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  • Online Resource  (5)
  • Oxford University Press (OUP)  (5)
  • 1
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    Online Resource
    Prospective observational cohort study on grading the severity of postoperative complications in global surgery research
    Oxford University Press (OUP) ; 2019
    In:  British Journal of Surgery Vol. 106, No. 2 ( 2019-01-08), p. e73-e80
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 106, No. 2 ( 2019-01-08), p. e73-e80
    Abstract: The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1002/bjs.11025
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2006309-X
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  • 2
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    Implementation of clinical guidelines in Brazil: should academic detailing be used?
    Oxford University Press (OUP) ; 2016
    In:  Journal of Pharmaceutical Health Services Research Vol. 7, No. 2 ( 2016-06), p. 105-115
    Details
    In: Journal of Pharmaceutical Health Services Research, Oxford University Press (OUP), Vol. 7, No. 2 ( 2016-06), p. 105-115
    Type of Medium: Online Resource
    ISSN: 1759-8885
    URL: Article
    DOI: 10.1111/jphs.12133
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
    detail.hit.zdb_id: 2558609-9
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  • 3
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    Regular consumption of red meat and health behaviors in the Brazilian population
    Oxford University Press (OUP) ; 2020
    In:  European Journal of Public Health Vol. 30, No. Supplement_5 ( 2020-09-01)
    Details
    In: European Journal of Public Health, Oxford University Press (OUP), Vol. 30, No. Supplement_5 ( 2020-09-01)
    Abstract: The consumption of red meat should not surpass 500 g of cooked weight per week. Regular consumption can exceed this recommendation, increasing the risk of chronic diseases. Objective Estimate the prevalence of the regular consumption of red meat according to health behaviors in Brazilian adults (≥18 years). Methods A cross-sectional study was conducted with data from the 2013 National Health Survey, which is a household inquiry with a representative sample of the population ≥18 years of age. The regular consumption of red meat (beef, pork, goat) was defined as ≥ 5 days/week. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated according to health behaviors (healthy and unhealthy eating patterns, smoking, practice of physical activity during leisure and alcohol intake). Results A total of 60,202 adults were interviewed, 52.9% of whom were women and mean age was 42.9 years (95%CI: 42.6-43.2). The prevalence of regular red meat consumption was 36.7% (95%CI: 36.0-37.5) and was higher among those who ingested soft drinks/artificial juice (PR = 1.08) and sweets (PR = 1.05) ≥3 days/week, ingested beans (PR = 1.07) and raw vegetables (PR = 1.03) ≥5 days/week, ingested fatty meat (PR = 1.09), smokers (PR = 1.05), individuals who were inactive during leisure (PR = 1.04) and those who consumed alcohol ≥2 times/week (PR = 1.06). The prevalence was lower among those who ate fruit (PR = 0.99) and chicken (PR = 0.95) ≥5 days/week, those who ate fish (PR = 0.90) at least 1 day/week and those who drank no fat/low fat milk rather than whole milk. Conclusions The regular consumption of red meat was higher among individuals who ingested unhealthy foods more often, those who ingested fatty meat, smokers, those who ingested alcoholic beverages and those who did not practice physical activity. Actions are needed to reduce the frequency of red meat consumption. Key messages Regular consumption of red meat can exceed the recommendation of 500 g of cooked weight per week. The regular consumption of red meat was associated with the more frequent ingestion of unhealthy foods and fatty meat.
