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OBJECTIVE: Through a retrospective analysis of 1,203 cases of referral from primary healthcare units to a specialized quaternary vascular surgical service, the findings of this study revealed a high proportion of inappropriate referrals, which may represent a substantial subutilization of this highly complex service. Consequently, in this study, we aimed to evaluate 1,203 cases of referral to a quaternary vascular surgical service, in São Paulo, Brazil, over a 6-year period, to assess the appropriate need for referral; in addition to the prevalence of surgical indications. METHODS: In this retrospective analysis, we reviewed the institutional records of participants referred from Basic Healthcare Units to a vascular surgical service inside the Brazilian Unified Health System, between May 2015 and December 2020. Demographic and clinical data were collected. The participants were stratified, as per the reason for referral to the vascular surgical service, previous imaging studies, and surgical treatment indications. Referral appropriateness and complementary examinations were evaluated for each disease cohort. Finally, the prevalence of cases requiring surgical treatment was defined as the outcome measure. RESULTS: Of the 1,203 referrals evaluated, venous disease was the main reason for referral (53%), followed by peripheral arterial disease (19.4%). A considerable proportion of participants had been referred without complementary imaging or after a long duration of undergoing an examination. Referrals were regarded as inappropriate in 517 (43%) cases. Of these, 32 cases (6.2%) had been referred to the vascular surgical service, as the incorrect specialty. The percentage of referred participants who ultimately underwent surgical treatment was 39.92%. Carotid (18%) and peripheral arterial diseases (18.4%) were correlated with a lower prevalence of surgical treatments. CONCLUSION: The rate of referral appropriateness to specialized vascular care from primary care settings was low. This may represent a subutilization of quaternary surgical services, with low rates of surgical treatment.
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Instituciones de Atención Ambulatoria , Derivación y Consulta , Humanos , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Brasil , Masculino , Femenino , Persona de Mediana Edad , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Anciano , Procedimientos Quirúrgicos Vasculares/estadística & datos numéricos , Adulto , Enfermedades Vasculares/cirugía , Enfermedades Vasculares/epidemiología , Programas Nacionales de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: There are known health disparities in adolescent substance treatment access and engagement. The purpose of this project is to compare outcomes from school- and clinic-based substance treatment and to evaluate if providing school-based substance treatment reduces disparities in treatment access and engagement. METHOD: This quality improvement retrospective chart review compares baseline and outcome data for adolescents accessing school-based (n = 531) and clinic-based (n = 523) substance treatment in a natural quasi-experimental study with nonequivalent control group design. Baseline demographic and clinical measures include age, sex, ethnicity, race, and clinical diagnoses. Outcome measures include the number of sessions completed, proportion reaching a week of self-reported abstinence, and proportion providing a negative urine drug screen. RESULTS: Compared to the clinic-based sample, the school-based sample includes more female (47.65% vs 26.77%) and Hispanic/Latinx (59.89% vs 46.46%) adolescents. The school-based group has a similar proportion reaching a negative urine drug screen (31.84% vs 28.83%, p = .5259) or a week of abstinence (43.15% vs 41.03%, p = .6718) as the clinic-based sample. There are significant differences in total session completion over a period of 16 weeks between school-based and clinic-based adolescents. In multivariable analyses, there was a significant interaction effect of race/ethnicity by location on the number of sessions completed. CONCLUSION: Providing school-based substance treatment increases access to care and treatment engagement for female, African American, and Hispanic/Latinx adolescents without diminishing outcomes.
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Instituciones de Atención Ambulatoria , Disparidades en Atención de Salud , Servicios de Salud Escolar , Trastornos Relacionados con Sustancias , Adolescente , Femenino , Humanos , Etnicidad/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Servicios de Salud Escolar/estadística & datos numéricos , Masculino , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/etnología , Trastornos Relacionados con Sustancias/terapia , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Factores SexualesRESUMEN
OBJECTIVE: to describe the experience of a private outpatient network for hematology and oncology treatment in the adoption of management tools to face the risk of contamination by SARS-CoV-2. METHOD: an experience report on the use of a root cause analysis method to identify potential risks of contamination by COVID-19 among patients and employees. Through the risks identified through the Ishikawa Diagram, we built an action plan, linked to the 5W2H tool, for planning and decision-making implemented. RESULTS: the number of attendances in person and people circulating in the units was reduced, protective distance measures and new protection barriers were fundamental to control the risks of spreading COVID-19 in patients and employees. FINAL CONSIDERATIONS: the management tools served as a valuable tool in the construction of measures, making the measures in question more clearly and applicable.
