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- ItemSomente MetadadadosMapeamento internacional e avaliação de diretrizes de cuidados paliativos em câncer de mama(Universidade Federal de São Paulo (UNIFESP), 2015-12-31) Santos, Adson Roberto Franca dos [UNIFESP]; Atallah, Alvaro Nagib Atallah [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: carry out an international mapping and critically evaluate guidelines for palliative care in breast cancer. Design: mapping national and international literature during the period 2003-2014, using Cochrane Collaboration methodology with critical evaluation of the guidelines. Site: lybraries, online research sites. Participants: the author. Interventions: systematic literature search on palliative care in breast câncer and the analyses of the data collected. Key outcome measures: the studies identified would be evaluated through AGREE II instrument (The Agree Research Trust, 2009) which aims at evaluating guidelines, taking into account process elaboration methodology, transparency, and applicability, based on the best scientifficaly evidences. Results: 1477 citations were found in the databases. However, no specific palliative care guideline for breast câncer was identified, despite the relevance of the problem and the specificities and particularities of women, whether concerning physical nature, feminine identity, gender, body image, and several emotional, psychological, psychosocial, ethics and bioethics aspects, from diagnosis to death and grief, when cure is not possible. Conclusions: it was observed that the lack of specific guidilene for palliative care in breast cancer represents an important gap on patients care from diagnosis, and the several phases of treatment, as well as end of life care and grief, when cure is not possible.
- ItemAcesso aberto (Open Access)Rede de infarto com supradesnivelamento de ST: sistematização em 205 casos diminui eventos clínicos na rede pública(Sociedade Brasileira de Cardiologia - SBC, 2012-11-01) Caluza, Ana Christina Vellozo [UNIFESP]; Barbosa, Adriano H. [UNIFESP]; Gonçalves, Iran [UNIFESP]; Oliveira, Carlos Alexandre L. de [UNIFESP]; Matos, Lívia Nascimento de [UNIFESP]; Zeefried, Claus; Moreno, Antonio Célio C.; Tarkieltaub, Elcio; Alves, Claudia Maria Rodrigues [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Serviço de Atendimento Móvel de Urgência; Prefeitura Municipal de São Paulo Secretaria de Saúde; Hospital Municipal Prof. Dr. Alípio Correa NettoBACKGROUND: The major cause of death in the city of São Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15% and 20% due to difficulties inherent in large metropoles. OBJECTIVE:To describe in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI) of patients admitted via ambulance or peripheral hospitals, which are part of a structured training network (STEMI Network). METHODS: Health care teams of four emergency services (Ermelino Matarazzo, Campo Limpo, Tatuapé and Saboya) of the periphery of the city of São Paulo and advanced ambulances of the Emergency Mobile Health Care Service (abbreviation in Portuguese, SAMU) were trained to use tenecteplase or to refer for primary angioplasty. A central office for electrocardiogram reading was used. After thrombolysis, the patient was sent to a tertiary reference hospital to undergo cardiac catheterization immediately (in case of failed thrombolysis) or in 6 to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni- and multivariate analysis. RESULTS: From January 2010 to June 2011, 205 consecutive patients used the STEMI Network, and the findings were as follows: 87 anterior wall infarctions; 11 left bundle-branch blocks; 14 complete atrioventricular blocks; and 14 resuscitations after initial cardiorespiratory arrest. In-hospital mortality was 6.8% (14 patients), most of which due to cardiogenic shock, one hemorrhagic cerebrovascular accident, and one bleeding. CONCLUSION: The organization in the public health care system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer, and tertiary reference hospital, resulted in immediate improvement of STEMI outcomes.
- ItemAcesso aberto (Open Access)Rede de infarto com supradesnivelamento de ST: sistematização em 500 casos diminui eventos clínicos na rede pública(Universidade Federal de São Paulo (UNIFESP), 2016-08-30) Caluza, Ana Christina Vellozo [UNIFESP]; Carvalho, Antonio Carlos de Camargo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: The major cause of deaths in the city of Sao Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15-20% due to difficulties inherent in large metropoles. Objectives: To describe in-hospital mortality in ST Elevation acute myocardial infarction (STEMI) of patients admitted via ambulance or peripheral hospitals, which are part of a structured training network (STEMI Network). Methods: Health care teams of seven emergency services (Ermelino Matarazzo, Campo Limpo, Tatuapé, Saboya, João XXIII, Pirituba, Público municipal) of the periphery of the São Paulo and advanced ambulances of Emergency Mobile Health Care Service (abbreviation in Portuguese, SAMU) were trained to use tenecteplase or to refer for primary angioplasty. A central office for electrocardiogram reading was used. After thrombolysis, the patient was sent to a tertiary reference hospital to undergo cardiac catheterization immediately (in case of failed thrombolysis) or in to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni and multivariate analysis. Results: From November 2009 to November consecutive patients used the STEMI network, and the findings were as follows: anterior wall infarctions, 37 complete atrioventricular blocks, 41 cases occurring cardiogenic shock PCR, 2 cases of hemorrhagic stroke and intra-hospital mortality was 6,5% (33 cases). There was no difference in mortality relation to initial reperfusion (PCIxFI), both in-hospital (>0,05) and late (p=0,566). Late mortality was 8 % and adverse events were 10.7% of angina, 4.1% reinfarction, 1.4% and 0.5 % of stroke. The late ejection fraction was higher in cases of FI (p = 0.023). Conclusions: The organization in a public health system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer and a tertiary reference hospital, resulted in immediate improvement of STEMI outcomes.