RESUMO
OBJECTIVES: To investigate whether the effect of a flexible ICU visiting policy that includes flexible visitation plus visitor education on anxiety symptoms of family members is mediated by satisfaction and involvement in patient care. DESIGN: We embedded a multivariable path mediation analysis within a cluster-randomized crossover trial as a secondary analysis of The ICU Visits Study (ClinicalTrials.gov number: NCT02932358). SETTING: Thirty-six medical-surgical ICUs in Brazil. PATIENTS: Closest relatives of adult ICU patients. INTERVENTIONS: Flexible visitation (12 hr/d) supported by family education or usual restricted visitation (median, 1.5 hr/d). MEASUREMENTS AND MAIN RESULTS: Overall, 863 family members were assessed (mean age, 44.7 yr; women, 70.1%). Compared with the restricted visitation (n = 436), flexible visitation (n = 427) resulted in better mean anxiety scores (6.1 vs 7.8; mean difference, -1.78 [95% CI, -2.31 to -1.22]), as well as higher standardized scores of satisfaction (67% [95% CI, 55-79]) and involvement in patient care (77% [95% CI, 64-89]). The mediated effect of flexible visitation on mean anxiety scores through each incremental sd of satisfaction and involvement in patient care were -0.47 (95% CI, -0.68 to -0.24) and 0.29 (95% CI, 0.04-0.54), respectively. Upon exploratory analyses, emotional support, helping the ICU staff to understand patient needs, helping the patient to interpret ICU staff instructions, and patient reorientation were the domains of involvement in patient care associated with increased anxiety. CONCLUSIONS: A flexible ICU visiting policy reduces anxiety symptoms among family members and appears to work by increasing satisfaction. However, increased participation in some activities of patient care as a result of flexible visitation was associated with higher severity of anxiety symptoms.
Assuntos
Ansiedade/etiologia , Família/psicologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Visitas a Pacientes/psicologia , Adulto , Ansiedade/prevenção & controle , Ansiedade/psicologia , Brasil , Análise por Conglomerados , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Visitas a Pacientes/estatística & dados numéricosRESUMO
AIM: Evaluate efficacy/safety of oral l-ornithine-l-aspartate (LOLA) in controlling minimal hepatic encephalopathy (MHE). METHODS: Consecutive cirrhotic outpatients with MHE (defined by psychometric number connection tests A/B [NCT-A/B] and digit symbol substitution test [DSST] score of >2 standard deviations) were randomized to a 60-day oral LOLA (5 g t.i.d) or placebo group. Critical flicker frequency test (CFF), quantitative electroencephalogram (qEEG), arterial ammonia (NH3), Beck's anxiety-depression forms and liver disease quality of life (LD-QOL) were assessed. Patients were followed for 6 months after the end of the study to assess LOLA prophylactic role on overt hepatic encephalopathy (OHE). RESULTS: Sixty-four patients were included, 63 (98.4%) with MHE. In six of these patients, CFT was less than 39 Hz (9.52%); NH3 was increased in 32 (50.8%); 25% had abnormal qEEG. Age, sex, scholarship, Child-Pugh (CP), Model for End-Stage Liver Disease, NCT-A/B, DSST, CFF and NH3 were similar in both groups at the baseline. LOLA led to a significant improvement in NCT-B age-controlled z-score (3.4 ± 3.4 vs 1.5 ± 2.3, P = 0.01) and CFF (42.2 ± 5.8 vs 45.2 ± 5.8, P = 0.02), comparing the first and the last visit, but there were no differences between LOLA and placebo regarding the whole psychometric battery, CFF, LD-QOL and Beck's forms. No serious adverse effects occurred. Patients taking LOLA had less episodes of OHE at 6 months (5% vs 37.9%, P = 0.016), as they have significant improvement on liver function assessed by CP (P < 0.001). CONCLUSION: A 60-day oral LOLA course was not better than placebo in treating MHE, but was useful in preventing further episodes of OHE.
