Investigation on the Use of an Automated Question-and-Answer Post-Dispensing Follow-up Application during the Medication Period / 医薬品情報学

Objective: Continuous medication management is demanded from community pharmacists, including mandatory follow-ups (FUs) during the medication period. To improve their efficiency and quality, a software application (app) is being introduced. We investigated the use of the app for FUs by comparing it to the use of phone calls.Design: This was a retrospective studythat collected FU records from participating pharmacies.Methods: FU records of an automated question-and-answer post-dispensing app and phone calls made at 10 pharmacies in June-July 2021 were collected. Differences in the work time and contents of each FU tool were evaluated.Results: Of the 138 eligible cases, 69 (50.0%) used the app and 62 (44.93%) used phones. There was 1 case of FU interruption using the app and 12 for those using phone calls. Preparation time to initiate FU was shorter using the app than phone calls (0.28 ± 0.96 min vs. 5.06 ± 5.44 min). Moreover, there were more cases of pharmaceutical problems identified using the app than phone calls (69.57% vs. 35.48%).Conclusion: The FU app maybe a more efficient tool for identifying problems than phone calls. Further studies are needed to optimize the tool according to patient characteristics.

Maternal and child predictors associated with loss to follow-up in the newborn hearing screening program: a cohort study in maternity hospitals in northeastern Brazil / Preditores maternos e infantis associados a perda de seguimento do programa triagem auditiva neonatal: estudo de coorte em maternidades do nordeste do Brasil

ABSTRACT Purpose Analyze maternal and child predictors associated with loss to follow-up in the newborn hearing screening program at maternity hospitals in northeastern Brazil. Methods Retrospective cohort study, including secondary data from infants (n=604) referred to the newborn hearing screening program in two maternity hospitals for monitoring and/or diagnosis. The predictors evaluated included socioeconomic factors, such as maternal age, marital status, income, schooling, place of residence, number of children and number of prenatal visits. In addition, maternal and child health factors, such as smoking and drug intake during pregnancy, consanguinity, congenital infections, craniofacial malformations, use of ototoxic drugs, syndromes and a history of hearing loss in the family. Statistical analysis was performed based on binary logistic regression models, using the stepwise method. Results The logistic regression model containing the number of prenatal visits and the history of hearing loss in the family was significant [χ2(2) =34.271; p<0.001]. The number of prenatal visits (OR = 2.343; 95% CI = 1.626 - 3.376) and family history of hearing loss (OR = 2.167; 95% CI = 1.507 - 3.115) were significant predictors. The other predictors were not significant. Conclusion The results reveal that newborns whose mothers had ≤ 5 prenatal visits and those with a family history of hearing loss increased their likelihood of loss to follow-up by 2.3 and 2.1 times, respectively. It is important to provide subsidies for public health improvements in order to help advise, guide and educate mothers, especially during prenatal care.

RESUMO Objetivo Analisar preditores maternos e infantis associados a perda de seguimento do programa de triagem auditiva neonatal em maternidades em maternidades do nordeste do Brasil. Método Estudo de coorte retrospectivo, incluindo dados secundários de lactentes (n=604) que foram encaminhados para o monitoramento e/ou diagnóstico do programa de triagem auditiva neonatal, em duas maternidades do nordeste do Brasil. Preditores avaliados incluíram fatores socioeconômicos, como, idade materna, estado civil, renda, escolaridade, local de residência, número de filhos e número de pré-natais; E fatores de saúde materno e infantil, como, fumo e drogas durante a gestação, consanguinidade, infecções congênitas, malformações craniofaciais, uso de drogas ototóxicas, síndromes e história de perda auditiva na família. Foi realizado análise estatística baseada em modelos de regressão logística binária, método stepwise. Resultados O modelo de regressão logística contendo o número de pré-natais e a história de perda auditiva na família foi significativo [χ2(2) =34,271; p<0,001]. Foram preditores significativos, o número de pré-natais (OR = 2,343; IC 95%= 1,626 - 3,376) e a história de perda auditiva na família (OR =2,167; IC 95% = 1,507 - 3,115), os demais preditores, não apresentaram significância neste estudo. Conclusão Os resultados demonstram que estão associados e aumentam as chances de perda de seguimento do programa, recém-nascidos cuja mães realizaram ≤ 5 pré-natais com 2,3 vezes mais chances e história de perda auditiva na família aumentando os riscos em 2,1 vezes a mais. É importante fornecer subsídios para que sejam implementadas melhorias na saúde pública que visem aconselhar, orientar e conscientizar as mães, principalmente durante os pré-natais.

