Diretivas antecipadas de vontade: instrumento de autonomia para pacientes oncológicos / Advance directives: autonomy tool for cancer patients / Directivas anticipadas: un instrumento de autonomía para los pacientes oncológicos

Resumo Diretivas antecipadas de vontade permitem que pacientes designem um representante legal e manifestem seus desejos a serem cumpridos quando se tornarem incapazes de se comunicar. Neste estudo, objetivou-se avaliar o conhecimento e as preferências de pacientes oncológicos sobre essas diretivas. Trata-se de pesquisa quantitativa e transversal realizada por meio do preenchimento de dois modelos de diretivas antecipadas de vontade e da aplicação de um questionário. Constatou-se que 87,38% dos pacientes nunca tinham ouvido falar em tais diretivas, 97,2% desconheciam os modelos e 95% não referiram dificuldade de preenchimento. Após o esclarecimento, 93,46% consideraram importante que todas as pessoas elaborem as diretivas, 94,86% que elas sejam disponibilizadas aos pacientes e 91,12% que seja aprovada uma lei federal. O esclarecimento sobre o conceito de diretivas antecipadas de vontade contribuiu para aumentar o interesse de pacientes oncológicos pela utilização desse direito, que fortalece sua autonomia pessoal quando incapazes de se comunicar.

Abstract Advance directives allow patients to assign a legal representative and express their wishes to be fulfilled when they can no longer communicate. This study evaluated cancer patients' knowledge and preferences regarding these directives. A cross-sectional quantitative research was conducted by filling out two advance directive models and a questionnaire. Of the total sample, 87.38% had never heard of such document, 97.2% ignored the two models available and 95% had no difficulties filling it out. After clarifications, 93.46% considered it important for all patients to write a directive, 94.86% expressed that advance directives should be made available to patients and 91.12% argued that a federal law should be passed. Explaining the concept of advanced directives increased the interest of cancer patients in exercising this right which strengthen their autonomy.

Resumen Las directivas anticipadas permiten a los pacientes designar a un representante legal y manifestar sus decisiones cuando no puedan comunicarse. Este estudio evaluó el conocimiento y las preferencias de los pacientes oncológicos sobre este documento. Se realizó una investigación cuantitativa y transversal, mediante la respuesta a dos modelos de directivas anticipadas y la aplicación de un cuestionario. El 87,38% de los pacientes no conocían este documento, el 97,2% de ellos desconocían los modelos y el 95% declararon no tener dificultades para responderlos. Tras la aclaración, el 93,46% de los entrevistados consideraban importante que todos elaboraran el documento, el 94,86% que debían ponerlo a disposición de los pacientes y el 91,12% que se aprobara una ley federal. La aclaración del concepto de voluntades anticipadas contribuye a incrementar el interés de los pacientes oncológicos por hacer uso de este derecho, que refuerza su autonomía personal cuando ya no pueden comunicarse.

Execução da lista de verificação de segurança cirúrgica em operações pediátricas: avaliação da conformidade / Ejecución de la lista de seguridad quirúrgica en operaciones pediátricas: evaluación de la conformidad / Implementation of the surgical safety checklist for pediatric operations: compliance assessment

Resumo OBJETIVO Avaliar a conformidade da execução da lista de verificação de segurança cirúrgica. MÉTODOS Estudo avaliativo, observacional, transversal e descritivo, com abordagem quantitativa, realizado com 431 cirurgias pediátricas, em hospital público do Distrito Federal, entre agosto de 2017 e fevereiro de 2018. Os dados foram coletados por observação não participante e analisados por estatística descritiva. RESULTADOS O checklist foi realizado em 90,3% das cirurgias, no entanto, a completude do instrumento e a adesão verbal a todos os itens não foram observadas em nenhum procedimento. 95,4% das cirurgias prosseguiram mesmo com a identificação de falhas em processos de segurança. Observou-se checagens inapropriadas, inexatidão do momento de aplicação, execução na ausência de profissionais essenciais e falta de participação ativa. CONCLUSÕES O estudo revelou inconformidades na adesão ao checklist e na execução de práticas seguras, configurando um alerta para o risco sistemático sofrido pelo paciente cirúrgico e para a necessidade de intervenções imediatas.

