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☐ ☆ ✇ Revista da Escola de Enfermagem da USP

Evolución clínica y supervivencia de pacientes neurocríticos

— Septiembre 16th 2019 at 15:03
RESUMO Objetivo Avaliar a evolução clínica e sobrevida de pacientes neurocríticos em Unidades Hospitalares. Método Coorte com pacientes acompanhados no período de setembro de 2012 a junho de 2016, internados em hospitais públicos e privados. Os dados foram analisados inicialmente a partir da estatística descritiva e inferencial. Como forma de análise da sobrevida, foi aplicado o indicador de Kaplan-Meier. O modelo de regressão para riscos proporcionais de Cox foi empregado para a análise dos fatores prognósticos, calculando-se a razão de risco. Resultados Participaram do estudo 1.289 pacientes. Os que possuíam Escala de Coma de Glasgow com maior valor apresentaram maior sobrevida, e o incremento de um ponto no escore dessa Escala correspondeu a uma melhora de 42% em sua sobrevida. Na análise de sobrevida, o sexo e o uso de drogas vasoativas mostraram diferença significativa. Conclusão Pacientes do sexo feminino, que possuem melhor escore da Escala de Coma de Glasgow e em uso de drogas vasoativas apresentaram maior sobrevida.
RESUMEN Objetivo Evolución clínica y supervivencia de pacientes neurocríticos en Unidades Hospitalarias. Método Cohorte con pacientes seguidos en el período de septiembre de 2012 a junio de 2016, en estancia en hospitales públicos y privados. Los datos fueron analizados inicialmente mediante la estadística descriptiva e inferencial. Como modo de análisis de la supervivencia, se aplicó el indicador de Kaplan-Meier. El modelo de regresión para riesgos proporcionales de Cox fue empleado para el análisis de los factores pronósticos, calculándose la razón de riesgo. Resultados Participaron en el estudio 1.289 pacientes. Los que tenían Escala de Coma de Glasgow con mayor valor presentaron mayor supervivencia, y el incremento de un punto en el score de dicha Escala correspondió a un mejora del 42% en su supervivencia. En el análisis de supervivencia, el sexo y el uso de drogas vasoactivas mostraron diferencia significativa. Conclusión Pacientes del sexo femenino que tienen mejor score de la Escala de Coma de Glasgow y en uso de drogas vasoactivas presentaron mayor supervivencia.
ABSTRACT Objective To evaluate the clinical evolution and survival of neurocritical patients in Hospital Units. Method Cohort with hospitalized patients in follow-up treatment in public and private hospitals between September 2012 and June 2016. Data were initially analyzed from descriptive and inferential statistics. The Kaplan-Meier indicator was applied as a form of survival analysis. The Cox proportional hazards regression model was used to analyze the prognostic factors by calculating the hazard ratio. Results Participation of 1,289 patients in the study. Patients with a higher score on the Glasgow Coma Scale presented greater survival, and the one-point increase in the scale score corresponded to 42% improvement in their survival. In the analysis of survival, sex and the use of vasoactive drugs showed a significant difference. Conclusion Female patients with a better score on the Glasgow Coma Scale and using vasoactive drugs had higher survival rates.
☐ ☆ ✇ Revista da Escola de Enfermagem da USP

Alteraciones cardiorrespiratorias de pacientes sometidos a la oxigenoterapia hiperbárica