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Adaptación Psicológica , Instituciones de Atención Ambulatoria/estadística & datos numéricos , COVID-19/psicología , Oncología Médica/métodos , Salud Laboral , Guías como Asunto , Humanos , Pandemias , Equipo de Protección Personal , SARS-CoV-2RESUMEN
The demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents' training in laboratory ordering practice provides an opportunity for quality improvement. We collected information on demographics, the main reason for the appointment, preexisting medical conditions and presence of co-morbidities from first-visit patients to the internal medicine outpatient service of our university general hospital. We also collected information on all laboratory tests ordered by the attending medical residents. At a follow-up visit, we recorded residents' subjective perception on the usefulness of each ordered laboratory test for the purposes of diagnosis, prognosis, treatment or screening. We observed that 17.3% of all ordered tests had no perceived utility by the attending resident. Tests were usually ordered to exclude differential diagnoses (26.7%) and to help prognosis estimation (19.1%). Age and co-morbidity influenced the chosen category to legitimate usefulness of tests ordering. This study suggests that clinical objectives (diagnosis, prognosis, treatment or prevention) as well as personalization to age and previous health conditions should be considered before test ordering to allow a more appropriate laboratory tests ordering, but further studies are necessary to examine this framework beyond this medical training scenario.
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Instituciones de Atención Ambulatoria/estadística & datos numéricos , Actitud del Personal de Salud , Técnicas de Laboratorio Clínico , Medicina Interna/educación , Internado y Residencia/estadística & datos numéricos , Adulto , Estudios de Cohortes , Femenino , Humanos , MasculinoRESUMEN
Abstract Introduction Specialized psychosocial care centers (Centros de Atenção Psicossocial [CAPS]) are mental health services focused on social rehabilitation and reducing hospitalization of patients with severe and persistent mental illness. Collective multiprofessional activities (CMPA) are the main therapeutic tools used at CAPS. This study aimed to determine rates of adherence to CMPA and identify factors associated with adherence. Methods This is a cross-sectional study in which 111 CAPS users were evaluated using questionnaires covering patient characteristics, clinical status, and treatment and incorporating the Functioning Assessment Short Test (FAST), the Clinical Global Impression - Severity scale (CGI-S), and the Clinical Global Impression - Improvement scale (CGI-I). Adherence was defined as attendance at 50% or more CMPA during the previous 3 months. Data were analyzed using descriptive statistics, bivariate analysis, and Poisson logistic regression with robust variance to estimate prevalence ratios. Results CPMA adherence was 43%. Having children aged 14 years or younger was significantly associated with non-adherence (71%, p = 0.001). Poor or partial adherence to psychotropic drugs tended to be associated (p = 0.066) with poor adherence (33% higher risk), as was the number of psychiatric hospitalizations during CAPS (p = 0.076), with a cumulative association of 5% non-adherence per hospitalization. Conclusions CMPA adherence was low in the study. It is necessary to consider the environment in which the individual lives and invest in support networks, providing patients and family members with explanations about the importance of CMPA to rehabilitation and attempting to tailor the care provided to each patient's needs. There was an association between greater number of psychiatric hospitalizations and non-adherence, suggesting that CAPS are fulfilling a preventive role.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Grupo de Atención al Paciente/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Rehabilitación Psiquiátrica/estadística & datos numéricos , Intervención Psicosocial/estadística & datos numéricos , Trastornos Mentales/rehabilitación , Servicios de Salud Mental/estadística & datos numéricos , Socialización , Brasil , Estudios Transversales , Instituciones de Atención Ambulatoria/estadística & datos numéricosRESUMEN
INTRODUCTION: Specialized psychosocial care centers (Centros de Atenção Psicossocial [CAPS]) are mental health services focused on social rehabilitation and reducing hospitalization of patients with severe and persistent mental illness. Collective multiprofessional activities (CMPA) are the main therapeutic tools used at CAPS. This study aimed to determine rates of adherence to CMPA and identify factors associated with adherence. METHODS: This is a cross-sectional study in which 111 CAPS users were evaluated using questionnaires covering patient characteristics, clinical status, and treatment and incorporating the Functioning Assessment Short Test (FAST), the Clinical Global Impression - Severity scale (CGI-S), and the Clinical Global Impression - Improvement scale (CGI-I). Adherence was defined as attendance at 50% or more CMPA during the previous 3 months. Data were analyzed using descriptive statistics, bivariate analysis, and Poisson logistic regression with robust variance to estimate prevalence ratios. RESULTS: CPMA adherence was 43%. Having children aged 14 years or younger was significantly associated with non-adherence (71%, p = 0.001). Poor or partial adherence to psychotropic drugs tended to be associated (p = 0.066) with poor adherence (33% higher risk), as was the number of psychiatric hospitalizations during CAPS (p = 0.076), with a cumulative association of 5% non-adherence per hospitalization. CONCLUSIONS: CMPA adherence was low in the study. It is necessary to consider the environment in which the individual lives and invest in support networks, providing patients and family members with explanations about the importance of CMPA to rehabilitation and attempting to tailor the care provided to each patient's needs. There was an association between greater number of psychiatric hospitalizations and non-adherence, suggesting that CAPS are fulfilling a preventive role.
