ABSTRACT
BACKGROUND: In general, patients are referred for rheumatological evaluation due to isolated laboratory abnormalities, especially antinuclear antibody (ANA) positivity, with the risk of more severe patients remaining on the waiting list for longer than desired. The aim of this study was to analyze the demographic, clinical, and laboratory information of patients referred to a specialized rheumatological care unit because of positive antinuclear antibody. METHODS: This is a retrospective study of 99 out of 1670 patients seen by the same rheumatologist between 01/01/2011 and 01/01/2019. Patients whose referrals were exclusively due to the ANA test result and the specialist's final diagnosis being "abnormal finding of serum immunological test" (ICD-10 R769) were included. Sociodemographic, clinical, and laboratory information were extracted from the consulting rheumatologist's chart. Descriptive statistics were used for data analysis. RESULTS: A total of 99 patients were included, most of whom were female (84.8%) with a median age of 49 years. At the moment of specialist's appointment, 97 patients (97.9%) repeated the ANA test, and 77 patients remained positive. Of these, only 35 (35.35%) were in a high titer range (greater than or equal to 1:320). Complete blood count for cytopenia's investigation was not performed in a high percentage of patients (22.2%), as well as urinalysis (31.3%). In addition, more than 70% of patients score 0 to 1 classification criteria for Systemic Lupus Erythematosus, according to SLE - ACR 1987 (American College of Rheumatology) and SLICC 2012 (Systemic Lupus International Collaborating Clinics). CONCLUSIONS: Most patients are still referred for specialized evaluation due to the misinterpretation of laboratory tests that were inappropriately requested in patients without clinical evidence of autoimmune rheumatic disease.
Subject(s)
Antibodies, Antinuclear , Referral and Consultation , Humans , Antibodies, Antinuclear/blood , Female , Male , Middle Aged , Cross-Sectional Studies , Brazil , Retrospective Studies , Adult , Rheumatic Diseases/diagnosis , Rheumatology , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/blood , Lupus Erythematosus, Systemic/immunology , AgedABSTRACT
Resumo O consentimento informado objetiva proteger a autonomia de potenciais participantes de pesquisas, fornecendo as informações necessárias para a decisão sobre participar ou não. Este estudo relata uma experiência de processo de consentimento informado via telefone. Houve sucesso no contato telefônico com mais de 90% das pacientes elegíveis; 1,16% entenderam as informações fornecidas, mas não aceitaram participar da pesquisa; e 0,70% recusaram dar o consentimento por telefone e pediram que o termo de consentimento fosse enviado por correio. Participaram do estudo mulheres de todas as regiões do país. A maioria tinha algum procedimento marcado em um dos hospitais pesquisados para pelo menos 62 dias após a data da ligação. Os resultados mostram que o consentimento por telefone pode ser um método alternativo de recrutamento de pacientes, tendo em vista a alta taxa de adesão dos participantes e a redução no tempo de coleta de dados.
Abstract Informed consent aims to protect the autonomy of potential research participants, providing the information necessary to make the right decision. This study reports the experience of collecting the informed consent via telephone from individuals. Telephone contact was successfully achieved for more than 90% of the participants; 1.16% understood the survey, but did not accept to participate; and 0.70% refused to provide telephone consent and required a consent form by mail. Women from all regions of Brazil participated and most had some procedure in the hospital at least 62 days after the date of the call. The results show that telephone consent can be an alternative method of recruiting patients given the high rate of acceptance of the participants and time gains in data collection.
Resumen El consentimiento informado tiene como objeto proteger la autonomía de los posibles participantes de investigaciones, proporcionándoles la información necesaria para que decidan si aceptan o no participar. Este estudio relata una experiencia de proceso de consentimiento informado por teléfono. El contacto telefónico se realizó con éxito con más del 90% de los participantes; el 1,16% entendió la información suministrada, pero no aceptó participar en la investigación; y el 0,70% se negó a otorgar el consentimiento por teléfono y solicitó que se le enviara el formulario de consentimiento por correo. Participaron en el estudio mujeres de todas las regiones de Brasil. La mayoría de las participantes tenía algún procedimiento programado en uno de los hospitales investigados al menos 62 días después de la fecha de la llamada telefónica. Los resultados muestran que el consentimiento por teléfono puede ser un método alternativo para reclutar a los pacientes, una vez que hubo una alta tasa de adherencia de los participantes y reducción en el tiempo para la recopilación de datos.