— Septiembre 16th 2019 at 15:03
RESUMO Objetivo Avaliar modificações cardiorrespiratórias em decorrência de sessão única de oxigenoterapia hiperbárica. Método Estudo aleatorizado com pacientes: grupos-controle e oxigenoterapia hiperbárica. As avaliações ocorreram no início, durante e após a exposição ao oxigênio puro acima de uma atmosfera, durante 2 horas. A pressão arterial sistêmica, saturação periférica de oxigênio, frequência de pulso, volume e capacidade pulmonar, pressões inspiratória e expiratória máximas foram avaliadas. A saturação periférica de oxigênio, frequência de pulso e pressão arterial sistêmica foram avaliadas durante a pressurização na primeira hora. Os dados foram avaliados pelo teste de ANOVA, Mann-Whitney e teste t independente (p<0,05). Resultados Foram avaliados 14 pacientes adultos. No grupo sob terapia (sete sujeitos), idade: 49,57±14,59 anos houve redução da frequência de pulso de 16 batimentos por minuto após 35 minutos de terapia (análise intragrupo), e a saturação periférica de oxigênio foi maior neste mesmo período se comparado ao grupo-controle. Conclusão A oxigenoterapia hiperbárica promove alterações cardiorrespiratórias com o aumento da saturação periférica de oxigênio e redução da frequência de pulso, sem alterar os níveis pressóricos arteriais e a força, volumes e capacidades respiratórios.
RESUMEN Objetivo Evaluar modificaciones cardiorrespiratorias consecuentes de sesión única de oxigenoterapia hiperbárica. Método Estudio aleatorizado con pacientes: grupos de control y oxigenoterapia hiperbárica. Las evaluaciones ocurrieron en el inicio, durante y después de la exposición al oxígeno puro por encima de una atmósfera, durante dos horas. La presión arterial sistémica, saturación periférica de oxígeno, frecuencia de pulso, volumen y capacidad pulmonar, presiones inspiratoria y espiratoria máximas fueron evaluadas. La saturación periférica de oxígeno, frecuencia de pulso y presión arterial sistémica fueron evaluadas durante la presurización en la primera hora. Los datos fueron evaluados por el test de ANOVA, Mann Whitney y prueba t independiente (p<0,05). Resultados Fueron evaluados 14 pacientes adultos. En el grupo bajo terapia (siete sujetos), edad: 49,57±14,59 años, hubo reducción de la frecuencia de pulso de 16 latidos por minuto tras 35 minutos de terapia (análisis intragrupo), y la saturación periférica de oxígeno fue mayor en ese mismo período si comparado con el grupo de control. Conclusión La oxigenoterapia hiperbárica proporciona alteraciones cardiorrespiratorias con el aumento de la saturación periférica de oxígeno y la reducción de la frecuencia de pulso, sin alterar los niveles de presión arteriales y la fuerza, volúmenes y capacidades respiratorios.
ABSTRACT Objective To evaluate cardiorespiratory alterations due to a single session of hyperbaric oxygen therapy. Method Randomized study with patients: a control group and hyperbaric oxygen therapy. Evaluations occurred in the beginning, during, and after exposure to pure oxygen above atmosphere for 2 hours. Systemic blood pressure, peripheral oxygen saturation, pulse rate, lung volume and lung capacity, and maximal inspiratory and expiratory pressures were evaluated. Peripheral oxygen saturation, pulse rate, and systemic blood pressure were evaluated during the pressurizing in the first hour. Data were evaluated by means of ANOVA, Mann-Whitney, and independent t-test (p<0.05). Results A total of 14 adult patients were evaluated. In the group under therapy (seven subjects), aged: 49.57±14.59 years, there was a decrease in the pulse rate of 16 beats per minute after 35 minutes of therapy (intragroup analysis), and the peripheral oxygen saturation was higher within the same period compared to the control group. Conclusion The hyperbaric oxygen therapy promotes cardiorespiratory alterations with the increase of the peripheral oxygen saturation and decrease of the pulse rate, without altering blood pressure levels and the strength, volumes, and respiratory capacities.
☐ ☆ ✇ Revista da Escola de Enfermagem da USP

El plan individual de parto como estrategia de enseñanza aprendizaje de las buenas prácticas de atención obstétrica

