ABSTRACT
Resumen: El uso de apoyo nutricional ambulatorio, enteral o parenteral, ha sido un paso necesario en la opti mización del soporte nutricional en pacientes, que, por diversas patologías, no logran cumplir con sus requerimientos por vía oral (VO). En el presente artículo se presentan las recomendaciones de la Rama de Nutrición, dirigidas a los equipos de salud que atienden pacientes pediátricos, que requieran alimentación enteral por un tiempo prolongado. Su objetivo general es entregar pautas para un co rrecto manejo en estos pacientes. Se describe la conformación ideal del equipo de salud para atención y seguimiento de dichos pacientes, los criterios de ingreso al programa y su forma de evaluación en el tiempo. Además, se describen características generales de la alimentación enteral, vías de admi nistración, fórmulas enterales disponibles, complicaciones de este soporte nutricional y por último monitorización y seguimiento del paciente.
Abstract The use of home enteral or parenteral nutrition has been a necessary step in the optimization of nu tritional support in patients who, due to several diseases, fail to meet their nutritional requirements by oral feeding. This article presents the recommendations of the Chilean Pediatric Society Nutritio nal Branch, aimed at health teams that treat pediatric patients who require enteral feeding for a long time. The general objective is to provide guidelines for the proper management of these patients. It describes the ideal conformation of the health team for the care and follow-up of those patients, the program admission criteria, and its evaluation method over time. In addition, it describes general characteristics of enteral feeding, routes of administration, available enteral formulas, complications, and patient follow-up.
Subject(s)
Humans , Child , Adolescent , Enteral Nutrition/standards , Home Care Services/standards , Pediatrics , Societies, Medical , Chile , Chronic Disease , Enteral Nutrition/adverse effects , Enteral Nutrition/methods , Aftercare/methods , Aftercare/standardsABSTRACT
ABSTRACT Objective: To analyze the association between the characteristics of follow-up in health services and adherence to antihypertensive medication in patients with cardiovascular disease. Method: Analytical study carried out with 270 patients suffering from hypertension and hospitalized due to cardiovascular complications. Data collection occurred between November 2015 and April 2016, involving sociodemographic variables, presence of self-reported diabetes, accessibility and use of health services, blood pressure levels and medication adherence (analyzed through the Morisky-Green Test). Results: The rate of adherence to antihypertensive therapy was 63.0%. Enrollment in the Hiperdia program had no statistical significance to medication adherence. People who attended at least between 4 and 6 nursing consultations throughout the data collection period (p = 0.02) had better adherence. Conclusion: The study's findings provide support for the reorientation of health services and their public policies towards improving adherence to antihypertensive therapeutics.
RESUMEN Objetivo: Analizar la asociación entre las características del seguimiento en servicios de salud y la adhesión al tratamiento antihipertensivo en pacientes con enfermedad cardiovascular. Método: Estudio analítico, realizado con 270 pacientes con hipertensión internados por la ocurrencia de complicación cardiovascular. La recolección de datos ocurrió entre noviembre de 2015 y abril de 2016. Se analizaron variables sociodemográficas, presencia de diabetes autorreferida, condiciones de acceso y utilización de servicios de salud, niveles de presión arterial y adhesión terapéutica a través de la prueba de Morisky-Green. Resultados: La tasa de adhesión terapéutica antihipertensiva identificada fue del 63,0%. El registro en el programa Hiperdia no presentó significancia estadística con la adhesión. Esta medida fue mejor en aquellos que asistieron entre 4 y 6 consultas de enfermería en el año (p=0,02). Conclusión: Los hallazgos proporcionan subsidios para la reorientación de los servicios de salud y sus políticas públicas para la ampliación de la adhesión terapéutica antihipertensiva.
RESUMO Objetivo: Analisar a associação entre as características do acompanhamento em serviços de saúde e a adesão ao tratamento anti-hipertensivo em pacientes com doença cardiovascular. Método: Estudo analítico, realizado com 270 pacientes com hipertensão internados pela ocorrência de complicação cardiovascular. A coleta de dados ocorreu entre novembro de 2015 e abril de 2016. Analisaram-se variáveis sociodemográficas, presença de diabetes autorreferida, condições de acesso e utilização de serviços de saúde, níveis de pressão arterial e adesão terapêutica por meio do Teste de Morisky-Green (TMG). Resultados: A taxa de adesão terapêutica anti-hipertensiva identificada foi de 63,0%. O cadastro no programa Hiperdia não apresentou significância estatística com a adesão. Esta medida foi melhor naqueles que compareceram entre 4 e 6 consultas de enfermagem no ano (p=0,02). Conclusão: Os achados fornecem subsídios para a reorientação dos serviços de saúde e suas políticas públicas para a ampliação da adesão terapêutica anti-hipertensiva.
Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Quality of Health Care/standards , Aftercare/standards , Medication Adherence/psychology , Antihypertensive Agents/administration & dosage , Brazil , Health Knowledge, Attitudes, Practice , Aftercare/methods , Aftercare/statistics & numerical data , Medication Adherence/statistics & numerical data , Hypertension/psychology , Hypertension/drug therapy , Middle Aged , Antihypertensive Agents/therapeutic useABSTRACT
ABSTRACT Purpose: To assess the need for postnatal evaluation and the medium term outcome in patients with isolated unilateral low grade prenatally detected hydronephrosis. Materials and Methods: We prospectively selected 424 patients (690 kidney units) with a prenatal diagnosis of urinary tract dilatation between 2010 and 2013. We included only those patients with isolated unilateral low-grade hydronephrosis who underwent at least 2 postnatal ultrasound examinations. The Society for Fetal Urology (SFU) grading system was utilized for assessment of the hydronephrosis. We excluded patients with bilateral dilation or other urological abnormalities. The fate of hydronephrosis including resolution, stability or worsening was documented. Results: A total of 66 infants (44 boys and 22 girls) with antenatally diagnosed unilateral urinary tract dilation (23 right and 43 left) were identified. Ultrasounds showed SFU grade 1 hydronephrosis in 32 patients (48%) and SFU grade 2 hydronephrosis in 34 (52%). After a mean follow-up period of 32 months (range 12 to 60), 37 patients (56%) had complete resolution of hydronephrosis while the remaining 29 were stable (44%). None of our patients developed UTIs during follow-up and none required surgical intervention. Conclusions: Prenatally detected, isolated unilateral low-grade hydronephrosis usually have a favorable prognosis. All cases in our cohort showed either stability or resolution of hydronephrosis without any harmful consequences. Based on our findings on medium-term in this category of patients, long-term follow-up is not warranted.
Subject(s)
Humans , Male , Female , Ultrasonography, Prenatal/standards , Aftercare/standards , Fetal Diseases/diagnostic imaging , Hydronephrosis/embryology , Hydronephrosis/diagnostic imaging , Time Factors , Severity of Illness Index , Sex Factors , Prospective Studies , Gestational Age , Risk Assessment , Kaplan-Meier Estimate , Fetal Diseases/pathology , Hydronephrosis/pathologyABSTRACT
Resumen: Introducción: La evaluación ecocardiográfica de pacientes post-trasplante cardiaco pediátrico es una herramienta útil. Sin embargo, aún es necesario definir un protocolo óptimo de seguimiento. Obje tivo: Caracterizar los resultados de la aplicación de un protocolo de evaluación ecocardiográfica fun cional en pacientes en control post-trasplante cardiaco pediátrico ortotópico. Pacientes y Método: Posterior al trasplante cardiaco pediátrico se realizó una ecocardiografía con un protocolo funcional que incluyó strain longitudinal global. Se evaluaron además los datos de la biopsia endomiocárdica y del estudio hemodinámico contemporáneos. Resultados: De un total de 9 pacientes sólo 1 presentó disfunción sistólica de ventrículo izquierdo según parámetros clásicos, pero casi la totalidad presentó un strain longitudinal global alterado. No se observaron episodios de rechazo moderado o severo en estos pacientes. Todos los pacientes presentaban disfunción sistólica ventricular derecha. No se ob servó correlación entre estos parámetros y la presión de arteria pulmonar. Conclusiones: Se observó disfunción sistólica biventricular subclínica en la mayoría de los pacientes de esta serie. No hubo aso ciación con episodios de rechazo o con hipertensión pulmonar, lo que podría estar en relación con la ausencia de episodios de rechazo moderado o severo en la biopsia contemporánea y con el reducido tamaño muestral. Sólo el seguimiento a largo plazo de estos pacientes permitirá definir la relevancia clínica de los hallazgos descritos.
