ABSTRACT
El presente manual de procedimientos, documenta las principales actividades de atención integral que ofrece el personal de enfermería, como parte del proceso de atención en salud, describe el cuidado y atenciones que se ofrecen a la persona en los establecimientos de salud, mediante el enfoque por procesos institucional. Este enfoque fomenta el desarrollo organizacional y el mejoramiento continuo para cumplir la misión del Ministerio de Salud
This manual of procedures documents the main activities of comprehensive care offered by nursing staff as part of the health care process. It describes the care and attention offered to people in health facilities, using the institutional process approach. This approach promotes organizational development and continuous improvement to fulfill the mission of the Ministry of Health
Subject(s)
Critical Pathways , Manuals as Topic , El SalvadorABSTRACT
The aim of this study was to evaluate the vital signs related with different dental treatments, and correlate with demographic data and participants' anxiety level. This is a prospective clinical study with 60 participants, divided into 3 groups of dental procedures: (1) restorative treatment, (2) extractions and biopsies, and (3) gingival treatment. A level of anxiety questionnaire before dental procedure proposed by Corah's Dental Anxiety Scale was collected. Respiratory rate, systolic and diastolic pressure, temperature and oxygenation were measured before, during and after the procedures. 31 (51.7 %) women and 29 (48.3 %) men were included, with mean age of 41.75 years old. Most participants (50 %) were classified as very little anxious. Diastolic pressure before the procedure was higher for slightly anxious patients when compar ed with very little anxious patients (p=0.028). Systolic pressure before, during and after the procedure was higher for participan ts above 40 years old (p=0,001). Heart rate (p=0,050) and temperature (p=0,041) was higher before the restorative treatment. Anxiety can promote changes in vital signs in the dental environment. Vital signs, sex, age and level of anxiety do influence the blood pressure at different clinical moments. Dental procedures have association with variations in temperature, heart and respiratory rate.
El objetivo de este estudio fue evaluar los signos vitales relacionados con diferentes tratamientos dentales y correlacionarlos con datos demográficos y el nivel de ansiedad de los participantes. Este es un estudio clínico prospectivo con 60 participantes, divididos en 3 grupos de procedimientos dentales: (1) tratamiento restaurador, (2) extracciones y biopsias, y (3) tratamiento gingival. Se recogió un cuestionario de nivel de ansiedad antes del procedimiento odontológico propuesto por la Escala de Ansiedad Dental de Corah. Se midieron la frecuencia respiratoria, la presión sistólica y diastólica, la temperatura y la oxigenación antes, durante y después de los procedimientos. Se incluyeron 31 (51,7 %) mujeres y 29 (48,3 %) hombres, con edad media de 41,75 años. La mayoría de los participantes (50 %) fueron clasificados como muy poco ansiosos. La presión diastólica antes del procedimiento fue mayor en los pacientes ligeramente ansiosos en comparación con los pacientes muy poco ansiosos(p=0,028). La presión sistólica antes, durante y después del procedimiento fue mayor para los participantes mayores de 40 años (p=0,001). La frecuencia cardíaca (p=0,050) y la temperatura (p=0,041) fueron mayores antes del tratamiento restaurativo. La ansiedad puede promover cambios en los signos vitales en el entorno dental. Los signos vitales, el sexo, la edad y el nivel de ansiedad sí influyen en la presión arterial en los diferentes momentos clínicos. Los procedimientos dentales tienen asociación con variaciones de temperatura, frecuencia cardíaca y respiratoria.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Anxiety , Dental Care , Prospective Studies , Surveys and Questionnaires , Critical Pathways , Age and Sex Distribution , Vital Signs , Heart RateABSTRACT
Background and Objectives@#Heart Failure (HF) remains a major health concern worldwide. In the Philippine General Hospital (PGH), HF is consistently a top cause of mortality and readmissions among adults. The American College of Cardiology (ACC) and European Society of Cardiology (ESC) published guidelines for interventions that improve quality of life and survival, but they are underused and untested for local acceptability. Hospitals overseas used order sets created from these guidelines, which resulted in a considerable decrease in in-hospital mortality and healthcare costs. We aimed to develop an order set for adult patients with acute heart failure (AHF) admitted to the PGH Emergency Department (ED) to improve care outcomes.@*Methods@#This study utilized a mixed methods approach to create the AHF order set. ESC and ACC HF guidelines were appraised using the AGREE II tool. Class I interventions for AHF were included in the initial order set. Through focused group discussions (FGD), clinicians and other care team members involved in the management of AHF patients at PGH ED modified and validated the order set. Stakeholders were asked to use online Delphi and FGD to get a consensus on how to amend, approve, and carry out the order given.@*Results@#Upon review of HF guidelines, 29 recommendations on patient monitoring, initial diagnostic, and therapeutic interventions were adopted in the order set. Orders on subspecialty referrals and ED disposition were introduced. The AHF patient was operationally defined in the setting of PGH ED. The clinical orders fit the PGH context, ensuring evidence-based, cost-effective, and accessible care responsiveness to patients’ needs and suitable for local practice. Workflow changes due to COVID-19 were considered. Potential barriers to implementation were identified and addressed. The final order set was adopted for implementation through stakeholder consensus.@*Conclusion@#The PGH developed and adopted its own AHF order set that is locally applicable and can potentially optimize outcomes of care.
