RESUMO
Decision aids (DAs) help patients participate in healthcare decisions by improving knowledge and clarifying values and preferences, thus favoring a more active role in the decision process. DAs exist as a physical support (paper, DVD, audio) or computerized formats. They can be used independently by patients before and after consultations, or with a health professional during consultations. Unisanté has created a DA for use during consultations presenting available smoking cessation aids (www.howtoquit.ch). A local study showed that the DA is considered easy to use and useful by the doctors interviewed. The use of DAs in addictions to other substances, in conjunction with shared decision making, shows a favourable effect on the involvement of patients in their health and therapeutic adherence.
Les outils d'aide à la décision (AD) soutiennent les patient-e-s dans leurs choix médicaux en majorant leurs connaissances et en clarifiant leurs valeurs et préférences, ce qui leur permet de s'impliquer dans le processus décisionnel. Les AD existent en tant que supports physiques (papier, DVD) ou informatiques. Ils peuvent être utilisés par les patient-e-s avant/après la consultation ou avec le-la professionnel-le de santé durant la consultation. Unisanté a créé un AD présentant les aides à l'arrêt du tabac durant la consultation. Une étude locale a montré que l'usage de celui-ci a été jugé simple et utile par les médecins. L'utilisation d'AD dans les addictions à d'autres substances, renforcée par des entretiens de décision partagée, montre un effet favorable sur l'implication des patient-e-s et sur l'adhésion thérapeutique.
Assuntos
Médicos , Abandono do Hábito de Fumar , Atitude do Pessoal de Saúde , Tomada de Decisões , Técnicas de Apoio para a Decisão , Humanos , Participação do PacienteRESUMO
The aims of this study were to investigate the usefulness of serum C-reactive protein, procalcitonin, tumor necrosis factor alpha, interleukin-6, and interleukin-8 as postmortem markers of sepsis and to compare C-reactive protein and procalcitonin values in serum, vitreous humor, and cerebrospinal fluid in a series of sepsis cases and control subjects, in order to determine whether these measurements may be employed for the postmortem diagnosis of sepsis. Two study groups were formed, a sepsis group (eight subjects coming from the intensive care unit of two university hospitals, with a clinical diagnosis of sepsis in vivo) and control group (ten autopsy cases admitted to two university medicolegal centers, deceased from natural and unnatural causes, without elements to presume an underlying sepsis as the cause of death). Serum C-reactive protein and procalcitonin concentrations were significantly different between sepsis cases and control cases, whereas serum tumor necrosis factor alpha, interleukin-6, and interleukin-8 values were not significantly different between the two groups, suggesting that measurement of interleukin-6, interleukin-8, and tumor necrosis factor alpha is non-optimal for postmortem discrimination of cases with sepsis. In the sepsis group, vitreous procalcitonin was detectable in seven out of eight cases. In the control group, vitreous procalcitonin was clearly detectable only in one case, which also showed an increase of all markers in serum and for which the cause of death was myocardial infarction associated with multi-organic failure. According to the results of this study, the determination of vitreous procalcitonin may be an alternative to the serum procalcitonin for the postmortem diagnosis of sepsis.