Abstract: Introduction: The echocardiographic evaluation of patients after heart transplantation is a useful tool. However, it is still necessary to define an optimal follow-up protocol. Objective: To describe the results of the application of a functional echocardiographic protocol in patients being followed after pediatric heart transplantation. Patients and Method: Alls patients being followed at our institution after pediatric heart transplantation underwent an echocardiographic examination with a functional protocol that included global longitudinal strain. Contemporaneous endomyocardial biopsy results and hemodynamic data were recorded. Results: 9 patients were evaluated with our echocardiographic functional protocol. Of these patients, only 1 showed systolic left ventricular dysfunction according to classic parameters. However, almost all patients had an abnormal global longitudinal strain. Right ventricular systolic dysfunction was observed in all patients. No epidodes of moderate to severe rejectiom were recorded. No correlation was observed between these parameters and pulmonary artery pressure. Conclusions: Subclinical biventricular systolic dysfunction was observed in the majority of the patients in this study. No association with rejection episodes or pulmonary hypertension was observed, which may be related to the absence of moderate or severe rejection episodes during the study period, and to the small sample size. Long term follow-up of these patients may better define the clinical relevance of our findings.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Postoperative Care/methods , Postoperative Complications/diagnostic imaging , Echocardiography, Doppler/methods , Heart Transplantation , Aftercare/methods , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Postoperative Care/standards , Echocardiography, Doppler/standards , Pilot Projects , Clinical Protocols , Prospective Studies , Follow-Up Studies , Aftercare/standards , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Left/etiologyABSTRACT
ABSTRACT Introduction: Nutritional counseling and growth follow-up are priorities when providing care to children; however, these have not been completely incorporated into primary health care. Objective: To know the difficulties for providing nutritional counseling and child growth follow-up, from a professional healthcare perspective. Method: Qualitative study, using Donabedian as theoretical framework, developed by 53 professionals in the field of primary health care. Data was obtained from focal groups and submitted to content analysis. Results: The main difficulties for nutritional counseling were clustered in the category of 'perceptions and beliefs related to child feeding'. The 'problems of infrastructure and healthcare' and 'maintenance of the hegemonic medical model' are the main difficulties for following-up growth. Final considerations: Besides investments in infrastructure, healthcare training is indispensable considering beliefs and professional experiences, so in fact, nutritional counseling and child growth follow-up are incorporated in primary health care.
RESUMEN Introducción: El asesoramiento nutricional y el acompañamiento del crecimiento son prioridad en la atención del niño aunque todavía no estén plenamente incorporados en la atención básica. Objetivo: Conocer las dificultades para desempeñar el asesoramiento nutricional y el acompañamiento del crecimiento infantil según la perspectiva de los profesionales de la salud. Método: Estudio cualitativo, basado en el referencial de Donabedian, desarrollado con 53 profesionales de la salud en la atención básica. Los datos se obtuvieron mediante grupos focales y se sometieron al análisis de contenido. Resultados: Las principales dificultades sobre el asesoramiento nutricional se reunieron en la categoría 'percepciones y creencias relacionadas a la alimentación infantil'. En el acompañamiento del crecimiento, las categorías 'problemas de infraestructura y funcionamiento de los servicios de salud' y 'mantenimiento del modelo médico hegemónico' representaron las principales dificultades. Consideraciones finales: Además de la necesidad de invertir en infraestructura, es imprescindible que las capacitaciones en el servicio consideren las creencias y experiencias de los profesionales para que, de hecho, el asesoramiento nutricional y el acompañamiento del crecimiento infantil sean incorporados a la atención básica.
RESUMO Introdução: Aconselhamento nutricional e acompanhamento do crescimento são prioritários na assistência à criança, porém, ainda não estão plenamente incorporados na atenção básica. Objetivo: Conhecer as dificuldades para realizar aconselhamento nutricional e acompanhamento do crescimento infantil, na perspectiva de profissionais de saúde. Método: Estudo qualitativo, fundamentado no referencial de Donabedian, desenvolvido com 53 profissionais de saúde da atenção básica. Dados foram obtidos por grupos focais e submetidos à análise de conteúdo. Resultados: As principais dificuldades para o aconselhamento nutricional reuniram-se na categoria 'percepções e crenças relacionadas à alimentação infantil'. Para o acompanhamento do crescimento, as categorias 'problemas de infraestrutura e funcionamento dos serviços de saúde' e 'manutenção do modelo médico hegemônico' representaram as principais dificuldades. Considerações finais: Além de investimentos na infraestrutura, é imprescindível que capacitações em serviço considerem crenças e experiências dos profissionais para que, de fato, o aconselhamento nutricional e acompanhamento do crescimento infantil sejam incorporados na atenção básica.