Subject(s)
Quality Improvement , Critical PathwaysABSTRACT
Lung cancer (LC) is the leading cause of death among patients with cancer both in worldwide and China. China accounts for 11.4% of the total number of cancer cases and 18.0% of the total number of cancer deaths in the world. Standardizing the diagnosis and treatment of LC is a key measure to improve the survival rate of LC patients and reduce the mortality rate. However, county hospitals generally face the problem of inaccessibility to advanced diagnostic and treatment technologies. Therefore, when developing quality control standards and clinical diagnosis and treatment specifications, it is necessary to combine the actual situation of county hospitals and formulate specific recommendations. The recommendations of treatment measures also need to consider the approval status of indications and whether it is included in the National Reimbursement Drug List (NRDL), to ensure the access to medicines. In order to solve the above problems, based on existing guidelines at home and abroad and the clinical work characteristics of county hospitals, the first clinical pathway in Chinese county for LC diagnosis and treatment (2023 edition) was compiled. This pathway elaborated on the imaging diagnosis, pathological diagnosis, molecular testing, and precision medicine based on histological-pathological types, tumor-node-metastasis (TNM) classification, and molecular classification, developed different diagnosis and treatment processes for different types of LC patients. Simultaneously, according to the actual work situation of county hospitals, the diagnosis and treatment recommendations in clinical scenarios are divided into basic strategies and optional strategies for elaboration. The basic strategies are the standards that county hospitals must meet, while the optional strategies provide more choices for hospitals, which are convenient for county doctors to put into clinical practice. All the recommended diagnostic and treatment plans strictly refer to existing guidelines and consensus, ensuring the scientificity.
Subject(s)
Humans , Lung Neoplasms/drug therapy , Critical Pathways , Precision Medicine , Diagnosis, Differential , ChinaABSTRACT
Lung cancer (LC) is the leading cause of death among patients with cancer both in worldwide and China. China accounts for 11.4% of the total number of cancer cases and 18.0% of the total number of cancer deaths in the world. Standardizing the diagnosis and treatment of LC is a key measure to improve the survival rate of LC patients and reduce the mortality rate. However, county hospitals generally face the problem of inaccessibility to advanced diagnostic and treatment technologies. Therefore, when developing quality control standards and clinical diagnosis and treatment specifications, it is necessary to combine the actual situation of county hospitals and formulate specific recommendations. The recommendations of treatment measures also need to consider the approval status of indications and whether it is included in the National Reimbursement Drug List (NRDL), to ensure the access to medicines. In order to solve the above problems, based on existing guidelines at home and abroad and the clinical work characteristics of county hospitals, the first clinical pathway in Chinese county for LC diagnosis and treatment (2023 edition) was compiled. This pathway elaborated on the imaging diagnosis, pathological diagnosis, molecular testing, and precision medicine based on histological-pathological types, tumor-node-metastasis (TNM) classification, and molecular classification, developed different diagnosis and treatment processes for different types of LC patients. Simultaneously, according to the actual work situation of county hospitals, the diagnosis and treatment recommendations in clinical scenarios are divided into basic strategies and optional strategies for elaboration. The basic strategies are the standards that county hospitals must meet, while the optional strategies provide more choices for hospitals, which are convenient for county doctors to put into clinical practice. All the recommended diagnostic and treatment plans strictly refer to existing guidelines and consensus, ensuring the scientificity.
Subject(s)
Humans , Lung Neoplasms/drug therapy , Critical Pathways , Precision Medicine , Diagnosis, Differential , ChinaABSTRACT
RESUMO OBJETIVO: Descrever padrões de trajetórias de autoavaliação de saúde (AAS) e investigar sua associação com fatores sociodemográficos, ocupacionais e de saúde. MÉTODOS: Amostra composta por 7.738 servidores públicos ativos do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) avaliados entre 2008 e 2020. Utilizando-se a curva de crescimento de classe latente, foram definidos os padrões de trajetórias da AAS, obtidos em 11 pontos no tempo. Modelos logísticos multinomiais foram testados para analisar associações entre as exposições e os padrões de trajetórias de AAS. RESULTADOS: Três padrões de trajetórias de AAS emergiram: i- boa, ii- regular e iii-ruim (29%, 61% e 10% dos participantes, respectivamente). Após ajustes, tiveram maiores chances de serem classificados com padrões de trajetória de AAS ruim, comparado à boa, o sexo feminino, a raça/ cor autorreferida parda, referir frequente conflito do trabalho para a família ou da família para o trabalho. Além disso, os fatores associados a maiores chances de apresentar padrão de trajetória de AAS ruim ou regular, comparados à boa, foram escolaridade até o ensino médio, menor renda, trabalho passivo, alto desgaste no trabalho, baixo apoio social, ocupação manual, percepção de escassez de tempo para o autocuidado e lazer, ter sobrepeso ou obesidade, um estilo de vida não saudável e comorbidades. CONCLUSÃO: Condições socioeconômicas e ocupacionais adversas, estilo de vida não saudável e comorbidades foram associadas ao pior padrão de trajetórias de AAS.
ABSTRACT OBJECTIVE: To describe patterns of self-rated health (SRH) trajectories and investigate their association with sociodemographic, occupational, and health factors. METHODS: The sample consisted of 7,738 active public servants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), evaluated from 2008 to 2020. The patterns of SRH trajectories were obtained by eleven time points, using the latent class growth curve. A multinomial logistic model was used to test associations between the exposures and patterns of trajectories of SRH. RESULTS: Three patterns of trajectories of SRH were identified: i- good, ii- moderate, and iii- poor (29%, 61%, and 10% of the participants, respectively). Adjusted results showed that women, mixed-race, frequent work to family or family to work conflict were associated with a greater chance of poor pattern of trajectory of SRH, compared to good pattern. Besides, high school, low income, passive work, high strain, low social support, lack of time selfcare and leisure, overweight, obesity, unhealthy lifestyle, and the presence of comorbidities were associated with a greater chance of moderate and poor pattern of trajectory of SRH, when compared with a good pattern. CONCLUSION: Adverse socioeconomic and occupational conditions, as well as unhealthy lifestyle and comorbidities were associated with worse SRH patterns of trajectories.
