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Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status

TERRA, Ricardo Mingarini; TEIXEIRA, Lisete Ribeiro; BIBAS, Benoit Jacques; PEGO-FERNANDES, Paulo Manuel; VARGAS, Francisco Suso; JATENE, Fabio Biscegli
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
36.720095%
OBJECTIVES: To evaluate the effectiveness and safety of pleurodesis carried out entirely on an outpatient basis in patients with recurrent malignant pleural effusions and Karnofsky Performance Status scores <70. METHODS: This study was a prospective trial comprising patients with symptomatic recurrent malignant pleural effusion and Karnofsky Performance Status scores <70 but >30. All selected patients underwent pleural catheter placement (14 Fr) in an outpatient facility. When chest radiography revealed post-drainage lung expansion of >90%, pleurodesis (3 g of talc) was performed. Catheters were maintained until the daily output was ,100 mL/day. The patients were evaluated in the first month and every three months thereafter for fluid recurrence, the need for additional procedures, and complications. RESULTS: During the study period (January 2005 to July 2007), 64 patients (24 men, 40 women), with an average age of 61.4 years, underwent elective chest tube drainage. Primary sites of the underlying malignancy were breast (27), lung (22), and others (15). Sixty-six pleural catheters were placed (bilaterally in 2 patients), and 52 talc pleurodesis procedures were performed. Fourteen patients had a trapped lung and were excluded from the trial. No complications were observed during catheter placement or pleurodesis. Post-pleurodesis complications included catheter obstruction (4 patients) and empyema (1). The average drainage time was 9.9 days. The recurrence rate observed in patients that were alive 30 days after pleurodesis was 13.9% (5/36 patients). Six patients required additional procedures after the pleurodesis. The average survival time was 101 days. CONCLUSION: In this study...

Outpatient treatment with intravenous antimicrobial therapy and oral levofloxacin in patients with febrile neutropenia and hematological malignancies

BELLESSO, Marcelo; COSTA, Silvia Figueiredo; PRACCHIA, Luis Fernando; DIAS, Lucia Cristina Santos; CHAMONE, Dalton; DORLHIAC-LLACER, Pedro Enrique
Fonte: SPRINGER Publicador: SPRINGER
Tipo: Artigo de Revista Científica
Português
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The purpose of this study was to evaluate outcomes such as success of the initial therapy, failure of outpatient treatment, and death in outpatient treatment during intravenous antimicrobial therapy in patients with febrile neutropenia (FN) and hematological malignancies. In addition, clinical and laboratory data and the Multinational Association for Supportive Care of Cancer index (MASCC) were compared with failure of outpatient treatment and death. In a retrospective study, we evaluated FN following chemotherapy events that were treated initially with cefepime, with or without teicoplanin and replaced by levofloxacin after 48 h of defervescence in patients with good general conditions and ANC > 500/mm(3). Of the 178 FN episodes occurred in 126 patients, we observed success of the initial therapy in 63.5% of the events, failure of outpatient treatment in 20.8%, and death in 6.2%. The success rate of oral levofloxacin after defervescence was 99% (95 out of 96). Using multivariate analysis, significant risks of failure of outpatient treatment were found to be smoking (odds ratio (OR) 3.14, confidence interval (CI) 1.14-8.66; p = 0.027) and serum creatinine levels > 1.2 mg/dL (OR 7.97, CI 2.19-28.95; p = 0.002). With regard to death...

Outpatient Radioiodine Therapy for Thyroid Cancer A Safe Nuclear Medicine Procedure