Congenital syphilis: associated factors in a follow-up outpatient clinic / Sífilis congênita: fatores associados em um ambulatório de seguimento

Abstract Objective: This study aimed to describe the characteristics of mothers and children assisted in a follow-up clinic for congenital syphilis and identify the factors associated with the confirmation of the diagnosis. Methods: This is a prospective study conducted from 2016 to 2019 in Montes Claros, Northern Minas Gerais, Brazil. Specific forms addressing maternal sociodemographic, behavioral, and lifestyle habit characteristics, as well as characteristics related to access to healthcare, were used. Hierarchical Poisson regression analysis was performed to define the factors associated with diagnostic confirmation, including the calculation of the prevalence ratios (PR) and respective 95% confidence intervals (95%CI). Results: A total of 200 binomials (mother-child) who attended at least one appointment as part of the follow-up after discharge from the maternity hospital were eligible for the study. The mothers were mostly young (79.0%), with a low educational level (43.0%), and black (89.5%). Nearly half of the mothers reported not having a steady sexual partner (42.5%). About a quarter attended less than six prenatal appointments (27.5%). Nearly half did not treat the disease adequately during pregnancy (24.5%). The diagnosis of congenital syphilis was confirmed for 116 children. The following factors were associated with the diagnostic confirmation after multiple analyses: low maternal educational level (PR 1.30; 95%CI 1.05-1.60), maternal risky sexual behavior (PR 1.34; 95%CI 1.07-1.66), inadequate treatment of the mother (PR 3.16; 95%CI 2.42-4.47), and lack of treatment of the partner (PR 1.44; 95%CI 1,18-1.81). Conclusions: Syphilis remains a major challenge. The results highlight the social inequities associated with congenital syphilis and the lack of proper management of pregnant women and their partners.

Resumo Objetivo: Descrever as características de mães e crianças atendidas em um ambulatório de acompanhamento de sífilis congênita e identificar os fatores associados à confirmação do diagnóstico. Métodos: Trata-se de um estudo prospectivo realizado de 2016 a 2019, em Montes Claros, norte de Minas Gerais. Foram utilizados formulários específicos que abordavam características sociodemográficas, comportamentais e de hábitos de vida das mães, bem como características relacionadas ao acesso aos cuidados de saúde. Foi realizada análise de regressão de Poisson hierárquica para s definição dos fatores associados à confirmação diagnóstica, com cálculo das razões de prevalência (RP) e respectivos intervalos de confiança de 95% (IC95%). Resultados: Duzentos binômios (mãe-filho) que compareceram a pelo menos uma consulta como parte do acompanhamento após a alta da maternidade foram elegíveis para o estudo. As mães eram, em sua maioria, jovens (79,0%), com baixa escolaridade (43,0%) e negras (89,5%). Quase metade das mães relatou não ter parceiro sexual fixo (42,5%). Cerca de um quarto compareceu a menos de seis consultas de pré-natal (27,5%). Quase metade não tratou a doença adequadamente durante a gravidez (24,5%). O diagnóstico de sífilis congênita foi confirmado em 116 crianças. Os seguintes fatores foram associados à confirmação diagnóstica após análise múltipla: baixa escolaridade materna (RP 1,30; IC95% 1,05-1,60), comportamento de risco materno (RP 1,34; IC95% 1,07-1,66), tratamento inadequado da mãe (RP 3,16; IC95% 2,42-4,47) e falta de tratamento do companheiro (RP 1,44; IC95% 1,18-1,81). Conclusões: A sífilis continua sendo um grande desafio. Os resultados revelam as iniquidades sociais associadas à sífilis congênita e a falta de manejo adequado das gestantes e seus parceiros.