Resumen OBJETIVO Evaluar la conformidad de ejecución de la lista de verificación de la seguridad de la cirugía. MÉTODOS Estudio evaluativo, observacional, transversal y descriptivo, con abordaje cuantitativo, realizado con 431 cirugías pediátricas, en un hospital público del Distrito Federal, entre agosto de 2017 y febrero de 2018. Se recolectaron los datos a través de la observación no participante y estos se analizaron por medio de la estadística descriptiva. RESULTADOS El checklist se realizó en 90,3% de las cirugías, sin embargo, no se pudo observar el uso total de la herramienta, así como la adhesión verbal a todos los elementos en ningún procedimiento. 95,4% de las cirugías prosiguieron aún con fallas en los procesos de seguridad. Se pudo observar controles inapropiados, inexactitud del momento de uso, ejecución en ausencia de profesionales cruciales y falta de participación activa. CONCLUSIONES El estudio reveló inconformidades en la adhesión al checklist y en la ejecución de prácticas seguras, configurando una alerta para el riesgo sistemático sufrido por el paciente quirúrgico y para la necesidad de intervenciones inmediatas.

Abstract OBJECTIVE To evaluate compliance with the surgical safety checklist. METHODS Evaluative, observational, cross-sectional and descriptive study with a quantitative approach, performed in 431 pediatric surgeries, in a public hospital in the Federal District, between August 2017 and February 2018. Data were collected by non-participant observation and analyzed by descriptive statistics. RESULTS The checklist was performed in 90.3% of the surgeries, however, the completeness of the instrument and the verbal adherence to all the items were not observed in any procedure. 95.4% of the surgeries continued even with the identification of failures in safety processes. Inappropriate checks, inaccuracy of timing, performance in the absence of key professionals, and lack of active participation were observed. CONCLUSIONS The study showed the existence of nonconformities in the adherence to the checklist and in the execution of safe practices, being an alert for the systematic risk suffered by the surgical patient and for the need for immediate interventions.

Indicaciones restrictivas y anestesia / Restrictive indications and anesthesia

Anesthesiologists may deal with ethical dilemmas when looking after Not To Be Resuscitated (NTBR) patients. Sometimes the latters are scheduled to undergo surgical procedures that are palliative in nature. With the advent of the cardio pulmonary resuscitation in the 1960s, new problems arose, such as long resuscitations, quality of life impairment and unnecessary protracted agony. Besides the fear to death and suffering, resuscitation’s dread appeared. In the beginning, the decisión to reject the resuscitation was the physician’s responsability. The development of the Patient Self-Determination Act (PSDA) transfered to the patient or to his/her legal surrogates the right to decide about his/her medical treatment, specially at the end of life. This article revised the evolution that allowed to exercise the patient autonomy, as well as the best way to proceed when anesthesia and surgery are necessary to care for a patient with a Do Not Resuscitate Order.

El anestesiólogo puede enfrentar dilemas éticos cuando debe anestesiar pacientes con indicaciones restrictivas (Límite del Esfuerzo Terapéutico, Orden de No Reanimar). Estos pacientes con frecuencia son sometidos a intervenciones destinadas a mejorar su calidad de vida, o para el control de síntomas, a pesar de tener un mal pronóstico evolutivo, y/o deterioro de su condición física. A mediados de la década de 1960, con la RCP (Reanimación Cardiopulmonar) aparecieron nuevos problemas, como reanimaciones reiteradas, deterioro de la calidad de vida, y prolongación de la agonía. Entonces, al miedo a la muerte y al sufrimiento, se sumó el miedo a la reanimación. Inicialmente, el médico responsable del paciente era el único habilitado para rechazar estas medidas de reanimación (NTBR, “not to be resuscitated”), con el subsiguiente debate bioético. Mas tarde, el desarrollo del principio de autonomía, transfirió al paciente y a su entorno más cercano el derecho a tomar decisiones informadas sobre su propio tratamiento médico1. Este artículo revisa los antecedentes relevantes que han permitido el traspaso del poder de decisión a los pacientes, así como la mejor forma de proceder ante la necesidad de administrarles anestesia cuando hay indicaciones restrictivas.