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Trastornos Mentales/rehabilitación , Servicios de Salud Mental/estadística & datos numéricos , Grupo de Atención al Paciente/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Rehabilitación Psiquiátrica/estadística & datos numéricos , Intervención Psicosocial/estadística & datos numéricos , Adulto , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , SocializaciónAsunto(s)
Envejecimiento , Control de Enfermedades Transmisibles , Infecciones por Coronavirus , Psiquiatría Geriátrica , Servicios de Salud para Ancianos , Servicios de Salud Mental , Pandemias , Neumonía Viral , Anciano , Envejecimiento/fisiología , Envejecimiento/psicología , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Betacoronavirus , Brasil/epidemiología , COVID-19 , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Psiquiatría Geriátrica/métodos , Psiquiatría Geriátrica/tendencias , Necesidades y Demandas de Servicios de Salud , Servicios de Salud para Ancianos/organización & administración , Servicios de Salud para Ancianos/tendencias , Humanos , Salud Mental/tendencias , Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/tendencias , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Brechas de la Práctica Profesional , SARS-CoV-2 , Atención Terciaria de Salud/métodos , Atención Terciaria de Salud/tendenciasRESUMEN
OBJECTIVES: to report a clinical case of needle phobia which culminated in cardiac arrest and describe the outcome of a care plan based on fear and anxiety diagnoses, using the Roy adaptation model as the framework. METHODS: case study conducted in a chemotherapy outpatient unit in Rio de Janeiro. Care was guided by the nursing process and the use of instruments to assess the venous network, anxiety and fear. RESULTS: the Roy adaptation model enabled proposing nursing interventions that allowed the study subject to adapt to the external and internal stimuli triggered by vasovagal syndrome. The instruments indicated the choice of an adequate semi-implanted venous access device and led to improved levels of anxiety and fear. FINAL CONSIDERATIONS: after carrying out the nursing activities, anxiety was reduced, and the patient achieved greater control over fear.
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Quimioterapia/enfermería , Agujas/efectos adversos , Trastornos Fóbicos/enfermería , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Brasil , Humanos , Masculino , Atención de Enfermería/métodos , Trastornos Fóbicos/psicología , Adulto JovenRESUMEN
Background: Pelvic inflammatory disease (PID) diagnosis is often challenging as well as its treatment. This study sought to characterize the diagnostic and therapeutic trend among physicians at the outpatient level, in Quito, Ecuador, where currently no nationwide screening or specific clinical guideline has been implemented on PID or its main microbiological agents. Methods: A retrospective analysis of medical records with pelvic inflammatory disease diagnosis in an outpatient clinic was performed. Electronic medical records from 2013 to 2018 with any pelvic inflammatory disease-related diagnoses were retrieved. Information with regard to age, sexually related risk factors, symptoms and physical exam findings, ancillary tests, method of diagnosis, and antibiotic regimens was extracted. Results: A total of 186 records were included. The most frequent clinical manifestations were vaginal discharge (47%) and pelvic pain (39%). In the physical examination, leucorrhea was the most frequent finding (47%), followed by lower abdominal tenderness (35%) and cervical motion tenderness in 51 patients (27%). A clinical diagnosis was established in 60% of patients, while 37% had a transvaginal sonography-guided diagnosis. Antibiotic treatment was prescribed with standard regimens in 3% of cases, while other regimens were used in 93% of patients. Additionally, an average of 1.9 drugs were prescribed per patient, with a range from 1 to 5, all in different combinations and dosages. Conclusions: No standardized methods of diagnosis or treatment were identifiable. These findings highlight the need for standardization of the diagnosis and treatment of PID attributed to chlamydial and gonococcal infections.