— Septiembre 16th 2019 at 15:03
RESUMO Objetivo Verificar o conhecimento de estudantes sobre o plano individual de parto e conhecer sua opinião a respeito da utilização dessa estratégia de ensino-aprendizagem e das boas práticas obstétricas. Método Estudo descritivo, com alunos de Obstetrícia que cursavam estágios na atenção básica. A coleta dos dados realizada de 01/2017 a 05/2017, por meio digital, na Plataforma Google Formulários®. A análise foi realizada por estatística descritiva de categorização de enunciados. O estudo seguiu os padrões éticos exigidos. Resultados O formulário foi enviado a 97 discentes e respondido por 40% deles. Todos os respondentes informaram conhecer o plano de parto, e 87% aplicaram-no durante o atendimento de pré-natal. Os apontamentos mais frequentes (45%) acerca do plano de parto foram os que promoviam empoderamento e autonomia à mulher. As sugestões metodológicas mais citadas para a sua aplicação foram focar o conteúdo (76%) e aumentar o número de encontros (50%). O plano individual de parto foi reconhecido por 79% dos participantes como importante estratégia de ensino. Conclusão Além de conhecerem o plano de parto e aplicá-lo, os estudantes o consideram muito relevante para o ensino e a aprendizagem das boas práticas obstétricas.
RESUMEN Objetivo Verificar el conocimiento de estudiantes acerca del plan individual de parto y conocer su comprensión respecto de la utilización de dicha estrategia de enseñanza aprendizaje y de las buenas prácticas obstétricas. Método Estudio descriptivo, con alumnos de Obstetricia que cursaban pasantías en la atención básica. La recolección de datos fue realizada de 01/2017 a 05/2017, por medio electrónico, en la Plataforma Google Formularios®. El análisis fue llevado a cabo por estadística descriptiva de categorización de enunciados. El estudio siguió los estándares éticos exigidos. Resultados El formulario fue enviado a 97 discentes y respondido por el 40% de ellos. Todos los respondedores informaron conocer el plan de parto, y el 87% lo aplicaron durante la atención de prenatal. Los planteamientos más frecuentes (45%) acerca del plan de parto fueron los que promovían empoderamiento y autonomía a la mujer. Las sugerencias metodológicas más citadas para su aplicación fueron enfocar el contenido (76%) y aumentar el número de encuentros (50%). El plan individual de parto fue reconocido por el 79% de los participantes como importante estrategia de enseñanza. Conclusión Además de conocer el plan de parto y aplicarlo, los estudiantes lo consideran muy relevante para la enseñanza y el aprendizaje y de las buenas prácticas obstétricas.
ABSTRACT Objective To verify students’ knowledge about individual birth planning and learn their opinion about the use of this teaching-learning strategy for good obstetric practices. Method This is a descriptive study conducted with midwifery students who made primary health care internships. Data collection was performed digitally from 01/2017 to 05/2017 through the Google Forms®Platform. The analysis was performed by descriptive categorization statistics of statements. The study followed the required ethical standards. Results The form was sent to 97 students and answered by 40% of them. All respondents reported knowing the birth planning, and 87% applied it during prenatal care. The most frequent (45%) points about the birth plan were those that promoted women’s empowerment and autonomy. The most cited methodological suggestions for its application were to focus on content (76%) and increase the number of meetings (50%). Individual birth planning was recognized by 79% of the participants as an important teaching strategy. Conclusion In addition to knowing birth planning and applying it, the students consider it very relevant for teaching and learning good obstetrical practices.
☐ ☆ ✇ Evidencias Cochrane

Aspirina como tratamiento complementario de los antipsicóticos para los pacientes con esquizofrenia

— Septiembre 16th 2019 at 13:01
Antecedentes La esquizofrenia es una enfermedad mental grave que afecta a alrededor de 21 millones de personas en todo el mundo. Los síntomas de la esquizofrenia habitualmente se clasifican en positivos (p. ej. alucinaciones y pensamientos delirantes), negativos (p. ej. retraimiento y dificultad en
☐ ☆ ✇ Evidencias Cochrane

¿Las intervenciones para dejar de fumar son efectivas para dejar de fumar y reducir la actividad de la enfermedad en pacientes con enfermedad articular inflamatoria crónica?