Preterm General Movements in Prediction of Neurodevelopmental Disability and Cerebral Palsy at Two Years: A Prospective Cohort Study

Background: A neurological assessment before discharge from the NICU would enable early targeted intervention to mitigate the risk and severity of cerebral palsy (CP) and neurodevelopmental disability. Objective: To assess the accuracy of general movements (GM) in the preterm and fidgety movement periods in predicting neurodevelopmental disability and cerebral palsy in very preterm infants (?32 weeks gestational age) at 18-24 months corrected gestational age. Study design: Prospective cohort study Participants: One hundred and seventy very preterm infants, mean (SD) gestation 29.8 (1.32) weeks, and birthweight 1215 (226) g. Outcomes: Infants underwent GM assessments in the preterm period (31-36 weeks post-conception age) and fidgety movement period (8-18 weeks post term age). Neurodevelopmental outcomes were assessed in 127 children using the Griffiths Mental Developmental Scales-2. Results: Nine children had neurodevelopmental disability (two infants with cerebral palsy and seven with global developmental delay. The relative risk (95% CI) for neurodevelopmental disability was 1.46 (0.31-6.89) with preterm movements and 6.07 (0.97 – 38.05) with fidgety movements. Sensitivity and specificity values for the prediction of neurodevelopmental disability were 33% and 64% in the preterm period and 25% and 92% in the fidgety movement period, respectively. The sensitivity and specificity values for prediction of CP were 50% and 63% in the preterm period and 100% and 93% in the fidgety movement period, respectively. Conclusion: Preterm movements showed lower sensitivity and specificity than fidgety movements in predicting later CP and neurodevelopmental disability in preterm infants.

Effect of follow-up care based on the knowledge attitude belief practice theory on postoperative care quality and readmission rate in children with critical congenital heart disease / 中华健康管理学杂志

Objective:To explore the effect of follow-up care based on the knowledge attitude belief practice theory on postoperative care quality and readmission rate for children with critical congenital heart disease (CCHD).Methods:From June 2018 to October 2020, 76 children with CCHD admitted to this hospital were selected and divided into 38 cases in the control group and 38 cases in the study group according to the random number table method. The control group was given routine follow-up care after discharge, and the study group was given follow-up care based on the knowledge attitude belief practice theory besides the routine follow-up care for the control group after discharge. The readmission rates during the follow-up period were compared between the two groups, and the quality of care and self-efficacy (GSES) of caregivers were compared between the two groups at discharge, 6 months after discharge.Results:During the follow-up period, the readmission rate of the study group was 2.63% (1/38) lower than that of the control group 18.42% (7/38) ( P<0.05); 6 months after discharge, the study group had higher scores of care quality in postoperative feeding, surgical incision care, medication after discharge, prevention of complications, and critical illness recognition than those of the control group [(10.56±1.12) vs (9.78±1.03), (10.92±1.05) vs (9.96±0.98), (10.62±1.32) vs (9.35±1.02), (10.95±1.03) vs (9.97±0.99), (11.05±0.80) vs (9.23±0.75), (10.56±1.35) vs (8.95±0.99)] (all P<0.05); 6 months after discharge, the caregiver′s GSES score of the study group was higher than that of the control group ( P<0.05). Conclusion:Follow-up care based on the knowledge attitude belief practice theory can improve the quality of postoperative care for children with CCHD, reduce the readmission rate, and improve the self-efficacy of caregivers.

Validação de um instrumento para controle de cura sifilítica em puérperas e recém-nascidos / Validation of an instrument for control syphilitic cure control in puerperal women and newborns / Validación de un instrumento para el control de la curación sifilítica en puérperas y recién nacidos