WILLEGAIGNON, Jose; SAPIENZA, Marcelo; ONO, Carla; WATANABE, Tomoco; GUIMARAES, Maria Ines; GUTTERRES, Ricardo; MARECHAL, Maria Helena; BUCHPIGUEL, Carlos
Fonte: LIPPINCOTT WILLIAMS & WILKINS Publicador: LIPPINCOTT WILLIAMS & WILKINS
Tipo: Artigo de Revista Científica
Português
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Purposes: To evaluate the dosimetric effect of outpatient radioiodine therapy for thyroid cancer in members of a patient`s family and their living environment, when using iodine-131 doses reaching 7.4 GBq. The following parameters were thus defined: (a) whole-body radiation doses to caregivers, (b) the production of contaminated solid waste, and (c) radiation potential and surface contamination within patients` living quarters. Methods: In total, 100 patients were treated on an outpatient basis, taking into consideration their acceptable living conditions, interests, and willingness to comply with medical and radiation safety guidelines. Both the caregivers and the radiation dose potentiality inside patients` residences were monitored by using thermoluminescent dosimeters. Surface contamination and contaminated solid wastes were identified and measured with a Geiger-Muller detector. Results: A total of 90 monitored individuals received a mean dose of 0.27 (+/- 0.28) mSv, and the maximum dose registered was 1.6 mSv. The mean value for the potential dose within all living quarters was 0.31(+/- 0.34) mSv, and the mean value per monitored surface was 5.58 Bq/cm(2) for all the 1659 points measured. The overall production of contaminated solid wastes was at a low level...

Could the treatment of differentiated thyroid carcinoma with 3.7 and 5.55 GBq of ((131)I)NaI, on an outpatient basis, be safe?

CARVALHO, Jose Willegaignon de Amorim de; SAPIENZA, Marcelo; ONO, Carla; WATANABE, Tomoco; GUIMARAES, Maria Ines; GUTTERRES, Ricardo; MARECHAL, Maria Helena; BUCHPIGUEL, Carlos
Fonte: LIPPINCOTT WILLIAMS & WILKINS Publicador: LIPPINCOTT WILLIAMS & WILKINS
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
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Objectives The first objective of this study was to evaluate the radiological impact on relatives and the environment because of outpatient treatment of differentiated thyroid carcinoma with 3.7 and 5.55 GBq of ((131)I)NaI. The second objective was to determine, analyze, and evaluate whole-body radiation dose to caregivers, the production of contaminated solid waste, and the potentiality of radiation dose and surface contamination existing inside patients` households. Methods Twenty patients were treated on an outpatient basis, taking into consideration their acceptable living conditions, interests, and willingness to comply with medical and radiation-safety guidelines. The caregivers themselves, as well as the potentiality of the radiation dose inside patients` residences, were monitored with a thermo-luminescence dosimeter. Surface contamination and contaminated solid wastes were identified and measured by using a Geiger-Muller detector. Results and discussion Twenty-six monitored individuals received accumulated effective radiation doses of less than 1.0 mSv, and only one 2.8 mSv, throughout the 7 days of measurement. The maximum registered value for the potential of radiation dose inside all living areas was 1.30 mSv. The monitored surface contamination inside patients` dwellings showed a mean value of 4.2 Bq/cm(2) for all surfaces found to be contaminated. A total of 2.5l of contaminated solid waste was generated by the patients with 3.33 MBq of all estimated activity. Conclusion This study revealed that the treatment of differentiated thyroid carcinoma with 3.7 and 5.55 GBq of ((131)I)NaI...

Molecular Characterization of Strains of Respiratory Syncytial Virus Identified in a Hematopoietic Stem Cell Transplant Outpatient Unit Over 2 Years: Community or Nosocomial Infection?