— Septiembre 16th 2019 at 13:01
Antecedentes El hábito de fumar tabaco aumenta el riesgo de desarrollar enfermedades inflamatorias articulares (EIA) como la artritis reumatoide, donde las articulaciones reciben un daño progresivo por parte del propio sistema inmunológico del cuerpo. El hábito de fumar también puede empeorar los
☐ ☆ ✇ Evidencias Cochrane

Medicamentos para tratar el delirio en pacientes adultos en estado grave

— Septiembre 16th 2019 at 13:01
Pregunta de la revisión Se examinó la evidencia de los ensayos controlados aleatorios sobre los beneficios y la seguridad de todos los medicamentos recetados utilizados para el tratamiento de los pacientes adultos en estado grave con delirio en las unidades de cuidados intensivos (UCI)
☐ ☆ ✇ Evidencias Cochrane

Balneoterapia para la insuficiencia venosa crónica (IVC)

— Septiembre 16th 2019 at 13:01
Antecedentes La insuficiencia venosa crónica es una enfermedad causada por el transporte anormal de sangre a las venas de las extremidades inferiores, lo que significa que las venas no pueden bombear suficiente sangre de vuelta al corazón. Este trastorno es definido por varios signos, de los cuales
☐ ☆ ✇ Evidencias Cochrane

Antiarrítmicos para mantener el ritmo sinusal (latidos cardíacos normales) después de revertir la fibrilación auricular (corrección de un latido cardíaco irregular)

— Septiembre 16th 2019 at 13:01
Pregunta de la revisión Se examinó la evidencia acerca del efecto de los fármacos antiarrítmicos sobre la mortalidad (muerte), el accidente cerebrovascular, los efectos secundarios que dan lugar a que los pacientes dejen de tomar el medicamento y las recurrencias de latidos cardíacos irregulares,
☐ ☆ ✇ Evidencias Cochrane

Certolizumab pegol para el tratamiento de la enfermedad de Crohn activa

— Septiembre 16th 2019 at 13:01
Pregunta de la revisión Se examinó la evidencia sobre los efectos beneficiosos y perjudiciales del certolizumab pegol en pacientes con enfermedad de Crohn activa. Antecedentes La enfermedad de Crohn es una enfermedad inflamatoria crónica que afecta principalmente el tubo digestivo, como el
☐ ☆ ✇ Evidencias Cochrane

Prebióticos para prevenir la hiperbilirrubinemia en recién nacidos

— Septiembre 16th 2019 at 12:01
Pregunta de la revisión: ¿Los prebióticos previenen la hiperbilirrubinemia (niveles elevados de bilirrubina que lleva a ictericia) en los recién nacidos? Antecedentes: La ictericia ocurre en cerca de dos tercios de todos los recién nacidos durante los primeros días de vida. La fototerapia se
☐ ☆ ✇ Evidencias Cochrane

Conflictos de intereses financieros y resultados, conclusiones y calidad de las revisiones sistemáticas

— Septiembre 16th 2019 at 12:01
Las prácticas de tratamiento de los pacientes a menudo se basan en la investigación clínica. Las revisiones sistemáticas son un tipo fundamental de investigación clínica de este tipo. Cuando se han realizado varios estudios similares (es decir, estudios que investigan las mismas preguntas mediante
☐ ☆ ✇ BMJ Open

Evaluating the impact of cycle helmet use on severe traumatic brain injury and death in a national cohort of over 11000 pedal cyclists: a retrospective study from the NHS England Trauma Audit and Research Network dataset

Por: Dodds · N. · Johnson · R. · Walton · B. · Bouamra · O. · Yates · D. · Lecky · F. E. · Thompson · J. — Septiembre 13th 2019 at 17:20
Objectives

In the last 10 years there has been a significant increase in cycle traffic in the UK, with an associated increase in the overall number of cycling injuries. Despite this, and the significant media, political and public health debate into this issue, there remains an absence of studies from the UK assessing the impact of helmet use on rates of serious injury presenting to the National Health Service (NHS) in cyclists.

Setting

The NHS England Trauma Audit and Research Network (TARN) Database was interrogated to identify all adult (≥16 years) patients presenting to hospital with cycling-related major injuries, during a period from 14 March 2012 to 30 September 2017 (the last date for which a validated dataset was available).

Participants

11 patients met inclusion criteria. Data on the use of cycling helmets were available in 6621 patients.

Outcome measures

TARN injury descriptors were used to compare patterns of injury, care and mortality in helmeted versus non-helmeted cohorts.