RESUMO
As reestruturações necessárias nos serviços de saúde em decorrência da pandemia da COVID-19 geraram impactos na assistência aos pacientes hospitalizados, em especial àqueles gravemente afetados pela doença. A atuação da psicologia em Unidades de Terapia Intensiva dedicadas a esses pacientes requer a ampliação de ferramentas clínicas que possibilitem o atendimento às demandas psicológicas nesse contexto. Esse artigo discute, a partir de um relato de experiência, as atividades desenvolvidas pela equipe de psicologia em um Centro de Terapia Intensiva voltado ao tratamento da COVID-19: atendimento remoto a familiares, atendimento aos pacientes, visitas virtuais e presenciais. As intervenções realizadas, em consonância com o referencial teórico utilizado, indicam os seguintes benefícios: fortalecimento das conexões entre paciente, família e equipe; atenuação do sofrimento provocado pela situação de isolamento; prevenção de agravos em saúde mental relacionados ao luto complicado e à vivência de experiências traumáticas. Espera-se que as inovações nas práticas desenvolvidas sigam contribuindo para qualificar a atenção a pacientes críticos após a pandemia.(AU)
The reorganization needed in health care services due to the COVID-19 pandemic generated a substantial impact on the assistance of hospital patients, especially those who are severely affected by the disease. The psychologist's work in Intensive Care Units, dedicated to these specific patients, requires the amplification of clinical tools that enable the assistance of the psychological demands in this context. In an experience report format, this article discusses the activities developed by the psychological team in an Intensive Care Unit dedicated to the treatment of COVID-19 patients such as: families' remote support, direct patient´s psychological care and virtual and face to face visits. The interventions, in accordance with the theoretical background used, indicate the following benefits: strengthening of the connection between patient, family and health care teams, attenuation of suffering provoked by isolation, the prevention of the aggravation of mental health problems related to complicated mourning processes and the experience of traumatic situations. It is hoped that the innovative developed practices can continue to contribute to qualify the assistance of critically ill patients after the pandemic.(AU)
La necesaria reestructuración de los servicios de salud como consecuencia de la pandemia COVID-19 ha repercutido en la atención de los pacientes hospitalarios, especialmente en los afectados gravemente por la enfermedad. El trabajo de la psicología en las Unidades de Cuidados Intensivos dedicadas a estos pacientes requiere la ampliación de herramientas clínicas que permitan atender las demandas psicológicas de este contexto. Este artículo analiza, a partir de un relato de experiencia, las actividades desarrolladas por el equipo de psicología en un Centro de Cuidados Intensivos enfocado al tratamiento del COVID-19: atención remota a familiares, atención a pacientes, visitas virtuales y presenciales. Las intervenciones realizadas, en consonancia con el referencial teórico utilizado, señalan los siguientes beneficios: fortalecimiento de las conexiones entre paciente, familia y equipo; mitigación del sufrimiento causado por la situación de aislamiento; prevención de agravios en salud mental relacionados al duelo complicado y experiencias traumáticas. Se espera que las innovaciones en las prácticas desarrolladas continúen contribuyendo para calificar la atención de los pacientes críticos pasada la pandemia.(AU)
Assuntos
Psicologia Clínica , Psicoterapia , Estresse Psicológico , Luto , Saúde Mental , COVID-19 , Unidades de Terapia IntensivaRESUMO
BACKGROUNDS: Some symptoms present in melanoma patients are directly related to psychological stress, which emphasizes the need to evaluate quality of life (QoL) in these patients at all the stages of their disease. OBJECTIVES: The objective of this study was to evaluate quality of life in a sample of patients diagnosed with melanoma, using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. METHODS: A descriptive, cross sectional study was conducted between July and December, 2006 with all patients with skin melanoma receiving follow-up care at the Department of Dermatology of the Porto Alegre Teaching Hospital, Federal University of Rio Grande do Sul. RESULTS: Sixty patients were included in the study. Mean age was 55.6 years. Poor education level (primary school or less) was associated with a poorer FACT-G score. Patients with a family history of the disease had higher QoL scores in 3 of the 4 categories evaluated: physical, emotional and functional wellbeing (p<0.01). QoL scores were higher in married patients (82.42) compared to single patients (70.28) (p<0.01). Patients with metastases had lower scores in the functional wellbeing category and this difference was statistically significant. CONCLUSIONS: Factors related to the tumor, as well as gender, age and employment status, were not found to be predictive of quality of life in this sample. Quality of life scores were lower in the functional wellbeing domain in patients with metastases. Married patients are able to count on greater comfort and emotional support to help them deal with the diagnosis of melanoma. Patients with a family history of melanoma had significantly higher quality of life scores, while those with poor education levels had lower scores.
Assuntos
Melanoma/psicologia , Qualidade de Vida/psicologia , Perfil de Impacto da Doença , Neoplasias Cutâneas/psicologia , Estudos Transversais , Escolaridade , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
OBJETIVOS: Estimar a prevalência de sintomas depressivos entre idosos internados no Serviço de Emergência do Hospital de Clínicas de Porto Alegre-RS e verificar a associação entre sintomas depressivos e características sociodemográficas e de utilização de serviços de saúde pelos idosos. MÉTODOS: Estudo transversal com 96 idosos internados em um serviço de emergência. A presença de sintomas depressivos foi avaliada por meio da aplicação da Escala de Depressão Geriátrica - versão reduzida (EDG-15), e foi aplicado instrumento sobre variáveis sociodemográficas e de utilização dos serviços de saúde. Foram realizadas análises descritivas e bivariáveis, e o nível de significância estatística adotado foi de 5% (p≤0,05). RESULTADOS: Encontrou-se a prevalência de 36,5% de sintomas depressivos na amostra, sendo que destes, 6,3% dos idosos apresentavam pontuação sugestiva de depressão grave. Identificou-se associação significativa entre sintomas depressivos e viuvez, observando-se que os sintomas depressivos foram mais frequentes entre as mulheres, os de baixa escolaridade e os que não utilizaram serviços de saúde. CONCLUSÃO: O estudo encontrou alta prevalência de sintomas depressivos entre idosos internados no serviço de emergência. Ressalta-se a importância do reconhecimento e realização do diagnóstico de depressão em idosos nesses serviços com objetivo de se trabalhar com uma visão ampliada do processo de saúde-doença, oferecer tratamento e melhores intervenções na rede.