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Instituciones de Atención Ambulatoria/estadística & datos numéricos , Enfermedad Inflamatoria Pélvica/diagnóstico , Estándares de Referencia , Adolescente , Adulto , Antibacterianos/uso terapéutico , Estudios Transversales , Ecuador/epidemiología , Registros Electrónicos de Salud , Femenino , Humanos , Persona de Mediana Edad , Enfermedad Inflamatoria Pélvica/diagnóstico por imagen , Enfermedad Inflamatoria Pélvica/tratamiento farmacológico , Enfermedad Inflamatoria Pélvica/epidemiología , Proyectos Piloto , Estudios Retrospectivos , Factores de Riesgo , Conducta Sexual , Ultrasonografía , Adulto JovenRESUMEN
BACKGROUND: We conducted a national impact evaluation of routine rotavirus vaccination on childhood diarrhea in Peru, accounting for potential modifying factors. METHODS: We utilized a dataset compiled from Peruvian governmental sources to fit negative binomial models investigating the impact of rotavirus vaccination, piped water access, sewerage access and poverty on the rate of diarrhea clinic visits in children under 5 years old in 194 Peruvian provinces. We considered the interaction between these factors to assess whether water access, sanitation access, or poverty modified the association between ongoing rotavirus vaccination and childhood diarrhea clinic visits. We compared the "pre-vaccine" (2005-2009) and "post-vaccine" (2010-2015) eras. RESULTS: The rate of childhood diarrhea clinic visits was 7% [95% confidence interval (CI): 3%-10%] lower in the post-vaccine era compared with the pre-vaccine era, controlling for long-term trend and El Niño seasons. No impact of rotavirus vaccination was identified in provinces with the lowest access to piped water (when <40% of province households had piped water) or in the lowest category of sewerage (when <17% of province households had a sewerage connection). Accounting for long-term and El Niño trends, the rate of childhood diarrhea clinic visits was lower in the post-vaccine era by 7% (95% CI: 2%-12%), 13% (95% CI: 7%-19%) and 15% (95% CI: 10%-20%) in the second, third and fourth (highest) quartiles of piped water access, respectively (compared with the pre-vaccine era); results for sewerage access were similar. CONCLUSION: Improved water/sanitation may operate synergistically with rotavirus vaccination to reduce childhood clinic visits for diarrhea in Peru.
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Instituciones de Atención Ambulatoria/estadística & datos numéricos , Diarrea/epidemiología , Infecciones por Rotavirus/prevención & control , Vacunas contra Rotavirus/administración & dosificación , Aguas del Alcantarillado , Vacunación/estadística & datos numéricos , Agua , Atención Ambulatoria , Preescolar , Diarrea/prevención & control , Diarrea/virología , Humanos , Perú/epidemiología , Infecciones por Rotavirus/epidemiología , Saneamiento/estadística & datos numéricos , Estaciones del AñoRESUMEN
OBJECTIVES: To evaluate the effectiveness of NIC interventions "Teaching: Disease Process", "Health Education" and "Cardiac Care" in the improvement of NOC results in individuals with Heart Failure (HF), and the Nursing Diagnosis (ND) "Ineffective Health Control". METHODS: Retrospective cohort, conducted at a Health Education in Nursing outpatient clinic. Fourteen patients with HF had follow-up for one year in six bimonthly consultations. The effectiveness of interventions was verified through the change of the result scores through the Friedman's Non-Parametric Test and Analysis of Non-Parametric Variance for repeated measures. The level of significance was 5%. RESULTS: The interventions were implemented in consultations in a variety of activities. There was a significant improvement in the result scores until the fourth visit (p<0.001). CONCLUSIONS: The interventions were effective in improving outcomes in patients with HF and Ineffective Health Control.
