Fernando Nogueira

Characteristics of Acute Asthma Patients Attended Frequently Compared with Those Attended Only Occasionally in an Emergency Department

Asthma patients that depend on emergency department (ED) services are generally considered to have extremely poor disease control and prognosis. It is important to identify characteristics related to poor disease control and frequent visits to the ED to apply appropriate clinical management. This study comprised a cross-sectional survey of consecutive patients with asthma exacerbation (age ≥12 years) presenting at the adult ED of a large, tertiary care, university-affiliated hospital over a 2-month period. The frequent visitors (FV) were defined by ≥3 visits to the ED in the preceding year, and the occasional visitors (OV) by ≤2 visits. Eighty-six patients (61 females and 25 males) were included in the study (mean age 38 ± 18 years). Of these patients, 51.2% were FV and 48.8% were OV. Sixty-nine percent had annual income lower than A

Early prediction of poor outcome in patients with acute asthma in the emergency room

3000 and 66.3% had ≤8 years of the formal education. Only 18.6% had used inhaled corticosteroids, 79.1% identified the asthma attack severity, 70.9% increased or initiated inhaled β-agonist, 20.9% increased or initiated steroid therapy, and 55.8% had an asthma action plan for attack. The number of hospital admissions in past year (OR 4.3, P = .02), use of home nebulizer (OR 3.6, P = .05) and the lack of a written asthma action plan (OR 3.3, P = .03) were independently associated with frequent visits to the ED. We conclude that a substantial proportion of the patients that visit the ED are FV. These patients are more likely to have hospital admission in the past year, to use a home nebulizer, and to lack a written asthma action plan. They should be considered the most important target for asthma education.

Efeito da implantação de um protocolo assistencial de asma aguda no serviço de emergência de um hospital universitário

Early identification of patients who need hospitalization or patients who should be discharged would be helpful for the management of acute asthma in the emergency room. The objective of the present study was to examine the clinical and pulmonary functional measures used during the first hour of assessment of acute asthma in the emergency room in order to predict the outcome. We evaluated 88 patients. The inclusion criteria were age between 12 and 55 years, forced expiratory volume in the first second below 50% of predicted value, and no history of chronic disease or pregnancy. After baseline evaluation, all patients were treated with 2.5 mg albuterol delivered by nebulization every 20 min in the first hour and 60 mg of intravenous methylprednisolone. Patients were reevaluated after 60 min of treatment. Sixty-five patients (73.9%) were successfully treated and discharged from the emergency room (good responders), and 23 (26.1%) were hospitalized or were treated and discharged with relapse within 10 days (poor responders). A predictive index was developed: peak expiratory flow rates after 1 h < or =0% of predicted values and accessory muscle use after 1 h. The index ranged from 0 to 2. An index of 1 or higher presented a sensitivity of 74.0, a specificity of 69.0, a positive predictive value of 46.0, and a negative predictive value of 88.0. It was possible to predict outcome in the first hour of management of acute asthma in the emergency room when the index score was 0 or 2.

Doença de Castleman: uma apresentação pouco frequente

INTRODUCAO: Existe grande variabilidade de pratica clinica no tratamento da asma aguda na sala de emergencia, o que interfere na qualidade de atendimento. OBJETIVO: Avaliar o efeito da implantacao de um protocolo assistencial de asma aguda no Servico de Emergencia do Hospital de Clinicas de Porto Alegre. METODO: Estudo transversal, antes e apos a implantacao do protocolo assistencial de asma aguda no setor de adultos (idade > 12 anos) do referido servico, avaliando o efeito das recomendacoes sobre a avaliacao objetiva da gravidade, solicitacoes de exames, uso de terapeutica recomendada, uso de terapeutica nao-recomendada e desfechos da crise. RESULTADOS: Na fase pre-implantacao, foram estudados 108 pacientes e, na fase pos-implantacao, 96 pacientes. Houve aumento na utilizacao da oximetria de pulso (de 8% para 77%, p < 0,001) e do pico de fluxo expiratorio (de 5% para 21%, p < 0,001). Ocorreu aumento na utilizacao de recursos radiologicos (de 33% para 66%, p < 0,001) e de hemograma (de 11% para 25%, p = 0,016). Houve aumento no numero de pacientes que receberam as tres nebulizacoes preconizadas para a primeira hora de tratamento (de 22% para 36%, p=0,04). Embora a utilizacao geral de corticoide nao se tenha modificado, houve aumento no uso de corticoide oral (de 8,3% para 28%, p < 0,001). Nao houve alteracao significativa na utilizacao de medidas terapeuticas nao-preconizadas, no tempo de permanencia na sala de emergencia, nem nas taxas de internacoes e de altas. CONCLUSAO: A aplicacao do protocolo assistencial de asma aguda na sala de emergencia obteve efeito positivo, com maior utilizacao de medidas objetivas na avaliacao da gravidade e de medidas terapeuticas recomendadas, porem nao teve repercussao sobre tratamento e desfechos.