MACHADO, Adriana F.; SALLUM, Maria Anice M.; BOAS, Lucy S. Vilas; TATENO, Adriona F.; MACHADO, Clarisse M.
Fonte: ELSEVIER SCIENCE INC Publicador: ELSEVIER SCIENCE INC
Tipo: Artigo de Revista Científica
Português
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Respiratory syncytial virus (RSV) is recognized as the leading cause of nosocomial respiratory infection among hematopoietic stem cell transplant (HSCT) recipients, causing considerable morbidity and mortality. RSV is easily transmitted by contact with contaminated surfaces, and in HSCT units, more than 50% of RSV infections have been characterized as of nosocomial origin. From April 2001 to October 2002, RSV was identified by direct immunofluorescent assay in 42 symptomatic HSCT recipients. Seven RSV strains from 2001 and 12 RSV strains from 2002 were sequenced. RNA extraction, cDNA synthesis, and seminested polymerase chain reaction (PCR) with primers complementary to RSV genes G and F were pet-formed. PCR products were analyzed by nucleotide sequencing of the C-terminal region of gene G for typing (in group A or B). Of the 7 strains analyzed in 2001, only 2 belonged to group B; the other 5 belonged to group A. Of these 7 strains, 3 were identical and were from recipients receiving outpatient care. In 2002, of the 12 strains analyzed, 3 belonged to group A and the other 9 belonged to group B. Of these 9 strains, 7 were genetically identical and were also from recipients receiving outpatient care. Therefore, multiple strains of RSV cocirculated in the hematopoietic stem cell transplant units (ward and outpatient units) between 2001 and 2002. Nosocomial transmission was more likely to occur at the HSCT outpatient unit than in the HSCT ward. Infection control practices should also be implemented in the outpatient setting.; Fapesp[2001/11087-2]; Fapesp[2002 08465-8]; CAPES; Brazilian Ministry of Education

"Avaliação do estado de ansiedade em pacientes submetidos a cirurgias eletivas sob regime ambulatorial ou sob regime de internação" ; Evaluation of anxiety state in patients submitted to elective surgery in an outpatient or hospitalization regime

Giuntini, Patricia Bodnar
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 27/04/2006 Português
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Introdução. A ansiedade é um sentimento normal que prepara o organismo para situações adversas. É difícil de ser quantificada, porém pode ser estimada por meio de escalas subjetivas como a analógica visual, a comportamental e a verbal ou de maneira objetiva indireta por meio de parâmetros hemodinâmicos ou quantificação de hormônios do estresse no plasma ou na saliva. Cirurgias realizadas sob regime ambulatorial acarretam menor custo e menor índice de infecção hospitalar. No entanto, não existem dados suficientes para afirmar que a não internação hospitalar provoca menor grau de ansiedade nos pacientes. Objetivo. Quantificar e comparar mediante a utilização de escalas, questionários e dosagem do cortisol salivar, o grau de ansiedade de pacientes submetidas a cirurgias sob regime ambulatorial ou sob regime de internação. Casuística e método – Foram constituídos dois grupos de 12 pacientes cada um: grupo RA no qual as pacientes foram operadas eletivamente sob regime ambulatorial e grupo RI no qual as pacientes foram operadas eletivamente sob regime de internação. Todas as pacientes foram avaliadas quanto ao estado de ansiedade na véspera e no dia da cirurgia por meio da aplicação das escalas de Spielberger (traço e estado)...

Avaliação do resultado terapêutico de um ambulatório antitabágico multidisciplinar; Assessment of outpatient smoking cessation clinic, in a general hospital

Lotufo, João Paulo Becker
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 03/11/2014 Português
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INTRODUÇÃO: O tabagismo é reconhecido, atualmente, como um dos maiores problemas de saúde em todo o mundo. Há uma "epidemia" global de uso de tabaco nos países em desenvolvimento, no século 21. OBJETIVOS: Analisar: as características gerais dos indivíduos matriculados espontaneamente em um ambulatório antitabágico; a eficácia geral do tratamento antitabágico e dos medicamentos; as mudanças nas características dos participantes antes e após a Lei Ambiente Fechado Livre do Cigarro em São Paulo e os níveis de cotinina urinária em fumantes ativos, passivos e controles. CASUÍSTICA E MÉTODOS: Foi realizado um estudo de coorte histórica cujo critério de inclusão foi a matrícula no ambulatório antitabágico do HU USP, no período de 2004 a 2011. Os dados foram coletados por meio de consulta a protocolos padronizados e ao sistema informatizado do serviço. Foram analisados os resultados de dosagens de cotinina e creatinina realizadas em amostras biológicas. RESULTADOS: Dentre os 1736 pacientes atendidos houve predomínio de mulheres (62,1%), brancos (75,3%) e indivíduos com idade entre 41 e 60 anos (63,1%). Aproximadamente 80% iniciaram o tabagismo antes dos 20 anos e 75% apresentaram grau de dependência moderado a grave. Dentre os 620 indivíduos acompanhados a partir de 2009...