Subject(s)
Humans , Male , Female , Research , Bioethics , Consent Forms , Informed Consent , NeoplasmsABSTRACT
Introdução: O câncer do colo do útero ocupa o quarto tipo mais comum na população feminina. O teste citopatológico é a principal estratégia do programa de rastreamento, seguido da realização de colposcopia e biópsia, se necessário. Objetivo: Descrever e comparar as características sociodemográficas e clínicas, bem como o itinerário diagnóstico de mulheres portadoras de câncer do colo do útero usuárias do Sistema Único de Saúde (SUS) e do Sistema de Saúde Suplementar (Convênios). Metodologia: Trata-se de um estudo transversal com 391 mulheres com câncer do colo do útero usuárias do SUS e do Sistema de Saúde Suplementar, com até 18 meses de tratamento, através de um questionário estruturado. Utilizou-se o teste de Mann-Whitney, Qui-quadrado e Exato de Fisher para se verificar a relação entre as variáveis de exposição e desfecho, bem como os Modelos de Regressão Logística e Linear para se verificar os fatores associados ao risco de atraso do diagnóstico, bem como o impacto de cada variável no tempo total do itinerário diagnóstico. Resultados: O tempo entre os primeiros sintomas ou primeiro exame alterado até a biópsia, entre a biópsia e a primeira consulta com o ginecologista da oncologia, bem como tempo total do itinerário diagnóstico foi significativamente maior no grupo SUS em comparação ao grupo do Sistema de Saúde Suplementar. Serem atendidas pelo SUS pode aumentar em 1,74 vezes a chance de as mulheres terem atraso diagnóstico e aumento de 91 dias no tempo total desse itinerário, juntamente com a característica de estar desempregada, que pode aumentar em 96 dias. Conclusão: Mulheres atendidas pelo SUS tiveram maior dificuldade em agendar exames e consultas, demoraram mais para procurar por atendimento médico e fizeram o diagnóstico mais tardiamente, com estadiamento mais avançado, em comparação às mulheres do grupo do Sistema de Saúde Suplementar. Assim, torna-se necessária a reestruturação e organização do programa de rastreamento do câncer do colo do útero no Brasil (AU)
Introduction: Cervical cancer is the fourth most common type in the female population. Cytopathologic testing is the primary strategy of (AU) the screening program, followed by colposcopy and biopsy if necessary. Objective: Describe and compare sociodemographic, clinical characteristics and the diagnosis of women with cervical cancer using the Unified Health System (SUS) and the Supplementary Health System (Healthy Ensurance). Methods: This is a cross-sectional study with 391 women with cervical cancer using the SUS and the Supplementary Health System, with up to 18 months of treatment, through a structured questionnaire. The Mann-Whitney, Chi-square and Fisher Exact test were used to verify the relationship between the exposure and outcome variables, as well as the Logistic and Linear Regression Models to verify the factors associated with the risk of delay of the diagnosis, as well as the impact of each variable on the total time of the diagnostic route. Results: The time between the first symptoms or the first altered examination until the biopsy, between the biopsy and the first consultation with the gynaecologist of oncology, as well as the total time of the diagnostic itinerary was significantly higher in the SUS group compared to the group of the Supplementary Health System. Being attended to by the SUS can increase by 1.74 times the chance of women having a diagnosis delay and a 91-day increase in the total time of this itinerary, along with the characteristic of being unemployed, which can increase by 96 days. Conclusion: Women attended by the SUS had greater difficulty in scheduling exams and appointments, took longer to seek medical care and later diagnosed, with more advanced staging, compared to women in the Supplementary Health System group. Thus, it is necessary to reorganize and organize the screening program for cervical cancer in Brazil (AU)
