Rivaroxabana em Pacientes Ambulatoriais com COVID-19 Leve ou Moderada: Fundamentação e Desenho do Estudo CARE (CARE - Coalition COVID-19 Brazil VIII) / Rivaroxaban in Outpatients with Mild or Moderate COVID-19: Rationale and Design of the Study CARE (CARE - Coalition COVID-19 Brazil VIII)

Resumo Fundamento Estudos anteriores revelaram alto risco de eventos tromboembólicos arteriais e venosos como consequência de danos virais diretos do SARS-CoV-2 em células endoteliais e um meio procoagulante devido ao aumento de biomarcadores como o D-dímero, fibrinogênio, fator VIII. Foram realizados ensaios controlados randomizados de terapias antitrombóticas em pacientes internados, no entanto, poucos estudos avaliaram o papel da tromboprofilaxia no ambiente ambulatorial. Objetivo Avaliar se a profilaxia antitrombótica com rivaroxabana reduz o risco de eventos trombóticos venosos ou arteriais, suporte ventilatório invasivo e morte em pacientes ambulatoriais com COVID-19. Métodos O estudo CARE é um ensaio randomizado, aberto, multicêntrico e controlado por rivaroxabana 10 mg uma vez por dia durante 14 dias ou tratamento local padrão isolado, para a prevenção de resultados adversos, registrado no Clinicaltrials.gov (NCT04757857). Os critérios de inclusão são adultos com infecção confirmada ou suspeita do SARS-CoV-2, com sintomas leves ou moderados, sem indicação de hospitalização, no prazo de 7 dias após o início dos sintomas e um fator de risco de complicação da COVID-19 (>65 anos, hipertensão, diabetes, asma, doença pulmonar obstrutiva crônica ou outras doenças pulmonares crônicas, tabagismo, imunossupressão ou obesidade). O desfecho primário composto inclui tromboembolismo venoso, necessidade de ventilação mecânica invasiva, eventos cardiovasculares agudos maiores e mortalidade no prazo de 30 dias após a randomização, sendo avaliado segundo o princípio da intenção de tratar. Todos os pacientes assinaram termo de consentimento. Foi estabelecido um nível de significância de 5% para todos os testes estatísticos. Resultados Os principais desfechos trombóticos e hemorrágicos, hospitalizações e mortes serão avaliados centralmente por um comitê de eventos clínicos independente, sob a condição cega para a alocação dos grupos de tratamento. Conclusão O estudo CARE fornecerá informação relevante e contemporânea sobre o possível papel da tromboprofilaxia em pacientes ambulatoriais com COVID-19.

Abstract Background Previous studies have demonstrated a high risk of arterial and venous thromboembolic events as a consequence of direct viral damage to endothelial cells by SARS-CoV-2 and a procoagulant milieu due to increased biomarkers, such as D-dimer, fibrinogen, and factor VIII. Although randomized controlled trials of antithrombotic therapies have been conducted in hospitalized patients, few have evaluated the role of thromboprophylaxis in an outpatient setting. Objective To assess whether antithrombotic prophylaxis with rivaroxaban reduces the risk of venous or arterial thrombotic events, invasive ventilatory support, and death in COVID-19 outpatients. Methods The COVID Antithrombotic Rivaroxaban Evaluation (CARE) study, a multicenter, randomized, open-label, controlled trial of rivaroxaban 10 mg once daily for 14 days or local standard treatment alone to prevent adverse outcomes, is registered in clinicaltrials.gov (NCT04757857). The inclusion criteria are adults with confirmed or suspected SARS-CoV-2 infection and mild or moderate symptoms without indication for hospitalization, within 7 days of symptom onset, and 1 risk factor for COVID-19 complication (> 65 years, hypertension, diabetes mellitus, asthma, chronic obstructive pulmonary disease or other chronic lung diseases, smoking, immunosuppression, or obesity). The primary composite endpoint, which includes venous thromboembolism, invasive mechanical ventilation, major acute cardiovascular events, and mortality within 30 days of randomization, will be assessed according to the intention-to-treat principle. All patients will provide informed consent. A significance level of 5% will be used for all statistical tests. Results Major thrombotic and bleeding outcomes, hospitalizations, and deaths will be centrally adjudicated by an independent clinical events committee blinded to the assigned treatment groups. Conclusion The CARE study will provide relevant and contemporary information about the potential role of thromboprophylaxis in outpatients with COVID-19.

Conocimientos sobre donación de sangre en pacientes de un hospital de Amazonas, Perú / Knowledge about blood donation in patients of a hospital in Amazonas, Peru

RESUMEN El objetivo del estudio fue determinar el nivel de conocimientos sobre donación de sangre que tienen los pacientes externos que acuden a un hospital en Bagua Grande. Se realizó un estudio descriptivo transversal durante mayo a julio del 2019. Se elaboró y aplicó un cuestionario estructurado. Se captó a 244 personas que acudieron a consultorios externos mediante un muestreo sistemático. Los participantes obtuvieron una media de respuestas correctas de 8,90 (DE: 3,25) puntos de un total de 21. Se encontró que la edad y el grado de instrucción estaban correlacionados con el puntaje (rho = -0,21; p < 0,001 y rho = 0,38; p < 0,001, respectivamente). La procedencia y ocupación afectaron al puntaje (p < 0,001). Los conocimientos hallados en la población estudiada son bajos, pero esto no estaría relacionado con el antecedente de donación. Las intervenciones que se elaboren para mejorar la donación de sangre no solo se deben enfocar en brindar conocimientos, ya que otros factores estarían más relacionados con este resultado.

ABSTRACT This study aimed to determine the level of knowledge about blood donation among outpatients from a hospital in Bagua Grande. A descriptive cross-sectional study was conducted from May to July 2019. We developed and applied a structured questionnaire. A total of 244 outpatients were recruited through systematic sampling. Participants obtained a mean number of correct answers of 8.90 (SD: 3.25) points out of 21. Age and educational level were found to be correlated with the score (rho = -0.21; p < 0.001 and rho = 0.38; p < 0.001, respectively). Place of origin and occupation affected the score (p < 0.001). We found a low level of knowledge in the studied population, but this would not be related to previous history of donation. Interventions to improve blood donation should not only focus on providing knowledge, since other factors would be more related to this result.