Subject(s)
Humans , Male , Female , Child, Preschool , Adult , Perception , Child Development , Aftercare/standards , Nutritional Support/standards , Counseling/methods , Counseling/standards , Pediatrics/methods , Pediatrics/standards , Primary Health Care/methods , Primary Health Care/standards , Primary Health Care/trends , Socioeconomic Factors , Brazil , Aftercare/methods , Nutritional Support/methods , Nutritional Support/statistics & numerical data , Qualitative Research , Workforce , Nutritional Sciences , Middle AgedABSTRACT
ABSTRACT Objective: the purpose of this study was to evaluate the efficacy of telephone-based support for the metabolic control of elderly patients with diabetes mellitus. Method: a pragmatic study was conducted in two groups, called G1 (n=36) and G2 (n=27), at a health unit from the countryside of São Paulo state. Patients in G1 group received telephone support over four months, through 16 telephone contacts with educational material; for the G2 group the educational material was mailed. Results: significant differences were found. The G1 group showed a reduction of the parameters of fasting glucose, as well as systolic and diastolic blood pressure. In G2 group a modest reduction was noted in some parameters, with no significant difference. Conclusion: telephone support was effective to deliver patient education to the diabetic elderly, leading to the reduction of fasting blood glucose. This, combined with other strategies, can contribute to reduce glycated hemoglobin (NCT 01972412).
RESUMEN Objetivo: evaluar la efectividad del soporte telefónico en el control metabólico de ancianos con diabetes mellitus. Método: estudio pragmático con 63 participantes, divididos en dos grupos denominados G1(n=36) y G2(n=27), en una unidad de salud del interior paulista. El soporte telefónico fue ofrecido durante cuatro meses para el G1, consistiendo en 16 llamadas telefónicas de contenido educativo, y para el G2, se realizaron envíos por vía postal. Resultados: en el G1 hubo significatividad estadística en la reducción de los parámetros de las variables glucemia en ayunas, presión arterial sistólica y diastólica. En el G2 hubo discreta reducción en algunas variables, pero sin significatividad estadística. Conclusión: el soporte telefónico fue considerado como estrategia educativa efectiva para ancianos con diabetes mellitus y favoreció la reducción de la glucemia en ayunas. En conjunto con otras estrategias, puede agregar valor a la reducción de hemoglobina glicosilada (NCT 01972412).
RESUMO Objetivo: avaliar a efetividade do suporte telefônico no controle metabólico de idosos com diabetes mellitus. Método: estudo pragmático com 63 participantes, alocados em dois grupos, denominados G1(n=36) e G2(n=27), em uma unidade de saúde do interior paulista. O suporte telefônico foi oferecido, durante quatro meses, para o G1, por meio de 16 ligações telefônicas com conteúdo educativo, e, para o G2, foram enviadas correspondências por via postal. Resultados: no G1 houve significância estatística na redução dos parâmetros das variáveis glicemia de jejum, pressão arterial sistólica e diastólica. No G2, houve redução discreta de algumas variáveis, mas sem significância estatística. Conclusão: o suporte telefônico foi considerado uma estratégia educativa efetiva para idosos com diabetes mellitus e favoreceu a redução da glicemia de jejum e, em conjunto com outras estratégias, pode agregar valor na redução da hemoglobina glicada (NCT 01972412).
