RESUMO
OBJECTIVE: Recent theory has proposed that a dysfunction of the opioid system modulates mood, reward and pain; seems to be unstable in people with Borderline Personality Disorder. Our purpose is to analyze the evidence on the efficacy of the use of buprenorphine, nalmefene, naloxone and naltrexone, in the treatment of dissociative symptoms, self-mutilation and suicidal behavior of these patients. METHOD: We conducted a systematic search of MEDLINE and LILACS databases, to retrieve relevant articles. Included studies were experimental and observational designs of borderline personality samples in which dissociative symptoms, self mutilation or suicidal behavior was reported as an outcome and evaluated with some impact measures. RESULTS: A total of eight studies were reviewed. These provided interesting expectations about posible treatment lines in Borderline Personality Disorder using opioid antagonists. The subgroup most benefited was the one who has analgesia and highest number of diagnostic criteria. CONCLUSIONS: Studies of higher methodological quality are needed, in larger population samples and using control of confounding variables that allow us to estimate a value power calculation, and thus be able to support firm conclusions.
Assuntos
Transtorno da Personalidade Borderline , Transtornos Dissociativos , Antagonistas de Entorpecentes , Automutilação , Ideação Suicida , Transtorno da Personalidade Borderline/tratamento farmacológico , Buprenorfina/uso terapêutico , Transtornos Dissociativos/tratamento farmacológico , Humanos , Naloxona/uso terapêutico , Naltrexona/análogos & derivados , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Estudos Observacionais como Assunto , Automutilação/tratamento farmacológicoRESUMO
OBJECTIVE To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017. DESIGN This prospective, pre-post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate. RESULTS During the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34-0.6; P<.001). CONCLUSIONS Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina. Infect Control Hosp Epidemiol 2018;39:445-451.
Assuntos
Bacteriemia , Infecções Relacionadas a Cateter , Cateteres Venosos Centrais/efeitos adversos , Infecção Hospitalar , Controle de Infecções , Argentina/epidemiologia , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Fatores de RiscoRESUMO
BACKGROUND: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in 11 hospitals within 5 cities of Argentina from January 2014-April 2017. METHODS: A multicenter, prospective, before-after surveillance study was conducted through the use of International Nosocomial Infection Control Consortium Surveillance Online System. During baseline, we performed outcome surveillance of VAP applying the definitions of the Centers for Disease Control andPrevention's National Healthcare Safety Network. During intervention, we implemented the IMA, which included a bundle of infection prevention practice interventions, education, outcome surveillance, process surveillance, feedback on VAP rates and consequences, and performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention. RESULTS: We recorded 3,940 patients admitted to 14 intensive care units. At baseline, there were 19.9 VAPs per 1,000 mechanical ventilator (MV)-days-with 2,920 MV-days and 58 VAPs, which was reduced during intervention to 9.4 VAPs per 1,000 MV-days-with 9,261 MV-days and 103 VAPs. This accounted for a 52% rate reduction (incidence density rate, 0.48; 95% confidence interval, 0.3-0.7; P .001). CONCLUSIONS: Implementing the IMA was associated with significant reductions in VAP rates in intensive care units within Argentina.
Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Cidades/epidemiologia , Feminino , Hospitais , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
El Programa Nacional de Inmunizaciones en Argentina es-tablece la administración universal y obligatoria de las vacunas doble adultos (dT) y hepatitis B (HB) y las vacunas antigripal y antineumocó-cica para poblaciones especiales y mayores de 65 años. Son gratuitas y, excepto las vacunas antigripal y antineumocócica en personas en-tre 2-64 años, no requieren prescripción para su administración. Sin embargo, las tasas de vacunación en los adultos son bajas. Mejorar las coberturas vacunales en adultos es un desafío. Realizamos un estu-dio prospectivo de corte transversal para evaluar la implementación de una estrategia de vacunación combinada para aumentar la vacunación de los adultos de una institución. Esta se basó en el requerimiento obli-gatorio de dT en las cirugías programadas junto con el consejo médico en el vacunatorio y el acceso inmediato a la vacunación. Como resulta-do de esta estrategia se administraron 2.946 dosis extra que represen-tan un aumento de 312 % sobre las dosis sin intervención. Esta estrate-gia simple podría ser replicada fácilmente en otros centros
The National Immunization Program in Argentina recom-mends tetanus and diphtheria vaccine [Td] and hepatitis B for all healthy adults and influenza and pneumococcal vaccines for special populations. Despite the fact that these vaccines are free and without requirement for prescription, rates of vaccination remain low in adults.Improving vaccina-tion coverage among adults remains a major challenge. We performed a prospective cross-sectional study to assess a combined vaccination strat-egy in order to enhance compliance in a single institution. It was based on institutional requirement of Td vaccine for all elective surgery plus med-ical counseling provided by a trained physician at the Vaccination Room and immediate access to vaccination. As a result of this strategy, 2946 extra doses of vaccines were given. These doses represent an increase of 312% from the doses estimated without our intervention. This simple strategy may be easily replicated in other centers