Diagnostic costs: a research in a family medicine outpatient clinic

The aim of this study is to evaluate the direct diagnostic costs for disease groups and other variables (such as gender, age, seasons) that are related to the direct diagnostic costs based on a 3-year data. The population of the study consisted of 31,401 patients who applied to family medicine outpatient clinic in Turkey between January 1st, 2016 and December 31st, 2018. With this study, we determined in which disease groups of the family medicine outpatient clinic weremost frequently admitted. Then, total and average diagnostic costs for these disease groups were calculated. Three-year data gave us the opportunity to examine the trend in diagnostic costs. Based on this, we demonstratedwhich diseases' total and average diagnostic costs increased or decreased during 3 years. Moreover, we examined how diagnostic costs showed a trend in both Turkish liras and USA dollars' rate for 3 years. Finally, we analysedwhether the diagnostic costs differed according to variables such as age, gender and season. There has been relatively little analysis on the diagnostic costs in the previous literature. Therefore, we expect to contribute to both theoristsand healthcare managers for diagnostic costs with this study.

O adoecimento dos trabalhadores de enfermagem e os riscos psicossociais no trabalho / Enfermedades de los trabajadores de enfermería y riesgos psicosociales en el trabajo / Work-related disorders and psychosocial risks in nursing professionals

Resumo Objetivo Analisar o adoecimento físico e psicossocial decorrente do trabalho do profissional de enfermagem que atua em ambulatório de hospital universitário e sua inter-relação com os riscos psicossociais. Métodos Estudo epidemiológico transversal, realizado com 388 profissionais de enfermagem de ambulatórios universitários, no município do Rio de Janeiro, RJ. Utilizou-se um questionário para caracterização dos participantes e a Escala de Danos Físicos e Psicossociais no Trabalho, a coleta de dados ocorreu de julho a dezembro de 2018. Realizou-se análise descritiva das variáveis e a classificação de risco dos danos. Para a análise estatística bivariada, utilizou-se a medida de associação razão de chances, com intervalo de confiança de 95%, nível de significância de 5%. Resultados O contexto de trabalho ambulatorial da enfermagem põe em risco a saúde física dos profissionais; porém, há de se considerar também o seu perfil, que, além de uma longa trajetória na enfermagem, aponta para a sua rotatividade pelos setores do hospital, finalizando no ambulatório. Partindo dessa perspectiva, esses profissionais podem já estar adoecidos fisicamente ao serem alocados nos ambulatórios, para desenvolverem suas atividades laborais. Conclusão Os danos físicos receberam as piores avaliações, dados corroborados pela literatura nacional e internacional, os quais estiveram associados aos desfechos investigados, destacando-se a presença de doenças crônicas e o absenteísmo por doenças.

Resumen Objetivo Analizar las enfermedades físicas y psicosociales resultantes del trabajo de profesionales de enfermería que trabajan en el ambulatorio de un hospital universitario y su interrelación con los riesgos psicosociales. Métodos Estudio epidemiológico transversal, realizado con 388 profesionales de enfermería de ambulatorios universitarios en el municipio de Rio de Janeiro, estado de Rio de Janeiro. Se utilizó un cuestionario para la caracterización de los participantes y la Escala de Daños Físicos y Psicosociales en el Trabajo. La recopilación de datos se llevó a cabo de julio a diciembre de 2018. Se realizó el análisis descriptivo de las variables y la clasificación de riesgo de los daños. Para el análisis estadístico bivariado, se utilizó la medida de asociación razón de momios, con intervalo de confianza del 95 %, nivel de significancia del 5 %. Resultados El contexto de trabajo en un ambulatorio de enfermería pone en riesgo la salud física de los profesionales. Sin embargo, se debe considerar también su perfil, que, además de una larga trayectoria en enfermería, indica una rotación por los sectores del hospital, que termina en el ambulatorio. Partiendo de esa perspectiva, estos profesionales pueden ya estar enfermos físicamente al ser destinados a los ambulatorios para que desarrollen sus actividades laborales. Conclusión Los daños físicos recibieron las peores evaluaciones, datos corroborados por la literatura nacional e internacional, que estuvieron asociados a los desenlaces investigados, con énfasis en la presencia de enfermedades crónicas y ausentismo por enfermedad.

Abstract Objective To analyze the physical and psychosocial work-related disorders of nursing professionals working in the outpatient clinic of a university hospital, and its interrelationship with psychosocial risks. Methods An epidemiological and cross-sectional study was conducted with 388 nursing professionals from outpatient clinics of a university hospital in the city of Rio de Janeiro, RJ, Brazil. A questionnaire was used to characterize the participants and the Work-Related Physical and Psychosocial Disorder Scale (WRDS). Data collection occurred from July to December of 2018. Descriptive analysis of the variables and the risk classification of the disorder were performed. For the bivariate statistical analysis, the odds ratio association measure was obtained, using a 95% confidence interval, 5% significance level. Results The outpatient nursing work context jeopardizes the physical health of professionals at risk; however, it is also necessary to understand their profile, which, in addition to a long trajectory in nursing, points to their constant rotation among the sectors of the hospital, ending up in the outpatient setting. From this perspective, these professionals may already be physically unhealthy, when they are allocated to the outpatient clinics. Conclusion Physical disorders received the worst evaluations, data supported by national and international literature, which were associated with the outcomes investigated, highlighting the presence of chronic diseases and absence due to illness.

Fatores correlacionados à fragilidade de idosos em atenção ambulatorial: diferença entre grupos etários / Factores correlacionados con la fragilidad de los ancianos en la atención ambulatoria: diferencia entre grupos de edad / Factors correlated with the frailty of elderly in outpatient care: difference between age groups

RESUMO Objetivo correlacionar variáveis sociodemográficas e de saúde de idosos de diferentes grupos etários com a fragilidade. Método estudo quantitativo, transversal, realizado com 50 idosos atendidos em um Ambulatório de Gerontologia no interior de São Paulo. Foram coletados dados sociodemográficos e de saúde, sendo: fragilidade; desempenho cognitivo; dependência em Atividades Básicas e Instrumentais de Vida Diária e sintomas depressivos. Para a análise dos dados, foi utilizado o teste de correlação de Spearman. Resultados houve o predomínio de mulheres, com média de 79,4 (±9,4) anos de idade e baixa escolaridade. Foram considerados frágeis 58,3% dos idosos entre 60 e 79 anos e 84,6% daqueles acima de 80 anos. No primeiro grupo, houve correlação entre a fragilidade e o maior número de medicamentos, pior desempenho cognitivo, dependência em Atividades Básicas e Instrumentais de Vida Diária. Nos mais longevos, a fragilidade correlacionou-se ao maior número de morbidades, pior desempenho cognitivo e dependência em Atividades Básicas e Instrumentais de Vida Diária. Conclusão e implicações para a prática: as correlações encontradas permitem o estabelecimento de medidas para aperfeiçoar o planejamento de ações voltadas à assistência ambulatorial, possibilitando organizar prioridades de prevenção e intervenção.

