ABSTRACT
Stroke constitutes a significant global cause of mortality and disability. The implementation of stroke units influences hospital quality indicators, guiding care management. We aimed to compare hospital length of stay (LOS), in-hospital mortality, and post-discharge mortality between stroke patients admitted in the pre- and post-implementation periods of a stroke unit in a public hospital in southern Brazil. This retrospective cohort study used real-world data from one reference hospital, focusing on the intervention (stroke unit) and comparing it to the general ward (control). We analyzed the electronic medical records of 674 patients admitted from 2009 to 2012 in the general ward and 766 patients from 2013 to 2018 in the stroke unit. Admission to the stroke unit was associated with a 43% reduction in the likelihood of prolonged hospitalization. However, there was no significant difference in the risk of in-hospital mortality between the groups (Hazard ratio = 0.90; Interquartile range = 0.58 to 1.39). The incidence of death at three, six and twelve months post-discharge did not differ between the groups. Our study results indicate significant improvements in care processes for SU patients, including shorter LOS and better adherence to treatment protocols. However, our observations revealed no significant difference in mortality rates, either during hospitalization or after discharge, between the SU and GW groups. While SU implementation enhances efficiency in stroke care, further research is needed to explore long-term outcomes and optimize management strategies.
ABSTRACT
O fortalecimento em Cuidados Paliativos (CP) na Atenção Primária à Saúde (APS) aumenta a qualidade do atendimento no fim de vida e possibilita redução de complicações por longas internações. O objetivo deste trabalho foi analisar dados sobre a mortalidade ocorrida em portadores de doenças crônicas avançadas não transmissíveis vinculados à Unidade Básica de Saúde Vila Floresta do Grupo Hospitalar Conceição (USVF-GHC) e verificar quantos destes seriam elegíveis aos CP. Trata-se de uma pesquisa de caráter transversal, descritiva e de abordagem quantitativa e retrospectiva. Os dados são provenientes de registros eletrônicos em saúde, do relatório de monitoramento gerencial, dos prontuários na USVF-GHC e da vigilância epidemiológica de Porto Alegre. Utilizou-se a escala Palliative Care Screening Tool (PCST) para critério de elegibilidade à CP. De um total de 155 pessoas que faleceram e moravam no território de atuação da USVF-GHC no ano de 2019, 55,2%(n=86) eram do sexo feminino, 54,2%(n=84) eram idosos com mais de 80 anos, 23,9%(n=37) tinham o tempo entre diagnóstico e óbito com mais de 5 anos, em 69,7%(n=108) dos casos o local de falecimento foi o hospital, 66,5%(n=103) não tinham prontuário, para 34,8%(n=54) foram as neoplasias as principais causas de óbito e 42,6%(n=66) foram considerados elegíveis aos CP segundo a PCST. Conclui-se que o perfil de pessoas com diagnóstico há mais de cinco anos da doença que resultou no óbito poderia ser observado com maior atenção pelas equipes da APS no que diz respeito aos CP, aumentando as buscas ativas e estabelecendo comunicação efetiva com os hospitais na transferência de cuidados.
Strengthening in Palliative Care (PC) in Primary Healthcare (PHC) increases the quality of care at the end of life and reduces complications from long hospitalizations. The objective of this work was to analyze data on mortality that occurred in patients with advanced chronic non-communicable diseases associated with the Vila Floresta Primary Healthcare Center of the Conceição Hospital Group (VFPHC-CHG) and to verify how many of these would be eligible to PC. It is a transverse, descriptive and quantitative and retrospective approach research. Data come from electronic health records, management monitoring report, VFPHC-CHG medical records and Porto Alegre Epidemiological Surveillance. The Palliative Care Screening Tool (PCST) scale for PC eligibility criterion. Out of a total of 155 people who died and lived in the VFPHC-CHG covered territory in 2019, 55.2% (n = 86) were female, 54.2% (n = 84) were elderly and more 80 years old, 23.9% (n = 37) had died within five years after diagnosis, in 69.7% (n = 108) of cases the place of death was the hospital, 66.5% (n = 103) had no medical record, were neoplasms the main causes of death in 34.8%(n = 54), and 42.6% (n = 66) were considered eligible for PC according to PCST. It is concluded that the profile of people with diagnosis for over five years of the disease that resulted in death could be observed more carefully by PHC teams regarding PC, increasing the search for those who are eligible and establishing effective communication with hospitals in care transfer.
ABSTRACT
Objective: The purpose of this study was to evaluate the long-term effects of adding osteopathic manipulative treatment (OMT) to neck exercises compared to exercises alone for individuals with non-specific chronic neck pain (NCNP). Methods: A randomized controlled trial was conducted by assigning 90 individuals with NCNP into the following 2 groups: (1) exercises group (EG, nâ¯=â¯45) or (2) OMT plus exercises group (OMT/EG, nâ¯=â¯45). All participants received 4 weeks of treatment. The clinical outcomes were recorded at baseline and at 3 and 6 months after the treatment. The primary outcomes were pain and function-Numerical Pain Rating Scale (NPRS), Pressure Pain Threshold, and the Neck Disability Index (NDI). The secondary outcomes included range of motion for cervical spine rotation, Fear-Avoidance Beliefs Questionnaire, and Pain Self-Efficacy Questionnaire. Results: In comparison to baseline data, both groups had a reduction of NPRS (P < .05) and NDI (P < .05) after the treatment. However, no statistically significant differences in pain intensity or disability were found when OMT/EG was compared to EG alone at 3 months (Pâ¯=â¯0.1 and Pâ¯=â¯0.2, respectively) and at 6 months (Pâ¯=â¯0.4 and Pâ¯=â¯0.9, respectively for pain and disability) and no difference was found between OMT/EG and the EG in the secondary outcomes during the same follow-up period (P > .05). Conclusion: Outcomes of pain and functionality for patients in both groups were improved at 6 months. Our findings show that the combination of OMT and neck exercises for 4 weeks did not improve functionality and reduction of pain in patients with NCNP.
ABSTRACT
INTRODUCTION: Myasthenia Gravis (MG) is an autoimmune disease. The characteristic symptoms of the disease are muscle weakness and fatigue. These symptoms affect de oral muscles causing dysarthria, affecting about 60% of patients with disease progression. PURPOSE: Describe the speech pattern of patients with MG and comparing with healthy controls (HC). MATERIAL AND METHODS: Case-control study. Participants were divided in MG group (MGG) with 38 patients MG diagnosed and HC with 18 individuals matched for age and sex. MGG was evaluated with clinical and motor scales and answered self-perceived questionnaires. Speech assessment of both groups included: recording of speech tasks, acoustic and auditory-perceptual analysis. RESULTS: In the MGG, 68.24% of the patients were female, with average age of 50.21 years old (±16.47), 14.18 years (±9.52) of disease duration and a motor scale of 11.19 points (±8.79). The auditory-perceptual analysis verified that 47.36% (n = 18) participants in MGG presented mild dysarthria, 10.52% (n = 4) moderate dysarthria, with a high percentage of alterations in phonation (95.2%) and breathing (52.63%). The acoustic analysis verified a change in phonation, with significantly higher shimmer values in the MGG compared to the HC and articulation with a significant difference between the groups for the first formant of the /iu/ (p = <.001). No correlation was found between the diagnosis of speech disorder and the dysarthria self-perception questionnaire. CONCLUSION: We found dysarthria mild in MG patients with changes in the motor bases phonation and breathing, with no correlation with severity and disease duration.