OBJETIVO: Validar um instrumento para controle de cura sifilítica em puérperas e seus RN, após alta da maternidade. MÉTODO: Design Science Research, com juízes escolhidos pela técnica "bola de neve". Seguiram-se as etapas de: levantamento bibliográfico; elaboração da tecnologia; validação pelos especialistas, avaliando a tecnologia através de um instrumento de coleta de dados ­ com uma escala de Likert e espaços para justificativas abertas. A análise dos dados foi feita pelo cálculo do Índice de Validade de Conteúdo (IVC) para cada item para o instrumento. O contato entre pesquisador e juízes se deu via e-mail. RESULTADOS: Participaram da avaliação 5 juízes especialistas. Todos os itens foram considerados relevantes (IVC≥ 0,80), gerando, para o instrumento como um todo, um IVC= 1. Os itens da seção "Identificação do(a) usuário(a)" foram incrementados; na seção "Informações diagnósticas e terapêuticas", julgou-se pertinente manter campo para registro do teste não-treponêmico, excluindo teste treponêmico. CONCLUSÃO: O instrumento foi validado, apresentando confiabilidade de implementação. A tecnologia será capaz de auxiliar profissionais da atenção primária a conduzir o controle de cura sifilítica de RN e puérperas; e poderá fortificar a comunicação entre os níveis de atenção à saúde. (AU)

Objective: To validate an instrument to control syphilitic cure in puerperal women and their newborns, after discharge from the maternity hospital. Methods: Design Science Research, with judges chosen by the "snowball" technique. The following steps were taken: bibliographic survey; development of the technology; validation by specialists, who evaluated the technology through a data collection instrument - with a Likert scale and spaces for open justifications. Data analysis was performed by calculating the Content Validity Index (CVI) at each item for the instrument. The contact between the researcher and the judges was done via e-mail. Results: Five expert judges participated in the evaluation. All items were considered relevant (CVI≥ 0.80), generating, for the instrument as a whole, a CVI= 1. The items in the section "User identification" were increased; in the section "Diagnostic and therapeutic information", it was deemed pertinent to keep the field for recording the non-treponemal test, excluding the treponemal test. Conclusion: The instrument was validated, showing its reliability for implementation. The technology will be able to assist Primary Health Care professionals to conduct the control of syphilitic cure of newborns and postpartum women; in addition, it can strengthen communication between levels of health care. (AU)

Objetivo: Validar un instrumento para el control de la curación sifilítica en puérperas y sus recién nacidos, luego del alta de la maternidad. Métodos: Design science research, con jueces elegidos mediante la técnica de "bola de nieve". Se dieron los siguientes pasos: estudio bibliográfico; desarrollo tecnológico; validación por especialistas, evaluando la tecnología a través de un instrumento de recolección de datos - con escala Likert y espacios para justificaciones abiertas. El análisis de los datos se realizó calculando el Índice de Validez de Contenido (IVC) para cada ítem del instrumento. El contacto entre el investigador y los jueces se realizó vía correo electrónico. Resultados: Cinco jueces expertos participaron en la evaluación. Todos los ítems fueron considerados relevantes (IVC ≥ 0,80), generando, para el instrumento en su conjunto, un IVC = 1. Se incrementaron los ítems del apartado "Identificación del usuario"; en el apartado "Información diagnóstica y terapéutica", se consideró pertinente mantener el campo para el registro de la prueba no treponémica, excluyendo la prueba treponémica. Conclusión: El instrumento fue validado, mostrando confiabilidad de implementación. La tecnología podrá ayudar a los profesionales de atención primaria a realizar el control de la curación sifilítica de recién nacidos y puérperas; y puede fortalecer la comunicación entre los niveles de atención de la salud. (AU)

Validating the Utilization of the Patient Compliance Instruction Support System “FollowNavi” for Follow-up Inhalation Instructions / 医薬品情報学

Objective: Following the amendment of the Pharmaceutical and Medical Device Act in December 2019, continuous follow-up of patients during treatment has been mandated for pharmacists. The follow-up methods may involve contacting patients via telephone and social networking services (SNS). The SNS is advantageous over telephone, because patients can respond to the pharmacists at their convenience. Therefore, we developed a patient compliance instruction support system “FollowNavi” using LINE. We prepared a content of inhalation drugs used to treat bronchial asthma for assessment using FollowNavi and conducted questionnaire surveys among patients and pharmacists to validate its utility.Methods: FollowNavi was used from May1 to July 31, 2020, to follow up patients diagnosed with bronchial asthma for whom long-term control medicine (inhalation drugs) was prescribed for the first time or prescriptions were changed from other inhalation drugs. Subsequently, when the patients revisited the pharmacy, we conducted a questionnaire survey regarding the usability of FollowNavi. We also conducted a questionnaire survey among the pharmacists.Results: Seven and five responses were received from patients who were followed up via FollowNavi and pharmacists who used FollowNavi, respectively. Furthermore, 28.6% of the patients responded “I could solve the problem through LINE” and 71.4% responded “I did not have anything in particular that I could not understand.” As for pharmacists, 60.0% responded that they could obtain sufficient information from the patients through FollowNavi.Conclusion: The results suggest that follow-up after providing inhalation instructions using the inhalation drug content of FollowNavi may be useful for both patients and pharmacists.