RESUMEN Objetivo correlacionar variables sociodemográficas y de salud de ancianos de diferentes grupos de edad con fragilidad. Método estudio cuantitativo, transversal, realizado con 50 ancianos atendidos en un Ambulatorio de Gerontología del interior de São Paulo. Se recogieron datos sociodemográficos y de salud, así: fragilidad; rendimiento cognitivo; dependencia de las Actividades Básicas e Instrumentales de la Vida Diaria y síntomas depresivos. Para el análisis de los datos se utilizó la prueba de correlación de Spearman. Resultados hubo predominio del sexo femenino, con media de 79,4 (±9,4) años de edad y baja escolaridad. El 58,3% de los ancianos entre 60 y 79 años y el 84,6% de los mayores de 80 años fueron considerados frágiles. En el primer grupo, hubo correlación entre la fragilidad y el mayor número de medicamentos, peor desempeño cognitivo, dependencia de las Actividades Básicas e Instrumentales de la Vida Diaria. En los mayores, la fragilidad se correlacionó con mayor número de morbilidades, peor desempeño cognitivo y dependencia de las Actividades Básicas e Instrumentales de la Vida Diaria. Conclusión e implicaciones para la práctica: las correlaciones encontradas permiten establecer medidas para mejorar la planificación de acciones dirigidas a la atención ambulatoria, posibilitando la organización de prioridades de prevención e intervención.

Abstract Objective to correlate socio-demographic and health variables of elderly people of different age groups with frailty. Method this is a quantitative, cross-sectional study conducted with 50 elderly individuals seen at a Gerontology Outpatient Clinic in the interior of São Paulo. Socio-demographic and health data were collected, including: frailty, cognitive performance, dependence on Basic and Instrumental Activities of Daily Living, and depressive symptoms. For data analysis, the Spearman correlation test was used. Results there was a predominance of women, with a mean age of 79.4 (±9.4) years and low education. A total of 58.3% of the elderly aged between 60 and 79 years and 84.6% of those above 80 years were considered frail. In the first group, there was a correlation between frailty and a higher number of medications, worse cognitive performance, and dependence on Basic and Instrumental Activities of Daily Living. In the oldest old, frailty correlated with a greater number of morbidities, worse cognitive performance, and dependence on Basic and Instrumental Activities of Daily Living. Conclusion and implications for practice the correlations found allow the establishment of measures to improve the planning of actions aimed at outpatient care, enabling the organization of prevention and intervention priorities.

Outpatient Clinic Practice of Hospice and Palliative Care in Peking Union Medical College Hospital / 中国医学科学院学报

Objective To share the outpatient clinic practice of hospice and palliative care at the Department of Geriatrics,Peking Union Medical College Hospital.Methods We conducted a retrospective analysis on the consecutive clinic data of doctor N in Geriatric Outpatient Clinic,Peking Union Medical College Hospital from January 1,2016 to December 31,2019.The patients aged 85 years and older,as well as those with end stage malignant tumor,non-tumor dysfunction due to chronic diseases or primary diseases without effective treatment were defined as patients with palliative care need.The basic information,symptoms,consultation purposes and treatments of these patients were collected.Results Among the 2502 visits during the study period,1388 patients with palliative care needs were admitted and recorded,with an average age of(69.7±13.5)years(8-105 years),among which 73.3% were patients over 60 years old and 712(51.3%)were males.Among these patients,63.4% visited specifically to seek for palliative care service and 87.2% of the visits were due to distress caused by advanced malignant tumors.Of the 221 patients with non-tumor diseases,frailty and neurodegenerative diseases were the leading life-threating cause.Of the 5483 symptoms recorded,pain(21.2%),anorexia(13.1%),fatigue(11.6%),constipation(6.9%),insomnia(4.6%),and abdominal distension(4.6%)were the six common symptoms.In the 2502 visits,26.2% of the patients had mutiple visits,and 50.3% of the patients with multiple visits had more than three visits;38.6% of patients visited the clinic themselves,and 65.7% of visits were attended by two or more family members(including the patients).The average duration of visit was(19.6±8.5)min(2-85 min),and 13.5%,53.0%,25.6% and 7.9% of the patients completed the consultation within 10,11-20,21-30 and over 30 min,respectively.Conclusion There is strong demand of palliative care in the outpatient clinic of Department of Geriatrics in Peking Union Medical College Hospital and it is feasible to provide palliative care service for patients with serious diseases in geriatric outpatient clinics.

Pain and Satisfaction Levels upon Removal of External Fixator at an Outpatient Facility / Nível de satisfação e dor na retirada de fixador externo em um ambulatório

Abstract Objective To quantify the levels of satisfaction and pain of patients submitted to external fixation removal without anesthesia at an outpatient facility. Methods The present was a prospective study involving 28 patients using external fixators who answered 3 questionnaires associated with the Visual Analogue and Numerical Pain Scale during different moments of the removal. Results The average pain prior to fixator removal was of 3.61. Shortly after the procedure, the patients reported that, on average, the most intense pain scored 6.68, and the least intense pain, 2.25 points. The average pain variation was of 4.43 points, and pain after 1 week scored, on average, 2.03 points. The recollection of the pain after fixator removal scored lower than the pain reported immediately after the procedure (mean value: 5.29). Most patients were middle-aged men, and 89.3% used circular external fixators. The main limb segment involved was the leg, and most patients (71.4%) had never used an external fixator before; they preferred the removal at an outpatient facility because it was faster (75%), and to avoid hospitalization (25%). The most intense pain was felt during the removal of Schanz pins (60.7%), being worse in the extremities of the limbs for 75% of the patients. An absolute majority of 85.7% was satisfied with the removal, and 82.1% stated that they would undergo the procedure again. Conclusion External fixator removal at an outpatient facility without anesthesia is a well-tolerated option for patients, with good levels of approval and satisfaction.