OBJECTIVES: To estimate the prevalence of depressive symptoms among elderly patients admitted in the emergency service of Porto Alegre Clinical Hospital, Rio Grande do Sul state, Brazil, and assess the association between depressive symptoms and sociodemographic characteristics and use of health services by the elderly. METHODS: Cross-sectional study of 96 elderly patients admitted to the emergency room. The presence of depressive symptoms was evaluated through the application of the Geriatric Depression Scale - short version (GDS-15), and was applied instrument on sociodemographic variables and use of health services. Descriptive and bivariate analyzes were performed, and statistical significance level was 5% (p≤0.05). RESULTS: We found a prevalence of 36.5% of depressive symptoms in the sample, and of these, 6.3% of the elderly had scores suggestive of severe depression. It identified significant association between depressive symptoms and widowhood, observing that depressive symptoms were more frequent among women, low education and those who did not use health services. CONCLUSION: The study found high prevalence of depressive symptoms among elderly patients admitted in the emergency department. It emphasizes the importance of recognizing and making the diagnosis of depression in the elderly in these services in order to work with a broader view of the health-disease process, provide treatment and better interventions on the network.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso , Depressão/epidemiologia , Depressão/epidemiologia , Serviço Hospitalar de Emergência , BrasilRESUMO
FUNDAMENTOS: Alguns sintomas presentes nos pacientes com melanoma estão diretamente relacionados à tensão psicológ ica, o que reforça a necessidade de avaliar a qualidade de vida em todas as fases da doença. OBJETIVOS: Avaliar a qualidade de vida dos pacientes diagnosticados com melanoma por meio do questionário Fact-G. MÉTODOS: Estudo descritivo transversal que incluiu todos os pacientes em seguimento no serviço de dermatologia do Hospital de Clínicas de Porto Alegre entre julho e dezembro de 2006. RESULTADOS: Sessenta pacientes foram incluídos. A idade média foi de 55,6 anos. O nível de escolaridade até primeiro grau foi correlacionado a escores mais baixos no Fact-G. Os pacientes com história familiar apresentaram maiores escores de QoL em três das quatro categorias avaliadas: bem-estar físico, emocional e funcional (P < 0,01). Pacientes casados mostraram melhor qualidade de vida (82,42) que os solteiros (70,28; P < 0,01). Os pacientes com metástase obtiveram uma menor pontuação no questionário no domínio bem-estar funcional. CONCLUSÕES: Os fatores relacionados ao tumor, assim como o sexo, a idade e a situação de emprego, não foram preditores de qualidade de vida. Pacientes com metástases apresentaram pior qualidade de vida no domínio bem-estar funcional. Pacientes casados têm mais conforto e apoio emocional para lidar com o diagnóstico do tumor. Os pacientes com história familiar de melanoma tiveram melhor qualidade de vida e os com baixa escolaridade, uma pior qualidade de vida.
BACKGROUNDS: Some symptoms present in melanoma patients are directly related to psychological stress, which emphasizes the need to evaluate quality of life (QoL) in these patients at all the stages of their disease. OBJECTIVES: The objective of this study was to evaluate quality of life in a sample of patients diagnosed with melanoma, using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. METHODS: A descriptive, cross sectional study was conducted between July and December, 2006 with all patients with skin melanoma receiving follow-up care at the Department of Dermatology of the Porto Alegre Teaching Hospital, Federal University of Rio Grande do Sul. RESULTS: Sixty patients were included in the study. Mean age was 55.6 years. Poor education level (primary school or less) was associated with a poorer FACT-G score. Patients with a family history of the disease had higher QoL scores in 3 of the 4 categories evaluated: physical, emotional and functional wellbeing (p<0.01). QoL scores were higher in married patients (82.42) compared to single patients (70.28) (p<0.01). Patients with metastases had lower scores in the functional wellbeing category and this difference was statistically significant. CONCLUSIONS: Factors related to the tumor, as well as gender, age and employment status, were not found to be predictive of quality of life in this sample. Quality of life scores were lower in the functional wellbeing domain in patients with metastases. Married patients are able to count on greater comfort and emotional support to help them deal with the diagnosis of melanoma. Patients with a family history of melanoma had significantly higher quality of life scores, while those with poor education levels had lower scores.