Processo de alta hospitalar de pessoas com acidente vascular cerebral: uma revisão narrativa de literatura

O estudo objetivou a realização de uma revisão narrativa de literatura sobre o processo de alta hospitalar de pessoas com Acidente Vascular Cerebral (AVC). A busca foi realizada nas bases de dados, PubMed e Google Acadêmico, entre os meses de julho e agosto de 2021. Foram utilizados os descritores: “Stroke”, “discharge planning” OR “Transitional Care” AND “Caregivers”. Como critério de inclusão considerou-se publicações que abordaram o tema, publicadas entre os anos de 2016 a 2021, escritos em idioma português ou inglês e com acesso online. A pré-seleção considerou a leitura de título e resumo das publicaçãoes e classificou ao final 11 para leitura completa. Como principais resultados encontrou-se que o profissional mais envolvido no processo de alta hospitalar de pacientes acometidos por AVC é o enfermeiro (a). Entretanto, parece haver dificuldades no processo de transição do cuidado, principalmente no que se refere a comunicação e envolvimento dos pacientes e cuidadores na tomada de decisão. O planejamento da alta representa estratégia essencial para a transferência do paciente do hospital para casa e pode contribuir para a diminuição: das taxas de reinternação, das complicações, do tempo de internação hospitalar, dos custos de atendimento e de mortalidade. Ainda, destaca-se importância da educação em saúde e do trabalho interprofissional para o cuidado integral de pessoas com AVC.

Transitional care from the hospital to the home in heart failure: implementation of best practices

ABSTRACT Objectives: Assess the compliance of the implementation of better evidence in the transitional care of the person with heart failure from the hospital to the home. Methods: Evidence implementation project according to the JBI methodology in a cardiology hospital in São Paulo. Six criteria were audited before and after implementing strategies to increase compliance with best practices. 14 nurses and 22 patients participated in the audits. Results: In the baseline audit, compliance was null with five of the six criteria. Strategies: training of nurses; reformulation of the hospital discharge form and guidance on self-care in care contexts; and making telephone contact on the 7th, 14th and 21st days after discharge. In the follow-up audit, there was 100% compliance with five of the six criteria. Conclusion: The project made it possible to increase the compliance of transitional care practices in people with heart failure with the recommendations based on the best evidence.

Transitional care of nurses to older adults with artificial pacemaker

ABSTRACT Objective: to understand how the transitional care of nurses to olde adults with artificial pacemaker occurs. Method: a qualitative research, carried out in a philanthropic hospital in the city of Salvador, Bahia, Brazil. Fourteen nurses working in surgical and cardiac inpatient units participated. Data were collected between August and November 2020, through semi-structured interviews, and analyzed using the methodological framework Discourse of the Collective Subject and discussed in the light of Afaf Meleis’ theory of transitions. Results: nurses’ incipient knowledge about transitional care was identified. It was observed that the nursing discharge report is a facilitating instrument for transitional care. Final considerations: the study pointed out that the transitional care of nurses to older adults with artificial pacemakers does not have a theoretical foundation, reporting as a priority the care with the pacemaker identification card and with the surgical wound.

Pediatric urology research in 2020: A bibliometric analysis of the top 100 most cited articles

Background: Pediatric Urology deals with genitourinary diseases. Present study aimed to collect the top-cited article in Pediatric Urology in order to define the most debated and studied topics. Methods: The journals reported in “Urology & Nephrology” category of the 2019 edition of Journal Citation Reports, together with the most relevant journals of “Transplantation,” “Pediatrics,” and “Surgery” categories, were browsed. The articles of interest in Pediatric Urology with more than 50 citations were collected. A bibliometric analysis was performed to collect the top 100 cited articles. Results: The top-cited articles were published in 27 journals (23%), with a median impact factor of 2.676 (IQR 1.981–5.642). Seventeen of them (63%) belonged to “Urology and Nephrology” category. The median number of citations was 82 (IQR 64–113). The most productive journal, with 23 articles, was “The Journal of Urology.” Forty-eight top-cited articles were Guidelines or Reviews of the literature and only four papers were randomized controlled trials. The most relevant topic was “congenital anomalies” with 18 articles. As to minimally invasive surgery, eight studies were identified. All of them dealt with robotic-assisted laparoscopic surgery. Two articles reported the current evidence about transitional care. Conclusions: The top-cited articles were dispersed among journals of different areas. Current scientific literature deal with congenital anomalies, more specifically with obstructive uropathies and hypospadias. In the last decade, one of the most relevant innovation in pediatric urology was the introduction of robotic surgery. Transitional care has become a timely topic.