Resumo Objetivo Quantificar os níveis de satisfação e dor dos pacientes submetidos a retirada ambulatorial de fixadores externos sem anestesia. Métodos Estudo prospectivo envolvendo 28 pacientes usando fixadores externos submetidos a três questionários associados à Escala Visual Analógica e Numérica da dor durante diferentes etapas da retirada. Resultados A média de dor prévia à retirada foi de 3,61. Logo após o término do procedimento, encontramos média de 6,68 para a dor mais intensa, e de 2,25 para a dor menos intensa. A variação da dor média foi de 4,43, e a dor após uma semana teve média de 2,03. A lembrança dolorosa da retirada foi menor do que a dor referida imediatamente após a retirada (média de 5,29). A predominância no estudo foi de pacientes do sexo masculino de meia-idade, e 89,3% usavam fixador externo do tipo circular. O principal segmento dos membros envolvido foi a perna, e a maior parte dos pacientes não havia feito uso de fixador externo previamente (71,4%); eles optaram pela retirada ambulatorial por se tratar de opção mais rápida (75%), e para evitar internação hospitalar (25%). O momento de dor mais intensa ocorreu durante a retirada dos pinos de Schanz (60,7%), sendo pior nas extremidades dos membros para 75% dos entrevistados. Uma maioria absoluta de 85,7% mostrou-se satisfeita após a retirada, e 82,1% afirmaram que se submeteriam novamente ao procedimento. Conclusão A retirada ambulatorial de fixadores externos sem anestesia é uma opção bem tolerada pelos pacientes, tratando-se de um procedimento com bons níveis de aceitabilidade e satisfação.

Perfil da equipe de enfermagem de unidades ambulatoriais universitárias: considerações para a saúde do trabalhador / Perfil del equipo de enfermería de unidades ambulatorias universitarias: consideraciones para la salud del trabajador / Profile of the nursing team of university outpatient units: worker health considerations

RESUMO Objetivo identificar o perfil sociodemográfico, laboral e de saúde da equipe de enfermagem de unidades ambulatoriais especializadas. Método Estudo quantitativo, descritivo, realizado com 388 profissionais de enfermagem de ambulatórios de universidades públicas no município do Rio de Janeiro. Os dados foram coletados por equipe de auxiliares capacitados. A análise foi realizada por meio do software SPSS. Resultados houve predomínio do sexo feminino, idade acima de 50 anos, profissionais casados e com filhos. Percentual maior de trabalhadores possuía Pós-Graduação Lato Sensu, vínculo permanente, um vínculo empregatício e carga horária laboral de 31 a 60 horas semanais. Prevaleceram aqueles que autoavaliaram o estado de saúde como bom. Dentre as doenças crônicas com diagnóstico médico, destacaram-se o estresse, as doenças osteoarticulares e as varizes. Conclusões e implicações para a prática os resultados mostraram, além de dados que corroboram com a realidade nacional e internacional, uma realidade que não é prerrogativa apenas da enfermagem, como o duplo vínculo e uma alta prevalência de estresse associado a outros problemas de saúde. Observa-se um cenário preocupante no mundo do trabalho da equipe de enfermagem ambulatorial, o qual traz à tona concepções e práticas negativas potencialmente causadoras de insatisfações, riscos, danos, inseguranças e adoecimentos no trabalho.

RESUMEN Objetivo identificar el perfil sociodemográfico, laboral y de salud del equipo de enfermería de unidades ambulatorias especializadas. Método estudio cuantitativo, descriptivo, realizado con 388 profesionales de enfermería de ambulatorios de universidades públicas del município de Rio de Janeiro. Los datos fueron recolectados por auxiliares capacitados. El análisis se realizó utilizando software SPSS. Resultados se observó predominio del sexo feminino, edad superior a 50 años, profesionales casados ​​y con hijos. Un porcentaje mayor de trabajadores poseía Posgrado Lato Sensu, vínculo permanente, vínculo de empleo y carga horaria laboral de 31 a 60 horas semanales. Prevalecerán aquellos que auto validarán el estado de salud como bueno. Entre las enfermedades crónicas con diagnóstico médico se destacan estrés, las enfermedades osteoarticulares y varices. Conclusiones e implicaciones para la práctica los resultados mostraron, además de datos que corroboran con la realidad nacional e internacional, una realidad que no es prerrogativa apenas de la enfermería, como el doble vínculo y alta prevalencia de estrés asociados a otros problemas de salud. Esto demuestra un escenario preocupante en el mundo del trabajo del equipo de enfermería ambulatoria, el cual trae a tono concepciones y prácticas negativas potencialmente causantes de insatisfacciones, riesgos, daños, inseguridades y enfermedades en el trabajo.

ABSTRACT Objective to identify the sociodemographic, occupational and health profile of nursing staff working at specialized outpatient units. Method a descriptive study with a quantitative approach, conducted with 388 nursing professionals from outpatient clinics of public universities in the city of Rio de Janeiro. Data were collected by trained auxiliary team. Analysis was performed using SPSS software. Results there was a predominance of females, aged over 50 years, married professionals, and with children. A higher percentage of workers had Lato Sensu Graduate studies, permanent employment, an employment relationship and workload of 31 to 60 hours per week. Those who self-rated health prevailed as good. Chronic diseases with medical diagnosis, that stand out, include stress, osteoarticular diseases and varicose veins. Conclusions and implications for the practice the results showed, in addition to data that corroborate the national and international reality, a reality that is not only prerogative of nursing, such as the double bond and a high prevalence of stress associated with other health problems. This shows a worrying setting in the outpatient nursing staff work world, which brings out negative conceptions and practices potentially causing dissatisfaction, risk, damage, insecurity, and illness at work.

