rate of graft loss. Mycophenolate mofetil (MMF) therapy significantly down-regulated Ab synthesis in all patients groups when compared with AZA. The development of humoral antidonor response post-transplantation is associated with a dismal graft prognosis. This is the first report that acute urologic obstruction may be followed by unspecific lymphocytotoxic and anti-HLA Ab synthesis, surmising that a protracted obstruction may promote renal fibrosis through antibody mediation. The significant down-regulation of the humoral response by MMF when compared with AZA may herald a lower risk to mount a chronic rejection process.