Hand hygiene compliance of healthcare professionals in an emergency department / Adhesión de los profesionales sanitarios a la higienización de las manos en servicio de urgencias / Adesão dos profissionais de saúde à higienização das mãos em pronto-socorro

Abstract OBJECTIVE To analyze compliance with hand hygiene by healthcare professionals in an emergency department unit. METHOD This is a longitudinal quantitative study developed in 2015 with healthcare professionals from a university hospital in the state of Rio Grande do Sul. Each professional was monitored three times by direct non-participant observation at WHO's five recommended moments in hand hygiene, taking the concepts of opportunity, indication and action into account. Descriptive and analytical statistics were used. RESULTS Fifty-nine healthcare professionals participated in the study. The compliance rate was 54.2%. Nurses and physiotherapists showed a compliance rate of 66.6% and resident physicians, 41.3%. When compliance was compared among professional categories, nurses showed greater compliance than resident physicians (OR = 2.83, CI = 95%: 1.09-7.34). CONCLUSION Hand hygiene compliance was low. Multidisciplinary approaches could be important strategies for forming partnerships to develop learning and implementation of hand hygiene practices.

Resumen OBJETIVO Analizar la adhesión de los profesionales sanitarios a la higienización de las manos en servicio de urgencias. MÉTODO Estudio cuantitativo longitudinal desarrollado con profesionales sanitarios de un Hospital Universitario de Río Grande do Sul, en 2015. Para cada profesional, se llevaron a cabo tres acompañamientos con observación directa no participante en los cinco momentos preconizados para la higienización de las manos, teniendo en cuenta los conceptos de Oportunidad, Indicación y Acción. Se utilizó la estadística descriptiva y analítica. RESULTADOS Participaron en el estudio 59 profesionales sanitarios. La tasa de adhesión fue del 54,2%. Los enfermeros y fisioterapeutas obtuvieron la tasa de adhesión del 66,6% y los médicos residentes, del 41,3%. Al compararse la adhesión entre las categorías profesionales, los enfermeros tuvieron mayor adherencia que los médicos residentes (RC=2,83; IC=95%:1,09-7,34). CONCLUSIÓN La adhesión a la higienización de las manos fue baja. Abordajes multidisciplinarios pueden ser estrategias importantes para formar alianzas que desarrollen el aprendizaje y la puesta en marcha de prácticas de HM.

Resumo OBJETIVO Analisar a adesão à higienização das mãos dos profissionais de saúde em unidade de Pronto-Socorro. MÉTODO Estudo quantitativo longitudinal desenvolvido com profissionais de saúde de um Hospital Universitário do Rio Grande do Sul, em 2015. Para cada profissional, realizaram-se três acompanhamentos com observação direta não participante nos cinco momentos preconizados para higienização das mãos, levando-se em conta os conceitos de Oportunidade, Indicação e Ação. Utilizou-se da estatística descritiva e analítica. RESULTADOS Participaram do estudo 59 profissionais de saúde. A taxa de adesão foi de 54,2%. Os enfermeiros e fisioterapeutas obtiveram a taxa de adesão de 66,6% e os médicos residentes, de 41,3%. Ao ser comparada a adesão entre as categorias profissionais, os enfermeiros tiveram maior aderência do que os médicos residentes (RC=2,83; IC=95%:1,09-7,34). CONCLUSÃO A adesão à higienização das mãos foi baixa. Abordagens multidisciplinares podem ser estratégias importantes para formar parcerias que desenvolvam a aprendizagem e a efetivação de práticas de HM.

Assessment of adherence to the guidelines for the management of nausea and vomiting induced by chemotherapy / Avaliação da aderência à diretriz de cuidados para náuseas e vômitos induzidos por quimioterapia

ABSTRACT Objective: To assess adherence of the prescribing physicians in a private cancer care center to the American Society of Clinical Oncology guideline for antiemetic prophylaxis, in the first cycle of antineoplastic chemotherapy. Methods: A total of 139 chemotherapy regimens, of 105 patients, were evaluated retrospectively from 2011 to 2013. Results: We observed 78% of non-adherence to the guideline rate. The main disagreements with the directive were the prescription of higher doses of dexamethasone and excessive use of 5-HT3 antagonist for low risk emetogenic chemotherapy regimens. On univariate analysis, hematological malignancies (p=0.005), the use of two or more chemotherapy (p=0.05) and high emetogenic risk regimes (p=0.012) were factors statistically associated with greater adherence to guidelines. Treatment based on paclitaxel was the only significant risk factor for non-adherence (p=0.02). By multivariate analysis, the chemotherapy of high emetogenic risk most correlated with adherence to guideline (p=0.05). Conclusion: We concluded that the adherence to guidelines is greater if the chemotherapy regime has high emetogenic risk. Educational efforts should focus more intensely on the management of chemotherapy regimens with low and moderate emetogenic potential. Perhaps the development of a computer generated reminder may improve the adherence to guidelines. .