Diabetes as a risk factor of acute kidney injury in vancomycin users: an observational and prospective study

Diabetes was investigated as a risk factor for nephrotoxicity induced by vancomycin. In the present study, the drug's nephrotoxic effect was indirectly evaluated by Glomerular Filtration Rate, albuminuria and serum levels of creatinine and urea on the 1st, 7th and 14th days of vancomicyn therapy in a group of diabetic and non-diabetic patients, with and without previous nephropathy. The correlations between investigated variables (including the population's epidemiological profile and hospital care) were measured by the Spearman test. The sample consisted of 132 patients, predominantly male diabetic patients with previous nephropathy, over 40 years, receiving ≥ 10 grams of vancomycin for the treatment of infectious diseases and showing satisfactory clinical outcomes. A risk of vancomycin drug interaction with potential nephrotoxic outcome was observed in 36.4% of patients who used multiple drugs. Furthermore, 80% of patients had an increase of at least 0.5 mg.dL-1 in baseline serum levels of creatinine and urea at the end of the study. This was more common among the diabetic patients with previous nephropathy, showing higher albuminuria and a reduction in the Glomerular Filtration Rate. Therefore, it has been recommended that the use of vancomycin in diabetic patients should be in careful dosages and that kidney functioning be monitored.

Prevention and control strategies of new coronavirus pneumonia in general hospitals / 重庆医学

The new coronavirus pneumonia has been listed as one of the Class B infectious disease but is managed as Class A infectious disease. To prevent and control its spread in hospitals, the outpatient department is the first key gate. Based on the relevant diagnosis and treatment strategies of the National Health Commission of the People's Republic of China, combined with the actual situation of the hospital's epidemic prevention and control work, this article formulated comprehensive prevention and control strategies from the perspective of the patients and staffs. From the aspects of organization and leadership, medical epidemic prevention, pre-screening and screening, process formulation, admission management, cleaning and disinfection, epidemic report, prevention and control supervision, personnel and material deployment, patient education, comprehensive management, personnel management and psychological support and so on, advice and guidance on prevention and control of this infectious disease in outpatient department of hospital were provided.

Teaching clinic for training of general practitioners in suburban of a Shanghai community / 中华全科医师杂志

In order to improve the quality of clinical teaching, Xidu Community Health Service Center of Shanghai Fengxian District established a teaching clinic for training of general practitioners in 2015. The clinic served as a suburban teaching station of Department of General Practice of Zhongshan Hospital, a tertiary university hospital. This article introduces the implementation methods, achievements, practical experiences and work prospects of the clinic. The issues of system evaluation and the generalization of this teaching model for training of general practitioners are also discussed in the article.

Challenges and countermeasures of thoracic surgery in the epidemic of novel coronavirus pneumonia / 中国胸心血管外科临床杂志

@#Since December 2019, a novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) outbreak has occurred in Wuhan, Hubei Province, and the epidemic situation has continued to spread. Such cases have also been found in other parts of the country. The spread of the novel coronavirus pneumonia epidemic has brought great challenges to the clinical practice of thoracic surgery. Outpatient clinics need to strengthen the differential diagnosis of ground glass opacity and pulmonary plaque shadows. During the epidemic, surgical indications are strictly controlled, and selective surgery is postponed. Patients planning to undergo a limited period of surgery should be quarantined for 2 weeks and have a nucleic acid test when necessary before surgery. For patients who are planning to undergo emergency surgery, nucleic acid testing should be carried out before surgery, and three-level protection should be performed during surgery. Patients who are planning to undergo emergency surgery in the epidemic area should be confirmed with or without novel coronavirus pneumonia before operation, and perform nucleic acid test if necessary. Surgical disinfection and isolation measures should be strictly carried out. Among postoperative patients, cases with new coronavirus infection were actively investigated. For the rescue of patients with novel coronavirus infection, attention needs to be paid to prevention and treatment and related complications, including mechanical ventilation-related pneumothorax or mediastinal emphysema, and injury after tracheal intubation.

Capacidade funcional e eventos estressores em idosos / Functional capacity and stressful events in elderly population / Capacidad funcional y acontecimientos estresantes en personas mayores

OBJETIVO: relacionar a capacidade funcional e os eventos estressores em pessoas idosas. MÉTODO: trata-se de estudo transversal, com abordagem quantitativa, realizado com 80 idosos atendidos no ambulatório de um hospital universitário em João Pessoa, Paraíba, Brasil. A coleta de dados foi realizada por meio de entrevista, um instrumento semiestruturado para obtenção de dados sociodemográficos, além do índice de Barthel e do inventário de eventos de vida estressantes para idosos. RESULTADOS: foram observadas correlações negativas e com significância estatística (p ≤ 0,05) entre os escores da capacidade funcional e o número e intensidade dos eventos estressantes vivenciados pelos idosos. CONCLUSÃO: a vivência de eventos estressores pelos idosos atuou de forma negativa sobre a capacidade funcional, causando prejuízos para a autonomia e a independência desses indivíduos.(AU)

Objective: to relate the functional capacity and stressor events in older adults. Method: cross-sectional study with a quantitative approach conducted with 80 elderly patients treated at the outpatient clinic of a university hospital in João Pessoa, Paraíba, Brazil. Data collection was performed through interviews, and we used a semi-structured instrument for obtaining socio-demographic data, and the Barthel index and the inventory of stressful life events for the older adults. Results: we observed negative and statistically significant correlations (p ≤ 0.05) between the functional capacity scores and the number and intensity of stressful events experienced by the elderly patients. Conclusion: the experience of stressful events by the elderly patients acted negatively on functional capacity, causing damage to the autonomy and independence of these individuals.(AU)

Objetivo: relacionar la capacidad funcional y los acontecimientos estresantes en ancianos. Método: estudio transversal con enfoque cuantitativo, realizado con 80 pacientes de edad avanzada tratados en la clínica ambulatoria de un hospital universitario de João Pessoa, Paraíba, Brasil. La recogida de datos se realizó a través de entrevistas, un instrumento semiestructurado para obtener datos sociodemográficos, así como el índice de Barthel y el inventario de acontecimientos vitales estresantes para los ancianos. Resultados: se observaron correlaciones negativas y estadísticamente significativas (p ≤ 0,05) entre los puntajes de capacidad funcional y el número e intensidad de acontecimientos estresantes vividos por los ancianos. Conclusión: la experiencia de acontecimientos estresantes por parte de los adultos mayores actuó negativamente en la capacidad funcional, causando daños a la autonomía y a la independencia de estos individuos.(AU)