Results

Data on cycle helmet use were available for 6621 of the 11 192 cycle-related injuries entered onto the TARN Database in the 66 months of this study (93 excluded as not pedal cyclists). There was a significantly higher crude 30-day mortality in un-helmeted cyclists 5.6% (4.8%–6.6%) versus helmeted cyclists 1.8% (1.4%–2.2%) (p

Conclusions

This study suggests that there is a significant correlation between use of cycle helmets and reduction in adjusted mortality and morbidity associated with TBI and facial injury.

☐ ☆ ✇ BMJ Open

Investigating the impact of enhanced community case management and monthly screening and treatment on the transmissibility of malaria infections in Burkina Faso: study protocol for a cluster-randomised trial

Por: Collins · K. A. · Ouedraogo · A. · Guelbeogo · W. M. · Awandu · S. S. · Stone · W. · Soulama · I. · Ouattara · M. S. · Nombre · A. · Diarra · A. · Bradley · J. · Selvaraj · P. · Gerardin · J. · Drakeley · C. · Bousema · T. · Tiono · A. — Septiembre 13th 2019 at 17:20
Introduction

A large proportion of malaria-infected individuals in endemic areas do not experience symptoms that prompt treatment-seeking. These asymptomatically infected individuals may retain their infections for many months during which sexual-stage parasites (gametocytes) are produced that may be transmissible to mosquitoes. Reductions in malaria transmission could be achieved by detecting and treating these infections early. This study assesses the impact of enhanced community case management (CCM) and monthly screening and treatment (MSAT) on the prevalence and transmissibility of malaria infections.

Methods and analysis

This cluster-randomised trial will take place in Sapone, an area of intense, highly seasonal malaria in Burkina Faso. In total, 180 compounds will be randomised to one of three interventions: arm 1 - current standard of care with passively monitored malaria infections; arm 2 - standard of care plus enhanced CCM, comprising active weekly screening for fever, and detection and treatment of infections in fever positive individuals using conventional rapid diagnostic tests (RDTs); or arm 3 - standard of care and enhanced CCM, plus MSAT using RDTs. The study will be conducted over approximately 18 months covering two high-transmission seasons and the intervening dry season. The recruitment strategy aims to ensure that overall transmission and force of infection is not affected so we are able to continuously evaluate the impact of interventions in the context of ongoing intense malaria transmission. The main objectives of the study are to determine the impact of enhanced CCM and MSAT on the prevalence and density of parasitaemia and gametocytaemia and the transmissibility of infections. This will be achieved by molecular detection of infections in all study participants during start and end season cross-sectional surveys and routine sampling of malaria-positive individuals to assess their infectiousness to mosquitoes.

Ethics and dissemination

The study has been reviewed and approved by the London School of Hygiene and Tropical Medicine (LSHTM) (Review number: 14724) and The Centre National de Recherche et de Formation sur le Paludisme institutional review board (IRB) (Deliberation N° 2018/000002/MS/SG/CNRFP/CIB) and Burkina Faso national medical ethics committees (Deliberation N° 2018-01-010).

Findings of the study will be shared with the community via local opinion leaders and community meetings. Results may also be shared through conferences, seminars, reports, theses and peer-reviewed publications; disease occurrence data and study outcomes will be shared with the Ministry of Health. Data will be published in an online digital repository.

Trial registration number

NCT03705624.

☐ ☆ ✇ BMJ Open

Barriers and enablers for the implementation of clinical practice guidelines in China: a mixed-method study

Por: Jin · Y. · Li · Z. · Han · F. · Huang · D. · Huang · Q. · Cao · Y. · Weng · H. · Zeng · X.-T. · Wang · X. · Shang · H.-C. — Septiembre 13th 2019 at 17:20
Objectives

The aim of this study was to explore perspectives and reasoning of medical staff from Class A tertiary hospitals about the factors hindering and facilitating the uptake and use of clinical practice guidelines (CPGs) during medical procedures.

Design

Mixed-method research study to collect and analyse both quantitative and qualitative data.

Setting

Class A tertiary hospitals in China.