RESUMO Objetivo: Avaliar a adesão dos médicos prescritores, de um centro privado especializado em oncologia, à diretriz de antiêmese profilática da American Society of Clinical Oncology, no primeiro ciclo de quimioterapia antineoplásica. Métodos: Foram avaliados retrospectivamente 139 esquemas de quimioterapia, de 105 pacientes, tratados no período de 2011 a 2013. Resultados: Foram observados 78% de taxa de não adesão à diretriz. As principais discordâncias com a diretriz foram prescrição de doses mais elevadas de dexametasona e uso excessivo de antagonista 5-HT3 para regimes de quimioterapia de risco emetogênico baixo. Pela análise univariada, malignidades hematológicas (p=0,005), uso de dois ou mais quimioterápicos (p=0,05) e regimes de alto risco emetogênico (p=0,012) foram fatores estatisticamente associados a maior adesão à diretriz. O tratamento baseado em paclitaxel foi o único fator estatisticamente significativo para a não adesão (p=0,02). Pela análise multivariada, a quimioterapia de alto risco emetogênico apresentou maior correlação com a adesão à diretriz (p=0,05). Conclusão: Houve maior aderência para a quimioterapia de alto risco emetogênico. Esforços educacionais devem se concentrar mais intensamente na gestão de regimes de quimioterapia com potencial emetogênico baixo e moderado. Talvez o desenvolvimento de lembretes gerados por sistemas informatizados possa melhorar a aderência à diretriz. .

Causas de la falta de adherencia a las guías terapéuticas para la neumonía grave / Causes of non-adherence to therapeutic guidelines in severe community-acquired pneumonia

Objetivo: Valorar tasa de adherencia y causas de no adherencia a las guías terapéuticas internacionales para la prescripción antibiótica empírica en la neumonía grave en Latinoamérica. Métodos: Encuesta clínica realizada a 36 médicos de Latinoamérica donde se pedía indicar el tratamiento empírico en 2 casos clínicos ficticios de pacientes con infección respiratoria grave: neumonía adquirida en la comunidad y neumonía nosocomial. Resultados: En el caso de la neumonía comunitaria el tratamiento fue adecuado en el 30,6% de las prescripciones. Las causas de no adherencia fueron monoterapia (16,0%), cobertura no indicada para multirresistentes (4,0%) y empleo de antibióticos con espectro inadecuado (44,0%). En el caso de la neumonía nosocomial el cumplimiento de las guías terapéuticas Infectious Disease Society of America/American Thoracic Society fue del 2,8%. Las causas de falta de adherencia fueron monoterapia (14,3%) y la falta de doble tratamiento antibiótico frente a Pseudomonas aeruginosa (85,7%). En caso de considerar correcta la monoterapia con actividad frente a P. aeruginosa, el tratamiento sería adecuado en el 100% de los casos. Conclusión: En la neumonía comunitaria la adherencia a las guías terapéuticas Infectious Disease Society of America/American Thoracic Society fue del 30,6%; la causa más frecuente de incumplimiento fue el uso de monoterapia. La adherencia en el caso de la neumonía nosocomial fue del 2,8% y la causa más importante de incumplimiento fue la falta de doble tratamiento frente a P. aeruginosa, considerando adecuada monoterapia con actividad frente a P. aeruginosa la adherencia sería del 100%. .

