PERFIL DE CUIDADORES DE LA TERCERA EDADE EN UNA INSTITUCIÓN DE LARGA PERMANENCIA EN IMPERATRIZ, MA

Diante do aumento da oferta de trabalho dos profissionais cuidadores de idosos e da escassez de literatura sobre seu perfil foi realizado um estudo observacional, do tipo transversal com cuidadores formais de uma instituição de longa permanência para idosos no munícipio de Imperatriz – MA. Os objetivos do trabalho foram descrever variáveis sociodemográficas, identificar as dificuldades enfrentadas durante o exercício das atividades laborais, além de avaliar o estado de saúde dos cuidadores. A amostra foi composta por 14 profissionais que auxiliavam os idosos na realização das atividades diárias e aceitaram participar do estudo. Os resultados obtidos sugerem que os cuidadores avaliados são em sua maioria mulheres solteiras, com menos de 50 anos de idade, com baixa renda salarial, que receberam algum tipo capacitação para o cuidado dos idosos. Pela análise dos resultados foi possível concluir que os cuidadores necessitam de suporte dos serviços de saúde para prevenir e/ou minimizar a sobrecarga de trabalho e possíveis enfermidades. O estudo também evidencia a importância de se conhecer as dificuldades institucionais vivenciadas pelos cuidadores, buscando enfoque para a reorganização dos serviços de assistência ao idoso institucionalizado.Faced with increased labor supply of caregivers for elderly and the scarce literature about their sociodemographic and clinical profile, observational research was carried out with formal caregivers in a long-term care facility in the city of Imperatriz – MA. The goals were to describe sociodemographic variables, identify difficulties during work activities, and evaluate the health status of caregivers. The sample was composed of 14 professionals who helped the elderly carry out daily activities. Data collection was carried out from April to May 2015 through questionnaires answered individually by caregivers, following a structured script previously tested. The questions were read to the respondents and the answers were filled out by the interviewers. A descriptive technique was used In the statistical analysis. The results evidenced that 42.8% of participants were between 31 and 40 years old, 64.2% were women, 42.8% were single, 50% had personal income of up to one minimum wage, 50% had no complete high school, and 71.42% received some kind of training to care for the elderly. In addition, 64.3% of respondents considered it necessary to receive medical care to check their health status. For the analysis of the results it was concluded that caregivers need support of health services to prevent and/or minimize the workload and possible illnesses. The study also highlights the importance of knowing the institutional difficulties experienced by caregivers, seeking to approach the reorganization of support services for institutionalized elderly.Ante el aumento de la oferta de trabajo de los cuidadores de de la tercera edad y la escasez de su perfil sociodemográfico y clínico, se llevó a cabo un estudio observacional con los cuidadores formales de una Institucione de Larga Permanencia para Mayores en el municipio de Imperatriz – MA. Los objetivos fueron describir las variables sociodemográficas, identificar las dificultades enfrentadas durante la realización de las actividades de trabajo y evaluar el estado de salud de los cuidadores. La muestra se compone de 14 profesionales que ayudaron a las personas mayores en la realización de las actividades diarias y aceptaron participar em el estudio. La recolección de datos se llevó a cabo entre abril y mayo de 2015 mediante cuestionarios respondidos de forma individual por el cuidador, a raíz de la escritura estructurada previamente probado. Las preguntas fueron leídas a los encuestados y las respuestas llenas, por extensión, en la forma. En el análisis estadístico, se utilizó la técnica descriptiva. Los resultados mostraron que 42,8% tenía entre 31 y 40 años, 64,2% de los cuidadores eran mujeres; 42,8% eran solteros; 50% tenía ingresos personales de hasta un salario mínimo; 50% no había completado la escuela secundaria y 71,42% recibido algún tipo de formación para el cuidado de los ancianos. Además, 64,3% de los encuestados consideró necesario recibir atención médica para comprobar su estado de salud. Para el análisis de los resultados se concluyó que los cuidadores necesitan apoyo de los servicios de salud para prevenir y/o reducir al mínimo la carga de trabajo y las posibles enfermedades. El estudio también muestra la importancia de conocer las dificultades institucionales que experimentan los cuidadores y centrarse en la reorganización de los servicios de atención para los ancianos institucionalizados

Principais complicações dos esquemas de revascularização do tecido cardíaco em indivíduos que sofreram infarto agudo do miocárdio