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aftercare/standards , Counseling/methods , Diabetes Mellitus/therapy , Telephone , Aftercare/methods , Diabetes Mellitus/psychology , Middle AgedABSTRACT
To identify the prevalence of endocrine dysfunction in Iranians with beta-thalassaemia, we assessed thyroid, parathyroid, pancreatic and adrenal function in 150 beta-thalassaemic patients aged 10-22 years at the Paediatrics Unit, Shiraz University of Medical Sciences. Primary hypothyroidism was found in 6.0% of patients [mean age: 14.6 +/- 1.9 years], hypoparathyroidism in 7.3% [14.5 +/- 3.2 years], type 1 diabetes mellitus in 7.3% [13.9 +/- 2.8 years] and adrenal insufficiency in 1 patient. The relatively high frequency of endocrine dysfunction found in our study may be a result of poor disease control and management in early life when irreversible tissue damage occurs due to iron overload. These findings reinforce the importance of regular follow-up of patients with beta-thalassaemia major for early detection and management of associated complications
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Adrenal Insufficiency/epidemiology , Aftercare/standards , Blood Transfusion/adverse effects , Deferoxamine , Ferritins/blood , Growth Disorders/diagnosis , Hypoparathyroidism/epidemiology , Iron Chelating AgentsABSTRACT
To evaluate the United Arab Emirate National Newborn Screening Programme we compared coverage, timeliness of programme indicators [age at sampling, recall and treatment initiation, timing of specimen delivery and laboratory results] and specimen quality with international st and ards. Recall rate, sensitivity, specificity, positive predictive values and relative incidence rates for phenylketonuria [PKU] and congenital hypothyroidism [CH] were calculated. Investigations for hypothyroidism included thyroid function studies [T3, T4, fT4 and TSH], technetium-99m thyroid scan when possible and thyroglobulin and thyroid antibodies when indicated. PKU investigations included plasma amino acids and measurement of biopterin defects. In the 6 years before December 2000, 138,718 neonates were screened. Relative incidences for CH and for classic PKU were 1:1570 and 1:20,050 respectively
Subject(s)
Humans , Aftercare/standards , Age Factors , Amino Acids/blood , Biopterin/blood , Birth Rate , Congenital Hypothyroidism , Health Services Needs and Demand , Hypothyroidism/epidemiology , Infant, NewbornABSTRACT
As private medical practitioners play a major role of in providing care to pulmonary tuberculosis [TB] patients, a survey was made of knowledge and practice in 2 cities in Pakistan. Only 1 of the 245 physicians was aware that cough > 3 weeks alone is the main symptom suggesting pulmonary TB. The majority diagnosed [80%] and treated [83%] cases themselves without referral. Less than 1% relied on sputum microscopy alone for diagnosis. None of the practitioners were following National TB Control guidelines for prescribing drugs and none ensured compliance with anti-TB treatment under supervision of a doctor/health worker. Only 3% kept records of pulmonary TB patients. None of the physicians assessed the effectiveness of treatment with sputum microscopy alone; the majority [76%] used only clinical assessment
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Aftercare/standards , Antitubercular Agents , Attitude of Health Personnel , Health Knowledge, Attitudes, Practice , Practice Patterns, Physicians'/standards , Physicians, Family/standards , Private Practice/standards , Referral and Consultation/standards , Sputum/microbiologyABSTRACT
Demographic characteristics and factors associated with immediate relapse to heroin use among 40 male Bahraini heroin abusers were studied 1 week after discharge from the Drug and Alcohol Rehabilitation Unit in Bahrain. The mean age of the patients was 32.7 years, the age at which drug abuse began ranged from 12 years to 31 years, and the age range of regular use was 15-37 years. More than half the patients were single, unemployed, unskilled labourers with secondary-school education. The vast majority used heroin intravenously. Negative emotional states and drug-related cues were seen by the majority of the subjects as influential in their immediate relapse after discharge. Findings suggest that the treatment and rehabilitation unit in Bahrain should look into the issues of after-care
Subject(s)
Adolescent , Adult , Child , Humans , Male , Middle Aged , Aftercare/standards , Age Distribution , Attitude to Health , Cues , Needs Assessment , Patient Discharge , Risk Factors , Socioeconomic FactorsABSTRACT
El programa "Control de Tuberculosis de la PNP SS" fue creado en el año 1988, teniendo como objetivo la buena administración del tratamiento, así como evaluar la respuesta y complicaciones de éste; depende del Departamento de Neumología del HC PNP; interviene activamente en acciones preventivas, como charlas, vacunas y quimioprofilaxis, esta última ampliada a pacientes con anticuerpos HIV. La captación de los pacientes es a demanda pasiva y el método diagnóstico de mayor importancia es la baciloscopía. El tratamiento es de acuerdo al Manual de Normas y Procedimientos de la Tuberculosis en el Perú. En el estudio de cohorte del segundo semestre 1991, de pacientes con baciloscopía positiva el 85.8 por ciento fue curado, 4.3 por ciento de fracasos. Abandonos, transferencias y fallecidos 3.2 por ciento respectivamente. En el primer semestre 1992 ingresaron al programa 221 pacientes, 185 con TBC pulmonar (64.8 por ciento BK positivo) y 36 TBC extrapulmonar (22 por ciento BK positivo y 53 por ciento por Anatomía patológica).