A time series analysis of meteorological factors and hospital outpatient admissions for cardiovascular disease in the Northern district of Guizhou Province, China

Jie,Y.; Houjin,H.; Mengxue,Y.; Wei,Q.; Jie,X.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2014 Português
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Findings on the effects of weather on health, especially the effects of ambient temperature on overall morbidity, remain inconsistent. We conducted a time series study to examine the acute effects of meteorological factors (mainly air temperature) on daily hospital outpatient admissions for cardiovascular disease (CVD) in Zunyi City, China, from January 1, 2007 to November 30, 2009. We used the generalized additive model with penalized splines to analyze hospital outpatient admissions, climatic parameters, and covariate data. Results show that, in Zunyi, air temperature was associated with hospital outpatient admission for CVD. When air temperature was less than 10°C, hospital outpatient admissions for CVD increased 1.07-fold with each increase of 1°C, and when air temperature was more than 10°C, an increase in air temperature by 1°C was associated with a 0.99-fold decrease in hospital outpatient admissions for CVD over the previous year. Our analyses provided statistically significant evidence that in China meteorological factors have adverse effects on the health of the general population. Further research with consistent methodology is needed to clarify the magnitude of these effects and to show which populations and individuals are vulnerable.

The prevalence of medical/clinical technology over psychosocial care actions in outpatient mental health services

Fiorati,Regina Celia; Saeki,Toyoko
Fonte: ABRASCO - Associação Brasileira de Saúde Coletiva Publicador: ABRASCO - Associação Brasileira de Saúde Coletiva
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2013 Português
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The scope of this study was to evaluate how aspects of mental health policy in Brazil have been conceived and implemented in outpatient services, such as the Regional Outpatient Mental Health Clinic and the Psychosocial Care Center II, both in Ribeirão Preto, São Paulo. Semi-direct interviews and focus groups were conducted with 22 health professionals. The theoretical method and data analysis were supported by the dialectical hermeneutic framework of Jürgen Habermas. The following aspects were detected: considerable technological advancement in health actions and centrality of clinical-medical technology in relation to other nonmedical therapeutic actions; the prioritization of treatment options emphasizing pathology and drug therapy, and a process of mounting precariousness in labor relations. With respect to psychosocial rehabilitation, analysis revealed that instrumental and technically-oriented treatment is imposed upon the practical and dialogical rationale proposed by Brazilian Psychiatric Reform. As an alternative, participatory evaluative research is required in order to unify clinical and psychosocial rehabilitation actions in therapeutic projects, while establishing mechanisms to promote the improvement of care based on the psychosocial care model.

Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status

Terra,Ricardo Mingarini; Teixeira,Lisete Ribeiro; Bibas,Benoit Jacques; Pego-Fernandes,Paulo Manuel; Vargas,Francisco Suso; Jatene,Fabio Biscegli
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2011 Português
Relevância na Pesquisa
36.720095%
OBJECTIVES: To evaluate the effectiveness and safety of pleurodesis carried out entirely on an outpatient basis in patients with recurrent malignant pleural effusions and Karnofsky Performance Status scores <70. METHODS: This study was a prospective trial comprising patients with symptomatic recurrent malignant pleural effusion and Karnofsky Performance Status scores <70 but >30. All selected patients underwent pleural catheter placement (14 Fr) in an outpatient facility. When chest radiography revealed post-drainage lung expansion of >90%, pleurodesis (3 g of talc) was performed. Catheters were maintained until the daily output was ,100 mL/day. The patients were evaluated in the first month and every three months thereafter for fluid recurrence, the need for additional procedures, and complications. RESULTS: During the study period (January 2005 to July 2007), 64 patients (24 men, 40 women), with an average age of 61.4 years, underwent elective chest tube drainage. Primary sites of the underlying malignancy were breast (27), lung (22), and others (15). Sixty-six pleural catheters were placed (bilaterally in 2 patients), and 52 talc pleurodesis procedures were performed. Fourteen patients had a trapped lung and were excluded from the trial. No complications were observed during catheter placement or pleurodesis. Post-pleurodesis complications included catheter obstruction (4 patients) and empyema (1). The average drainage time was 9.9 days. The recurrence rate observed in patients that were alive 30 days after pleurodesis was 13.9% (5/36 patients). Six patients required additional procedures after the pleurodesis. The average survival time was 101 days. CONCLUSION: In this study...

