Carlos Rodrigues da Silva Filho

Climacteric symptoms and quality of life: validity of women's health questionnaire

OBJECTIVE To evaluate the reliability and validity of the Portuguese version of the Womens Health Questionnaire. METHODS In order to evaluate the Womens Health Questionnaire (WHQ), an analytical cross-sectional study was carried out at the womens menopause outpatient clinic of a university hospital in São Paulo, Brazil. There were studied 87 women in perimenopause or menopause, defined as experiencing at least one years absence of menstrual flow. The following variables were collected: demographic data, clinical variables (Kupperman index and correlate numeric scale) and quality of life indexes (SF-36 and utility). RESULTS The WHQ proved to be a questionnaire easily translated into Portuguese and well-adjusted to Brazilian women. The internal consistency of the overall WHQ was excellent (Cronbach alpha =0.83; 95% CI: 0.71-0.91). Test-retest reliability was also excellent (intraclass correlation coefficient [ICC]=0.92; 95% IC: 0.86-0.96) and had good absolute agreement (0.84; 95% CI: 0.71-0.92). A satisfactory clinical validity was observed. The construct validity was corroborated by clear associations with others scales. A good index of responsiveness after the intervention was reached. CONCLUSIONS The Portuguese version of the WHQ is of easy and fast administration and understanding. Its measuring properties were related, allowing its use in the evaluation of Brazilian climacteric womens quality of life for various purposes.

Avaliação da qualidade de estudos clínicos e seu impacto nas metanálises

OBJETIVO: Analisar se diferentes instrumentos de avaliacao de qualidade, aplicados a um grupo de estudos clinicos que se correlacionam e qual seu impacto no resultado na metanalise. METODOS: Foram analisados 38 estudos clinicos randomizados e controlados, selecionados para a revisao sistematica sobre a eficacia terapeutica do Interferon Alfa no tratamento da hepatite cronica pelo virus B. Utilizaram-se os seguintes instrumentos: Maastricht (M), Delphi (D) e Jadad (J) e o metodo da Colaboracao Cochrane (CC), considerado padrao-ouro. Os resultados definidos pelos tres instrumentos foram comparados pelo teste de Correlacao de Spearman. O teste de Kappa (K) avaliou a concordância entre os revisores na aplicacao dos instrumentos e o teste de Kappa ponderado analisou o ordenamento de qualidade definido pelos instrumentos. O clareamento do HBV-DNA e HbeAg foi o desfecho avaliado na metanalise. RESULTADOS: Os estudos foram de regular e baixa qualidade. A concordância entre os revisores foi, de acordo com o instrumento: D=0.12, J=0.29 e M=0.33 e CC= 0,53. A correlacao foi moderada e homogenea (D/J=0,51; D/M=0,53 e J/M=0,52). Os resultados da metanalise (HBV-DNA), variaram de RR=0,71; IC 95%: 0,66-0,77 a RR=0,67; IC 95%: 0,58-0,79 e (HbeAg) de RR=0,85; IC 95%: 0,80-0,90 a RR=0,85; IC 95%:0,77-0,93, dependendo da qualidade dos estudos incluidos. CONCLUSOES: Os instrumentos de avaliacao de qualidade tem boa correlacao. Nas revisoes sistematicas que apontem a mesma direcao do efeito, a avaliacao pode nao alterar significantemente seu resultado. O metodo da Colaboracao Cochrane e o mais reprodutivel e de simples aplicacao.

Implementação de uma diretriz para pneumonia adquirida na comunidade em um hospital público no Brasil

OBJECTIVE: To implement community-acquired pneumonia (CAP) guidelines at a public hospital in Brazil and to evaluate the impact of these guidelines on health care quality. METHODS: A quasi-experimental study, with a before-and-after design, involving adult patients diagnosed with CAP and hospitalized between July of 2007 and October of 2008 in the general ward of the Marilia School of Medicine Hospital das Clinicas, located in the city of Marilia, Brazil. RESULTS: During the study period, 68 patients were diagnosed with CAP: 48 before the implementation of the guidelines and 20 after their implementation. After the implementation of the guidelines, 85% of the cases were treated in accordance with the guidelines, and there was a significant increase in the use of antibiotic therapy for atypical bacteria in patients with severe CAP (6.3% vs. 75.0%; p < 0.001). Comparing the pre-implementation and post-implementation periods, we observed a trend toward a decrease in the mortality (35.4% vs. 15.0%; p = 0.09) and toward an increase in the recording of SpO2 in the medical charts of the patients (18% vs. 30%; p = 0.42). During the study period, the degree of severity was not recorded on the medical charts of most patients. In addition, the initiation of antibiotic therapy followed a pre-established schedule, regardless of the severity of the infection. CONCLUSIONS: This study showed that, although the development and implementation of CAP guidelines promoted the optimization of the treatment, there were no significant differences regarding the assessment of severity, SpO2 recording, or the initiation of antibiotic therapy. Therefore, strategies that are more effective are needed in order to modify variables related to the work of physicians and nurses.