Participants

The inclusion criteria for the questionnaire survey and qualitative research were (1) medical practitioners and (2) years of practice: above 5 years in a tertiary hospital.

Methods

Questionnaires were distributed to medical staff in 11 cities to collect quantitative data. Frequency and ranking of barriers and enablers were analysed. Spearman correlations were computed to explore the correlation between years of practice, professional title ranking and educational background with self-reported guideline adherence. Using a constructivist grounded theory method, qualitative data were generated via in-depth face-to-face interviews with Chinese medical practitioners.

Results

A total of 359 medical practitioners were surveyed and 32 medical practitioners interviewed in 11 cities. Higher frequency and higher ranking of barriers all converged on ‘lack of access’, ‘less convenient’, ‘lack of applicability’ and ‘lack of evidence from Chinese sample’. Higher frequency and higher ranking of enablers converged on ‘Short formats presentation’, ‘Utilisation of various media’, ‘Information visualisation’ and ‘Linking to patient electronic medical records’. There were no relationships between characteristics of respondents with self-reported adherence. This research produced a theoretical understanding of the experience of medical practitioners when using guidelines. Themes identified were as follows: existing intrinsic flaws in guidelines, deficient or incomplete system mechanism and being ambiguous.

Conclusion

Our findings provide a comprehensive and culturally sensitive perspective in understanding guideline implementation in China. Strategies addressing those barriers should be further discussed and researched in the future.

☐ ☆ ✇ BMJ Open

Completeness of obstetric referral letters/notes from subdistrict to district level in three rural districts in Greater Accra region of Ghana: an implementation research using mixed methods

Por: Amoakoh-Coleman · M. · Ansah · E. · Klipstein-Grobusch · K. · Arhinful · D. — Septiembre 13th 2019 at 17:20
Objective

To assess the completeness of obstetric referral letters/notes at the district level of healthcare.

Design

An implementation research within three districts in Greater Accra region using mixed methods. During baseline and intervention phases, referral processes for all obstetric referrals from lower level facilities seen at the district hospitals were documented including indications for referrals, availability and completeness of referral notes/forms. An assessment of before and after intervention availability and completeness of referral forms was carried out. Focus group discussions, non-participant observations and in-depth interviews with health workers and pregnant women were conducted for qualitative data.

Setting

Three (3) districts in the Greater Accra region of Ghana.

Participants

Pregnant women referred from lower levels of care to and seen at the district hospital, health workers within the three districts and pregnant women attending antenatal clinic in the district and their family members or spouses.

Intervention

An enhanced interfacility referral communication system consisting of training, provision of communication tools for facilities, formation of hospital referral teams and strengthening feedback mechanisms.

Outcome

Completeness of obstetric referral letters/notes.

Results

Proportion of obstetric referrals with referral notes improved from 27.2% to 44.3% from the baseline to intervention period. Mean completeness (95% CI) of all forms was 71.3% (64.1% to 78.5%) for the study period, improving from 70.7% (60.4% to 80.9%) to 71.9% (61.1% to 82.7%) from baseline to intervention periods. Health workers reported they do not always provide referral notes and that most referral notes are not completely filled due to various reasons.

Conclusions

Most obstetric referrals did not have referral notes. The few notes provided were not completely filled. Interventions such as training of health workers, regular review of referral processes and use of electronic records can help improve both the provision of and completeness of the referral notes.

☐ ☆ ✇ BMJ Open

General practitioners predictions of their own patients health literacy: a cross-sectional study in Belgium

Por: Storms · H. · Aertgeerts · B. · Vandenabeele · F. · Claes · N. — Septiembre 13th 2019 at 17:20
Objectives

To support patients in their disease management, providing information that is adjusted to patients’ knowledge and ability to process health information (ie, health literacy) is crucial. To ensure effective health communication, general practitioners (GPs) should be able to identify people with limited health literacy. To this end, (dis)agreement between patients’ health literacy and GPs’ estimations thereof was examined. Also, characteristics impacting health literacy (dis)agreement were studied.

Design

Cross-sectional survey of general practice patients and GPs undertaken in 2016–17.