The article aims to identify the main complications, listed in the literature, in patients after myocardial revascularization schemes. And as a secondary objective, to expose the main concepts about Coronary Artery Diseases (CADs). This is a narrative review of a critical and analytical nature, in research on the main concepts regarding CABG complications, in addition to the essential aspects of diagnosis and treatment. A review of articles was carried out in the Scientific Electronic Library Online (SciELO) and PubMed databases, with the following Health Sciences Descriptors (DeCS): Coronary disease; Acute myocardial infarction; Revascularization. Cardiovascular Diseases (CVDs) are the main cause of global mortality and have the potential to cause significant and irreversible damage, such as physical limitations and dependence, which directly affect patients' quality of life. In summary, the study made it possible to identify and understand the complications faced by patients who have undergone AMI and have undergone different methods of cardiac revascularization as treatment. Complications observed include atrial fibrillation, sudden death, ventricular arrhythmias, heart failure, infections, new episodes of heart attack, as well as stroke and hemorrhagic events that can lead to postoperative death.El artículo tiene como objetivo identificar las principales complicaciones, enumeradas en la literatura, en pacientes después de esquemas de revascularización miocárdica. Y como objetivo secundario, exponer los conceptos principales sobre las Enfermedades de las Arterias Coronarias (EAC). Se trata de una revisión narrativa, de carácter crítico y analítico, en la investigación sobre los principales conceptos sobre las complicaciones de la CABG, además de los aspectos esenciales del diagnóstico y tratamiento. Se realizó una revisión de artículos en las bases de datos Scientific Electronic Library Online (SciELO) y PubMed, con los siguientes Descriptores en Ciencias de la Salud (DeCS): Enfermedad coronaria; Infarto agudo del miocardio; Revascularización. Las Enfermedades Cardiovasculares (ECV) son la principal causa de mortalidad global y tienen el potencial de causar daños importantes e irreversibles, como limitaciones físicas y dependencia, que afectan directamente la calidad de vida de los pacientes. En resumen, el estudio permitió identificar y comprender las complicaciones que enfrentan los pacientes que han sufrido un IAM y han sido sometidos a diferentes métodos de revascularización cardíaca como tratamiento. Las complicaciones observadas incluyen fibrilación auricular, muerte súbita, arritmias ventriculares, insuficiencia cardíaca, infecciones, nuevos episodios de infarto, así como accidentes cerebrovasculares y eventos hemorrágicos que pueden provocar la muerte posoperatoria.O artigo possui como objetivo identificar as principais complicações, listadas em literatura, em pacientes após os esquemas de revascularização do miocárdio. E como objetivo secundário, expor os principais conceitos sobre as Doenças Arteriais Coronarianas (DACs). Trata-se de uma revisão narrativa de caráter crítico e analítico, na  pesquisa  sobre  os principais  conceitos  no  que tange às complicações da CRM, além dos aspectos essenciais de diagnóstico e tratamento. Foi  realizada  uma  revisão  de  artigos  nas  bases  de  dados   Scientific  Electronic  Library  Online (SciELO) e PubMed, com os seguintes Descritores em Ciências  da  Saúde  (DeCS): Doença coronariana; Infarto agudo do miocárdio; Revascularização. As Doenças Cardiovasculares (DCVs) constituem a principal causa de mortalidade global e têm o potencial de provocar danos significativos e irreversíveis, como limitações físicas e dependência, que afetam diretamente a qualidade de vida dos pacientes.Em síntese, o estudo permitiu identificar e entender as complicações enfrentadas por pacientes que passaram por IAM e foram submetidos a diferentes métodos de revascularização cardíaca como tratamento. As complicações observadas incluem fibrilação atrial, morte súbita, arritmias ventriculares, insuficiência cardíaca, infecções, novos episódios de infarto, além de AVC e eventos hemorrágicos que podem levar à morte pós-operatória

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

Note: These guidelines are for information purposes and should not replace the clinical judgment of a physician, who must ultimately determine the appropriate treatment for each patient

Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave : the global UNITE-COVID study

Purpose To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality

Guidance on mucositis assessment from the MASCC Mucositis Study Group and ISOO: an international Delphi studyResearch in context

Summary: Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022–July 2023). The first phase involved a survey to MASCC-MSG members (January 2022–May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023–May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)