Érica Batassini

Development and validation of a simple questionnaire for the identification of hereditary breast cancer in primary care

BackgroundBreast cancer is a significant public health problem worldwide and the development of tools to identify individuals at-risk for hereditary breast cancer syndromes, where specific interventions can be proposed to reduce risk, has become increasingly relevant. A previous study in Southern Brazil has shown that a family history suggestive of these syndromes may be prevalent at the primary care level. Development of a simple and sensitive instrument, easily applicable in primary care units, would be particularly helpful in underserved communities in which identification and referral of high-risk individuals is difficult.MethodsA simple 7-question instrument about family history of breast, ovarian and colorectal cancer, FHS-7, was developed to screen for individuals with an increased risk for hereditary breast cancer syndromes. FHS-7 was applied to 9218 women during routine visits to primary care units in Southern Brazil. Two consecutive samples of 885 women and 910 women who answered positively to at least one question and negatively to all questions were included, respectively. The sensitivity, specificity and positive and negative predictive values were determined.ResultsOf the 885 women reporting a positive family history, 211 (23.8%; CI95%: 21.5–26.2) had a pedigree suggestive of a hereditary breast and/or breast and colorectal cancer syndrome. Using as cut point one positive answer, the sensitivity and specificity of the instrument were 87.6% and 56.4%, respectively. Concordance between answers in two different applications was given by a intra-class correlation (ICC) of 0.84 for at least one positive answer. Temporal stability of the instrument was adequate (ICC = 0.65).ConclusionA simple instrument for the identification of the most common hereditary breast cancer syndrome phenotypes, showing good specificity and temporal stability was developed and could be used as a screening tool in primary care to refer at-risk individuals for genetic evaluations.

Nasoenteral tube: factors associated with delay between indication and use in emergency services

Objetivo: conhecer o tempo entre indicacao e uso da sonda nasoenteral (SNE) e fatores associados a atrasos. Metodo: coorte prospectiva que acompanhou adultos de uma Emergencia brasileira, desde a indicacao ao uso da SNE, avaliando-se variaveis clinicas e do processo de trabalho. Adotou-se o modelo de Equacoes de Estimacoes Generalizadas para identificar fatores associados a atrasos em cada etapa do processo. Resultados: o tempo entre indicacao e uso da SNE foi 573 (IQR: 360-1093) minutos, em 150 insercoes de SNE. Insercoes em pacientes que anteriormente nao a utilizavam, retardos na rotina assistencial medica, da nutricao e enfermagem, uso de ventilacao mecânica, noradrenalina e jejum foram fatores para maior tempo ate o uso da sonda. Conclusao: o tempo entre indicacao e uso de SNE foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados as condicoes clinicas do paciente e a gestao da assistencia contribuiriam para atrasos.OBJECTIVE to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. METHOD A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. RESULTS the time between indication and use of NET was 573 (IQR: 3601,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. CONCLUSION the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays.

Sonda nasoenteral : fatores associados ao delay entre indicação e uso em emergência

Objetivo: conhecer o tempo entre indicacao e uso da sonda nasoenteral (SNE) e fatores associados a atrasos. Metodo: coorte prospectiva que acompanhou adultos de uma Emergencia brasileira, desde a indicacao ao uso da SNE, avaliando-se variaveis clinicas e do processo de trabalho. Adotou-se o modelo de Equacoes de Estimacoes Generalizadas para identificar fatores associados a atrasos em cada etapa do processo. Resultados: o tempo entre indicacao e uso da SNE foi 573 (IQR: 360-1093) minutos, em 150 insercoes de SNE. Insercoes em pacientes que anteriormente nao a utilizavam, retardos na rotina assistencial medica, da nutricao e enfermagem, uso de ventilacao mecânica, noradrenalina e jejum foram fatores para maior tempo ate o uso da sonda. Conclusao: o tempo entre indicacao e uso de SNE foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados as condicoes clinicas do paciente e a gestao da assistencia contribuiriam para atrasos.OBJECTIVE to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. METHOD A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. RESULTS the time between indication and use of NET was 573 (IQR: 3601,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. CONCLUSION the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays.

Sonda Nasogástrica: factores asociados al delay entre indicación y uso en Servicio de Urgencia

Objetivo: conhecer o tempo entre indicacao e uso da sonda nasoenteral (SNE) e fatores associados a atrasos. Metodo: coorte prospectiva que acompanhou adultos de uma Emergencia brasileira, desde a indicacao ao uso da SNE, avaliando-se variaveis clinicas e do processo de trabalho. Adotou-se o modelo de Equacoes de Estimacoes Generalizadas para identificar fatores associados a atrasos em cada etapa do processo. Resultados: o tempo entre indicacao e uso da SNE foi 573 (IQR: 360-1093) minutos, em 150 insercoes de SNE. Insercoes em pacientes que anteriormente nao a utilizavam, retardos na rotina assistencial medica, da nutricao e enfermagem, uso de ventilacao mecânica, noradrenalina e jejum foram fatores para maior tempo ate o uso da sonda. Conclusao: o tempo entre indicacao e uso de SNE foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados as condicoes clinicas do paciente e a gestao da assistencia contribuiriam para atrasos.OBJECTIVE to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. METHOD A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. RESULTS the time between indication and use of NET was 573 (IQR: 3601,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. CONCLUSION the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays.