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    Aripiprazole in the treatment of posttraumatic stress disorder: an open-label trial
    (Associação Brasileira de Psiquiatria - ABP, 2008-12-01) Mello, Marcelo Feijó de [UNIFESP]; Costa, Mariana Cadrobbi Pupo [UNIFESP]; Schoedl, Aline Ferri [UNIFESP]; Fiks, Jose Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: Post traumatic stress disorder is frequent in the general population (7.8%-lifetime-USA). The selective serotonin reuptake inhibitors are the first choice of treatment but result in low remission rates. This study aims to evaluate the effect of aripiprazole monotherapy for the treatment of post traumatic stress disorder. METHOD: Thirty-two patients diagnosed with post traumatic stress disorder were included in a 16-week open label trial of aripiprazole. They were evaluated at baseline, week 8, and 16 with the Clinician-Administered PTSD Scale, Beck Depression Inventory, Beck Anxiety Inventory, Medical Outcome Study Short Form 36, and Social Adjustment Scale. Statistical analysis were performed with an intention-to-treat approach and last observation carried forward. A general linear model for repeated measures comparing the factor with 3 continuous measures from baseline, 8 and 16 weeks was used. A between-subject factor was included RESULTS: Nine patients discontinued the treatment. The mean aripiprazole dose was 9.6 (± 4.3) mg/day. The mean scores at baseline and endpoint for all measures were: Clinician-Administered PTSD Scale - 82.7 (± 23.1) and 51.4 (± 31.4) (F = 11.247, p = 0.001); Beck Anxiety Inventory - 31.7 (± 13.4) and 25.4 (± 18.2) (F = 8.931, p = 0.011); Social Adjustment Scale - 2.4 (± 0.45) and 2.27 (± 0.57) (F = 8.633, p = 0.012); Medical Outcome Study Short Form 36 - 76.6 (± 14.11) and 94.01 (± 25.06) (F = 10.127 p = 0.007); and Beck Depression Inventory - 26.06 (± 11.6) and 21.35 (± 12.6) (F = 1.580, p = 0.042). In all measurements, the differences were statistically significant. CONCLUSIONS: Patients achieved a good response to treatment with aripiprazole, but placebo-controlled studies are needed for more accurate results.
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    Avaliação do perfil de reações adversas a medicamentos em pacientes internados no Hospital do Rim pós-transplante renal nos anos de 2019 e 2020
    (Universidade Federal de São Paulo, 2022-01-10) Callegari, Italo Rufino [UNIFESP]; Fonseca, Fernando Luiz Affonso [UNIFESP]; http://lattes.cnpq.br/6772382797320564
    Objetivo: Conduzir uma avaliação do perfil de reações adversas nos anos de 2019 e 2020 em pacientes pós-transplante renal. Métodos: Trata-se de um estudo do tipo corte transversal, com base de dados secundários, no intuito de conhecer as reações adversas que mais atingem pacientes pós-transplantados renais. A metodologia de busca de suspeita de reação adversa, foi realizada através da busca ativa pelos farmacêuticos do hospital. Critérios de inclusão: ser transplantado renal, estar internado no Hospital do Rim, apresentar suspeitas de reações adversas descritas no prontuário eletrônico do paciente e manifestar reações adversas nos primeiros 3 dias de tratamento. Não há critérios de exclusão. As reações adversas foram classificadas conforme o algoritmo de Naranjo para a causalidade e gravidade segundo Jeffrey K. Aronson e colaboradores. Análise estatística realziada pela correlação de Pearson. Os valores foram considerados estatisticamente significantes quando o valor de p<0,05. Resultados: Nos anos de 2019 e 2020 foram notificados 105 pacientes com reações adversas a medicamentos no Hospital do Rim. Dentre essas notificações, 35,2% (37) ocorreram ao longo do ano de 2019 e 64,7% (68) durante o ano de 2020. Na avaliação da gravidade das RAM’s, em 2019, 43,2% (16) das reações notificadas foram classificadas como leves, 29,7% (11) moderadas, 27% graves e não houve caso de reação adversa ao medicamento fatal. Em 2020, 67,6% (46) das reações notificadas foram classificadas como leves, 19,1% (13) moderadas, 11,7% graves e 1,5% (1) letal. Quanto à causalidade, em 2019, em um total de 37 notificações, se obteve 10,8% (4) das notificações classificadas como definida, 64,9% (24) provável, 24,3% (9) possível e não houve notificação classificada como duvidosa. No ano 2020, 68 notificações foram realizadas das quais 2,9% (2) foram classificadas como definidas, 83,8% (57) provável, 13,2% (9) possível, e novamente, não houve classificação considerada duvidosa. A correlação de gênero e reação adversa com 95% de confiança em 2019 foi p=0,8 e em 2020 p=0,8. Em relação a idade, com 95% de confiança em 2019 o valor p=0,7; em 2020 valor p=0,9. Conclusão: A análise do perfil de reações adversas a medicamentos em pacientes pós-transplante renal nos anos de 2019 e 2020 permitiu observar que a maioria das RAM’s observadas ocorrem em pacientes do sexo masculino, predominantemente adultos e idosos, embora não foi observado correlação estatística entre elas. Além disso, o estudo foi capaz de mostrar quais são as reações adversas que mais acontecem e quais os medicamentos relacionados a elas.