Perfil dos pacientes com fibrose cística atendidos em um hospital universitário de referência de Minas Gerais/Brasil / Profile of patient with cystic fibrosis treated in a reference university hospital of Minas Gerais/Brasil

Introdução: Os avanços no manejo da fibrose cística (FC) permitiram um aumento significativo da expectativa de vida dos indivíduos fibrocísticos Objetivo: Caracterizar o perfil epidemiológico e clínico dos pacientes com FC assistidos no ambulatório de um hospital universitário de referência no tratamento da doença. Métodos: Por meio da consulta aos prontuários dos pacientes em acompanhamento, foi realizada uma pesquisa descritiva, retrospectiva, entre janeiro a agosto de 2015. Resultados: A média de idade dos pacientes no período da avaliação e a média de idade ao diagnóstico foram de 10,06±6,93 e 1,71±3,28 anos, respectivamente. A maior parte da população era do sexo feminino, caucasiana, eutróficos, residentes fora do município de referência, possuía insuficiência pancreática, apresentava colonização bacteriana e realizava exercícios respiratórios, conforme orientados no ambulatório. A média do escore de Shwachman-Kulczycki foi de 88,63±11,09. Conclusão: Este perfil favorável evidencia que uma boa adesão ao tratamento e a compreensão acerca das orientações oferecidas pela equipe multiprofissional contribuíram para a manutenção do bom estado geral e estabilização dos sintomas.

Introduction: Advances in the management of cystic fibrosis (CF) allowed a significant increase in life expectancy of fibrocystic individuals. Objective: To characterize the epidemiological and clinical profile of CF patients assisted by the outpatient clinic of a reference university hospital in the treatment of the disease. Methods: A retrospective descriptive study was carried out from January to August 2015. Results: The mean age of the patients in the evaluation period and the mean age at diagnosis were 10.06 ± 6.93 and 1.71 ± 3.28 years, respectively. The majority of the population was female, caucasian, eutrophic, resident outside the reference municipality, had pancreatic insufficiency, bacterial colonization and performed respiratory exercises, as oriented in the outpatient clinic. The mean of the Shwachman-Kulczycki score was 88.63 ± 11.09. Conclusion: This favorable profile shows that a good adherence to the treatment and understanding about the guidelines offered by the multiprofessional team contributed to the maintenance of good general condition and stabilization of the symptoms.

Advanced Practice Nursing in Pediatric Urology: experience report in the Federal District / Práctica de Enfermería Avanzada en Uropediatría: relato de experiencia en el Distrito Federal / Prática Avançada de Enfermagem em Uropediatria: relato de experiência no Distrito Federal

ABSTRACT Objective: To describe the creation and implementation of the extension program Advanced Practice Nursing in Pediatric Urology, developed in the outpatient clinic of a teaching hospital in the Federal District. Method: This is an experience report regarding the implementation of an outpatient service aimed at children and adolescents with symptoms of bladder and bowel dysfunction. Results: Because it is an extension program linked to the university, it follows a different model of care, valuing empowerment, informed and shared decision making, which results in a stronger bond between patients, family and the Pediatric Urology nursing team. It has also become a privileged space for the production and use of scientific knowledge, associated with the principles of evidence-based practice. Conclusion: This project shows a different performance of the nurse-specialist-professor-researcher in Pediatric Urology Nursing, and it has become a reference in the Federal District, mainly for undergraduate and graduate nursing students.

RESUMEN Objetivo: Relatar sobre la creación e implantación del proyecto de extensión, titulado Práctica de Enfermería Avanzada en Uropediatría, desarrollado en el ambulatorio de un hospital de enseñanza del Distrito Federal. Método: Se trata de un relato de experiencia sobre la implantación de un servicio ambulatorio dirigido a niños y adolescentes portadores de síntomas de disfunción vesical e intestinal. Resultados: Por tratarse de un proyecto de extensión vinculado a la universidad, sigue un modelo diferenciado de atención que valora el empoderamiento y la toma de decisión informada y compartida, lo que fortalece el vínculo entre paciente, familia y equipo de enfermería de Uropediatría. Se ha vuelto, en consecuencia, un espacio privilegiado para la producción y aplicación de conocimientos científicos, articulado al referencial de la práctica basada en evidencias. Conclusión: Este proyecto demuestra una actuación diferenciada del enfermero-especialista-investigador-docente en el área de Enfermería en Uropediatría, y está siendo visto como referencia en el Distrito Federal, principalmente para alumnos de graduación y posgrado de Enfermería.

RESUMO Objetivo: Relatar a criação e implementação do projeto de extensão, intitulado Prática Avançada de Enfermagem em Uropediatria, desenvolvido no ambulatório de um hospital de ensino do Distrito Federal. Método: Trata-se de um relato de experiência sobre a implantação de um serviço ambulatorial direcionado a crianças e adolescentes portadores de sintomas de disfunção vesical e intestinal. Resultados: Por se tratar de um projeto de extensão vinculado à universidade, segue um modelo diferenciado de atendimento, que valoriza empoderamento e tomada de decisão informada e compartilhada, resultando no fortalecimento do vínculo entre pacientes, família e equipe de enfermagem de Uropediatria. Também se tornou um espaço privilegiado para produção e aplicação de conhecimentos científicos, articulado ao referencial da prática baseada em evidências. Conclusão: Este projeto mostra uma atuação diferenciada do enfermeiro-especialista-pesquisador-docente, na área de Enfermagem em Uropediatria, e vem se tornando referência no Distrito Federal, principalmente para alunos de graduação e pós-graduação em Enfermagem.