Investigating the Effect of Follow-up Care on the Self-concept of Patients under Coronary Artery Bypass Grafting

Introduction: Since coronary artery angina pectoris is a chronic disease, it negatively affects patients` self-concept. In this study, the effect of follow-up care on the self-concept of patients undergoing coronary artery bypass grafting was investigated.Materials and Methodology:In this study, the clinical trial was measured using self-concept questionnaire considering the effect of follow-up or constant care on 60 patients under coronary artery bypass grafting in Seyed-al-shohada heart centerof Urmia. Eight to twelve weeks after the operation, the follow-up care, which is an Iranian native model was administered through telephon. Data collection tools included patients` demographic data collection form as well as self-concept questionnaire consisting of 25 Likert-scale items of 1 to 5 (totally positive, positive, neutral, negative, totally negative), which measured 25 features. Results: In the current study, the mean age of patients in both groups (intervention and control) was 59.68±7.43 and 59.48±5.79years old, respectively.In addition, the mean weight of patients in both groups (intervention and control) equaled 77.82±10.67and 75.22±7.53 kg. According to the results of the mean, the perceived threat after the intervention was 45.16±4.28 in the intervention group and it was 40.43±5.22 in the control group, showing a significant statistical difference between two groups (p<0.001). The perceived challenge after the intervention was 70.86±6.82 in the intervention group and it was 67.13±6.37 in the control group, showing a significant statistical difference between two groups (p=0.028). Conclusion: Themean of self-concept score increased after the intervention and the observed results could have positive effects on the treatment of patients

Clínica em movimento: a cidade como cenário do acompanhamento terapêutico / Moving Clinic: the city as the setting to therapeutic follow-up care

O artigo aborda a prática do acompanhamento terapêutico em sua dimensão clínica-política. Pretende-se desenvolver uma reflexão a respeito da potência de se tomar a cidade como matéria da clínica a partir da prática do acompanhamento terapêutico. Para tanto, faremos uma incursão pelo modo a partir do qual se desenvolveu, na modernidade, a constituição dos discursos e medidas adotados com vistas a abarcar a experiência da loucura sob o estigma de doença mental. Em seguida, apresentaremos o contexto de revisionismo crítico acerca dos alicerces do saber médico-psiquiátrico, a partir da segunda metade do século XX, com o questionamento dos critérios utilizados para designar, delimitar e caracterizar os sujeitos alçados à categoria de alienados. O embasamento teórico está centrado em autores tais como Michel Foucault, Robert Castel e Franco Basaglia. O investimento nos espaços públicos faz com que esta estratégia de intervenção seja um importante ator no processo de Reforma psiquiátrica brasileira.(AU)

This article focus the therapeutical follow-up care practice in its clinical-political dimension. It is intended to develop a reflexion about the power of taking the city as a matter of the clinic from the practice of therapeutic follow-up. To achieve that, we shall make an incursion through the method from wich it has been developed, in modern times, the constitution of discourses and measures adopted in order to comprehend the experience of insanity under the stigma of a mental desease. Next, we present the context of critical revisionism about the foundations of medical-psychiatric knowledge, from the second half of the twentieth century, with the questioning of the criteria used to designate, delimit and characterize the subjects raised to the category of alienated. The theoretical basis is found in authors such as Michel Foucault, Robert Castel and Franco Basaglia. Investing in public spaces makes this intervention strategy to be an important agent in the Brazilian psychiatric reform process.(AU)

Factors Contributing For Noncompliance Of Follow-Up Care Among Post Cardiac Patients

