Fluxograma de atendimento ao portador de fibrilação atrial com COVID-19: REVISÃO integrativa / Flowchart of care for patients with atrial fibrillation with COVID-19: integrative review

INTRODUÇÃO: O novo coronavírus (SARS-CoV-2) tornou-se um problema de saúde mundial, propagando de forma rápida e contínua, aumentando constantemente a curva de infectados em pacientes com comorbidades. Dentre eles, os cardiopatas são os mais vulneráveis diante das complicações causadas pelo coronavírus. Este estudo objetivou identificar na literatura científica algoritmos de atendimento para os pacientes com Fibrilação Atrial com COVID-19. MÉTODO: Trata-se uma revisão integrativa da literatura científica. Utilizou-se o acrônimo PVO (Pacientes; Variáveis e Resultados (Outcome)), para elaboração de estratégias de buscas nas fontes de dados; PubMed, LILACs e MEDLINE, no período 2020 a 2021. Estabeleceram-se como critérios de inclusão: artigos na íntegra, gratuitos, nas línguas portuguesas e inglesas e que abordassem os descritores: Infecção por coronavírus; Arritmias Cardíacas e Pandemia. A análise foi apresentada de acordo com as características clínicas específicas identificadas e de algoritmos e fluxos de atendimentos. RESULTADOS: Dos 291 artigos foram selecionados seis artigos de acordo com os critérios de elegibilidade. Identificou-se que a Fibrilação Atrial (86,5%) é a arritmia predominante em pacientes infectados pela COVID-19, seguida de Flutter Atrial (5,4%), dos quais podem evoluir para as arritmias malignas como Fibrilação Ventricular (28,1%) e Taquicardia Ventricular sem pulso (28,1%), além de Bloqueio Atrioventricular de 1º grau (5,21%) e Bloqueio Atrioventricular Total (7,79%), Bloqueio de ramo direito (8,86%) e Bloqueio de ramo esquerdo (2,86%). Nota-se que na fase latente de infecção por COVID-19, os pacientes apresentaram alterações eletrocardiográficas, em quase 100% de seu tratamento, sendo a Fibrilação Atrial e suas complicações cardíacas não seguiam fluxo sólido e sistemáticos associados com o diagnóstico de COVID-19. CONCLUSÃO: A revisão literária possibilitou identificar que há falhas durante o atendimento para este perfil de paciente, desde locação do paciente até a monitorização ao tratamento medicamentoso. Percebe-se ainda que a proposta de um fluxograma de atendimento a este perfil de pacientes cardíacos possibilitará uma melhoria considerável no processo de gestão e na assistência de enfermagem em pacientes cardíacos nos serviços de saúde.

Sensory-Based Interventions for Adults with Dementia and Alzheimer's Disease: A Scoping Review.

The purpose of this review was to explore the effectiveness of sensory-based interventions for clients with dementia and Alzheimer's disease living in residential facilities. Nine databases and key sources were searched from 2002 to September 2017. Forty-seven articles met the inclusion criteria. There was strong evidence for use of massage. There was moderate evidence for occupationally and environmentally based multisensory activities including light, gardening, mealtime, music, Montessori, animal assisted therapy, dance, and yoga interventions. There was inconclusive evidence for aromatherapy, art, Snoezelen rooms, and combined visual and auditory interventions. Future research should focus on defining protocols for efficacious interventions.

Evidence for Interventions to Improve and Maintain Occupational Performance and Participation for People With Serious Mental Illness: A Systematic Review.

OBJECTIVE: This systematic review evaluates the evidence for the effectiveness of interventions within the scope of occupational therapy to improve and maintain performance and participation for people with serious mental illness. Areas included in this review are activities of daily living, instrumental activities of daily living, leisure, social participation, and rest and sleep. METHOD: Databases searched included MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. Reviewers read and assessed citations, abstracts, and full-text articles for inclusion and analysis. RESULTS: Sixty-one articles were selected for inclusion. The review yielded strong evidence for psychoeducation and occupation- and cognitive-based interventions, moderate evidence for skills-based interventions, and limited evidence for technology-supported interventions. CONCLUSION: Results of this review support use of evidence-based practice within the scope of occupational therapy, inclusion of occupational therapy practitioners as mental health service providers, and continued research.

Systematic Review of Occupational Therapy and Adult Cancer Rehabilitation: Part 2. Impact of Multidisciplinary Rehabilitation and Psychosocial, Sexuality, and Return-to-Work Interventions.