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    Diagnosis and therapeutical management offered to rheumatoid arthritis patients in Brazil - rheumatologists' answers from an assessment questionnaire
    (Medfarma-edicoes Medicas, Lda, 2009-01-01) Ferraz, Marcos Bosi [UNIFESP]; Soarez, Patricia Coelho de [UNIFESP]; Riera, Rachel [UNIFESP]; Ciconelli, Rozana Mesquita [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: The aim of this study was to evaluate in relation to diagnosis and treatment for Rheumatoid Arthritis (RA) patients Brazilian population, and compare the management offered to patients who are followed up in the public and private sectors.Material and Methods: An electronic questionnaire was sent to 650 rheumatologists, members of the Brazilian Rheumatology Society (SBR) and who were attending adult RA patients in the public and/or private sector, who had a contact e-mail address available in the SBR register and agreed to take part in the survey.Results: The rheumatologists estimated that 51.7% of the patients had had their disease diagnosed and of these, 56.1% were undergoing treatment. It was also estimated that 53.9% of the RA patients that was under treatment were being followed up by rheumatologists. The mean time interval estimated by the rheumatologists, between the appearance of the first symptoms of RA and the diagnosis made by a doctor, was greater among the patients who sought attendance in public services (1.8 years). There was no difference in clinical and radiographic assessment measures between the two types of service, with the exception of the application of HAQ, which was used more in public services. The principal drug association reported in both types of services was methotrexate and chloroquine. The rate of usage of associations between biological agents and methotrexate ranged from 6 to 8%. The main treatment-related difficulties were: access to the health system (public services) and cost of medication (private services).Conclusion: Approximately 50% of RA patients are being diagnosed and half of these are under treatment. There was no great difference in attendance within the public and private systems for these patients, whereas the main difficulty for the public system was access to attendance, for the private system it was the cost of the medication.
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    A espiritualidade em cuidados paliativos: estratégia de enfrentamento e conforto para pacientes, familiares e equipe multiprofissional
    (Universidade Federal de São Paulo, 2022-01-28) Gonçalves, Ana Rita de Araújo [UNIFESP]; Uchôa-Figueiredo, Lúcia da Rocha [UNIFESP]; http://lattes.cnpq.br/3179063226554474; Universidade Federal de São Paulo (UNIFESP)
    Introdução: Os cuidados paliativos consistem em uma abordagem para tratar pacientes com doenças ameaçadoras da continuidade da vida e seus familiares, tendo a espiritualidade como um dos âmbitos a serem abordados e acolhidos. Para tal, tem-se o capelão e/ou líderes religiosos que compõem a equipe paliativista, trabalhando a dimensão espiritual com todos os envolvidos nesta experiência, já que esta é de extrema valia dentro do delicado processo de contemplação da brevidade existencial em meio ao sofrimento. Objetivo: Buscar compreender sobre o enfrentamento dos cuidados de fim de vida e o quanto a espiritualidade proporciona maior conforto aos pacientes, familiares e a equipe. Metodologia: Este estudo trata de uma revisão bibliográfica realizada nas bases de dados Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Índice Bibliográfico Espanhol em Ciências da Saúde (IBECS) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), as pesquisas foram feitas nos meses de dezembro de dois mil e vinte e um (2021) e janeiro de dois mil e vinte e dois (2022), com os descritores “Cuidados paliativos” e “Espiritualidade”. Como critérios de inclusão foram selecionados os artigos dentro da temática, em português ou espanhol, publicados entre os últimos 5 anos, que contemplavam o público-alvo de adultos e/ou idosos e com acesso na íntegra. Sendo aqueles que abordavam a espiritualidade como parte essencial para os pacientes, equipe multiprofissional e seus familiares dentro dos cuidados paliativos. Foram excluídos os periódicos que não estavam em português ou espanhol, sem disponibilidade na íntegra de forma online, que focavam em áreas profissionais específicas, que foram publicados antes de 2016 e que abordavam a pediatria. Para incluir os artigos neste presente estudo, os mesmos foram lidos pelo seu resumo e atendendo aos critérios, separados para leitura total. Resultados: Os achados deste estudo mostraram que a espiritualidade é de suma importância para que os pacientes e seus familiares possam enfrentar o processo dos cuidados paliativos. Para as equipes, algumas pesquisas apontam que elas veem a espiritualidade como facilitadora e condutora das ações paliativistas, enquanto outras sentem insegurança e despreparo para abordar tal temática. Conclusão: A espiritualidade dentro dos cuidados paliativos é vista como estratégia de enfrentamento para os pacientes, familiares e equipe. Esta dimensão oferece conforto, como amparo, força, auxilia na manutenção da esperança e torna os indivíduos mais resilientes.