Subject(s)
Health , Adult Health , Longitudinal Studies , Latent Class Analysis , Self-Testing , Sociodemographic Factors , Critical Pathways , Life StyleABSTRACT
Resumo Este ensaio expõe a disputa em torno do rol taxativo da Agência Nacional de Saúde Suplementar (ANS), promovendo discussões entre os campos do direito e da saúde coletiva através dos documentos jurídicos disponibilizados publicamente. Nos julgados do Superior Tribunal de Justiça (STJ), são extraídas as teses da taxatividade e exemplificatividade do rol. Atravessando ao executivo e legislativo, serão colocados em tela a MP 1.067/21 e o PL 2033/22 (Lei nº 14.454/22), em especial o debate no Senado, evidenciando a atuação do advocacy. Na discussão, a literatura é convidada para contrapor as visões de direito à saúde baseado na verve mercadológica ou enquanto valor social. Demonstra-se que a querela do rol da ANS tem nos julgados do STJ, em 2022, um ponto crítico - e não surgimento. O executivo emitiu medida provisória em 2021 utilizando os argumentos economicistas e tecnocráticos, repetidos pela ANS e pelo Ministro Salomão. O judiciário vinha lidando com o crescente de ações decorrentes de negativas de coberturas, e com um STJ rachado entre as interpretações exemplificativa e taxativa do rol. O legislativo apresentava projetos de lei desde 2008. A atuação do advocacy ressaltou a ausência da saúde coletiva no debate e a ação de grupos motivados por relações individualizadas, transparecendo certo caráter paroquialista. Depreende-se, assim, que os poderes não atuam de forma estanque na definição de políticas de saúde no Brasil.
Abstract This essay exposes the dispute over the comprehensive List of Procedures and health events of the National Agency of Supplementary Health (ANS), promoting discussions between the fields of law and public health, through publicly available legal documents. In Superior Court of Justice (STJ) judgments, the theses whether the list is comprehensive or illustrative are extracted. Crossing to the executive and legislative branches, provisional executive order n. 1067/21 and bill n. 2033/22 will be selected, especially the debate in the Senate, evidencing the role of advocacy. In the discussion section, the literature is invited to oppose the views of the right to health based on market verve or as a social value. It is shown that the dispute over the ANS' list has 2022 as a critical point - and not as an arising point. The executive had already issued a provisional executive order in 2021 using the economistic and technocratic arguments, repeated by the ANS and Justice Salomão. The judiciary was already dealing with the growing number of lawsuits arising from denials of coverage, and with a STJ split between the comprehensive or illustrative interpretations of the list. The legislature has also presented bills since 2008. The advocacy performance highlighted the absence of public health and the action of groups motivated by individualized relationships. It appears that the powers do not act in a watertight manner in the definition of health policies in Brazil.
Subject(s)
Prepaid Health Plans/legislation & jurisprudence , Critical Pathways , Supplemental Health , Health's Judicialization , Health Policy/legislation & jurisprudenceABSTRACT
Contexto: Eating Assessment Tool (EAT-10) é um método clínico de detecção de disfagia, entendida como dificuldade na deglutição. Em pesquisa realizada no Brasil, foi observado que 9,5% de indivíduos saudáveis assintomáticos têm resultados do teste compatível com disfagia. Objetivo: Avaliar os possíveis fatores que influenciam o resultado anormal do teste em indivíduos saudáveis. Método: Estudo transversal realizado na Faculdade de Medicina de Ribeirão Preto (FMRP-USP) em 358 voluntários sem doenças e sem sintomas, nos quais foi aplicado o teste EAT-10. Resultados: Em 316 o resultado nos 10 itens do teste foi zero, e em 42 os resultados da somatória dos 10 itens foi igual ou superior a 3, considerado indicativo de disfagia. O resultado ≥ 3 ocorreu em 10 homens entre 144 (7%) e 32 mulheres entre 214 (15%), (P = 0,01). A mediana (limites) de idades daqueles com resultado zero foi de 39 (20-84) anos, e com resultado ≥ 3 foi de 32 (20-83) anos (P = 0,04). O índice de massa corporal (IMC) não apresentou diferença entre pessoas com e sem indicação de disfagia. O máximo escore possível para o item 5 (dificuldade na ingestão de medicamentos) foi o que obteve o maior percentual (43,9%) de máximo escore possível, sendo o fator mais importante para o resultado anormal. Discussão: Em indivíduos saudáveis, a dificuldade em ingerir medicamentos foi o fator que mais influenciou a ocorrência de resultado do teste EAT-10 indicativo de disfagia. Conclusão: Dificuldade na ingestão de medicamentos sólidos deve ser considerada quando da interpretação do teste.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Deglutition Disorders , Deglutition , Eating , Pharmaceutical Preparations , Critical Pathways , Drug UtilizationABSTRACT
OBJECTIVE@#Functional constipation (FC) is a common intestinal disease worldwide. Despite the presence of criteria such as Roman IV, there is no standardized diagnosis and treatment algorithm in Hong Kong that combines both Western and Chinese medicine approaches. This study integrates current effective and safe diagnosis and treatment methods for FC and provides a clear and scientific pathway for clinical professionals and patients.@*METHODS@#A systematic search of the PubMed, Cochrane Library, and China National Knowledge Infrastructure databases was performed from their inception to June 30th, 2022, collecting the current evidence about the efficacious integrative management for FC. We organized a meeting of professionals in fields relevant to treatment and management of FC to develop a consensus agreement on clinical pathway process.@*RESULTS@#We developed a clinical pathway for the treatment of FC based on the most recent published guidelines and consultation with experts. This pathway includes a hierarchy of recommendations for every step of the clinical process, including clinical intake, diagnostic examination, recommended labs, diagnostic flowchart, and guidance for selection of therapeutic drugs.@*CONCLUSION@#This pathway establishes clinical standards for the diagnosis and treatment of FC using Chinese medicine and Western medicine; it will help to provide high-quality medical services in Hong Kong for patients with FC. Please cite this article as: Wei DJ, Li HJ, Lyu ZP, Lyu AP, Bian ZX, Zhong LL. A clinical pathway for integrative medicine in the treatment of functional constipation in Hong Kong, China. J Integr Med. 2023; 21(6): 550-560.