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Educación en Salud/normas , Insuficiencia Cardíaca/psicología , Anciano , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Brasil , Estudios de Cohortes , Femenino , Educación en Salud/métodos , Educación en Salud/estadística & datos numéricos , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: To describe a monthly outreach pediatric cardiology clinic established to better understand the cardiac needs of immigrant/resettled refugee children. STUDY DESIGN: Data obtained between 2014 and 2017 from a monthly pediatric cardiology clinic at a Federally Qualified Health Center were analyzed using descriptive statistics. RESULTS: A total of 366 patients (222 male, 61%) were evaluated. Indications for referral included murmur (242, 66%), nonexertional symptoms (31, 9%), exertional symptoms (16, 4%), history of cardiac surgery/transcatheter interventions (15, 4%), previous diagnosis of heart conditions without intervention (13, 4%), arrhythmia/bradycardia (13, 4%), and others (36, 10%). Echocardiograms were performed on 136 patients (67 were abnormal, 49%). The most common final diagnoses include innocent murmur in 201 (55%), simple congenital heart disease in 61 (16%), complex congenital heart disease in 3 (1%), and acquired heart disease in 3 (1%). A total of 15 patients (4%) were ultimately determined to require surgical or cardiac catherization as an intervention. Patients have been followed for a median of 0.7 years (range 0-3.3 years). CONCLUSIONS: Rates of abnormal echocardiograms suggest a greater likelihood of congenital or acquired heart disease at time of initial consultation compared with nonimmigrant/refugee populations. The most common indication for referral to the outreach pediatric cardiology clinic was a murmur. Collaborative efforts between physicians and support services are essential in assisting this vulnerable population access pediatric subspecialty care.
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Instituciones de Atención Ambulatoria/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Cardiopatías Congénitas/diagnóstico , Soplos Cardíacos/diagnóstico , Refugiados/estadística & datos numéricos , Adolescente , Niño , Preescolar , Ecocardiografía/estadística & datos numéricos , Femenino , Cardiopatías Congénitas/epidemiología , Soplos Cardíacos/epidemiología , Humanos , Lactante , Masculino , Área sin Atención Médica , Estudios Retrospectivos , Texas/epidemiologíaRESUMEN
Utilization of ambulatory and outpatient services for primary, specialty, and surgical care has risen in the United States over the last decade, in parallel with the evolution of health care emergency management. Regulatory and accreditation authorities; legislature and policies; and real-life events such as hurricanes, tornadoes, and wildfires throughout the country have caused health care systems to take a more all-hazards approach for emergency management. While health care emergency management has grown tremendously in significance, outpatient settings have yet to see the same growth. However, concepts of comprehensive emergency management and the incident command system are important and valuable across all health care system settings, including outpatient facilities. The purpose of this article is to summarize regulatory requirements for outpatient health care emergency management, describe nuances of outpatient settings, and provide recommendations for how to successfully incorporate outpatient and ambulatory locations into the "Enterprise" model for comprehensive health care emergency management.
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Instituciones de Atención Ambulatoria/estadística & datos numéricos , Servicios Médicos de Urgencia/métodos , Instituciones de Atención Ambulatoria/organización & administración , Servicios Médicos de Urgencia/estadística & datos numéricos , HumanosRESUMEN
OBJECTIVE: Describe the lived experience of a grassroots, non-governmental disaster medical team (DMT) through a research lens and share practical lessons learned, based on the DMT's experience to support and inform future response teams. METHODS: Forty-five days after Hurricane Maria, a non-governmental DMT provided primary medical care via community based pop-up clinics and home visitations in 5 different areas of Puerto Rico. Observational data, photo images, and debriefing notes were collected and documented in the response team's daily activity log. Field notes were coded using a descriptive coding method and then categorized into 2 domains specific to public health and medical diagnosis. RESULTS: Medical aid was provided to nearly 300 (N = 296) residents. Field note observations identified exhaustion related to living conditions and the exacerbation of underlying conditions such as reactive airway diseases, diabetes, hypertension, and depression due to the compounding effects of multiple post-disaster triggers. During home visitations, feelings of sadness and helplessness were identified secondary to natural disaster trauma and current living conditions. CONCLUSION: Our non-governmental DMT displayed similar characteristics demonstrated by federal DMTs post natural disaster. A number of strategic lessons learned emerged from the public health intervention important to future non-governmental DMTs.