Setting

Forty-one general practices in two Dutch-speaking provinces in Belgium.

Participants

Patients (18 years of age and older) visiting general practices. Patients were excluded when having severe impairments (physical, mental, sensory).

Main outcome measures

Patients’ health literacy was assessed with 16-item European Health Literacy Survey Questionnaire. GPs indicated estimations on patients’ health literacy using a simple scale (inadequate; problematic; adequate). (Dis)agreement between patients’ health literacy and GPs’ estimations thereof (GPs’ estimations being equal to/higher/lower than patients’ health literacy) was measured using Kappa statistics. The impact of patient and GP characteristics, including duration of GP–patient relationships, on this (dis)agreement was examined using generalised linear logit model.

Results

Health literacy of patients (n=1375) was inadequate (n=201; 14.6%), problematic (n=299; 21.7%), adequate (n=875; 63.6%). GPs overestimated the proportion patients with adequate health literacy: adequate (n=1241; 90.3%), problematic (n=130; 9.5%) and inadequate (n=4; 0.3%). Overall, GPs’ correct; over-/underestimations of health literacy occurred for, respectively, 60.9%; 34.2%; 4.9% patients, resulting in a slight agreement (=0.033). The likelihood for GPs to over-/underestimate patients’ health literacy increases with decreasing educational level of patients; and decreasing number of years patients have been consulting with their GP.

Conclusions

Intuitively assessing health literacy is difficult. Patients’ education, the duration of GP–patient relationships and GPs’ gender impact GPs’ perceptions of patients’ health literacy.

☐ ☆ ✇ BMJ Open

Psychometric properties of the Arabic version of EPDS and BDI-II as a screening tool for antenatal depression: evidence from Qatar

Por: Naja · S. · Al-Kubaisi · N. · Chehab · M. · Al-Dahshan · A. · Abuhashem · N. · Bougmiza · I. — Septiembre 13th 2019 at 17:20
Objectives

The current study aimed to validate and determine the psychometric properties of the Arabic versions of the Beck Depression Inventory-II (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS) in Qatar.

Design

A cross-sectional study design was employed.

Setting

Antenatal care (ANC) clinics at nine primary healthcare centres.

Participants

Pregnant women (n=128) aged 15–46 years in different trimesters of pregnancy, attending the ANC clinics as well as capable of reading and writing in the Arabic language.

Results

A total of 128 participants were enrolled. On conducting the receiver operating characteristic (ROC) analysis, the EPDS showed a larger area under the curve at 0.951 than the BDI-II tool (0.912). Using Youden’s index, a score >13 on the EPDS (87% sensitivity, 90% specificity) and >19 on the BDI-II (96% sensitivity, 73% specificity) allowed for the greatest division between depressed and non-depressed participants.

Conclusion

To address the under-recognition of antenatal depression, physicians at primary healthcare centres in Qatar should be encouraged to utilise the EPDS to screen pregnant women seeking ANC services.

☐ ☆ ✇ BMJ Open

Patient and provider factors associated with enrolment in the pre-end-stage renal disease pay-for-performance programme in Taiwan: a cross-sectional study

Por: Hu · H.-Y. · Jian · F.-X. · Lai · Y.-j. · Yen · Y.-F. · Huang · N. · Hwang · S. J. — Septiembre 13th 2019 at 17:20
Objective

The incidence and prevalence of end-stage renal disease (ESRD) in Taiwan have been ranked the highest worldwide. Therefore, the National Health Insurance Administration has implemented the pre-ESRD pay-for-performance (P4P) programme since November 2006, which had significantly reduced the incidence of dialysis and all-cause mortality. This study aimed to identify the factors associated with the enrolment in the pre-ESRD P4P programme.

Design

Cross-sectional study.

Setting

The National Health Insurance research database 2007–2012 in Taiwan.

Participants

Patients with prevalent pre-ESRD aged more than 18 years between January 2007 and December 2012 were enrolled. Patient demographics and hospital characteristics between P4P and non-P4P groups were compared. A logistic regression model was used to analyse the factors associated with P4P enrolment, and a generalised estimating equation was used to verify the results.