Fatores de risco e acidentes ocupacionais em integrantes da equipe de enfermagem em ambulatório de especialidades de um hospital universitário; Risk factors and occupational accidents in members of a nursing team in an outpatient service in a university hospital

Valente, Neide Maria de Lourdes de Morais
Fonte: Universidade Federal de Goiás; Brasil; UFG; Programa de Pós-graduação em Ciências da Saúde (FM); Faculdade de Medicina - FM (RG) Publicador: Universidade Federal de Goiás; Brasil; UFG; Programa de Pós-graduação em Ciências da Saúde (FM); Faculdade de Medicina - FM (RG)
Tipo: Dissertação Formato: application/pdf
Português
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Nursing work exposes workers to risks that can lead to accidents and/or diseases. However, few studies investigate these risks and their consequences for nursing staff in outpatient services. The overall objective was to investigate the risk factors referred to by members of the nursing staff who work in outpatient specialties of a university hospital in the Midwest of Brazil. This cross-sectional, prospective, descriptive study, the data collection was performed using an instrument containing semi - structured questions administered at the time and place of work of the employee. The study included 76 nurses, with a mean age of 50 years, with time working in nursing for 17 years and working in outpatient service nine years. The results consisted of 410 responses concerning the exposure of professionals to risk factors, among which 133 were biological, psychosocial 133, 93 ergonomics, 32 physical and chemical 19. Approximately 90% of professionals reported using some type of Personal Protective Equipment, with gloves and masks the most used. Concern about occupational risks is insufficient to avoid them. New investigations on the subject are essential, as well as investments in preventive measures, such as physical infrastructure and continuing education.; O trabalho da enfermagem expõe seus profissionais a riscos que podem originar acidentes e/ou doenças. No entanto...

A cost analysis of inpatient compared with outpatient prostaglandin E₂ cervical priming for induction of labour: results from the OPRA trial; A cost analysis of inpatient compared with outpatient prostaglandin E(2) cervical priming for induction of labour: results from the OPRA trial

Adelson, P.; Wedlock, G.; Wilkinson, C.; Howard, K.; Bryce, R.; Turnbull, D.
Fonte: Australian Healthcare Association Publicador: Australian Healthcare Association
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
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Objective: To compare the costs of inpatient (usual care) with outpatient (intervention) care for cervical priming for induction of labour in women with healthy, low-risk pregnancies who are being induced for prolonged pregnancies or for social reasons. Methods: Data from a randomised controlled trial at two hospitals in South Australia were matched with hospital financial data. A cost analysis comparing women randomised to inpatient care with those randomised to outpatient care was performed, with an additional analysis focusing on those who received the intervention. Results: Overall, 48% of women randomised into the trial did not receive the intervention. Women randomised to outpatient care had an overall cost saving of $319 per woman (95% CI -$104 to $742) as compared with women randomised to usual care. When restricted to women who actually received the intervention, in-hospital cost savings of $433 (95% CI -$282 to $1148) were demonstrated in the outpatient group. However, these savings were partially offset by the cost of an outpatient priming clinic, reducing the overall cost savings to $156 per woman. Conclusions: Overall cost savings were not statistically significant in women who were randomised to or received the intervention. However...