Objective: To assess the adherence to Infectious Disease Society of America/American Thoracic Society guidelines and the causes of lack of adherence during empirical antibiotic prescription in severe pneumonia in Latin America. Methods: A clinical questionnaire was submitted to 36 physicians from Latin America; they were asked to indicate the empirical treatment in two fictitious cases of severe respiratory infection: community-acquired pneumonia and nosocomial pneumonia. Results: In the case of communityacquired pneumonia, 11 prescriptions of 36 (30.6%) were compliant with international guidelines. The causes for non-compliant treatment were monotherapy (16.0%), the unnecessary prescription of broad-spectrum antibiotics (40.0%) and the use of non-recommended antibiotics (44.0%). In the case of nosocomial pneumonia, the rate of adherence to the Infectious Disease Society of America/American Thoracic Society guidelines was 2.8% (1 patient of 36). The reasons for lack of compliance were monotherapy (14.3%) and a lack of dual antibiotic coverage against Pseudomonas aeruginosa (85.7%). If monotherapy with an antipseudomonal antibiotic was considered adequate, the antibiotic treatment would be adequate in 100% of the total prescriptions. Conclusion: The compliance rate with the Infectious Disease Society of America/American Thoracic Society guidelines in the community-acquired pneumonia scenario was 30.6%; the most frequent cause of lack of compliance was the indication of monotherapy. In the case of nosocomial pneumonia, the compliance rate with the guidelines was 2.8%, and the most important cause of non-adherence was lack of combined antipseudomonal therapy. If the use of monotherapy with an antipseudomonal antibiotic was considered the correct option, the treatment would be adequate in 100% of the prescriptions. .

Conhecimento de estudantes de medicina sobre o testamento vital / Knowledge of medical students regarding living wills

A terminalidade da vida levanta cada vez mais dilemas éticos. Dada a importância do tema e a recente regulamentação do testamento vital pelo Conselho Federal de Medicina, é de grande valor o conhecimento dessa problemática por parte dos futuros médicos. Assim, buscou-se aferir a compreensão dos estudantes de medicina da Universidade do Estado do Pará acerca do testamento vital e das decisões envolvendo o final da vida. O estudo qualiquantitativo descritivo e transversal entrevistou 238 estudantes por meio de questionário com 10 questões. Apenas 8% dos estudantes demonstraram ter uma noção clara sobre o significado do termo “testamento vital”. Apesar disso, após ouvirem a definição das diretivas antecipadas de vontade fornecida pelos pesquisadores, 92% deles declararam que respeitariam o previsto no testamento vital. Portanto, conclui-se que, embora boa parte dos entrevistados tenha pouco entendimento sobre o tema “testamento vital”, a grande maioria posicionou-se a favor de sua aceitação...

The end of a person’s life raises many ethical dilemmas. Recently, the Brazil’s Federal Council of Medicine approved and regulated the concept of “living will”; as a result, it is of considerable importance that doctors understand the issues that surround this matter. The aim of the present study was to evaluate the knowledge of medical students from the Pará State University, Brazil, of “living wills” and decisions involving the end of life. A cross-sectional study was performed with 238 students who answered a questionnaire of 10 questions. Only 8% of students demonstrated a clear understanding of the term “living will”. Nevertheless, when the definition of “living will” was explained to the participants of the study by the researchers, 92% of students declared that they would respect its provisions. Therefore it appears that while most respondents had a low level of understanding of the concept of “living will”, the vast majority positioned themselves in favor of accepting such a document...

La terminalidad de la vida levanta cada vez más dilemas éticos. Dada la importancia del tema y la reciente regulación del testamento vital por el Consejo Federal de Medicina del Brasil, es de gran valor el conocimiento de los futuros médicos acerca de este problema. Por lo tanto, tratamos de evaluar el conocimiento de los estudiantes de medicina de la Universidad del Estado del Pará, en Brasil, acerca del testamento vital y de las decisiones que involucran el final de la vida. La muestra del estudio cualitativo y cuantitativo descriptivo y transversal entrevistó 238 estudiantes y utilizó cuestionario con 10 preguntas. Sólo el 8% de los estudiantes han demostrado una clara comprensión sobre el término “testamento en vida”. Sin embargo, después de escuchar la definición de directrices anticipadas de voluntad proporcionada por los investigadores, el 92% del total declaró que respetarían las disposiciones del testamento vital. Por lo tanto, parece que la mayoría de los encuestados tienen un bajo nivel de comprensión del tema del “Testamento Vital”, pero la gran mayoría se ha posicionado a favor de la aceptación...