This article is the second part of a systematic review of evidence for the effectiveness of cancer rehabilitation interventions within the scope of occupational therapy that address the activity and participation needs of adult cancer survivors. This article focuses on the use of multidisciplinary rehabilitation and interventions that address psychosocial outcomes, sexuality, and return to work. Strong evidence indicates that multidisciplinary rehabilitation benefits cancer survivors and that psychosocial strategies can reduce anxiety and depression. Moderate evidence indicates that interventions can support survivors in returning to the level of sexuality desired and help with return to work. Part 1 of the review also appears in this issue.

Systematic Review of Occupational Therapy and Adult Cancer Rehabilitation: Part 1. Impact of Physical Activity and Symptom Management Interventions.

This article is the first part of a systematic review of evidence for the effectiveness of cancer rehabilitation interventions within the scope of occupational therapy that address the activity and participation needs of adult cancer survivors. This article focuses on the importance of physical activity and symptom management. Strong evidence supports the use of exercise for cancer-related fatigue and indicates that lymphedema is not exacerbated by exercise. Moderate evidence supports the use of yoga to relieve anxiety and depression and indicates that exercise as a whole may contribute to a return to precancer levels of sexual activity. The results of this review support inclusion of occupational therapy in cancer rehabilitation and reveal a significant need for more research to explore ways occupational therapy can positively influence the outcomes of cancer survivors. Part 2 of the review also appears in this issue.

Process-oriented guided-inquiry learning: a natural fit for occupational therapy education.

After a brief review of the major group cooperative learning strategies, this article presents the format and use of Process-Oriented Guided-Inquiry Learning (POGIL) as a recommended teaching strategy for occupational therapy classes. This recommendation is based upon evidence of effectiveness of this strategy for enhancing critical thinking, content retention, and teamwork. Strategies for learning the process and suggestions for its use are based upon literature evidence and the authors' experiences with this strategy over 4 years in a class on evidence-based practice.

Update on productive aging research in the American Journal of Occupational Therapy, 2013, and overview of research published 2009-2013.

In light of the Centennial Vision charge of supporting practice through evidence, this article reviews productive aging research published in the American Journal of Occupational Therapy (AJOT) in 2013 and as a whole from 2009 to 2013. Thirteen such articles were published in 2013, consisting of 4 systematic reviews that identified effective occupational therapy interventions for older adults with low vision; 1 randomized controlled trial that examined changes in occupational therapists' mental health practices with DVD training; and 8 descriptive articles addressing instrument development, practitioner decision making, patient management of medications, and effects of task activities on pain and participation levels. From 2009 to 2013, the quantity and quality of AJOT articles on productive aging increased; 63 articles were published, including 24 effectiveness studies, 14 basic research studies, 15 articles on instrument development and testing, 1 article linking occupational engagement and health, 6 articles on professional education, and 3 articles addressing professional questions.

Simultaneidade de fatores de risco cardiovascular controláveis: estudo de base populacional / Simultaneity of cardiovascular risk factors: population-based study

Fundamentos: As doenças cardiovasculares estão relacionadas à presença de fatores de risco, cuja combinação representa risco aumentado de doenças, sendo substancialmente maior a cada fator de risco adicional. Objetivo: Analisar a simultaneidade de fatores de risco cardiovascular entre adultos ≥40 anos segundo a presença de hipertensão arterial e/ou diabetes mellitus. Métodos: Estudo transversal de base populacional, no qual foram entrevistados aleatoriamente1180 sujeitos residentes em todos os setores censitários urbanos de Cambé, PR. As variáveis de estudo foram nove fatores de risco cardiovascular: tabagismo, consumo abusivo de álcool, inatividade física no lazer,excesso de peso, obesidade abdominal, baixo consumo de frutas, verduras e legumes, diabetes mellitus, colesterol HDL baixo e hipertensão arterial. Resultados: Entre os entrevistados, 54,3% eram mulheres e 45,7% homens. Os fatores de risco mais prevalentes foram: inatividade física no lazer, excesso de peso, baixo consumo de frutas, verduras e legumes e hipertensão arterial. Apenas 1,4% da população não apresentou fator de risco e um indivíduo apresentou todos. Não se observaram diferenças significativas nos fatores de risco quando estratificado por sexo. O número médio de fatores de risco foi significativamente mais elevado entre os idosos e entre as pessoas portadoras de hipertensão e diabetes. Conclusão: Verificou-se presença massiva de fatores de risco na população adulta, com destaque para aelevada prevalência simultânea de fatores. Além disso, a simultaneidade de fatores de risco cardiovascular entre as pessoas com hipertensão e diabetes revela que indivíduos com risco mais elevado aglomeram mais fatores, aumentando a probabilidade de ocorrência de eventos cardiovasculares.