Objective: Compliance in following healthy diet, physical activity schedule, cessation of smoking and alcohol, medication adherence and regular follow up is very essential component in the management of patients with cardiovascular disease to prevent reoccurrence and reduce mortality. Hence the study was conducted with the aim to assess the factors contributing for noncompliance of follow-up care among post cardiac patients. Methods: Cross-sectional research design was employed with 50 samples who matched the inclusion criteria were selected by convenience sampling technique. Demographic variables data were collected by using structured questionnaire followed by assessed the factors contributing for noncompliance using checklist. Results: The findings of the current study revealed that all physical, psychological, economical, social and spiritual factors were highly influenced the noncompliance. Of these, the highest percentage 80% reported lack of accessibility as well financial support and around 70% percentage reported side effects of medication and low health literacy. Conclusion: Health care providers need to be focussed on interventional strategies especially health education in discharge plan to ensure that these patients adhere to follow up including medication adherence, following physical activity plan, dietary modification, lifestyle changes and regular follow up visit to prevent readmission and lead a successful life.

Follow-Up Decision Support Tool for Public Healthcare: A Design Research Perspective / 대한의료정보학회지

OBJECTIVES: Mobile health (m-Health) technologies may provide an appropriate follow-up support service for patient groups with post-treatment conditions. While previous studies have introduced m-Health methods for patient care, a smart system that may provide follow-up communication and decision support remains limited to the management of a few specific types of diseases. This paper introduces an m-Health solution in the current climate of increased demand for electronic information exchange. METHODS: Adopting a novel design science research approach, we developed an innovative solution model for post-treatment follow-up decision support interaction for use by patients and physicians and then evaluated it by using convergent interviewing and focus group methods. RESULTS: The cloud-based solution was positively evaluated as supporting physicians and service providers in providing post-treatment follow-up services. Our framework provides a model as an artifact for extending care service systems to inform better follow-up interaction and decision-making. CONCLUSIONS: The study confirmed the perceived value and utility of the proposed Clinical Decision Support artifact indicating that it is promising and has potential to contribute and facilitate appropriate interactions and support for healthcare professionals for future follow-up operationalization. While the prototype was developed and tested in a developing country context, where the availability of doctors is limited for public healthcare, it was anticipated that the prototype would be user-friendly, easy to use, and suitable for post-treatment follow-up through mobility in remote locations.

O acompanhamento terapêutico na cena urbana: transicionalidade e interjogo na arena sociocultural / The therapeutic follow-up care in the urban scene: transitionality and interplay in the sociocultural arena

O presente artigo visa refletir sobre o acompanhamento terapêutico, no intuito de articular as análises de Donald Winnicott acerca da importância das provisões ambientais primárias, à qualidade da relação que se estabelece entre o acompanhante terapêutico e o sujeito acompanhado. O acompanhamento terapêutico se inscreve no processo de Reforma Psiquiátrica brasileira, sendo uma de suas características mais marcantes a proposta de uma clínica ampliada, que acontece nos territórios de vida daqueles que são assistidos. A partir desta perspectiva, buscaremos esquadrinhar as questões clínicas decorrentes dessa abertura para o "fora" que caracteriza este tipo de acompanhamento. Constata-se com isso que, no acompanhamento terapêutico, as relações clínicas são estabelecidas no "aqui e agora" do cotidiano coletivo, domínio no qual a realidade só pode ser compartilhada, fazendo com que o vínculo seja distinto daquele que permeia os consultórios e clínicas de atendimento, promovendo outra qualidade de relação a qual precisa ser mais bem explorada pela literatura acerca do tema, exigindo a criação de conceitos que escapem às categorias clínicas tradicionais.(AU)

This article aims to reflect on the therapeutic follow-up care, with the intention to articulate Donald Winnicott analysis about the importance of the primary environmental provisions, and to the quality of the relation established between the therapeutic accompanist and the subject who is followed-up. The therapeutic follow-up care is part of the Brazilian Psychiatric Reform process, being one of the most striking features the proposal of san expanded clinic, which takes place in the living territories of those who are assisted. From this perspective, we will seek to analyze the clinical issues arising from this openness to the "outside" that characterizes this kind of followup. It can be observed that, in the therapeutic follow-up care, clinical relations are established in the "here and now" of collective everyday life, a domain in which reality can only be shared, making that the bond established be different from the one that permeates the clinics and consulting services, promoting another kind of relations quality, which needs to be more explored by literature regardin this theme, demanding the creation of concepts which get away from traditional clinical categories.(AU)