Subject(s)
Humans , Hong Kong , Integrative Medicine , Critical Pathways , China , Constipation/therapyABSTRACT
Introdução:Partindo de toda a complexidade envolvida no enfrentamento da obesidade, o objetivo deste estudo foi analisar as trajetórias assistenciais de usuários com obesidade pela Rede de Atenção à Saúde do município de Porto Alegre-RS. Objetivo: analisar as trajetórias assistenciais de usuários com obesidade pela Rede de Atenção à Saúde do município de Porto Alegre-RS. Métodos:Estudo qualitativo e exploratório, com indivíduos que realizaram cirurgia bariátrica pela rede pública e profissionais de saúde, por meio de entrevista semiestruturada. Resultados: A partir da análise de conteúdo, foi possível traçar as trajetórias, destacando todos os pontos de atenção à saúde e profissionais acessados pelos usuários. Evidenciou-se que o cuidado àpessoa com obesidade se encontra fragilizado, ocorrendo em sua maioria em serviços especializados. A cirurgia bariátrica apareceu como uma opção central para o tratamento da obesidade, mesmo antes de se esgotarem outras tentativas de cuidado. Algumas das dificuldades apontadas foram a quase inexistência de equipe multiprofissional e a escassez de outras formas de cuidados. Como potencialidade,destacaram-se a facilidade de acessoe vínculos construídos na AB. Conclusão: Apesar dos avanços, o sistema de saúde brasileiro, em especial a Atenção Primária, ainda carece de melhorias, devendo ser vista não somente como primeiro local de acesso e encaminhamento, mas como ponto principal da rede, onde o usuário tenha suas necessidades reconhecidas.
Introduction: Starting from all the complexity involved in coping with obesity, the objective of this study was to analyze the care trajectories of users with obesity through the Health Care Network in the city of Porto Alegre.Objectives: to analyze the care trajectories of users with obesity through the Health Care Network in the city of Porto Alegre. Methods: Qualitative and exploratory study, with individuals who underwent bariatric surgery through the public network and with a health professional, through semi-structured interview. Results:From the content analysis it was possible to trace the trajectories, highlighting all the points of health care and professionals accessed by the users. It became evident that obesity care is weakened, mostly occurring in specialized services. Bariatric surgery appeared as a central option for the treatment of obesity, even before other attempts at care were exhausted. Some of the difficulties pointed out were the almost inexistence of a multidisciplinary team and the scarcity of other forms of care. As a potentiality, ease of access, service, and connection stood out. Conclusion:Despite the advances, the Brazilian health system, especially Primary Care, still needs improvement, and should be seen not only as the first place of access and referral, but as the main point of the network, where the user has their needs recognized.
Subject(s)
Humans , Primary Health Care , Unified Health System , Critical Pathways , Obesity Management , Obesity , Brazil , Health Personnel , Bariatric Surgery , Health Services AccessibilityABSTRACT
To discuss important topics regarding the dental procedures performed in patients before, during and after the radiotherapy treatment. The biological effects of ionizing radiation on bone tissue focusing on clinical care will be described. The invasive and not invasive procedures after radiotherapy treatment in the head and neck region will be addressed using scientific evidences to determine the appropriate moment for tooth extractions, periodontal management, and preventive procedures for osteoradionecrosis. Methods: Thirty-three studies including original studies and reviews were selected in MEDLINE database (PubMed). No year of publication restriction was applied. Language was restricted to the English, and the following Medical Subject Heading terms were used: radiotherapy, osteoradionecrosis, dental management. Studies of osteoradionecrosis involving clinical management of irradiated patients, with an emphasis on updated guidelines and protocols were selected. Results: Care in dental procedures were related about restorative treatment, endodontic treatment, rehabilitation for edentulous regions using prostheses and implants and periodontal procedures before, during and after RTX treatment. Conclusions: The dental procedures should and can be performed before, during but also after radiotherapy. However, the clinical procedures should be less invasive as possible. A maintenance plan that reduces the necessity for major and more invasive treatments after radiotherapy is recommended
Subject(s)
Osteoradionecrosis , Radiotherapy , Critical Pathways , Dentistry , Head and Neck NeoplasmsABSTRACT
Background: Experience from the Zaire Ebolavirus epidemic in the eastern Democratic Republic of the Congo (20182020) demonstrates that early initiation of essential critical care and administration of Zaire Ebolavirus specific monoclonal antibodies may be associated with improved outcomes among patients with Ebola virus disease (EVD). Objectives: This series describes 13 EVD patients and 276 patients with suspected EVD treated during a Zaire Ebolavirus outbreak in Guinea in 2021. Method: Patients with confirmed or suspected EVD were treated in two Ebola treatment centres (ETC) in the region of N'zérékoré. Data were reviewed from all patients with suspected or confirmed EVD hospitalised in these two ETCs during the outbreak (14 February 2021 19 June 2021). Ebola-specific monoclonal antibodies, were available 2 weeks after onset of the outbreak. Results: Nine of the 13 EVD patients (age range: 2270 years) survived. The four EVD patients who died, including one pregnant woman, presented with multi-organ dysfunction and died within 48 h of admission. All eight patients who received Ebola-specific monoclonal antibodies survived. Four of the 13 EVD patients were health workers. Improvement of ETC design facilitated implementation of WHO-recommended 'optimized supportive care for EVD'. In this context, pragmatic clinical training was integrated in routine ETC activities. Initial clinical manifestations of 13 confirmed EVD patients were similar to those of 276 patients with suspected, but subsequently non confirmed EVD. These patients suffered from other acute infections (e.g. malaria in 183 of 276 patients; 66%). Five of the 276 patients with suspected EVD died. One of these five patients had Lassa virus disease and a coronavirus disease 2019 (COVID-19) co-infection. Conclusion: Multidisciplinary outbreak response teams can rapidly optimise ETC design. Trained clinical teams can provide WHO-recommended optimised supportive care, including safe administration of Ebola-specific monoclonal antibodies. Pragmatic training in essential critical care can be integrated in routine ETC activities. Contribution: This article describes clinical realities associated with implementation of WHO-recommended standards of 'optimized supportive care' and administration of Ebola virus specific treatments. In this context, the importance of essential design principles of ETCs is underlined, which allow continuous visual contact and verbal interaction of health workers and families with their patients. Elements that may contribute to further quality of care improvements for patients with confirmed or suspected EVD are discussed.
