4 research outputs found

    Diagnóstico comunitário de 5 equipes de saúde da família docente-assistenciais de Petrópolis - RJ / Community diagnosis of 5 teaching family health teams - Petrópolis – RJ

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    INTRODUÇÃO A Atenção Primária à Saúde (APS) orientada para a comunidade é definida como uma abordagem que utiliza habilidades epidemiológicas e clínicas para que os programas atendam às necessidades específicas de saúde de uma população definida. A partir do diagnóstico comunitário, a equipe profissional é capaz de engendrar o planejamento de ações que permitam desviar o foco do atendimento voltado para demandas e centrado na cura, para o perfil de prevenção e promoção de saúde. METODOLOGIA Através da Estimativa Rápida Participativa são coletados dados de registros existentes na própria equipe e fontes secundárias, entrevistas com informantes-chaves roteirizadas, que terão identidade preservada, e observação ativa do território. É um estudo qualitativo, descritivo e transversal referente ao diagnóstico em saúde do território de cinco equipes de saúde da família vinculadas à Faculdade de Medicina de Petrópolis (FMP), realizado pelos residentes das respectivas unidades de saúde. O projeto obteve aprovação no Comitê de ética da instituição. OBJETIVO Realizar estudo comparativo do diagnóstico comunitário da situação de saúde dos territórios adscritos pelas cinco equipes de saúde da família vinculadas à FMP. RESULTADOS E DISCUSSÃO Entre os dados epidemiológicos foi possível perceber similaridade na pirâmide etária dos cadastrados das cinco equipes, uma pirâmide típica de transição demográfica. Os dados de pacientes cadastrados portadores de hipertensão e diabetes  alcançaram a prevalência esperada em apenas uma equipe (prevalência estimada pelo estudo Vigitel, 2016), demonstrando possível déficit de busca ativa, justificado por haverem algumas microáreas descobertas de agente comunitário de saúde, em todas as unidades. Esse dado levanta preocupações no que tange às demissões de ACS devido à nova Política Nacional de Atenção Básica. A metodologia participativa utilizada aponta ainda para maior integração equipe - comunidade, o que está no horizonte próximo.

    The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

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    © 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

    Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

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    This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

    Edoxaban versus warfarin in patients with atrial fibrillation

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    Contains fulltext : 125374.pdf (publisher's version ) (Open Access)BACKGROUND: Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known. METHODS: We conducted a randomized, double-blind, double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk atrial fibrillation (median follow-up, 2.8 years). The primary efficacy end point was stroke or systemic embolism. Each edoxaban regimen was tested for noninferiority to warfarin during the treatment period. The principal safety end point was major bleeding. RESULTS: The annualized rate of the primary end point during treatment was 1.50% with warfarin (median time in the therapeutic range, 68.4%), as compared with 1.18% with high-dose edoxaban (hazard ratio, 0.79; 97.5% confidence interval [CI], 0.63 to 0.99; P<0.001 for noninferiority) and 1.61% with low-dose edoxaban (hazard ratio, 1.07; 97.5% CI, 0.87 to 1.31; P=0.005 for noninferiority). In the intention-to-treat analysis, there was a trend favoring high-dose edoxaban versus warfarin (hazard ratio, 0.87; 97.5% CI, 0.73 to 1.04; P=0.08) and an unfavorable trend with low-dose edoxaban versus warfarin (hazard ratio, 1.13; 97.5% CI, 0.96 to 1.34; P=0.10). The annualized rate of major bleeding was 3.43% with warfarin versus 2.75% with high-dose edoxaban (hazard ratio, 0.80; 95% CI, 0.71 to 0.91; P<0.001) and 1.61% with low-dose edoxaban (hazard ratio, 0.47; 95% CI, 0.41 to 0.55; P<0.001). The corresponding annualized rates of death from cardiovascular causes were 3.17% versus 2.74% (hazard ratio, 0.86; 95% CI, 0.77 to 0.97; P=0.01), and 2.71% (hazard ratio, 0.85; 95% CI, 0.76 to 0.96; P=0.008), and the corresponding rates of the key secondary end point (a composite of stroke, systemic embolism, or death from cardiovascular causes) were 4.43% versus 3.85% (hazard ratio, 0.87; 95% CI, 0.78 to 0.96; P=0.005), and 4.23% (hazard ratio, 0.95; 95% CI, 0.86 to 1.05; P=0.32). CONCLUSIONS: Both once-daily regimens of edoxaban were noninferior to warfarin with respect to the prevention of stroke or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes. (Funded by Daiichi Sankyo Pharma Development; ENGAGE AF-TIMI 48 ClinicalTrials.gov number, NCT00781391.)
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