Caracterização de aspectos fonoaudiológicos segundo as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para Crianças e Jovens (CIF-CJ) / Characterization of communication disorders according to the categories of the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY)

RESUMO Objetivo Caracterizar o desempenho em aspectos fonoaudiológicos de pacientes ambulatoriais segundo as categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para Crianças e Jovens (CIF-CJ). Método Trata-se de estudo observacional descritivo, baseado em análise retrospectiva de dados secundários coletados em serviço fonoaudiológico ambulatorial da rede pública, com prontuários de pacientes com idades entre 5 e 16 anos avaliados entre 2010 e 2014. Foram analisados elementos dos relatórios de anamnese e avaliação, sendo identificadas categorias da CIF-CJ referentes aos componentes Funções do Corpo, Atividades e Participação e Fatores Ambientais. As categorias presentes foram definidas como as variáveis do estudo. Todas foram armazenadas como variáveis categóricas, sendo realizada análise descritiva por meio da distribuição de frequências. Resultados Foram incluídos 180 prontuários e das 168 categorias pré-selecionadas, 65 foram identificadas. Para as Funções do Corpo, 13 itens foram verificados, sendo a categoria com mais frequência referida em que se observa deficiência a funções mentais da linguagem. Para as 34 categorias identificadas pertencentes às Atividades e Participação, as mais frequentemente apontadas como dificuldade foram: aprender a ler - desempenho e realização das tarefas domésticas - desempenho. Das 18 categorias dos Fatores Ambientais, a descrita na maior parte dos relatórios como Barreira foi a atitudes individuais de conhecidos, pares, colegas, vizinhos e membros da comunidade. Conclusão Foram verificadas alterações em categorias dos três componentes da CIF-CJ analisados, indicando a existência de questões que afetaram o desempenho funcional em aspectos fonoaudiológicos de crianças e jovens atendidos em ambiente ambulatorial.

ABSTRACT Purpose Characterize the performance of outpatients regarding aspects of communication disorders according to the categories of the International Classification of Functioning, Disability and Health - Children and Youth Version (ICF-CY). Methods This is a descriptive, observational study based on a retrospective analysis of secondary data collected at a Speech-language Pathology outpatient clinic of the public health network, from records of patients aged 5-16 years, evaluated between 2010 and 2014. Elements of anamnesis and assessment reports were analyzed with identification of ICF-CY categories related to the following components: Body Functions, Activities and Participation, and Environmental Factors. These categories were defined as the study variables, stored as categorical variables, and had their frequency distribution investigated by descriptive statistical analysis. Results One hundred eighty medical records were included in the study, and 65 of the 168 pre-selected categories were identified. As for the component Body Functions, 13 items were verified, with the category related to impairment in Mental functions of language as the most frequently mentioned. Of the 34 categories identified in the component Activities and Participation, Learning to read - Performance and Doing housework - Performance were the ones that most frequently presented difficulties. Of the 18 categories of the component Environmental Factors, the one described in most reports as Barrier was Individual attitudes of acquaintances, peers, colleagues, neighbors, and community members. Conclusion Changes were found in categories of the three components of the ICF-CY analyzed, indicating the existence of issues that affected the functional performance regarding aspects of communication disorders of children and adolescents assisted at an outpatient environment.

Prevalence of unrecognized depression in patients with chronic pain without a history of psychiatric diseases

BACKGROUND: We aimed to investigate the prevalence of unrecognized depression in patients with chronic pain, but with no history of psychiatric diseases. METHODS: Patients with chronic pain who did not have a history of psychiatric disease were selected for this study. The Beck Depression Index (BDI) was used to evaluate depression. Participants' socio-demographic characteristics and pain-related characteristics were also recorded. RESULTS: The study included 94 consecutive patients with chronic pain (28 men and 66 women). Based on the BDI scores, 33/94 (35.1%) patients with chronic pain had comorbid depression. The prevalence of depression was significantly higher in our cohort than it was in the general population (P < 0.001). The standardized incidence ratio, adjusted for age and sex, was 2.77 in men and 2.60 in women. Patients who were unmarried (odds ratio [OR] = 3.714, P = 0.044), and who had subjective sleep disturbance (OR = 8.885, P < 0.001), were more likely to have moderate to severe depression. Patients with high education levels (OR = 0.244, P = 0.016), and who were economically active (OR = 0.284, P = 0.023), were less likely to have moderate to severe depression. CONCLUSIONS: Our results indicate that unrecognized depression in patients with chronic pain is common. Therefore, pain physicians should actively seek to identify these problems rather than relying on the patient to volunteer such information.

Factores asociados a la no utilización de los servicios formales de prestación en salud en la población peruana: análisis de la encuesta nacional de hogares (ENAHO) 2015 / Associated Factors to non-use of Formal Health Services in the Peruvian Population: Analysis of the National Household Survey (ENAHO) 2015

RESUMEN El objetivo del estudio fue estimar la prevalencia de la no utilización de los servicios formales de prestación de salud (NUSFPS) y sus factores asociados en Perú. Se realizó un análisis secundario de datos de la Encuesta Nacional de Hogares (ENAHO) del año 2015. Se definió como NUSFPS a aquellos participantes que, pese a haber presentado algún síntoma, malestar, enfermedad, recaída de enfermedad crónica o accidente durante el último mes, no acudieron a los servicios de salud. Se analizaron 35 036 participantes; la prevalencia de NUSFPS fue de 53,9% (IC95%:52,9-54,8). La NUSFPS fue superior en la costa (razón de prevalencia ajustada [RPa] = 1,24;IC95%:1,17-1,31), sierra (RPa =1,38;IC95%:1,31-1,46) y selva (RP = 1,25;IC95%:1,181,33) en comparación a Lima Metropolitana. Hubo mayor prevalencia de NUSFPS en los participantes sinseguro (RPa = 1,59; IC95%: 1,52-1,66) y afiliados al seguro integral de salud (RPa = 1,16; IC95%: 1,11-1,22) comparados con los afiliados a la Seguridad Social. En conclusión, más de la mitad de los participantes padecieron NUSFPS, lo cual se asoció con condiciones geográficas y de aseguramiento. Se sugieren políticas públicas informadas en la evidencia para mejorar esta situación.

ABSTRACT The aim of the study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors using the National Household Survey (ENAHO 2015). The participants were defined as NUHS if they have presented any symptoms, discomfort, illness, relapse of chronic illness or accident during the last month and did not go to the health services. 35036 participants were analyzed; the prevalence of NUHS was 53,9%. NUHS was higher in the coastal region (adjusted Prevalence Ratio [aPR]=1.24;95%CI:1.17-1.31), highlands (aPR=1.38; 95%CI: 1.31-1.46) and jungle (aPR=1.25,95%CI:1.18-1.33) compared to Lima. Likewise, there were a higher prevalence of NUHS in participants without health insurance (aPR=1.59;95%CI:1.52-1.66) and those affiliated to Ministry of Health insurance (aPR=1.16;95%CI:1.11-1.22) compared to those affiliated to Social Security. More than half of the participants suffered from NUHS, which was associated with geographical and health system conditions. It is required evidenced-informed public policies to improve this situation.