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Tormentas Ciclónicas/estadística & datos numéricos , Medicina de Desastres/métodos , Grupo de Atención al Paciente/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Tormentas Ciclónicas/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/estadística & datos numéricos , Puerto RicoRESUMEN
INTRODUCTION: The dramatic increase in the prevalence and clinical impact of infections caused by Carbapenemase-Producing Bacteria in the nosocomial setting in Latin America represents an emerging challenge to public health. The present study detected carbapenemase-producing Gram-negative bacteria in patients from a Hospital from Venezuela, by phenotypic and genotypic methods. METHODOLOGY: The bacterial identification was carried out using conventional methods. The resistance to carbapenems was performed by Kirby-Baüer disk diffusion method, according to CLSI recommendations. The modified Hodge Test, double-disk with phenylboronic acid, double-disk with EDTA and Blue Carba Test were performed to detect phenotypic carbapenemase producers. The carbapenemase-encoding genes blaKPC, blaVIM, blaIMP, blaOXA-2, blaOXA-3, blaOXA-15 and blaOXA-21 were determined. RESULTS: The bacterial species identified were Klebsiella pneumoniae complex (181), Pseudomonas aeruginosa (51), and Acinetobacter baumannii-calcoaceticus complex (119). KPC-type was detected in 40.17% of isolates and VIM-type in 14.53%. KPC-type gene was only identified in K. pneumoniae isolates (77.9%). VIM-type gene was identified in P. aeruginosa (86.27%) and K. pneumoniae isolates (3.87%). There was not detection of IMP-type and OXA-type genes. CONCLUSIONS: We found a predominance of K. pneumoniae KPC producers and a high rate of VIM-producing P. aeruginosa. The epidemiology of CPB in Venezuela is rapidly evolving, and enhanced surveillance and reporting are needed across the healthcare continuum.
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Instituciones de Atención Ambulatoria/estadística & datos numéricos , Proteínas Bacterianas/genética , Enterobacteriaceae/clasificación , Enterobacteriaceae/genética , Salud Pública , beta-Lactamasas/genética , Antibacterianos/farmacología , Proteínas Bacterianas/biosíntesis , Carbapenémicos/farmacología , Pruebas Antimicrobianas de Difusión por Disco , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/enzimología , Infecciones por Enterobacteriaceae/epidemiología , Infecciones por Enterobacteriaceae/microbiología , Genotipo , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Fenotipo , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/enzimología , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/aislamiento & purificación , Venezuela/epidemiología , beta-Lactamasas/biosíntesisRESUMEN
ABSTRACT Objectives: to report a clinical case of needle phobia which culminated in cardiac arrest and describe the outcome of a care plan based on fear and anxiety diagnoses, using the Roy adaptation model as the framework. Methods: case study conducted in a chemotherapy outpatient unit in Rio de Janeiro. Care was guided by the nursing process and the use of instruments to assess the venous network, anxiety and fear. Results: the Roy adaptation model enabled proposing nursing interventions that allowed the study subject to adapt to the external and internal stimuli triggered by vasovagal syndrome. The instruments indicated the choice of an adequate semi-implanted venous access device and led to improved levels of anxiety and fear. Final Considerations: after carrying out the nursing activities, anxiety was reduced, and the patient achieved greater control over fear.
RESUMEN Objetivos: informar sobre un caso clínico de fobia a las agujas derivado en paro cardiorrespiratorio, describir los resultados de un plan de atención orientado a diagnósticos de miedo y ansiedad, sobre referencial del Modelo de Adaptación de Roy. Métodos: estudio de caso observado en ambulatorio de quimioterapia de Rio de Janeiro. El trabajo profesional estuvo orientado por el proceso de enfermería, respaldado por utilización de instrumentos evaluadores de la red venosa, ansiedad y miedo. Resultados: el Modelo de Adaptación de Roy ofreció la propuesta de intervenciones de enfermería que le faciliten al sujeto estudiado adaptación a los estímulos externos e internos disparadores del síncope vasovagal. Los instrumentos indicaron que el catéter semiimplantado es el dispositivo de acceso venoso más adecuado, resultando en mejoras de los niveles de ansiedad y miedo. Consideraciones Finales: una vez realizadas las actividades de enfermería, la ansiedad disminuyó y el paciente obtuvo mayor autocontrol del miedo.