Subject(s)
Humans , Male , Female , Hemorrhagic Fever, Ebola , Ebola Vaccines , Lassa Fever , Antibodies, Monoclonal , Critical Pathways , Critical CareABSTRACT
The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care pathway, which is to reduce the perioperative stress and metabolic variation, with the ultimate goal of improving patient recovery and outcomes. This article reviews some hot issues in the clinical practice of ERAS in China. Currently, the concept and pathways of ERAS are very consistent with China's medical reform, and the basic principle of "safety first, efficiency second" should be adhered to. In specific clinical practice, multidisciplinary cooperation, the improvement of surgical quality and the implementation of prehabilitation pathway should be advocated. In addition, the ERAS approaches should be implemented individually to avoid mechanical understanding and dogmatic implementation. The implementation of ERAS and its clinical outcome should be audited to accumulate experience, and a feedback mechanism should be established to improve the outcome continuously. In clinical practice, "fast recovery" should not be the sole purpose. For patients, the decrease in the risk of readmission rate is more important as compared to discharge rate. Additionally, the disparities between the development of ERAS clinical research in China and that in the world are also analyzed in this review. A national ERAS database should be established on the basic platform of academic groups to ensure the development of high-quality clinical research in China.
Subject(s)
Humans , Critical Pathways , Enhanced Recovery After Surgery , Length of Stay , Perioperative Care/methods , Postoperative ComplicationsABSTRACT
Enhanced recovery after surgery (ERAS) has deeply influenced the clinical practice of surgery, anesthesia and nursing since its inception in 1997. The successful implementation of perioperative ERAS in gastric cancer depends on continually boosting the awareness and acceptance of ERAS among medical staff, carrying out multidisciplinary collaboration, improving patients' compliance and combining key items to the clinical pathways. Future efforts should be made to explore the most appropriate implementation strategy of perioperative ERAS in gastric cancer.
Subject(s)
Humans , Critical Pathways , Enhanced Recovery After Surgery , Perioperative Care , Postoperative Complications/prevention & control , Stomach Neoplasms/therapyABSTRACT
Background@#Uninvestigated dyspepsia is a common complaint in family practice in the Philippines. Patients usually seek consult due to severity of symptoms which affect their quality of life. The goals of management are short- and long-term symptom control, with reversal of possible underlying mechanisms, achievable through a combination of pharmacologic and non-pharmacologic interventions.@*Objective@#The main objective of this pathway is to guide family physicians and primary care physicians in the assessment, diagnosis and management of adult patients with uninvestigated dyspepsia through a shared decision-making process.@*Method@#This clinical pathway is an update of the PAFP’s Clinical Pathways for the Management of Dyspepsia in Adults (2016). The current panel utilized the ADAPTE method and prioritized reviewing relevant clinical practice guidelines from 2017 to present. Grading of recommendation was achieved through a mixture of strength of available evidence and a consensus from a panel of experts.@*Summary of Recommendations@#The main changes in the recommendations in this update are as follows: symptom-based classification of dyspepsia, screening for anxiety and depression, family and SCREEM assessment; initiation of therapeutic trial for most patients to whom H. pylori testing is not available; extension of initial PPI treatment to 4-8 weeks, consideration of antacids/alginates for immediate symptom relief, consideration of tricyclic antidepressants for non-responders to initial treatment; symptom-based non-pharmacologic advice, consideration of counseling and other psychosocial interventions; empowerment for self-treatment and as-needed therapy for those who have completed the initial treatment regimen@*Dissemination and Implementation@#This guideline shall be disseminated and implemented at the clinic and organizational level. It will be published in the “The Filipino Family Physician” journal, social media platforms and will be disseminated through PAFP local chapters, training institutions and during the national convention. Non-FCM primary care physicians will also be reached through relevant agencies. It shall be included in the references required during training activities and national exams of accredited training institutions, in coordination with the PAFP committee on Residency Training. It shall be incorporated in checklists for compliance in audits and QA cycles, with support from the PAFP committee on Quality Assurance and that on Standards for Family Practice. Feedback on utility and applicability will be actively sought from the intended users and other stakeholders.