Psychiatrische Institutsambulanzen in Baden-Württemberg : Behandlungsauftrag, Arbeitsweise, Evaluation; Psychiatric hospital outpatient clinics in Baden-Württemberg : specialization, prozesses, outcome evaluation

Köster, Margitta
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
Português
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Hintergrund: Im Zuge der Reform der gesetzlichen Krankenversicherung (GKV-Gesundheitsreformgesetz 2000) wurden seit April 2002 erstmals in Baden-Württemberg Psychiatrische Institutsambulanzen eingerichtet. Die vertraglichen Grundlagen fordern eine ergänzende zielgruppenorientierte Spezialversorgung, nämlich von chronisch und schwer psychisch Kranken sowie die Vermeidung von Krankenhausbehandlung. Methoden: Gegenstand der Untersuchung ist die Evaluation des neuen Versorgungsbausteins Psychiatrische Institutsambulanz. Der Zugang erfolgte unter 3 Aspekten: Im Rahmen einer multizentrischen Untersuchung wurden mittels ambulanter Basisdokumentation die Patientenstrukturen von 11 neu gegründeten Institutsambulanzen in Baden-Württemberg analysiert. Ein Vergleich der Einrichtungen sollte empirische Referenzwerte liefern, insbesondere hinsichtlich der Identifikation von Patientenprofilen und Aspekten der regionalen Versorgung. In Teil II wurde ein innovatives ambulantes Angebot für chronisch alkoholabhängige Patienten der Tübinger Institutsambulanz auf seine Erfolgsraten untersucht. Teil III evaluiert anhand bewährter Erfolgsstandards die Effektivität der Tübinger Institutsambulanz. Mittels Hospitalisierungsvergleich wurde an einer Stichprobe von 177 neu in die Institutsambulanz aufgenommenen Patienten und in einem Referenzzeitraum von 12 Monaten untersucht...

Die Behandlung depressiver Störungen durch den Allgemeinarzt im Unterschied zum Facharzt; Contrasting general practitioners with specialists regarding outpatient depression treatment in Germany

Salis, Lea Corina
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
Português
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Ausgangslage Hintergrund dieser Studie bilden qualitative Engpässe in der ambulanten Depressionsbehandlung in Deutschland. So bestehen auf behandlungsbezogener Ebene Defizite im adäquaten Erkennen und Behandeln und auf gesundheitspolitischer Ebene offene Herausforderungen in der interdisziplinären Zusammenarbeit zwischen Haus- und Fachärzten sowie ärztlichen Psychotherapeuten. Ziel Vorliegende Untersuchung hat zum Ziel, ein Modell für die Optimierung der ambulanten Depressionsbehandlung auf der Basis eines empirischen Vergleichs sowie aufgrund einer Literaturanalyse der aktuellen Situation in Deutschland zu entwickeln. Methodik Im Abstand von 6-8 Wochen wurden Einschätzungen von Haus- und Fachärzten zur Depressionsbehandlung unter Berücksichtigung von Patientenmeinungen erhoben und einander anhand von Einzelvergleichen gegenübergestellt. Vergleichsbasis bildeten unter anderem Daten zu Identifikation und Behandlung von Depressionen, Überweisung, Einstellung zur Behandlung sowie auf Patientenseite zu Gesundheitszustand, Zufriedenheit mit der Behandlung und medikamentöser Compliance. Insgesamt nahmen an dieser Studien 43 Haus- und 24 Fachärzte der Regionen Rheinland, Südbaden und München und 346 depressive Patienten dieser Ärzte an der Studie teil...

Measurement of nurses' workload in an oncology outpatient clinic

Souza,Célia Alves de; Jericó,Marli de Carvalho; Perroca,Marcia Galan
Fonte: Universidade de São Paulo, Escola de Enfermagem Publicador: Universidade de São Paulo, Escola de Enfermagem
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2014 Português
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The growing demand and the degree of patient care in oncological outpatient services, as well as the complexity of treatment have had an impact on the workload of nurses. This study aimed at measuring the workload and productivity of nurses in an oncological outpatient service. An observational study using a work sampling technique was conducted and included seven nurses working in an oncological outpatient service in the south-eastern region of Brazil. A total of 1,487 intervention or activity samples were obtained. Nurses used 43.2% of their time on indirect care, 33.2% on direct care, 11.6% on associated activities, and 12% on personal activities. Their mean productivity was 88.0%. The findings showed that nurses in this service spend most of their time in indirect care activities. Moreover, the productivity index in this study was above that recommended in the literature.

