Lucieni de Oliveira Conterno

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.

A experiência de uma instituição pública na formação do profissional de saúde para atuação em atenção primária

This scope of this paper is to analyze the training of nurses and physicians to work in primary care at a public institution in the municipality of Marilia, duly identifying the concepts of professors, coordinators and graduates in relation to the formation of health professionals. It is a qualitative, exploratory study with interviews conducted with 21 individuals. The results revealed that according to the individuals interviewed, both courses prepare professionals to work in primary care, albeit with limitations in relation to actions in management collective and care. The interviewees believe that the use of active methodologies has been important in the teaching and learning process. Also, the fact that from the first year of undergraduate studies the students participate in primary health care broadens their knowledge of this reality. The study highlights the need to enhance the teaching-service partnership and strategies to improve the training physicians to work in primary health care.

A integração ensino-serviço na formação de enfermeiros e médicos: a experiência da FAMEMA

The scope of this study is to identify contributions and limits of teaching-service integration between the School of Medicine of Marilia and the Municipal Health Department of Marilia for academia, for the health teams and for the community. The study involved cross-sectional research using a quantitative approach. A questionnaire with 20 affirmations structured around a Likert scale was applied to students, professors and collaborating professors with a total of 183 participants. A trend for a positive evaluation of teaching-service integration for professional education was revealed. As regards contributions of teaching-service integration to the community, the positive evaluation was close to 50%. The items referring to contributions to the health teams were the ones that had the highest number of negative responses. Data indicate that it is necessary to move forward such that teaching and service are considered interdependent processes with possibilities of joint reflections.

Uso excessivo do cateter vesical em pacientes internados em enfermarias de hospital universitário

This cohort study included 254 adult patients who used a urinary catheter (UC) during their hospitalization in a university hospital ward. The following were evaluated: catheter use, indication, time of permanence, urinary infection density, mortality, and hospital stay. Throughout the studied period, 14% of the hospitalized patients received UC, totaling 1735 UC-day. In 23% of cases, the procedure had not been prescribed, and neither was its indication documented. The average time of UC use was 6.8 days. Among clinical patients, the indication for UC was inadequate in 29%; time of permanence was considered inadequate in 49% of clinical patients and in 66.9% of surgical patients. Patients with inadequate UC use had more urinary tract infections (RR 1.86 IC95% 1.4 to 3.04) and longer hospital stay (11.9 and 8.9 days, p=0.002). This study permitted to identify flaws in the care process that are potentially changeable and important to avoid urinary tract infection by urinary catheter use.This cohort study included 254 adult patients who used a urinary catheter (UC) during their hospitalization in a university hospital ward. The following were evaluated: catheter use, indication, time of permanence, urinary infection density, mortality, and hospital stay. Throughout the studied period, 14% of the hospitalized patients received UC, totaling 1735 UC-day. In 23% of cases, the procedure had not been prescribed, and neither was its indication documented. The average time of UC use was 6.8 days. Among clinical patients, the indication for UC was inadequate in 29%; time of permanence was considered inadequate in 49% of clinical patients and in 66.9% of surgical patients. Patients with inadequate UC use had more urinary tract infections (RR 1.86 IC95% 1.4 to 3.04) and longer hospital stay (11.9 and 8.9 days, p=0.002). This study permitted to identify flaws in the care process that are potentially changeable and important to avoid urinary tract infection by urinary catheter use.

Prevalence of neurocognitive disorders and depression in a Brazilian HIV population