Multidimensional Measure of Instrumental Support in Transitional Care – Design and Pilot Test of a Questionnaire Assessing Instrumental Support Among Older Adults With Chronic Diseases

Background: Previous studies indicated that poor quantity and quality of instrumental support are one of the main barriers in the application of transitional care. Instrumental support, as one common function of social support, is the provision of financial assistance, material goods, or services. The purpose of our study is to develop a Instrumental Support in Transitional Care Questionnaire (ISTCQ), and use this questionnaire to make an assessment among older adults with chronic diseases. Methods: The draft questionnaire was examined by 18 experts from different professional fields performing three rounds of content validity testing with Delphi method. Afterwards, we conducted a pilot test recruiting 174 participants as a convenience sample in Nantong, China. The construct validity was confirmed via exploratory factor analysis and reliability was assessed using Cronbach's alpha. Results: The authority coefficient of experts was 0.74-0.99 and Kendall harmony coefficient W was 0.381. The exploratory factor analysis indicated that the questionnaire can be interpreted by three factors: namely, anticipated support (items 1, 2, 3, 4), received support (items 5, 6, 7, 8) and support satisfaction (items 9, 10, 11, 12). These three factors (eigenvalues > 1 and factor loading > 0.4) explained 69.128% of the total variance. Furthermore, the calculation of Cronbach's alpha and test-retest reliability have showed good reliability among each dimension of the 12-item questionnaire (Cronbach's alpha 0.711–0.827, test-retest reliability 0.704-0.818). Conclusion: Results from the pilot test demonstrated excellent reliability and validity of ISTCQ through each dimension and as an entire.

Differences in Clinical Outcomes of Adults Referred to a Homeless Transitional Care Program Based on Multimorbid Health Profiles: A Latent Class Analysis

Background: People experiencing homelessness face significant medical and psychiatric illness, yet few studies have characterized the effects of multimorbidity within this population. This study aimed to (a) delineate unique groups of individuals based on medical, psychiatric, and substance use disorder profiles, and (b) compare clinical outcomes across groups.Methods: We extracted administrative data from a health system electronic health record for adults referred to the Durham Homeless Care Transitions program from July 2016 to June 2020. We used latent class analysis to estimate classes in this cohort based on clinically important medical, psychiatric and substance use disorder diagnoses and compared health care utilization, overdose, and mortality at 12 months after referral.Results: We included 497 patients in the study and found 5 distinct groups: “low morbidity” (referent), “high comorbidity,” “high tri-morbidity,” “high alcohol use,” and “high medical illness.” All groups had greater number of admissions, longer mean duration of admissions, and more ED visits in the 12 months after referral compared to the “low morbidity” group. The “high medical illness” group had greater mortality 12 months after referral compared to the “low morbidity” group (OR, 2.53, 1.03–6.16; 95% CI, 1.03–6.16; p = 0.04). The “high comorbidity” group (OR, 5.23; 95% CI, 1.57–17.39; p < 0.007) and “high tri-morbidity” group (OR, 4.20; 95% CI, 1.26–14.01; p < 0.02) had greater 12-month drug overdose risk after referral compared to the referent group.Conclusions: These data suggest that distinct groups of people experiencing homelessness are affected differently by comorbidities, thus health care programs for this population should address their risk factors accordingly.