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    Estudo da Fase Intra-hospitalar da Revascularizacao Cirurgica do Miocardio em Pacientes Dialiticos
    (Sociedade Brasileira de Cardiologia - SBC, 2014-03-01) Miranda, Matheus; Hossne Junior, Nelson Americo [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Vargas, Guilherme Flora [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Juliano, Yara; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Santo Amaro
    Background:Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high.Objective:Evaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients.Methods:Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012.Results:High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality.Conclusion:Coronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions.
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    The experience of infectologists faced with death and dying among their patients over the course of the AIDS epidemic in the city of São Paulo: qualitative study
    (Associação Paulista de Medicina - APM, 2010-01-01) Shimma, Emi [UNIFESP]; Nogueira-Martins, Maria Cezira Fantini; Nogueira-Martins, Luiz Antonio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Sexually-Transmitted Diseases-AIDS (STD-AIDS) Reference and Training Center; State Health Department of São Paulo Institute of Health
    CONTEXT AND OBJECTIVE: With the emergence of the acquired immunodeficiency syndrome (AIDS) in 1981, infectologists' care practices went through great changes. The objective of this study was to describe and analyze the experiences of infectologists in dealing with death and dying among their patients, over the course of the AIDS epidemic in the city of São Paulo. DESIGN AND SETTING: A qualitative approach was used. Twenty infectologists from five hospitals that treat human immunodeficiency virus (HIV)/AIDS patients in the municipality of São Paulo were interviewed. METHODS: The sample was formed through the snowball process. The sample size was determined using the saturation criterion. To analyze the material obtained from the interviews, the procedure of thematic analysis was used. This consisted of finding the core meaning relating to the study objective, within the set of materials obtained. RESULTS: Analysis of the material obtained from the interviews led to three main themes: 1. The initial context of AIDS and its impact on infectologists; 2. Modifications to the infectologists' attachments to patients after the introduction of highly active antiretroviral therapy (HAART); 3. Coping with death and dying. CONCLUSIONS: This study shows the importance of considering the distress, emotional overload and adaptive mechanisms relating to death and dying among patients, both in training and in professional practice.