Clinical suspicion and diagnosis of obstructive sleep apnoea: a retrospective study

Castlemans disease is a rare lymphoproliferative disorder, with focal or systemic lymph node involvement, which rarely affects the lung parenchyma. We report the case of an asymptomatic immunocompetent male patient who had the rarest histological variant of the disease, a nodular parenchymal presentation. The patient underwent lobectomy, and the postoperative evolution was favorable. In the last 10 years, there have been only five reports of Castlemans disease presenting as a solitary pulmonary nodule. This case underscores the fact that Castlemans disease, albeit rare, should be included in the differential diagnosis of pulmonary nodules.

Comparing smoking cessation behaviour, attitudes and knowledge between trained and non-trained healthcare professionals

Background Obstructive sleep apnea (OSA) is an underdiagnosed syndrome with several associated comorbidities. Ambulatory cardiorespiratory polygraphy (CRP) is an accessible and reliable tool for diagnosis of OSA in patients with high clinical suspicion. Objectives To evaluate demographic data, symptoms, comorbidities and CRP results of patients of a central hospital. Methods Retrospective study conducted among patients who underwent ambulatory CRP over a 6-month period in a central hospital. Medical records were reviewed to collect data on patients’ demographic characteristics, symptoms, comorbidities and CRP reports. Descriptive statistical analysis was conducted to describe the sample. Results 193 patients enrolled the study (65%males, 35%females; mean age 61.9y) mainly referred from Pulmonology, Otorhinolaryngology and Endocrinology outpatient settings (40.9%, 23.3% and 14.0% respectively). Major reported symptoms were chronic snoring (98.4%), witnessed apneas (58.5%) and excessive daytime sleepiness (41.5%).The mean number of comorbidities per patient was 4.7. Hypertension (73.6%), dyslipidemia (67.4%), obesity (62.2%), rhinosinusitis (34.2%) and anxiety-depression disorder (34.2%) were the most frequent. 47.2% of patients were former or current smokers. OSA was diagnosed in 69.9% of patients, 28.1% of which were classified as severe. The mean apnea-hypopnea index in OSA patients was 25.1/h; mean total recorded time with oxygen saturation below 90% was 22.3%. Conclusions In our sample, the majority of patients with clinical suspicion of OSA had this diagnosis confirmed after performing CRP. This reflects a greater medical awareness about symptoms suggestive of OSA and associated comorbidities, enhancing diagnosis and treatment of this syndrome.

Participação, cultura política e cidades

Background: Smoking is one of the leading causes of preventable death worldwide. Healthcare professionals play a major role in promoting smoking cessation. Objectives: To compare self-reported behaviour, attitudes and knowledge about smoking cessation between healthcare professionals who did and did not receive training in this subject. Methods: Cross-sectional study carried out among nurses and physicians from a central hospital. A questionnaire was used to collect data on demographic characteristics, behaviour, attitudes and knowledge in relation to smoking cessation. Statistical analyses were conducted to compare the differences between healthcare professionals who received smoking cessation training and those who didn9t. Results: 101 participants enrolled the study, 59.4% having received training in smoking cessation and 40.6% not. Both trained and non-trained professionals frequently asked patients about their smoking status (88.3% and 85.4% respectively).Healthcare professionals who received training were more familiar with behavioural approaches to smoking cessation than those who didn9t (23.8% vs 2.97%; p-value Conclusions: Providing training in smoking cessation leads to increased knowledge among healthcare professionals. Most subjects recognized the importance of smoking cessation. Therefore it is crucial to provide them with training in this subject and enhance patients9 referral to smoking cessation programs.

Evaluation of a central hospital smoking cessation program: an 8-year retrospective study

This introductory text makes a commented presentation of the five articles that comprise the present dossier in the light of theoretical and bibliographical references on the topics of participation, political culture and cities. Our aim is contributing to the debate regarding deliberative democracy and its repercussions on the current sociological theory. The text is structured so that to allow linking the themes worked out in the articles, beginning by retrieving the historical context and theoretical references of the dimensions involved in the contents of the dossier.