Compliance to sublingual immunotherapy in patients with allergic rhinitis in Guangzhou city / 中国耳鼻咽喉头颈外科

ABSTRACT]OBJECTIVETo study the compliance to sublingual immunotherapy(SLIT) in patients with allergic rhinitis(AR) in Guangzhou city.METHODSFrom January 2014 to May 2014, 202 patients with AR received SLIT were followed up by telephone. According to age, the patients were divided into group A(age0.05). Main reasons for poor compliance included poor efficacy (48.48%), insufficient education about SLIT (16.67%), inconvenience (15.15%), and adverse reactions(10.61%).CONCLUSION In Guangzhou city, lost follow-up rate in AR patients receiving SLIT is high. Compliance to SLIT is relatively low and improvements shall be made.

PDE5 Inhibitor Treatment Persistence and Adherence in Brazilian Men: Post-hoc Analyses from a 6-Month, Prospective, Observational Study

Purpose Characterize persistence and adherence to phosphodiesterase type - 5 inhibitor (PDE5I) on-demand therapy over 6 months among Brazilian men in an observational, non-interventional study of Latin American men naïve to PDE5Is with erectile dysfunction (ED). Materials and Methods Men were prescribed PDE5Is per routine clinical practice. Persistence was defined as using ≥ 1 dose during the previous 4 - weeks, and adherence as following dosing instructions for the most recent dose, assessed using the Persistence and Adherence Questionnaire. Other measures included the Self - Esteem and Relationship (SEAR) Questionnaire, and International Index of Erectile Function (IIEF). Multivariate logistic regression was used to identify factors associated with persistence/adherence. Results 104 Brazilian men were enrolled; mean age by treatment was 53 to 59 years, and most presented with moderate ED (61.7%). The prescribed PDE5I was sildenafil citrate for 50 (48.1%), tadalafil for 36 (34.6%), vardenafil for 15 (14.4%), and lodenafil for 3 patients (2.9%). Overall treatment persistence was 69.2% and adherence was 70.2%; both were numerically higher with tadalafil (75.0%) versus sildenafil or vardenafil (range 60.0% to 68.0%). Potential associations of persistence and/or adherence were observed with education level, ED etiology, employment status, and coronary artery disease. Improvements in all IIEF domain scores, and both SEAR domain scores were observed for all treatments. Study limitations included the observational design, brief duration, dependence on patient self - reporting, and limited sample size. Conclusion Approximately two-thirds of PDE5I-naive, Brazilian men with ED were treatment persistent and adherent after 6 months. Further study is warranted to improve long-term outcomes of ED treatment. .

Current state of secondary prevention medication for patients with high risk of recurrent ischemic stroke in Changzhou city / 中华老年医学杂志

Objective To investigate the application of secondary prevention medication for patients with high risk of recurrent ischemic stroke in Changzhou city,analyze the reasons for decreased medication compliance,and evaluate the current secondary prevention medication.Methods We investigated 300 consecutive hospitalized patients with acute non-cardiogenic and ischemic stroke high risk.High risk of recurrent stroke was defined as ESSEN Stroke Risk Score (ESRS) ≥3.Different ESRS scales consisting of different parameters were analyzed.All of the patients received standard secondary prevention of ischemic stroke at discharge.After three months and a year follow up,antiplatelet therapy,therapy of risk factors (hypertension and diabetes mellitus),lipid lowering therapy,and medication compliance were investigated.Results Except for age (x2 =126.54,P =0.000) and previous cerebral ischemic stroke or transient ischemic attack (TIA) (x2 =21.27,P =0.000),there were no significant differences in other risk factors (hypertension,diabetes,previous myocardial infarction,heart diseases,smoke) in patients with different ESRS scale scores (all P＞ 0.05).Antiplatelet therapy utilization was 98.3％ (295/300),antihypertensive and antidiabetic drug use rates were 95.0％(255/268) and 100％(72/72),statin use rate reached to 99％ (297/300) at discharge.After three months follow up,medication compliance in hypertension and diabetes mellitus therapy was the best [88.1％(222/252)and 86.2％ (56/65)],followed by aspirin [82.0％ (228/278)],and clopidogrel [6.1％ (17/278)].The medication compliance in lipid lowering therapy was the worst [60.1％ (167/278)].After a year follow-up versus the previous three-month follow-up,the medication compliance in hypertension and diabetes mellitus therapy was increased,but had no significant difference [89.9 ％ (220/245) vs.88.1％ (222/252),93.4％(57/61)vs.86.2％(56/65),P＞0.05],and the medication compliances inantiplatelet therapy with aspirin and clopidogrel,and lipid lowering therapy were increased significantly [93.2％ (245/263)vs.82.0％ (228/278),30.8(81/263) vs.6.1％ (17/278),88.9％ (234/263) vs.60.1％ (167/278),all P＜0.01].The increment of use rate was higher in clopidogrel therapy than in aspirin therapy.Conclusions The secondary prevention medication achieves certain efficacies in patients with high risk of recurrent ischemic stroke in changzhou city.Long term follow-up and good communication between doctor and patient can effectively improve the medication compliance in secondary prevention,and can increase the use rate of antiplatelet therapy in patients with high risk of recurrent ischemic stroke.

Perceptions of Caregivers and Medical Staff toward DNR and AD / 한국호스피스완화의료학회지

PURPOSE: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). METHODS: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. RESULTS: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR chi2=44.56, P=0.001; AD chi2=16.23, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (chi2=7.41, P=0.0025). CONCLUSION: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.

Adherence level and knowledge about psychopharmacological treatment among patients discharged from psychiatric internment / Grau de adesão e conhecimento sobre tratamento psicofarmacológico entre pacientes egressos de internação psiquiátrica / Grado de adhesión y conocimiento sobre tratamiento psicofarmacológico entre pacientes egresados de internación psiquiátrica

This exploratory, descriptive and prospective study aimed to identify the degree of adherence to psychopharmacological treatment of patients who were discharged from psychiatric hospitalization and their knowledge about their prescription and diagnosis. The study was carried out at a Mental Health Service. The sample consisted of all service clients who were discharged from psychiatric hospitalization in the data collection period. A Sociodemographic Questionnaire and the Morisky-Green Test were the instruments used. Data were analyzed through central trend measures. In total, 48 patients participated in the study. Regarding adherence, 70.8 percent of them showed a low adherence level to psychopharmacological treatment. Moreover, only twenty-one patients knew what their diagnosis was and most did not know or partially knew the name and dose of all prescribed medications.

O objetivo deste trabalho foi identificar o grau de adesão ao tratamento psicofarmacológico dos pacientes egressos de internação psiquiátrica e seu conhecimento quanto à sua prescrição e diagnóstico. Trata-se de estudo exploratório, descritivo, prospectivo, realizado em um núcleo de saúde mental. A amostra foi composta por todos os clientes desse serviço que tiveram alta de internação psiquiátrica, no período de coleta, sendo utilizado um questionário sociodemográfico e o teste de adesão de Morisky e Green como instrumentos. Os dados foram analisados por medidas de tendência central. Fizeram parte da amostra 48 pacientes e, em relação à adesão, observou-se que 70,8 por cento deles foram classificados como baixo grau de adesão ao tratamento psicofarmacológico. Além disso, apenas vinte e um pacientes sabiam informar qual era seu diagnóstico, e a maioria deles não sabia, ou sabia parcialmente, o nome e dosagem de todos os medicamentos a eles prescritos.

El objetivo de este trabajo fue identificar el grado de adhesión al tratamiento psicofarmacológico de los pacientes egresados de internación psiquiátrica y evaluar su conocimiento en cuanto a su prescripción y diagnóstico. Se trata de un estudio exploratorio, descriptivo, prospectivo, realizado en un Núcleo de Salud Mental. La muestra fue compuesta por todos los clientes de este servicio que tuvieron alta de internación psiquiátrica en el período de recolección siendo utilizado un Cuestionario sociodemográfico y la Prueba de Adhesión de Morisky-Green como instrumentos. Los datos fueron analizados por medidas de tendencia central. Hicieron parte de la muestra 48 pacientes; en relación a la adhesión, se observó que 70,8 por ciento de ellos fueron clasificados con bajo grado de adhesión al tratamiento psicofarmacológico. Además de eso, apenas veintiún pacientes sabían informar cual era su diagnóstico y la mayoría de ellos no sabía o sabía parcialmente el nombre y dosis de todos los medicamentos que le fueron prescritos.