Subject(s)
Dyspepsia , Community Health Services , Critical PathwaysABSTRACT
Resumo Objetivo Avaliar registros dos cartões de pré-natal de puérperas atendidas em maternidades públicas e privadas. Método Estudo transversal que analisou fotos de 394 cartões de pré-natal de mulheres que participaram da pesquisa Nascer em Belo Horizonte. Os registros foram avaliados quanto ao preenchimento, legibilidade e completude das informações sociodemográficas, clínicas, obstétricas e exames laboratoriais. Resultados Evidenciou-se que 88,5% dos cartões não apresentaram registro do nome da unidade básica de referência, 76,9%, da maternidade de referência e 82,4%, da instituição de realização do pré-natal. A avaliação do edema, o uso de sulfato ferroso e ácido fólico não foram registrados em 55%, 91,1% e 92,6% dos cartões, respectivamente. A ausência de registros no gráfico de peso foi identificada em 86,8% dos cartões, e no de altura uterina, 79,7%. Conclusão e implicações para a prática Existem grandes lacunas no registro do processo de cuidado pré-natal nos cartões e cadernetas, o que pode comprometer a qualidade da assistência e o acompanhamento das gestantes. Os achados apontam para a necessidade da educação permanente em serviço direcionada aos profissionais de saúde, como os enfermeiros, quanto à importância da realização e registro das ações preconizadas no cuidado pré-natal.
Resumen Objetivo Analizar registros de las tarjetas de prenatal de puérperas atendidas en maternidades públicas y privadas. Métodos Estudio transversal, con fotos de 394 tarjetas de prenatal, provenientes de la investigación Nascer em Belo Horizonte (Nacer en Belo Horizonte), que analizó registros en cuanto al llenado, legibilidad y completitud de las informaciones sociodemográficas, clínicas, obstétricas y exámenes de laboratorio. Resultados El 88,5% de las tarjetas no tuvieron registro del nombre de la unidad básica de referencia, el 76,9%, de la maternidad de referencia y el 82,4%, de la institución de realización del prenatal. Evaluación del edema, uso de sulfato ferroso y ácido fólico no se registraron en el 55%, 91,1% y 92,6% de las tarjetas, respectivamente. La ausencia de registros en el gráfico de peso fue identificada en el 86,8% de las tarjetas, y en el 79,7% de altura uterina. Conclusión Existen grandes lagunas en el registro del proceso de asistencia prenatal, pudiendo comprometer la calidad de la asistencia y el acompañamiento de las gestantes. Implicaciones para la práctica Se necesita educación permanente dirigida a profesionales de la salud, como enfermeras, sobre la importancia de llevar a cabo y registrar las acciones recomendadas en la atención prenatal.
Abstract Objective To evaluate the antenatal care (ANC) home-based records of puerperal women attended in public and private maternity hospitals. Methods Cross-sectional study that analyzed photographs of 394 ANC home-based records of women who participated in the research Nascer em Belo Horizonte (Born in Belo Horizonte, in free translation). Records were assessed regarding completeness, legibility and completeness of sociodemographic, clinical, obstetric and laboratory data. Results 88.5% of the cards had no record of the name of the primary care unit of reference, 76.9% of the maternity of reference and 82.4% of the ANC institution. Evaluation of edema, use of ferrous sulfate and folic acid were not registered in 55%, 91.1% and 92.6% of the cards, respectively. The absence of records in the weight chart was identified in 86.8% of the cards, and in the uterine height chart, 79.7%. Conclusions and implications for practice There are large gaps in the registration of the ANC process in the home-based records, which may compromise the quality of care and follow-up of pregnant women. The findings point to the need for permanent education in service directed to health professionals, such as nurses, regarding the importance of carrying out and registering the actions recommended in ANC.
Subject(s)
Humans , Female , Pregnancy , Adult , Prenatal Care , Quality of Health Care , Medical Records/statistics & numerical data , Cross-Sectional Studies , Critical Pathways/statistics & numerical dataABSTRACT
Resumo Objetivo analisar a percepção da criança hospitalizada quanto ao uso do brinquedo terapêutico instrucional no preparo para a terapia intravenosa. Método estudo descritivo, com abordagem qualitativa, realizado em um hospital pediátrico público no município de Juazeiro do Norte - Ceará, entre os meses de julho a setembro de 2019. Participaram do estudo 31 crianças em idade pré-escolar e escolar. Os dados foram coletados por meio de uma entrevista semiestruturada e, posteriormente, analisados por meio do software IRAMUTEQ. Resultados diante da percepção das crianças acerca da terapia intravenosa, foi averiguado que elas compreenderam a técnica a partir da utilização do brinquedo terapêutico instrucional. Quando a criança tem a oportunidade de brincar e dramatizar a terapia intravenosa, por meio do brinquedo terapêutico instrucional, a ansiedade, a dor, a angústia, a solidão, o medo e o choro são atenuados. Conclusões e implicações para a prática orientar as crianças quanto à realização da terapia intravenosa favorece sua compreensão quanto aos reais benefícios desta técnica para a sua saúde, possibilitando, ainda, a compreensão do enfermeiro quanto às condições que representam riscos para a criança e intervenha em tempo hábil por meio da utilização de estratégias que favoreçam a recuperação da saúde e a minimização de traumas subsequentes advindos da hospitalização.