RESUMO Objetivos: reportar um caso clínico de fobia de agulha que culminou em parada cardiorrespiratória e descrever os resultados de um plano assistencial voltado aos diagnósticos de medo e ansiedade, tendo como referencial o Modelo de Adaptação de Roy. Métodos: estudo de caso, desenvolvido em ambulatório de quimioterapia do Rio de Janeiro. A atuação profissional foi orientada pelo processo de enfermagem e subsidiada pelo uso de instrumentos de avaliação da rede venosa, ansiedade e medo. Resultados: o Modelo de Adaptação de Roy facultou a proposição de intervenções de enfermagem que permitiram ao sujeito do estudo uma adaptação aos estímulos externos e internos desencadeadores de síndrome vasovagal. Os instrumentos indicaram a escolha de um cateter semi-implantado como dispositivo de acesso venoso adequado que resultou na melhora dos níveis de ansiedade e medo. Considerações Finais: após o desenvolvimento das atividades de enfermagem, a ansiedade diminuiu e o paciente obteve maior autocontrole do medo.
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Humanos , Masculino , Adulto Joven , Trastornos Fóbicos/enfermería , Quimioterapia/enfermería , Agujas/efectos adversos , Trastornos Fóbicos/psicología , Brasil , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Atención de Enfermería/métodosRESUMEN
Hypovitaminosis D is frequent worldwide. In Argentina, according to studies conducted between 1987 and 2015, prevalence was > 40% in the general population. In people living with HIV it may vary between 20 and 90%, but the prevalence in our environment is not known. Our objective was to determine the prevalence of hypovitaminosis D in a cohort of adults with HIV infection in the city of Buenos Aires. We analyzed retrospectively medical records of 814 HIV positive subjects older than 18 years with at least one determination of vitamin D. The median age was 44 years (interquartile range 21-80), 746 (91.6%) were men, and 813 (99.9%) were on antiretroviral treatment. Univariate and multivariate analyses were performed to determine the association of hypovitaminosis D with CD4 values, viral load for HIV, and antiretroviral therapy. The present study shows that, in our environment, hypovitaminosis D is very common in people with HIV infection. Although it does not reveal evidence of a relationship with viral load for HIV, immune status, or antiretroviral treatment, the systematic search for hypovitaminosis D is mandatory in this population, taking into account its high frequency and the increased risk of osteopenia, osteoporosis and fractures, as described in people with HIV.
La hipovitaminosis D es frecuente en el mundo. Según estudios realizados entre 1987 y 2015, en Argentina la prevalencia fue > 40%. En personas con infección por HIV variaría entre 20 y 90%, pero en nuestro medio no se conoce con precisión. Nuestro objetivo fue determinar la prevalencia de hipovitaminosis D en una cohorte de adultos con infección por HIV asistidos en forma ambulatoria en la ciudad de Buenos Aires. Se analizaron retrospectivamente las historias clínicas de 814 sujetos mayores de 18 años HIV positivos con al menos una determinación de vitamina D. La mediana de edad fue 44 años (rango intercuartílico 21-80), 746 (91.6%) eran hombres y 813 (99.9%) recibían tratamiento antirretroviral. Se realizó análisis uni y multivariado para determinar asociación entre hipovitaminosis D y valores de CD4, carga viral para HIV y terapia antirretroviral. La prevalencia de hipovitaminosis D fue 79.7% (insuficiencia 34.2%, deficiencia 45.5%). No se encontró asociación con el uso de efavirenz o inhibidores de la proteasa (p = 0.86 en ambos casos), con el recuento de linfocitos CD4, ni con la carga viral plasmática (p = 0.81 y 0.74, respectivamente). El presente estudio muestra que, en nuestro medio, la hipovitaminosis D es muy frecuente en personas con infección por HIV. Aun cuando no revela evidencia de relación con carga viral para HIV, estado inmune, ni tratamiento antirretroviral, es necesaria la búsqueda sistemática de hipovitaminosis D en esta población, en vista de la alta frecuencia de osteopenia y osteoporosis y el mayor riesgo de fracturas descripto en personas HIV positivas.
Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Infecciones por VIH/epidemiología , Deficiencia de Vitamina D/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Alquinos , Antirreumáticos/uso terapéutico , Argentina/epidemiología , Benzoxazinas/uso terapéutico , Recuento de Linfocito CD4 , Ciclopropanos , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Factores de Riesgo , Carga Viral , Deficiencia de Vitamina D/etiología , Adulto JovenRESUMEN
A chart review study of the sexually transmitted infection (STI) prevalence among persons living with HIV (PLHIV) was conducted among STI clinic attendees in Trinidad between January 2012 and December 2012. Data were abstracted from client records to obtain the clinical and the laboratory diagnoses of STIs. Descriptive and bivariate analyses were conducted, and factors significantly associated with the presence of a STI were assessed using multiple logistic regression. During this period, 385 PLHIV were seen; 104 (27.0%) were newly HIV diagnosed and 281 (73.0%) had a known history of HIV infection; 135 (35.1%) were diagnosed with a STI. Patients with known HIV infection were more likely to be diagnosed with a STI than those who were newly diagnosed (odds ratios: 6.99; 95% confidence interval: 3.79-12.89). The STI prevalence was high among PLHIV in Trinidad, identifying them as a critical target group for public health interventions to prevent the spread of HIV and STIs.
Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Infecciones por VIH/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , Conducta Sexual , Enfermedades de Transmisión Sexual/prevención & control , Trinidad y Tobago/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS: A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson's chi-square and Fisher's exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS: The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS: Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.
Asunto(s)
Cuidados Posteriores/estadística & datos numéricos , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Madres/estadística & datos numéricos , Pacientes Ambulatorios/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Sífilis Congénita/terapia , Adolescente , Adulto , Brasil/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/terapia , Factores de Riesgo , Factores Socioeconómicos , Sífilis Congénita/epidemiología , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Resultado del Tratamiento , Adulto JovenRESUMEN
La hipovitaminosis D es frecuente en el mundo. Según estudios realizados entre 1987 y 2015, en Argentina la prevalencia fue > 40%. En personas con infección por HIV variaría entre 20 y 90%, pero en nuestro medio no se conoce con precisión. Nuestro objetivo fue determinar la prevalencia de hipovitaminosis D en una cohorte de adultos con infección por HIV asistidos en forma ambulatoria en la ciudad de Buenos Aires. Se analizaron retrospectivamente las historias clínicas de 814 sujetos mayores de 18 años HIV positivos con al menos una determinación de vitamina D. La mediana de edad fue 44 años (rango intercuartílico 21-80), 746 (91.6%) eran hombres y 813 (99.9%) recibían tratamiento antirretroviral. Se realizó análisis uni y multivariado para determinar asociación entre hipovitaminosis D y valores de CD4, carga viral para HIV y terapia antirretroviral. La prevalencia de hipovitaminosis D fue 79.7% (insuficiencia 34.2%, deficiencia 45.5%). No se encontró asociación con el uso de efavirenz o inhibidores de la proteasa (p = 0.86 en ambos casos), con el recuento de linfocitos CD4, ni con la carga viral plasmática (p = 0.81 y 0.74, respectivamente). El presente estudio muestra que, en nuestro medio, la hipovitaminosis D es muy frecuente en personas con infección por HIV. Aun cuando no revela evidencia de relación con carga viral para HIV, estado inmune, ni tratamiento antirretroviral, es necesaria la búsqueda sistemática de hipovitaminosis D en esta población, en vista de la alta frecuencia de osteopenia y osteoporosis y el mayor riesgo de fracturas descripto en personas HIV positivas.
Hypovitaminosis D is frequent worldwide. In Argentina, according to studies conducted between 1987 and 2015, prevalence was > 40% in the general population. In people living with HIV it may vary between 20 and 90%, but the prevalence in our environment is not known. Our objective was to determine the prevalence of hypovitaminosis D in a cohort of adults with HIV infection in the city of Buenos Aires. We analyzed retrospectively medical records of 814 HIV positive subjects older than 18 years with at least one determination of vitamin D. The median age was 44 years (interquartile range 21-80), 746 (91.6%) were men, and 813 (99.9%) were on antiretroviral treatment. Univariate and multivariate analyses were performed to determine the association of hypovitaminosis D with CD4 values, viral load for HIV, and antiretroviral therapy. The present study shows that, in our environment, hypovitaminosis D is very common in people with HIV infection. Although it does not reveal evidence of a relationship with viral load for HIV, immune status, or antiretroviral treatment, the systematic search for hypovitaminosis D is mandatory in this population, taking into account its high frequency and the increased risk of osteopenia, osteoporosis and fractures, as described in people with HIV.