CIRURGIA AMBULATORIAL: DO CONCEITO À ORGANIZAÇÃO DE SERVIÇOS E SEUS RESULTADOS; OUTPATIENT SURGERY: THE CONCEPT, ORGANIZATION OF THE PROGRAM AND ITS´ RESULTS

Santos, José Sebastião; Sankarankutty, Ajith Kumar; Salgado Junior, Wilson; Kemp, Rafael; Leonel, Elias Paim; Silva Junior, Orlando Castro e
Fonte: Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto Publicador: Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Formato: application/pdf
Publicado em 30/09/2008 Português
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O desenvolvimento da cirurgia videoendoscópica, a introdução de drogas anestésicas de duração curta com efeitos colaterais reduzidos e as necessidades didáticas e assistenciais associadas à imperativa gestão racional dos leitos hospitalares têm contribuído para a expansão dos limites da cirurgia ambulatorial, em nosso meio. Esse trabalho traz os fundamentos da cirurgia ambulatorial nos seus aspectos conceituais, técnicos, éticos e legais. Nesse contexto, o processo de implantação de serviços de cirurgia ambulatorial de pequeno e grande porte e a evolução dos seus resultados são descritos. Finalmente, destaca-se o papel desse movimento técnico e político em sintonia com as diretrizes do Sistema Único de Saúde para a consolidação de uma rede de serviços de cirurgia ambulatorial que integra o Centro de Saúde Escola, o Hospital Estadual e o Hospital das Clínicas e conta com a cooperação da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo.; The progress of videoendoscopic surgery, the introduction of short-acting anesthetic drugs with fewer side-effects, as well as the need to teach and provide healthcare, in a scenario which mandates the rational use of available hospital beds has contributed to stretching the limits of outpatient surgery. This is a report on the fundamental conceptual aspects of outpatient surgery...

Plano de reformulação da assistência ambulatorial do Instituto Nacional de Previdência Social na cidade de São Paulo; Reformulation plan of the outpatient clinics of National Institute of Social Welfare in the city of S. Paulo, Brazil

Lima-Gonçalves, Ernesto; Fuchs, Milton; Almeida, Arthur de; Oguisso, Taka
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Artigo Avaliado pelos Pares Formato: application/pdf
Publicado em 01/06/1972 Português
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Foi apresentado plano de reformulação da assistência ambulatorial prestada pelo Instituto Nacional de Previdência Social a seus segurados e respectivos dependentes, na cidade de São Paulo, salientando, que uma avaliação desse tipo assume importância considerável, diante da carência de leitos hospitalares disponíveis. A primeira etapa do plano consistiu no levantamento da situação atual, o qual compreendeu três aspectos: quantitativos de pessoal, dimensionamento das instalações, localização em relação à área urbana. O resultado demonstrou deficiências em todos os Postos de Assistência, sob os três pontos de vista analisados. Foi elaborado plano de reformulação da rede ambulatorial, tomando por base a população previdenciária da cidade de São Paulo, a qual é de cerca de 4.500.000 pessoas. Esse plano funda-se em quatro premissas fundamentais: 1. dimensionamento adequado de unidades a serem construídas e definição das que deverão ser mantidas, de acordo com as necessidades das diferentes zonas da cidade; 2. localização adequada das novas unidades; 3. implantação de sistemas de unidades periféricas resultantes da integração de unidades da Secretaria da Saúde do Estado de São Paulo; 4. definição de retaguarda hospitalar adequada. O total de atendimentos capazes de serem oferecidos pela rede de Postos de Assistência...