Resumen Objetivo Analizar la percepción del niño hospitalizado cuanto al uso del juguete terapéutico instructivo en la preparación para la terapia intravenosa. Método Estudio descriptivo, con enfoque cualitativo, realizado en un hospital pediátrico público de la ciudad de Juazeiro do Norte - Ceará, entre julio y septiembre de 2019. Participaron 31 niños en edad preescolar y escolar. Los datos se recogieron mediante entrevista semiestructurada, posteriormente analizados con el software IRAMUTEQ. Resultados En vista de la percepción de los niños acerca de la terapia intravenosa, se encontró que ellos comprendieron la técnica a partir del uso del juguete terapéutico instructivo. Cuando tienen la oportunidad de jugar y dramatizar la terapia intravenosa, a través del juguete terapéutico instructivo, la ansiedad, el dolor, la angustia, la soledad, el miedo y el llanto son mitigados. Conclusiones e implicaciones para la práctica Orientar a los niños sobre la realización de la terapia intravenosa favorece su comprensión sobre los beneficios reales de esta técnica para su salud, permitiendo además que la enfermera comprenda las condiciones que suponen riesgos para el niño e intervenga de forma oportuna, mediante el uso de estrategias que favorezcan la recuperación de la salud y la minimización de traumas posteriores a la hospitalización.
Abstract Objective to analyze the perception of the hospitalized child regarding the use of the instructional therapeutic play in preparation for intravenous therapy. Method descriptive study, with a qualitative approach, performed in a public pediatric hospital in the city of Juazeiro do Norte - Ceará, between the months of July and September 2019. A total of 31 pre-school and school children participated in the study. The data were collected through a semi-structured interview, and later analyzed through IRAMUTEQ software. Results in view of the children's perception of intravenous therapy, it was found that they understood the technique, from the use of the instructional therapeutic play. When the child has the opportunity to play and dramatize intravenous therapy, through the instructional therapeutic play, the anxiety, the pain, the anguish, the loneliness, the fear and the crying are mitigated. Conclusion and implications for practice Orienting children in the performance of intravenous therapy favors their understanding of the real benefits of this technique for their health, allowing the nurse to understand the conditions that pose risks to the child, and intervene in a timely manner, through the use of strategies that favor the recovery of health and the minimization of subsequent trauma from hospitalization.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Play and Playthings , Child, Hospitalized/psychology , Injections, Intravenous/methods , Critical Pathways , Qualitative ResearchABSTRACT
A Doença Renal Crônica (DRC) é uma doença progressiva caracterizada pela presença de lesão renal e perda irreversível e gradativa da taxa de filtração glomerular. Os pacientes em hemodiálise vivem em condições particulares, necessitam ter acesso aos serviços de saúde, precisam controlar rigorosamente a dieta e o consumo de líquidos, possuem atividades laborais restringidas, além de poderem ter a diminuição de atividades físicas e perda da autonomia. O conhecimento sobre a trajetória da doença ou da trajetória da DRC é essencial para ajudar os pacientes e as famílias de forma eficaz a obterem sucesso nos esforços contínuos para o cuidado com a doença. O conceito de trajetória fornece uma maneira dos profissionais de saúde pensarem longitudinalmente e obter uma compreensão mais completa da natureza das doenças crônicas. O objetivo deste estudo consistiu em analisar a trajetória de adoecimento de indivíduos com DRC em tratamento hemodialítico. Trata-se de uma pesquisa qualitativa, descritiva. O cenário do estudo foi um serviço de nefrologia localizado em Belo Horizonte. Os participantes do estudo foram 25 pessoas em hemodiálise, com tempo mínimo de um ano de tratamento e maiores de 18 anos. Foram utilizadas entrevistas semiestruturadas para coleta de dados e, para análise, a técnica de Análise de Conteúdo temática. A partir das narrativas construíram-se 3 trajetórios da doevfgnça. Cada trajetória incluiu oito fases da doença crônica de acordo com o modelo de Corbin e Strauss. As trajetórias revelaram que embora os problemas enfrentados pelos participantes do estudo fossem semelhantes, a evolução da doença não foi a mesma para todos eles, mas expuseram de forma clara as fragilidades dos serviços de saúde e dos profissionais que compõem a rede de assistência à saúde. Sofrem influências dos contextos de vida de cada indivíduo, além da própria natureza da doença. Evidenciaram, claramente, a necessidade de fortalecer a atenção básica como a porta de entrada dos usuários, a fim de reduzir as vulnerabilidades para a DRC. As trajetórias podem facilitar a construção de modelos de cuidado que incorporem abordagens de autogestão apoiada por profissionais de saúde, que poderiam atender melhor às necessidades daqueles que vivem ao longo do tempo com essa doença progressiva. O conhecimento sobre a trajetória da DRC mostra ser uma ferramenta útil que tem o potencial para aumentar a adequação das intervenções criadas para os pacientes.