Background: Cardiovascular diseases are related to the presence of risk factors, whose combinations resultin higher risks for diseases, rising substantially with each additional risk factor.Objective: To analyze the simultaneity of cardiovascular risk factors among adults aged 40 years and more, by the presence of diabetes mellitus and hypertension. Methods: This population-based cross-sectional study randomly interviewed 1,180 subjects residingin all urban census tracts in Cambé, Paraná State.The study variables were nine cardiovascular risk factors: smoking, excessive alcohol consumption,physical inactivity, overweight, abdominal obesity,low fruit, greens and vegetable consumption,diabetes mellitus, low HDL cholesterol and hypertension. Results: Among the respondents, 54.3% were women and 45.7% men. The most prevalent risk factors were physical inactivity, overweight, low consumption of fruits, greens and vegetables and hypertension. Only1.4% of this population did not present risk factors and one person had all of them. No significant differences in risk factors were noted when stratified by gender. The average number of risk factors was significantly higher among the elderly and people with hypertension and diabetes. Conclusion: There was a massive presence of risk factors in the adult population, especially the high prevalence of concurrent factors. Further more, the simultaneity of cardiovascular risk factors among those with hypertension and diabetes shows that people at the highest risk cluster more factors together, boosting the probability of cardiovascular events.

Update on productive aging research in the American Journal of Occupational Therapy, 2012.

This article describes a review of articles on productive aging published in the American Journal of Occupational Therapy (AJOT) during 2012 in light of the Centennial Vision charge of supporting practice through evidence. Seventeen AJOT articles published in 2012 specifically addressed productive aging. Of 6 Level I studies, 4 were systematic reviews that identified effective occupational therapy interventions for community-dwelling older adults; 1 randomized controlled trial examined the effectiveness of writing life reviews for residents of senior residences, and 1 meta-analysis investigated the effectiveness of fall-related efficacy and engagement in activity or occupation. Two Level II studies and 2 Level III studies produced support for the effectiveness of individual and group-based occupational therapy interventions. Of 7 descriptive studies addressing a variety of areas, 4 addressed the reliability and validity of assessments. In 2012, AJOT published more and higher quality studies addressing a variety of issues related to productive aging.

Update on productive aging in the American Journal of Occupational Therapy 2011.

A review of the productive aging articles published in the American Journal of Occupational Therapy during 2011 was conducted and discussed in light of meeting the Centennial Vision charge of supporting practice through evidence. Twelve articles that specifically addressed productive aging were published in AJOT in 2011. The review of these 12 articles found seven Level I studies. Six of the articles were systematic reviews identifying effective interventions for people with Alzheimer's disease and related dementias and their caregivers, and 1 was a randomized controlled trial of fall prevention in community-dwelling older adults. Five were basic research studies. Two of the 5 studies researched professional issues, and 3 addressed client-based issues. The quantity of productive aging research published in 2011 was consistent with the quantity reported in 2009 and 2010. More studies building the body of evidence about the effectiveness of occupational therapy with older adults are needed.

Occupational therapy interventions for recovery in the areas of community integration and normative life roles for adults with serious mental illness: a systematic review.

This systematic review investigated research literature evaluating the effectiveness of occupational therapy interventions focusing on recovery in the areas of community integration and normative life roles for people with serious mental illness. The review included occupation- and activity-based interventions and interventions addressing performance skills and performance patterns, aspects of context and environment, activity demands, and client factors. The results indicated that the evidence of the effectiveness of social skills training is moderate to strong. The evidence for the effectiveness of life skills and instrumental activities of daily living (IADLs) training to improve performance is moderate, as is the evidence for neurocognitive training paired with skills training in the areas of work, social participation, and IADLs. The evidence for client-centered intervention and increased intensity and duration of treatment is limited but positive, and the evidence that providing intervention in the natural context is more beneficial than in the clinic setting is inconclusive.

Mental health evidence in the American Journal of Occupational Therapy.

We reviewed the mental health articles published in the American Journal of Occupational Therapy (AJOT) from 2008 through 2009 in light of meeting the Centennial Vision charge of supporting practice through evidence. Seven articles that addressed mental health practice were published in AJOT over these years. Review of the articles found that only two addressed effectiveness of occupational therapy intervention; one was rated as Level II evidence, and the other was rated as Level V evidence. Two articles addressed instrument development and testing. Three articles were basic research studies that expanded consideration about the needs of people with mental health conditions. Scholars and clinicians have begun to embrace the charge of the Centennial Vision to support practice with evidence and continue to embrace mental health practice but have a distance to travel. We hope that in the coming years, the profession will see more evidence published in AJOT supporting mental health as practiced by occupational therapists.