El presente artículo tiene por objeto reflexionar sobre el seguimiento terapéutico, con el fin de articular los análisis de Donald Winnicott sobre la importancia de las provisiones ambientales primarias, la calidad de la relación que se establece entre el acompañante terapéutico y el sujeto acompañado. El seguimiento terapéutico se inscribe en el proceso de Reforma Psiquiátrica brasileña, siendo una de sus características más marcantes la propuesta de una clínica ampliada, que ocurre en los territorios de vida de aquellos que son asistidos. A partir de esta perspectiva, buscaremos escudriñar las cuestiones clínicas derivadas de esa apertura hacia el "fuera" que caracteriza este tipo de acompañamiento. Se constata con ello que, en el acompañamiento terapéutico, las relaciones clínicas se establecen en el "aquí y ahora" del cotidiano colectivo, dominio en el cual la realidad sólo puede ser compartida, haciendo que el vínculo sea distinto del que permea los consultorios y clínicas de atención, promoviendo otra calidad de relación a la cual necesita ser mejor explotada por la literatura acerca del tema, exigiendo la creación de conceptos que escapen a las categorías clínicas tradicionales.(AU)

Complicaciones tardías en cohorte de lesionados medulares traumáticos de origen laboral / Late complications in a cohort of work related traumatic spinal cord injured patients

Introducción: Las complicaciones tardías en el lesionado medular (LM) son frecuentes, pesquisables y prevenibles mediante un programa de seguimiento. Objetivo: Determinar las complicaciones tardías que presentan los LM atendidos en Hospital del Trabajador (HT) de Asociación Chilena de Seguridad (ACHS), sometidos a programa de control de seguimiento, que viven en regiones rurales lejanas de Santiago. Pacientes y Métodos: Se evaluaron los pacientes LM en control de seguimiento en HT ACHS entre 2000 y 2006, a los que se les realizó evaluación multidisciplinaria, estudios de pesquisa de laboratorio, imaginología y entrevista de enfermería. El análisis estadístico se realiza por pruebas paramétricas. Resultados: Se controlaron 78 pacientes, 74 hombres y 4 mujeres, edad 48,7 +/- 11,8 años; la LM más frecuente fue paraplejia completa (52,6 por ciento). Todos los pacientes presentaron alguna complicación durante el período observado. Las complicaciones más frecuentes fueron dislipidemia (80,8 por ciento), dolor (71,8 por ciento), espasticidad (53,8 por ciento), infección urinaria (52,6 por ciento), constipación (48,7 por ciento) e insomnio (46,2 por ciento). 33,3 por ciento de los pacientes presentaron úlceras por presión. La prevalencia de diabetes mellitus fue 10,2 por ciento. Mediante ecografía abdominal se pesquisó 24,4 por ciento de colelitiasis y 24,4 por ciento de hígado graso. Discusión: La incidencia acumulada complicaciones tardías en los LM de nuestra cohorte es muy similar al descrito previamente, existiendo mayor frecuencia de enfermedades crónicas no trasmi-sibles (ECNT) que en la población general, debido a disminución de actividad física y alteración del metabolismo de lípidos y carbohidratos. Conclusiones: La alta incidencia acumulada de complicaciones tardías en LM recomienda desarrollar programas de evaluación de seguimiento multidisciplinario que permitan detectarlas precozmente.

Introduction: Late complications in spinal cord injured (SCI) are common, detectable and preventable by a follow up program. Aim: To determine late complications suffered by SCI treated at Hospital del Trabajador (HT) of Asociación Chilena de Seguridad (ACHS), subject to follow-up evaluation program and living in distant rural areas of Santiago. Patients and Methods: Patients evaluated in follow-up evaluation program of HT ACHS between 2000 and 2006 who underwent multidisciplinary evaluation, laboratory studies and imaging research and nursing interview. Statistical analysis was performed by parametric tests. Results: 78 patients were monitored, 74 men and 4 women, age 48.7 +/- 11.8 years; the most frequent SCI was complete paraplegia (52.6 percent). All patients had complications during the observation period. The most frequent complications were dyslipidemia (80.8 percent), pain (71.8 percent), spasticity (53.8 percent), uri-nary tract infection (52.6 percent), constipation (48.7 percent) and insomnia (46.2 percent). 33.3 percent of patients had pressure ulcers. The prevalence of diabetes mellitus was 10.2 percent. Abdominal ultrasound detected 24.4 percent of gallstones and 24.4 percent of fatty liver. Discussion: The incidence of late complications in our SCI cohort is very similar to that described previously, existing more frequent in chronic diseases than in the general population, due to decreased physical activity and altered lipid and carbohydrate metabolism. Conclusions: High incidence of late complications in SCI recommends develop a multidisciplinary evaluation program and screening tests to early detection of them.