Chronic Kidney Disease (CKD) is a progressive disease characterized by the presence of kidney damage and irreversible and gradual loss of glomerular filtration rate. Patients on hemodialysis live in particular conditions, need to have access to health services, need to strictly control their diet and fluid consumption, have restricted work activities, in addition to having reduced physical activity and loss of autonomy. Knowledge about the trajectory of the disease or the trajectory of CKD is essential to effectively help patients and families succeed in ongoing efforts to care for the disease. The trajectory concept provides a way for healthcare professionals to think longitudinally and gain a fuller understanding of the nature of chronic diseases. The aim of this study was to analyze the illness trajectory of individuals with CKD undergoing hemodialysis treatment. This is a qualitative, descriptive research. The study setting was a nephrology service located in Belo Horizonte. The study participants were 25 people on hemodialysis, with a minimum of one year of treatment and over 18 years of age. Semi-structured interviews were used for data collection and, for analysis, the thematic Content Analysis technique. From the narratives, 3 trajectories of the disease were constructed. Each trajectory included eight phases of chronic disease according to the Corbin and Strauss model. The trajectories revealed that although the problems faced by the study participants were similar, the course of the disease was not the same for all of them, but they clearly exposed the weaknesses of the health services and professionals that make up the health care network. They are influenced by the context of each individual's life, in addition to the nature of the disease. They clearly highlighted the need to strengthen primary care as the gateway for users, in order to reduce vulnerabilities to CKD. The trajectories can facilitate the construction of care models that incorporate self-management approaches supported by health professionals, which could better meet the needs of those who live with this progressive disease over time. Knowledge about the trajectory of CKD proves to be a useful tool that has the potential to increase the adequacy of interventions designed for patients.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Renal Dialysis , Critical Pathways , Continuity of Patient Care , Renal Insufficiency, ChronicABSTRACT
Introdução: A hemodiálise representa a principal modalidade de tratamento da Doença Renal Crônica em estágio terminal, sendo necessário para sua realização o estabelecimento de um acesso vascular. Nesse contexto, a fístula arteriovenosa representa o acesso ideal por representar menores complicações quando comparada a outros tipos de acessos, sendo o acompanhamento do processo de maturação pelo enfermeiro fundamental para sua sobrevida, destacando-se a construção de protocolos e instrumentos para um melhor acompanhamento da maturação, devendo estes serem orientados pelo processo de enfermagem. Objetivo: Descrever o processo de elaboração de um protocolo e instrumentos de enfermagem para o acompanhamento à pessoa com fístula arteriovenosa em maturação. Método: Estudo metodológico descritivo de métodos e de síntese de evidências sobre avaliação e acompanhamento do paciente na fase de maturação da fístula arteriovenosa, sendo conduzido em duas fases: 1) revisão das evidências de pesquisa sobre a avaliação da maturação da fístula por meio de uma revisão de escopo; 2) desenvolvimento de um protocolo e instrumentos para aplicação do processo de enfermagem utilizando as taxonomias de enfermagem NANDA-I, NIC e NOC e referencial teórico de Orem. Após a elaboração, o protocolo e instrumentos propostos foram apresentados e submetidos à avaliação-piloto em um serviço de Nefrologia. Resultados: A busca literária resultou em um corpus final de 38 publicações, e obteve-se como achados que o período de avaliação clínica deve ocorrer idealmente dentro de quatro a seis semanas do pós- operatório, com utilização das técnicas de anamnese e Exame Físico, sendo necessários identificar diversos elementos clínicos. Foram propostos um protocolo de enfermagem, um fluxograma de apoio à tomada de decisão do enfermeiro, e instrumentos para coleta de história do paciente, planejamento do cuidado de enfermagem e reavaliação contínua do paciente com fístula em fase de maturação. O teste piloto realizado contribuiu para tornar as tecnologias propostas mais adequadas quanto à clareza e simplicidade sendo considerados o protocolo e instrumentos apresentados válidos, com sugestão de modificações apenas no instrumento de planejamento de cuidados de enfermagem. Conclusão: O estudo permitiu construir tecnologias inovadoras no acompanhamento do paciente em período de maturação da FAV, constituindo meios de acompanhar o paciente de forma sistematizada, de forma a facilitar o planejamento das ações de enfermagem e envolvimento do paciente. Por fim, espera-se que os protótipos produzidos permitam ao enfermeiro colocar em prática as suas competências no cuidado à pessoa com fístula arteriovenosa em maturação, com expectativa de um trabalho futuro de validação dos instrumentais junto a especialistas e futuros usuários.
Introduction: The hemodialysis representing the main treatment modality in the Chronic Renal Disease in terninal stage, requiring the establishment of a vascular access. In this context, arteriovenous fistula represents the ideal access because it represents less complications when compared to other types of access, and the monitoring of the maturation process by the nurse is fundamental for its survival, highlighting the construction of protocols and instruments for better monitoring of maturation, which should be guided by the nursing process. Objective: Describe the process of elaborating a protocol and nursing instruments for monitoring person with a arteriovenous fistula under maturing. Method: Descriptive methodological study of methods and synthesis of evidence on evaluation and monitoring of the patient during the maturation phase of the arteriovenous fistula, being conducted in two phases: 1) review of the research evidence on the assessment of fistula maturation through a scoping review; 2) Development of a protocol and instrumentals for the application of the nursing proccess using the nursing taxonomies NANDA-I, NIC and NOC and Orem's theoretical framework. After elaboration, the proposed protocol and instruments were presented and submitted to a pilot evaluation in a Nephrology service. Results: The literary search resulted in a final corpus of 38 publications, and it was obtained as findings that the period of clinical evaluation should ideally occur within four to six weeks after the operation, using the techniques of anamnesis and Physical Examination, it is necessary to identify several clinical elements. A nursing protocol, a flowchart to support nurses' decision-making, and instruments for collecting the patient's history, planning nursing care and continuous reassessment of the patient with a fistula in the maturation phase were proposed as instrumental measures. The pilot test carried out contributed to make the proposed technologies more adequate in terms of clarity and simplicity, considering the instruments presented as valid with the suggestion of modifications only in the nursing care planning instrument. Conclusion: The study allowed the construction of innovative technologies in patient follow-up during arteriovenous fistula maturation period, constituing a means of monitoring the patient in a systematic way, in order to facilitate the planning of nursing actions and patient involvement. Finally, it is expected that the prototypes produced will allow nurses to put into practice their skills in caring for the person with maturing arteriovenous fistula, with the expectation of future work to validate the instruments with specialists and future users.