    Type of Medium: Online Resource
    ISSN: 1101-1262 , 1464-360X
    URL: Article
    DOI: 10.1093/eurpub/ckaa165.918
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2033525-8
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  • 4
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    Academic detailing program for rheumatoid arthritis: a contribution to Brazilian public health system sustainability
    Oxford University Press (OUP) ; 2020
    In:  Journal of Pharmaceutical Health Services Research Vol. 11, No. 3 ( 2020-08-04), p. 249-254
    Details
    In: Journal of Pharmaceutical Health Services Research, Oxford University Press (OUP), Vol. 11, No. 3 ( 2020-08-04), p. 249-254
    Abstract: In Brazil, specialty medicines for rheumatoid arthritis (RA) treatment are provided by the national health system (NHS) according to mandatory protocols. Knowing the rules for prescription of these biological agents is crucial to ensuring patient access to treatment. This study aims to evaluate the feasibility of an academic detailing strategy to promote the quality use of the medicines available in NHS among prescribers. Methods Forty-three specialists and general practitioners were visited by researchers to perform an academic detailing of the Clinical Protocols and Therapeutic Guidelines (PCDT) for RA adopted by NHS. After the visits, a survey was performed with prescribers to measure their perception in terms of satisfaction and information reliability with the academic visits. At the end, we perform a cost analysis to permit comparisons of this strategy with other educational activities. Key findings From 43 physicians that were visited, 28 responded to the telephone survey. Of these, 68% were very satisfied with the visit, 50% rated the content of the visit relevant to their practice, 64.3% agreed the duration of the visit did not affect their work, 60.7% agreed the distributed material would be useful for their professional practice, and 57.1% agreed that the visits added to their knowledge. A total of USDPPP 162.96 per prescriber (USDPPP 7,007.20, BRL14,185.00) were spent on the program. Conclusion The prescribers visited represent a large number of deferrals for the Specialized Component of Pharmaceutical Care (CEAF) drug applications. Therefore, the total amount spent on the implementation of this program and its potential for improving access to these medicines has the possibility to have a positive impact on the targeting of public expenditures and avoiding litigation against NHS. Academic detailing has the capability to become an effective strategy for PCDT dissemination and implementation.
    Type of Medium: Online Resource
    ISSN: 1759-8885 , 1759-8893
    URL: Article
    DOI: 10.1111/jphs.12365
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2558609-9
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  • 5
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    A cross-sectional study of the quality of life of patients living with type 1 diabetes treated with insulin glargine and neutral protamine Hagedorn insulin and the implications
    Oxford University Press (OUP) ; 2021
    In:  Journal of Pharmaceutical Health Services Research Vol. 12, No. 3 ( 2021-09-14), p. 332-342
    Details
    In: Journal of Pharmaceutical Health Services Research, Oxford University Press (OUP), Vol. 12, No. 3 ( 2021-09-14), p. 332-342
    Abstract: The study aim was to identify key factors associated with the health-related quality of life (HRQOL) of patients with type 1 diabetes mellitus (T1DM) treated with neutral protamine Hagedorn (NPH) insulin or human insulin analog glargine (IGLA). Methods We conducted two cross-sectional studies in Minas Gerais State, Brazil. One with 401 patients treated with IGLA, and the other with 179 T1DM patients treated with NPH. HRQOL was measured by Euroqol (EQ-5D-3L). Key findings Most participants were male (51%), aged between 18 and 40 years (47%), non-black (58%) and from the highest economic strata (A1-B2) (74%). Participants perceived their health as good/very good (51%), had one to three medical consultations in the previous year (51%), were not hospitalized in the previous year (74%), did not report angina (96%), diabetic neuropathy (90%), hearing loss (94%) or kidney disease (89%). Non-severe hypoglycaemia episodes in the last 30 days were reported by 17% of participants. Conclusions Higher HRQOL was associated with younger age (18–40 years), good/very good health self-perception, having had up to three medical consultations in the last year, not being hospitalized in the last year, having none to three comorbidities, not reporting angina, diabetic neuropathy, hearing loss or kidney disease and having had episodes of non-severe hypoglycaemia. In addition, the findings of our study demonstrated inequalities in access to treatment, which will be the subject of future research projects.
    Type of Medium: Online Resource
    ISSN: 1759-8893
    URL: Article
    DOI: 10.1093/jphsr/rmab021
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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