Crianças/adolescentes em quimioterapia ambulatorial: implicações para a enfermagem; Niños y adolescentes en quimioterapia ambulatoria: implicaciones para enfermería; Children and adolecents in outpatient clinic chemotherapy: nursing implications

Costa, Juliana Cardeal da; Lima, Regina Aparecida Garcia de
Fonte: Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto Publicador: Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Formato: application/pdf
Publicado em 01/06/2002 Português
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A hospitalização era a indicação mais comum na assistência à criança com câncer, entretanto, um grande enfoque vem sendo dado à desospitalização, viabilizada através do seguimento ambulatorial e/ou assistência domiciliar (home care). O objetivo deste trabalho é analisar as dificuldades que os pais enfrentam no ambiente domiciliar, quando seus filhos são submetidos à quimioterapia ambulatorial. Para tanto, foi realizada uma entrevista semi-estruturada com os pais, nos meses de janeiro e fevereiro de 2000, na sala de quimioterapia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, da Universidade de São Paulo. Os resultados apontam as seguintes dificuldades: alteração no cotidiano familiar; comunicação ineficiente; alteração da auto-imagem e reação adversa à quimioterapia. Este trabalho possibilitou o acesso a informações de real interesse para assistência à criança/adolescente com câncer e sua família. A partir dos dados empíricos, elaborou-se uma cartilha de orientação para o cuidado domiciliar.; La hospitalización todavía es indicación común en el niño con cáncer, aun así, un gran énfasis viene siendo dado a la deshospitalización, conseguida a través del seguimiento ambulatorio...

Outpatient laparoscopic cholecystectomy: A new gold standard for cholecystectomy?

Bueno Lledó,J.; Planells Roig,M.; Arnau Bertomeu,C.; Sanahuja Santafé,A.; Oviedo Bravo,M.; García Espinosa,R.; Martí Obiol,R.; Espí Salinas,A.
Fonte: Revista Española de Enfermedades Digestivas Publicador: Revista Española de Enfermedades Digestivas
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/01/2006 Português
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Objective: to contribute our experience for five years in the implemetation of outpatient laparoscopic cholecystectomy (LC). Patients: between January 1999 and March 2004 we performed 504 outpatient LCs. We applied both exclusion and inclusion criteria, an anesthetic and surgical protocol, and discharge-specific criteria. Postoperative management in "fast track" regime. Postoperative period controlled by protocol, including phone calls after cholecystectomy. Results: the ambulatory percentage in the global series was 88.8%, and mean hospital stay was 6.1 hours. Fifty-one patients required overnight stays (10.1%), most of them for "social" causes. Five patients required admission (between 24 and 48 hours) for different causes (conversion to laparotomy, intraoperative neumothorax, and postoperative medical complications). Six patients (1.1%) were readmitted, and we observed 11.6% postoperative complications in the global series, with abdominal parietal pain being most frequent. Phone localization by 22.00 p.m. in the same day of surgery was 100% complete for outpatient cases. Postoperative surveillance within the first month after surgery was completed in 93.9%, and within th first year in 86.7% of patients. Conclusions: outpatient LC is safe and feasible...

The influence of patients' complexity and general practitioners' characteristics on referrals to outpatient health services in an Italian region

Valent,Francesca; Deroma,Laura; Franzo,Antonella; Gobbato,Michele; Simon,Giorgio; Canciani,Luigi; Zanier,Loris
Fonte: Istituto Superiore di Sanità Publicador: Istituto Superiore di Sanità
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2015 Português
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BACKGROUND. Patient referrals to outpatient health services may affect both health outcomes and health expenditures. General practitioners (GP) have a crucial role in driving the use of outpatient services and recognizing factors which affect referrals is important for health managers and planners. OBJECTIVES. We investigated patient- and physician-related determinants of patient referrals in an Italian region. METHODS. This was cross-sectional study based on the individual linkage of administrative databases from the health information system of the Friuli Venezia Giulia region. For each GP of the region, the association of the number of patient referrals to different types of outpatient services with the proportion of patients with chronic conditions, with the number of hospital admissions and drug prescriptions in 2012, and with GP's characteristics was investigated through multilevel multivariable Poisson regression models. RESULTS. Some chronic conditions (e.g., cancer, autoimmune diseases, endocrine diseases, digestive system diseases) were positively associated with the number of referrals, as were hospital admissions and drug prescriptions. Time since GP's graduation was inversely related with referrals. CONCLUSION. Patient complexity and GP's experience affect referral rates. These factors should be considered in case of a reorganization of the general practice structure in Friuli Venezia Giulia.