INTRODUCTION Combined antiretroviral therapy has enabled human immunodeficiency virus (HIV) carriers to live longer. This increased life expectancy is associated with the occurrence of degenerative diseases, including HIV-associated neurocognitive disorders (HAND), which are diagnosed via a complex neuropsychological assessment. The International HIV Dementia Scale (IHDS) is a screening instrument validated in Brazil for use in the absence of neuropsychological evaluation. HIV patients are frequently diagnosed with depression. We aimed to determine the prevalence of neurocognitive impairment using the IHDS and depressive disorders using the Hamilton Rating Scale for Depression (HAM-D17), compare the IHDS performance with the performances on the Timed Gait Test (TGT), the Digit Symbol Coding Test (DS) and the Brazilian version of the Scale of Instrumental Activities of Daily Living (IADL), and evaluate the association between the IHDS performance and clinical-demographic variables. METHODS One hundred fourteen patients were evaluated in a cross-sectional study conducted in a public outpatient clinic for infectious diseases in Marília City, State of São Paulo, Brazil. Data were collected following consultation. Statistical analysis was performed in accordance with the nature and distribution of the data and hypotheses. RESULTS According to the IHDS, 53.2% of the sampled patients were neuropsychologically impaired. According to the HAM-D17, 26.3% had depressive disorders. There were significant associations between the IHDS and the TGT and DS. Multiple regression analysis indicated that female gender, educational level, and cluster of differentiation 4 (CD4) levels were significantly and independently associated with neurocognitive impairment. CONCLUSIONS The prevalence of neurocognitive impairment according to the IHDS is high and associated with female gender, education level, and low CD4 levels.

Tromboprofilaxia venosa em pacientes clínicos: análise de sua aplicação

OBJECTIVE Routine thromboprophylaxis, despite its well-known effectiveness and the fact that venous thromboembolism is a potentially avoidable condition, is not fully established in clinical practice. The objectives of the present study were to determine how often thromboprophylaxis is used and the presence of thromboembolism risk factors, and to verify the appropriateness of its use in medical inpatients, assuming a long-standing national guideline as a parameter. METHODS This was a retrospective cross-sectional study, involving inpatients with medical conditions in the adult general ward of a university hospital. The review was based on a defined guideline. RESULTS 146 patients were included in the review. At least one risk factor for venous thromboembolism was found in 94.5%. In 130 (89%) patients, prophylactic heparin was indicated, and some kind of heparin was prescribed in 73.3%. Regarding the adequacy of prophylaxis, 53.4% of prescriptions were correct regarding prophylaxis indication and dose; 24% had incorrect dose or frequency of use; 19.2% had no prophylaxis prescription, although it was indicated; and in five cases (3.4%), the drug was prescribed, even though it was not indicated. CONCLUSION Thromboprophylaxis is underused in this population, and an inappropriate dose was prescribed in 50% of cases. Therefore, future studies and interventions should include an educational program started from the emergency department care, an essential step to bring evidence closer to clinical practice.

The excessive use of urinary catheters in patients hospitalized in university hospital wards

This cohort study included 254 adult patients who used a urinary catheter (UC) during their hospitalization in a university hospital ward. The following were evaluated: catheter use, indication, time of permanence, urinary infection density, mortality, and hospital stay. Throughout the studied period, 14% of the hospitalized patients received UC, totaling 1735 UC-day. In 23% of cases, the procedure had not been prescribed, and neither was its indication documented. The average time of UC use was 6.8 days. Among clinical patients, the indication for UC was inadequate in 29%; time of permanence was considered inadequate in 49% of clinical patients and in 66.9% of surgical patients. Patients with inadequate UC use had more urinary tract infections (RR 1.86 IC95% 1.4 to 3.04) and longer hospital stay (11.9 and 8.9 days, p=0.002). This study permitted to identify flaws in the care process that are potentially changeable and important to avoid urinary tract infection by urinary catheter use.This cohort study included 254 adult patients who used a urinary catheter (UC) during their hospitalization in a university hospital ward. The following were evaluated: catheter use, indication, time of permanence, urinary infection density, mortality, and hospital stay. Throughout the studied period, 14% of the hospitalized patients received UC, totaling 1735 UC-day. In 23% of cases, the procedure had not been prescribed, and neither was its indication documented. The average time of UC use was 6.8 days. Among clinical patients, the indication for UC was inadequate in 29%; time of permanence was considered inadequate in 49% of clinical patients and in 66.9% of surgical patients. Patients with inadequate UC use had more urinary tract infections (RR 1.86 IC95% 1.4 to 3.04) and longer hospital stay (11.9 and 8.9 days, p=0.002). This study permitted to identify flaws in the care process that are potentially changeable and important to avoid urinary tract infection by urinary catheter use.