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    Fatores estressores do paciente e necessidades do familiar convivente em unidade de terapia intensiva coronariana
    (Universidade Federal de São Paulo (UNIFESP), 2018-11-28) Coelho, Alue Constantino [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; http://lattes.cnpq.br/3089430786971948; http://lattes.cnpq.br/2602947152920298; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION: The hospitalization at the Coronary Intensive Care Unit (ICU) generates stressful events and needs in patients and their families. The environment associated with the process of humanization is fundamental for the clinical stability, recovery, rehabilitation, wellbeing and satisfaction of family members and of the severe patients who need intensive care. Patient and Family Centered Care needs to be applied and valued, addressing the issues and needs of family members regarding patient care. OBJECTIVE: To evaluate the stressors of patients hospitalized in the Coronary Intensive Care Unit; to evaluate the need and satisfaction of family members living with patients hospitalized in a Coronary ICU. METHODS: It is an observational crosssectional study. The sample consisted of 200 participants, 100 patients with Acute Coronary Syndrome, after 24 hours of hospitalization in the Coronary ICU of Hospital São Paulo, and 100 relatives living with them. Data were collected from March 2016 to January 2018, after completing the inclusion criteria, presentation of the study and agreement of participation in the research. Firstly, the sociodemographic and clinical characterization form of the patient was applied followed by the scale of evaluation of stressors in an intensive care unit. At the time of the visit, the family sociodemographic characterization form and the inventory of needs and stressors of family members in intensive care INEFTI were applied. Stressors were analyzed and represented by the mean and standard deviation for each item and then compared. RESULTS: The majority of the patients are male, married, Catholic, retired, aged between 5160 years old, 1 st grade incomplete, autonomous, experiencing the first ICU stay, with two days in the unit, with a diagnosis of infarction Acute myocardial infarction with supra low level of the lower wall segment ST, with associated comorbidities, with arterial hypertension and dyslipidemia being the most prevalent, presenting complications such as Reverted Sudden Death and arrhythmia, classified at the time of admission with High Risk Grace Score and having their exit from the ICU with improved clinical condition and in outpatient followup. The most stressful factors of the patients were: "Having financial worries" (30%), "Not being able to communicate" (29%), "Not having control over themselves" (28%), "Being incapacitated to family "(27%) and" Not aware of the length of stay in the ICU "(27%). The cohabiting relatives are female, being children and spouses, married, Catholics, age between 1830 years, full second degree, employees, with monthly income of 1 to 3 Minimum Wages, with previous experience in ICU , aware of the diagnosis of the hospitalized patient, but not aware of the name of the doctor and the nurse responsible. Responses to the Inventory of Needs of Families in Intensive Care showed that family members were more important to their needs than they were satisfied. The most important needs were: to know the patient's chances of improvement, to be sure that the best possible treatment was being given to the patient, to be advised at home about changes in the patient's condition and to be informed about everything related to evolution of the patient. The need considered less satisfied by family members was to have a person who can give information over the phone. CONCLUSION: The stressors of the patient are related to their commitments, their responsibilities and their adaptation to their biopsychosocial evolution in the Coronary ICU and the satisfaction of their cohabiting relatives needs to be valued in front of their needs in search of good results. Therefore, it is necessary for professionals to extend the focus of care to the patient and the family, contemplating the process of humanization and the principles of Patient and Family Centered Care so that care is effective, safe and of quality, aiming at recovery and promotion the health of the patient and the prevention and satisfaction of his or her relative.
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    Linhas de cuidado integral em pacientes portadores de catarata
    (Universidade Federal de São Paulo (UNIFESP), 2020-07-30) Valladares, Marta Sonha Gomes Teixeira [UNIFESP]; Hirai, Flavio Eduardo [UNIFESP]; Universidade Federal de São Paulo
    The present study aims to track the paths of patients treated at the Cataract Division of the Universidade Federal de São Paulo (UNIFESP)/Hospital São Paulo (HSP) and to propose management flows for care lines. This is a descriptive cross-sectional study with a field research and a data collection instrument based on a questionnaire applied in four distinct moments as the patients were assisted in the institution: Screening, New Case (first visit), Pre-Anesthesia Evaluation (APA), and Post-Surgery. Apart from the information about the difficulties faced during these different phases of the treatment, the Net Promoter Score (NPS) has also been evaluated. The sample consisted of 121 patients attended at the Cataract Outpatient Clinic of HSP at UNIFESP from August 1918 to January 1919. In this study, the average age considering the four groups was 68.2 years, and 52% of the patients were female. In general, the educational profile has shown a poor education population and the majority had no difficulty in finding the place where the treatment would take place as the public transportation suits the region. The Net Promoter Score (NPS) values were the following: Screening: 33.3, New Case: 77.5, APA: 33.3 and PostSurgery: 86.7, suggesting a change in the perception of quality of service as the patients surpassed the different stages of the treatment. The care cycle for Brazilian health system (SUS) cataract patients should follow SUS hierarchy system and decentralization; and the treatment must be patient-oriented, with wide investment to guide users and health providers, using the best available technology within a management environment based on key indicators.
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    Pacientes em cuidados domiciliares: os desafios da capacitação dos cuidadores familiares
    (Universidade Federal de São Paulo (UNIFESP), 2018-08-13) Leite, Ciro Caires [UNIFESP]; Jurdi, Andrea Perosa Saigh [UNIFESP]; http://lattes.cnpq.br/4140547211703368; http://lattes.cnpq.br/2331012542894291; Universidade Federal de São Paulo (UNIFESP)
    A Atenção Domiciliar (AD) em saúde vem assumindo uma função de destaque diante do envelhecimento populacional. Nesta modalidade, os cuidados geralmente são fornecidos por familiares que muitas vezes não possuem nenhuma capacitação formal. Por isso, a preocupação com os desafios enfrentados pelos cuidadores é fundamental para que a assistência domiciliar a saúde possa ser adequada e atinja o seu propósito. Teve-se como objetivo deste estudo compreender as principais dificuldades relatadas pelos cuidadores familiares dos pacientes em acompanhamento em um serviço de AD. A pesquisa de natureza exploratória e descritiva, com abordagem qualitativa foi realizada com 04 cuidadores familiares em acompanhamento pelo Programa Melhor em Casa no município de Santos/SP. Os dados foram produzidos por meio de um roteiro de entrevista semiestruturado contendo questões relevantes sobre capacitação e realização dos cuidados. Após transcritas e analisadas, as entrevistas foram classificadas por núcleos temáticos. A repetição e o agrupamento dos dados geraram os seguintes temas para análise: A falta de conhecimento; medo, incerteza e a sobrecarga; e a necessidade de capacitação adequada. As falas revelaram algumas das dificuldades encontradas pelos cuidadores que em muitas situações não acreditaram estar preparados para desempenhar tais atividades relacionadas ao cuidado. Além disso, foi um consenso entre os participantes da pesquisa a necessidade da construção de programas de capacitação para os cuidadores domiciliares. A capacitação insuficiente e a falta de conhecimento específico podem interferir na qualidade de vida do paciente e causar consequências a saúde cuidador. Uma proposta para minimizar os impactos seria a implementação de um programa de capacitação com encontros periódicos com os profissionais de saúde. Esses encontros poderiam proporcionar esclarecimento de dúvidas quanto ao manejo e o cuidado com o paciente.
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    Perfil sociodemográfico dos pacientes do Departamento de Oftalmologia do Hospital São Paulo da Escola Paulista de Medicina no período de 2010 a 2015
    (Universidade Federal de São Paulo (UNIFESP), 2016-10-31) Morais, Antonio da Silva [UNIFESP]; Graziosi, Maria Elisabete Salvador [UNIFESP]; http://lattes.cnpq.br/2940944860729134; http://lattes.cnpq.br/1512334660706192; Universidade Federal de São Paulo (UNIFESP)
    It has been observed the increase of the seek for medical assistance at hospital in the São Paulo Public Network, mainly in Hospítal São Paulo. The Ophthalmology Department at Hospital São Paulo / Escola Paulista de Medicina has received a significant amount of patients, and many of them were from the other Brazilian States with the aim for seeking by specialized assistance. An increase of assistance/medical consultation has been realized, and the assistance to elderly patients. With this demand, it has been verified the need of organization and expansion assistance with the objetice to facilitate the patients flow at the Hospital São Paulo.
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    Sexuality after burn in Brazil: survey of burn health-care workers
    (Elsevier B.V., 2011-12-01) Piccolo, Monica Sarto [UNIFESP]; Daher, Ricardo Piccolo [UNIFESP]; Gragnani, Alfredo [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Patients who survive a major burn must live with emotional and physical sequela. in a literature review, we found that sexuality concerns of burn victims are rarely a focus of therapy. After suggestions from Rimmer et al. [12], using their questionnaire translated into Portuguese, we held a survey of burn-care professionals at the VII Brazilian Burn Congress.More than 120 practitioners from 41 centres, aged in average 41.2 years (1 standard deviation 10.96), completed the survey. A proportion of 63.7% were female, and 58.1% were Caucasians; 37.1% were physicians, 20.9% nurse practitioners and 16.9 were occupational therapists/physical therapists (OTs/PT)s. Psychologists made up 3.2%. Only 28% of the respondents felt comfortable in initiating a conversation about sexual intimacy with their patients. the vast majority believed it should be done by the psychologist. Only 38% felt their burn centre did an adequate job in that area. When compared with a study of our country's general population, we find similar results indicating that intimacy, sexuality and sexual intercourse are considered most important in a relationship.There is a significant lack of literature in sexuality after burn; most likely meaning it is ignored by most centres. There is a need for other similar surveys to be performed, as well as a collective consciousness of the need for discussions about sexuality with patients and their partners, providing counselling and treatment, when need. (C) 2011 Elsevier Ltd and ISBI. All rights reserved.