Diagnósticos de enfermagem entre usuários de anticoagulante oral acompanhados em ambulatório / Diagnósticos de enfermería entre usuarios de anticoagulante oral acompañados en ambulatorio / Nursing diagnoses among users of oral anticoagulants in outpatient follow-up

Objetivo identificar o perfil sociodemográfico e clínico, bem como principais diagnósticos de enfermagem entre usuários de anticoagulantes de uso oral acompanhados em ambulatório. Método pesquisa descritiva, transversal de abordagem quantitativa. Realizada com 128 usuários elegíveis acompanhados em ambulatório de hospital universitário público do Paraná, Brasil. Foram coletadas, em consulta de enfermagem e fonte documental, variáveis sociodemográficas e clínicas, bem como identificados diagnósticos de enfermagem segundo taxonomia da NANDA-International. Resultados a amostra foi predominantemente idosa; casada; de baixa escolaridade; com indicação de anticoagulação oral por fibrilação atrial e trombose venosa profunda; com adequado tempo médio de coagulação, expresso pela Razão Normalizada Internacional. Os cinco diagnósticos de enfermagem elencados pertenciam às classes de respostas cardiovasculares/pulmonares; infecção; ingestão; e controle da saúde. Conclusão os diagnósticos de enfermagem identificados coadunam-se ao perfil clínico dos usuários de anticoagulantes de uso oral acompanhados em ambulatório, o que reflete um cenário mais focado nas questões orgânico-funcionais, ainda que a necessidade de melhor controle da própria saúde e de domínio da promoção de saúde tenham emergido em menor proporção.

Objetivo identificar el perfil sociodemográfico y clínico, así como los principales diagnósticos de enfermería entre usuarios de anticoagulantes de uso oral acompañados en ambulatorio. Método investigación descriptiva, transversal con enfoque cuantitativo. Realizada con 128 usuarios elegibles acompañados en ambulatorio del hospital universitario público de Paraná, Brasil. Fueron recolectadas, en consulta de enfermería y base documental, variables sociodemográficas y clínicas, además de la identificación de diagnósticos de enfermería, de acuerdo con la taxonomía de la NANDA-International. Resultados la muestra se compuso predominantemente de personas mayores; casadas; de baja escolaridad; con indicación de anticoagulación oral por fibrilación atrial y trombosis venosa profunda; con una media de tempo adecuado de coagulación, expresado a través de la Razón Normalizada Internacional. Los cinco diagnósticos de enfermería enumerados pertenecían a las clases de respuestas cardiovasculares/pulmonares; infección; ingestión y; control de la salud. Conclusión los diagnósticos de enfermería identificados se coadunan al perfil clínico de los usuarios de anticoagulantes de uso oral acompañados en ambulatorio, lo que refleja un escenario más orientado para las cuestiones orgánico-funcionales, a pesar de que a necesidad de un mejor control de la propia salud y del dominio de la promoción de la salud hayan emergido en menor proporción.

Objective to identify the sociodemographic and clinical profile, as well as the main nursing diagnoses among users of oral anticoagulants in outpatient follow-up. Method it was a descriptive cross-sectional study with a quantitative approach, conducted with 128 eligible users in outpatient follow-up at a public university hospital in Paraná, Brazil. Sociodemographic and clinical variables were collected in nursing consultations and documentary sources, and the nursing diagnoses were identified according to NANDA International taxonomy. Results the sample was composed predominantly of elderly people; married; with low schooling; with indication of oral anticoagulation for atrial fibrillation and deep venous thrombosis; and adequate average clotting time expressed by the International Normalized Ratio. The five nursing diagnoses listed belonged to the classes of Cardiovascular/Pulmonary responses; Infection; Ingestion; and Health management. Conclusion the nursing diagnoses identified combine with the clinical profile of the users of oral anticoagulants in outpatient follow-up, thus reflecting a scenario more focused on organic-functional issues, although the need for better control of one's own health and domain of health promotion have emerged in a lesser extent.

Characteristics and satisfaction of outpatients in walk-in clinic of a Grade A tertiary hospital / 中华全科医师杂志

Objective To assess the characteristics and satisfaction of outpatients in walk-in clinic of a grade A tertiary hospital.Methods A total of 1 100 outpatients visiting walk-in clinic of the Second Hospital of Hebei Medical University during March 2016 and June 2016 were randomly selected for the questionnaire survey.The self-designed questionnaire included the general information of patients,the satisfaction degree to the walk-in clinic,to special clinics of the hospital or to community clinics and related reasons,and suggestions for further improvement.Results Total 947 valid questionnaires were received with a retrieval rate of 86.09％.Most of participants had one chronic disease (594,62.72％).The satisfaction degree of walk-in clinic (1.78) was higher than that of hospital special clinics (1.93) (P =0.010),in turn the latter(2.33)was higher than that of conmmnity clinics (P ＜ 0.001).The reasons for patient to choose the walk-in clinic were wide range of medications (389,41.08％),reliable quality (285,27.98％),short waiting time (249,26.29％) and so on.Suggestions for improvement of the walk-in clinic were further reducing the waiting time (428,45.20％),need specialists for chronic disease management (210,22.18％),raising reimbursement rate (172,18.16％) and so on.The reasons for patients to choose special clinic were need readjusting prescription (587,61.99％),special disease or drug (427,45.09％).The reasons of dissatisfaction with special clinic were long waiting time (476,50.26％),frequent transfer to multiple departments (221,23.34％),high registration fee (221,23.34％).The reasons for patients to choose community clinic were short distance (350,36.96％),better environment (350,36.96％),short waiting time (184,19.43％).The reason of dissatisfaction with community clinic were low qualification of medical staff (405,42.77％),insufficient medications (392,42.39％);distrusting the quality of drugs (263,27.77％).Suggestions for improvement of the community clinics were upgrading the qualification of medical staff (317,33.47％),enlarging drug variety (298,31.47％),improving medical environment (94,9.93％) and so on.Conclusion Most outpatients visiting walk-in clinic of grade A tertiary hospital are highly satisfied the clinic.To meet the patients' needs the primary medical unit should further improve their overall service.