Primary outcome measure

Enrolment in the pre-ESRD P4P programme.

Results

In total, 82 991 patients were enrolled in the programme, with a 45.6% participation rate. Patients who were males (adjusted OR (AOR)=0.89, 95% CI=0.86 to 0.91) and employed (AOR=0.95, 95% CI=0.92 to 0.97) had a significantly lower probability to be enrolled in the programme. Older patients (66–75 years old, AOR=1.23, 95% CI=1.14 to 1.33) and those with higher Charlson Comorbidities Index (CCI 5+, AOR=4.01, 95% CI=3.55 to 4.53) tended to be enrolled in the programme, while those in the 76+ years age group were not (AOR=1.03, 95% CI=0.95 to 1.13). Hospitals located in the central (AOR=1.48, 95% CI=1.05 to 2.08) and Kao-Ping regions (AOR=1.62, 95% CI=1.18 to 2.22) also tended to enrol patients in the pre-ESRD P4P programme. Enrolment rates increased over time.

Conclusion

Pre-ESRD patients of the female gender, greater age and more comorbidities were more likely to be enrolled in the pre-ESRD P4P programme. Healthcare providers and health authorities should focus attention on patients who are male, younger and with less comorbidities to improve the healthcare quality and equality for all pre-ESRD patients.

☐ ☆ ✇ BMJ Open

Reconceptualising precision public health

Por: Olstad · D. L. · McIntyre · L. — Septiembre 13th 2019 at 17:20

As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalisation, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalisation within research and practice. Social position shapes individuals’ unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualisations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalising these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to the identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualised thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.

As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalization, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalization within research and practice. Social position shapes individuals’ unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualizations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalizing these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualized thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.

☐ ☆ ✇ BMJ Open

Sedation versus general anaesthesia in endovascular therapy for anterior circulation acute ischaemic stroke: the multicentre randomised controlled AMETIS trial study protocol

Por: Chabanne · R. · Fernandez-Canal · C. · Degos · V. · Lukaszewicz · A.-C. · Velly · L. · Mrozek · S. · Perrigault · P.-F. · Molliex · S. · Tavernier · B. · Dahyot-Fizelier · C. · Verdonk · F. · Caumon · E. · Masgrau · A. · Begard · M. · Chabert · E. · Ferrier · A. · Jaber · S. · Bazin · J.- — Septiembre 13th 2019 at 17:20
Introduction

Endovascular thrombectomy is the standard of care for anterior circulation acute ischaemic stroke (AIS) secondary to emergent large vessel occlusion in patients who qualify. General anaesthesia (GA) or conscious sedation (CS) is usually required to ensure patient comfort and avoid agitation and movement during thrombectomy. However, the question of whether the use of GA or CS might influence functional outcome remains debated. Indeed, conflicting results exist between observational studies with better outcomes associated with CS and small monocentric randomised controlled trials favouring GA. Therefore, we aim to evaluate the effect of CS versus GA on functional outcome and periprocedural complications in endovascular mechanical thrombectomy for anterior circulation AIS.

Methods and analysis

Anesthesia Management in Endovascular Therapy for Ischemic Stroke (AMETIS) trial is an investigator initiated, multicentre, prospective, randomised controlled, two-arm trial. AMETIS trial will randomise 270 patients with anterior circulation AIS in a 1:1 ratio, stratified by centre, National Institutes of Health Stroke Scale (≤15 or >15) and association of intravenous thrombolysis or not to receive either CS or GA. The primary outcome is a composite of functional independence at 3 months and absence of perioperative complication occurring by day 7 after endovascular therapy for anterior circulation AIS. Functional independence is defined as a modified Rankin Scale score of 0–2 by day 90. Perioperative complications are defined as intervention-associated arterial perforation or dissection, pneumonia or myocardial infarction or cardiogenic acute pulmonary oedema or malignant stroke evolution occurring by day 7.

Ethics and dissemination

The AMETIS trial was approved by an independent ethics committee. Study began in august 2017. Results will be published in an international peer-reviewed medical journal.

Trial registration number

NCT03229148.

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