Análisis de gestión del control de seguimiento abreviado de pacientes con lesión medular traumática de origen laboral residentes en regiones / An analysis of the management of brief follow-ups in regional patients with spinal cord injuries of occupational origin

Introduction: spinal cord injury (SCI) patients require periodic preventive health screening systems for early detection of complications. Objective: toevaluate the quality of a brief follow-up evaluation (BFE) program implemented in SCI Hospital del Trabajador (HT), with patients living outside the Central Metropolitan region, considering efficacy and efficiency. Patients and methods: aretrospective case series study of SCI patients residing between Arica and Linares (Chile), who completed BFE between the year 2000 and 2012. A BFE consists of a scheduled check-up appointment at HT, in which the patient and laboratory tests performed at the patient´s regional hospital, are evaluated sequentially by a multidisciplinary team. Program results were compared with the traditional system used since 1998. Quality indicators were established for efficiency and efficacy, and cost savings evaluated. Results: during the study period, 95 patients participated in one or more BFE. The efficiency of the program improved: it required only 22.9 percent of the time previously needed; patient participation was 2.6higher; 76 percent of patients attended all required laboratory tests, and 87 percent completed a comprehensive multidisciplinary evaluation. On average, 60 complications were detected per year. The program saved 1,800 hospital bed days per year, equating to a total opportunity cost per patient of U.S. $ 192,442, or U.S. $ 14,803 per year. Discussion: the greatest strength of the program is its foundation in a standardized, multidisciplinary approach, involving the systematic recording of information, and structured detection and resolution of complications in our health system. Conclusion: the brief follow-up evaluation program at HT proved successful, with high efficiency and efficacy compared to the previous system.

Introducción: los lesionados medulares (LM) requieren de sistema de evaluación de salud preventivo periódico que permita detectar complicaciones precozmente. Objetivo: evaluar calidad del programa de control de seguimiento abreviado (CSA) de pacientes LM traumáticos de regiones, realizado en Hospital del Trabajador (HT), considerando eficiencia y eficacia. Pacientes y métodos: estudio retrospectivo de serie de casos de LM residentes entre ciudades de Arica y Linares, Chile, que realizaron CSA entre 2000-2012. El control abreviado consiste en evaluación programada, donde el paciente concurre con exámenes desde su regional para control multidisciplinario secuencial de un día en HT. Los resultados del programa se comparan con sistema tradicional de 1998. Se definen indicadores de calidad de eficiencia, eficacia y se evalúa ahorro económico. Resultados: durante el período de estudio, se realiza CSA en 95 pacientes LM. La eficiencia del programa abreviado mejoró, utilizando 22,9 por ciento del tiempo requerido previamente; la concurrencia al control aumentó 2,6 veces, asistiendo 76 por ciento con todos los exámenes y realizándose evaluación multidisciplinaria completa a 87 por ciento. Se detectaron 60 complicaciones promedio/anual. En trece años de funcionamiento del programa se ahorraron 1.800 días cama, sumado al costo-oportunidad de pacientes totalizaron US$ 192.442, US$ 14.803 promedio/anual. Discusión: la mayor fortaleza del programa es basarse en modelo estandarizado, multidisciplinario, con registro sistemático de información, detectando y resolviendo las complicaciones de manera homogénea en nuestro sistema de salud. Conclusión: el programa de control de seguimiento abreviado del HT ha sido exitoso, con alta eficiencia y eficacia, comparado con el sistema tradicional implementado hasta 1998.