ABSTRACT
Abstract Objectives: This study aims to investigate if a sampling method using virtual networks is feasible to survey AS adoption among this "hard-to-reach" population of Brazilian doctors. Methods: An online piloted 11-point structured survey questionnaire (designed using Googleforms®) probed the actual treatment patterns for adult patients with PTMCs, including treatment decision-making nonoperative options, was undertaken between 10 November and 30 November 2020. Participants were reached by the mobile phone Application (APP) and a snowball sampling strategy was used to recruit a total of 4783 members (maximum number of potential reach), which is the total of doctors of the all 21 social media WhatsApp® groups. Results: From a total of 4783 members (maximum number of potential reach), there were 657 (13.7%) doctors (actual reach) who clicked the web link of the questionnaire, out of whom 512 (10.7%) fully completed the online survey. Among the survey respondents, 361 were endocrinologists (70.5%) and 151 were surgeons (29.5%). Overall, for low-risk PTMCs in an elderly patient, 118 responders (23%) recommend AS, while 390 (76%) recommend immediate surgery as the management, including lobectomy (18.5%) and Total Thyroidectomy (58.2%). The present responders tended to recommend surgery for PTMCs that were located adjacent to the dorsal surface of the thyroid, were multiple, or raised the size during the follow-up. Conclusion: Using snowball sampling strategy as an innovative route to conduct surveys was feasible and applicable but the rate of response was still very low. Our data also suggests the need to investigate if AS is embraced by Brazilian doctors.
ABSTRACT
Diante da prevalência de distúrbios do controle glicêmico nas internações hospitalares, especialmente em pacientes portadores de diabetes mellitus, foram elaborados, pela equipe de endocrinologia do Hospital Geral Roberto Santos, protocolos informativos para padronização de condutas no manejo da hiperglicemia em pacientes críticos, não críticos e também para manejo de hipoglicemia no ambiente hospitalar. Trata-se de orientações elaboradas por médicos do corpo clínico da endocrinologia voltadas para os profissionais de saúde de todos os setores hospitalares, fundamentadas na importância crucial do correto manejo glicêmico de pacientes graves, internados em unidade de terapia intensiva, bem como daqueles sob cuidados médicos nos leitos de enfermaria, durante internação hospitalar. Além disso, diante do grande risco e da morbimortalidade associados aos episódios de hipoglicemia, preconizou-se a elaboração de um fluxo de conduta ágil e assertivo em caso de hipoglicemia. O tratamento objetivo e eficaz nesses cenários impacta fortemente o prognóstico dos pacientes, os desfechos clínicos e o tempo de internação. Palavras-chave: Hiperglicemia. Hipoglicemia. Complicações do diabetes.
Due to the prevalence of glycemic control in inpatients, especially diabetic patients, the Endocrinology team of the Hospital Geral Roberto Santos elaborated informative protocols for standardizing the management of hyperglycemia in critical and noncritical patients, as well as of hypoglycemia. Developed by endocrinologists and aimed at health professionals from all sectors, the protocols consist of orientations on the correct glycemic control in at-risk patients admitted to the Intensive Care Unit (ICU), as well as of nursing ward patients. Considering the high risk and morbimortality associated with hypoglycemia episodes, the protocol also preconizes the elaboration of a quick and assertive conduct. Objective and effective treatment in these scenarios strongly impacts prognoses, outcomes, and length of hospital stay.
Dada la prevalencia de trastornos del control glucémico en los ingresos hospitalarios, especialmente en pacientes con diabetes mellitus, el equipo de Endocrinología del Hospital Geral Roberto Santos creó protocolos informativos para estandarizar la conducta en el manejo de la hiperglucemia en pacientes críticos, no críticos y también para el manejo de hipoglucemia en el hospital. Se trata de guías elaboradas por médicos del cuadro clínico de endocrinología, dirigidas a profesionales de la salud de todos los sectores hospitalarios, basadas en la crucial importancia del correcto manejo glucémico de los pacientes críticos hospitalizados en la Unidad de Cuidados Intensivos; así como aquellos bajo atención médica en las camas de la sala durante la hospitalización. Además, dado el alto riesgo y la morbimortalidad asociados a los episodios de hipoglucemia, se recomendó el desarrollo de un flujo de conducta ágil y asertivo en caso de hipoglucemia. El tratamiento objetivo y eficaz en estos escenarios tiene un fuerte impacto en el pronóstico de los pacientes, la evolución clínica y la estancia hospitalaria.