Extra-hospital Care Research Articles

The perception of the information received from the doctor. A study on 103 onco-hematological patients with metastatic disease.

The aim of the study was to evaluate the perception that onco-hematological patients with metastatic disease have regarding the information received on their disease and treatment. Method. EORTC QLQ-INFO25 was administered anonymously to 103 patients.
 Results. 69% of patients were satisfied and 76% rate the information received very useful. More than half of the sample is not satisfied with the information on the effects of therapy on social and family life (53%), the effects of therapy on sexual activity (73%), the possibility of receiving extra-hospital care (78%), the rehabilitation services (81%), how to manage the disease at home (56%), the professional psychological support (69%). Overall, 46% would have preferred to receive more information, and 2% less. Discussion. The responses show that the greatest satisfaction is for the areas of purely medical relevance (information on the disease, information on medical investigations and information on the therapy carried out). Information by the doctor becomes deficient, from the patient's point of view, for those thematic areas that doctors did not consider to be their competence. Conclusion. Our data shows the lack of exchange between doctor and patient, in both directions and highlighted the need for training doctors on communication skills on psycho-social issues and quality of life concerns.

The role of exhaled nitric oxide in patients with chronic obstructive pulmonary disease undergoing laparotomy surgery – The noxious study

BackgroundChronic Obstructive Pulmonary Disease (COPD) has been associated with major perioperative morbidities or mortalities, especially in surgical patients receiving general anesthesia. The severity of the COPD and the degree of bronchial hyperreactivity can determine the perioperative anesthetic risk; therefore they have to be assessed by a thorough preoperative evaluation in order to give the rationale on which to decide for optimum anesthetic management. ObjectiveAim of the study was to assess the predictive applicability of exhaled Nitric Oxide (NO) in smoking surgical population with COPD, on the basis of morbidity and mortality. MethodsA prospective, observational study was undertaken in 70 smoking patients diagnosed with COPD scheduled for laparotomy surgery under general anesthesia COPD was evaluated with the GOLD Classification of Air Flow Limitation, the Modified MRC Dyspnoea Scale (mMRC), the BODE Index score and the 6 Minutes Walk Distance (6MWD) using spirometry parameters. All patients were observed for presenting perioperative and postoperative respiratory complications. A cut off value of 19 ppb was determined for fractional exhaled nitric oxide measured at expiratory flow of 50 mL/s (FENO50) to differentiate patients poor prognosis from those with favorable outcome. ResultsPatients with severe COPD had high BODE index score as well as FENO50. Elevated FENO50 is significantly related to multiple complications (p = 0.004) and postoperative cough (p < 0.001). Patients from the high FENO50 group that were not treated with steroids had a statistically significant higher incidence of extra hospital care need (p < 0.001). Increased FENO50 and ABCD classification are both related with the presentation of multiple complications (Odds ratio = 2.5, 95% CI 1.1 to 5.7, p = 0.028 for ABCD and Odds ratio = 6.39, 95% CI 1.33 to 30.5, p = 0.020 for FENO50). Increased FENO50 and ABCD are related with extra hospital care (p = 0.001 and p = 0.002 respectively) and combined with corticosteroid administration could predict the necessity for extra hospital care (Odds ratio 4.09, 95% CI 1.1 to 15.3, p = 0.036 for corticosteroid treatment, odds ratio 2.4, 95% CI 1.1 to 5.1, p = 0.029 for ABCD and odds ratio 7.93, 95% CI 1.7 to 35.3, p = 0.007 for FENO50). ConclusionThe FENO50 may identify high risk smoking surgical patients with COPD receiving general anesthesia. Perioperative and postoperative complications in COPD smoking patients undergoing abdominal surgery can be predicted using not only ABCD GOLD 2011 classification but also the FENO50 as a preoperative marker.

Terapia ocupacional nos contextos hospitalares: possibilidades e desafios da residência multiprofissional

Esse artigo e decorrente de uma apresentacao no Simposio de Terapia Ocupacional em Contextos Hospitalares sobre o tema a pos-graduacao no processo de formacao e pesquisa na Terapia Ocupacional em Contextos Hospitalares. Sem pretensao de esgotar um tema tao amplo, escolhemos fazer um pequeno recorte sobre a residencia multiprofissional. Pelo fato de ser uma experiencia nova em termos de terapia ocupacional consideramos oportuno pensar sobre o impacto que ela pode ter nao apenas na formacao de novos profissionais, mas tambem na pratica dos mais antigos. E importante pensar que se por um lado ela amplia possibilidades, por outra nos coloca desafios e a necessidade de refletir o que queremos: reproduzir modelos ja existentes de atuacao ou pensar novos modelos? Para isso, trazemos como exemplo dois dispositivos utilizados com os residentes para promover uma reflexao sobre a pratica: o diario reflexivo e o estudo de caso. Eles tem possibilitado novas reflexoes sobre as praticas existentes e a possibilidade de construcao de uma clinica ampliada. Acreditamos que a Residencia Multiprofissional possa ser uma otima possibilidade de consolidarmos a atuacao da TO em contextos hospitalares. Nao apenas pela chance de formacao e capacitacao de novos profissionais para o mercado, mas tambem de fazermos uma releitura de nossas praticas e contribuir para a construcao de um modelo de atencao mais integral. Entretanto, nenhum instrumento ou metodologia e magico ou transformador por si so, depende de como o utilizemos. Portanto isto nao esta posto, tem que ser construido por nos

Éditorial

Because of its sector-based organization and extra-hospital care, public psychiatry has a unique position in healthcare. This paper describes the tools and procedures used to analyze and allocate the resources of the "Centre Hospitalier Alpes-Isère", a hospital serving a catchment population of 530,000 adults. A consensus-based approach was used to validate the selected indicators and included the participation of a geographer. Five levels of resource allocation were identified and classified using a decision tree. At each level, the relevant authorities and criteria were identified as key components of the decision-making process. This paper describes the first three levels of care provision. Focusing on adult care, a comparative assessment of the resources allocated to general psychiatric care and specialist care was conducted, in addition to a comparative assessment of the resources allocated to each of the hospital's four local centers. Geographical accessibility to extramural facilities was also assessed. A study of the characteristics of each general psychiatry clinic revealed significant disparities. The paper highlights several issues: the poor knowledge of psychiatric epidemiological data relating to the population within the catchment area, the difficulty of assessing non-consolidated data or indicators from multiple sources, and the limited and partial nature of geographical data for characterizing and evaluating health care in the hospital's peripheral clinics. Several studies are currently underway to assess the operational effectiveness of the tools and procedures used to analyze and allocate resources.

Iniciativa multidisciplinaria para la mejora de la atención en el ataque cerebrovascular (ictus) en Andalucía: proyecto PLACA

A comprehensive and integrating approach of all emergency medical teams implied in cerebrovascular attack (CVA) has been proposed within the framework of Emergencies Andalusian Initiative. Key action points were: the identification of CVA by emergency medical teams, the development of extrahospital care protocols for the patients up to diagnostic confirmation, the implementation of specific assistance teams, the use of trustworthy epidemiological information, and the development of a training (and information) plan for health professionals. A multidisciplinary group was set up in order to propose improvement actions applicable to these key points in the area of a public health system and, finally, a consensus document was written that constituted the basis for Andalusian Acute Stroke Initiative (PLACA project).