Apreensão de tópicos em ética médica no ensino-aprendizagem de pequenos grupos: comparando a aprendizagem baseada em problemas com o modelo tradicional

OBJETIVO: O presente estudo tem como objetivo avaliar o ensino de etica medica durante o curso de medicina e se houve mudanca na aquisicao de conhecimentos em etica medica com o redirecionamento do modelo pedagogico da Faculdade de Medicina de Marilia. METODOS: Foi realizado estudo prospectivo e analitico, baseado na aplicacao de questionarios sobre temas gerais em Etica, em dois periodos distintos. RESULTADOS: Observou-se nao haver diferencas significantes entre a aquisicao de conhecimentos entre os dois metodos. Verificou-se que os alunos de anos mais proximos do termino do curso apresentaram desempenho significativamente melhor que os ingressantes no curso. Os topicos que apresentaram menor indice de acerto compreendiam o sigilo medico, o consentimento do responsavel, a autonomia do paciente, a prescricao medica, o prontuario medico e o corporativismo em relacao ao erro medico. CONCLUSAO: A variavel mais importante nao foi o modelo pedagogico e sim o tempo de exposicao ao tema. O modelo ABP da chance de distribuir o tema em varios modulos e tutorias durante o curso medico ajudando a acelerar o processo de aquisicao de conhecimentos em etica medica. Conclui-se que e necessario uma revitalizacao do ensino da Etica Medica em nossa instituicao, visando a uma maior integracao com a conjuntura socioeconomica de nosso pais.

Medication use by the elderly: analysis of prescribing, dispensing, and use in a medium-sized city in the state of São Paulo

Objective: To describe the prescribing, dispensing, use, adhesion, and storage of medicines to and by the elderly. Method: A descriptive cross-sectional study was performed in Estratégia Saúde da Família (Family Health Strategy) health centers (ESF), in Marília in the state of São Paulo, Brazil, based on the records of and interviews with 114 individuals seven to ten days after a medical consultation. A descriptive analysis was carried out. Results: The mean number of prescribed drugs was 4.98 per elderly patient. Of the total number of prescribed drugs, 81.5% were supplied by public services, with the nutrient (50%); antilipemic (62.1%); analgesic (30.7%); dermo-protector (66.6%); herbal (40%) and parasite and antifungal (37.5%) classes dispensed the least. A total of 83.8% of the Palavras-chave: Idoso. Uso de Medicamentos. Prescrições de Medicamentos. Estratégia Saúde da Família. http://dx.doi.org/10.1590/1981-22562017020.170062

Gravidade do déficit neurológico e incidência de infecções hospitalares em pacientes idosos com acidente vascular cerebral agudo

Aims: To evaluate the association between severity of neurological deficit/degree of functional disability and incidence of nosocomial infections, length of hospital stay, and mortality, in elderly patients with acute stroke.Methods: A prospective cohort study evaluated elderly patients with acute stroke, hospitalized at the Hospital of the Marilia Medical School, in Marilia, SP, Brazil. Inclusion criteria were patients aged 60 years or more and diagnosed with acute stroke. Patients were stratified according to the severity of the stroke by the National Institutes of Health Stroke Scale and the degree of dependence by the modified Rankin scale. All patients were followed from the time of admission to discharge or death.Results: We studied 113 patients with a mean age of 70.8 years, 63 (55.7%) men. The main underlying diseases were hypertension (77.9%) and type 2 diabetes mellitus (30.1%). Seventy-eight (69%) patients were affected for the first time and 86 (76.1%) had ischemic stroke. Nosocomial infection occurred in 24 patients (21.2%) and pneumonia was the most frequent (13.5%). The average length of hospital stay among patients with nosocomial infection was higher when compared to those without nosocomial infection (16.2±16.2 days and 33.2±22.9 days, p<0.001). There was association between score 16-42 points on the National Institute of Health Stroke Scale and the occurrence of nosocomial infection (risk ratio 4.4; 95% confidence interval 1.8 to 11.0). In-hospital mortality was 15.9%, higher among patients considered severe at admission compared to those with moderate to mild severity by the National Institute of Health Stroke Scale (34.6% and 1.6% respectively, p<0.001) and also among those who developed nosocomial infection when compared to those without this complication (37.5% and 10.1% respectively, p=0.003).Conclusions: Nosocomial infections were major complications among elderly patients with acute stroke and were associated with severity of neurological deficit, higher degree of dependence, longer hospital stay and higher mortality rate.