RICARDO TAVARES DE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
PAHC, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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- Criterion validity and inter-rater reliability o a palliative care screening tool for patients admitted to an emergency department intensive care unit(2018) RIBEIRO, Sabrina Correa da Costa; CARVALHO, Ricardo Tavares de; ROCHA, Juraci Aparecida; DIAS, Roger DagliusObjective. The use of palliative care (PC) screening criteria to trigger PC consultations may optimize the utilization of PC services, improve patient comfort, and reduce invasive and futile end-of-life care. The aim of the present study was to assess the criterion validity and inter-rater reliability of a PC screening tool for patients admitted to an emergency department intensive care unit (ED-ICU). Method. Observational retrospective study evaluating PC screening criteria based on the presence of advanced diagnosis and the use of two ""surprise questions"" (traditional and modified). Patients were classified at ED-ICU admission in four categories according to the proposed algorithm. Result. A total of 510 patients were included in the analysis. From these, 337 (66.1%) were category 1, 0 (0.0%) category 2, 63 (12.4%) category 3, and 110 (21.6%) category 4. Severity of illness (Simplified Acute Physiology Score III score and mechanical ventilation), mortality (ED-ICU and intrahospital), and PC-related measures (order for a PC consultation, time between admission and PC consultation, and transfer to a PC bed) were significantly different across groups, more evidently between categories 4 and 1. Category 3 patients presented similar outcomes to patients in category 1 for severity of illness and mortality. However, category 3 patients had a PC consultation ordered more frequently than did category 1 patients. The screening criteria were assessed by two independent raters (n = 100), and a substantial interrater reliability was found, with 80% of agreement and a kappa coefficient of 0.75 (95% confidence interval = 0.62, 0.88). Significance of results. This study is the first step toward the implementation of a PC screening tool in the ED-ICU. The tool was able to discriminate three groups of patients within a spectrum of increasing severity of illness, risk of death, and PC needs, presenting substantial inter-rater reliability. Future research should investigate the implementation of these screening criteria into routine practice of an ED-ICU.
- Palliative Care in the state of Rio de Janeiro (Brazil): characteristics of the services(2023) SILVA, C. N. G. da; POUSA, F. de Sousa; CORREA, T. L.; CARVALHO, R. T. deThis research explores the status of Palliative Care (PC) services in the state of Rio de Janeiro (RJ), Brazil, by iden-tifying the number of services and their respective characteristics. Through an observational, cross-sectional, de-scriptive, and quantitative approach, this study examines a textual and numerical database about professionals who provide palliative care assistance in Rio de Janeiro. Out of the existing palliative care services analyzed, fourteen were evaluated, twelve of which were located in the RJ metropolitan region. The majority of professionals worked with private funding within hospitals. The PC teams were most commonly composed of physicians, with only 17.1% of the professionals having formal PC training. Palliative Care services in Rio de Janeiro seem to follow a similar pattern to Brazil and Latin America. However, the characteristics of this pattern may not adequately address the significant needs of middle-income countries.
- Validity and reliability of the Brazilian version of the Patient Dignity Inventory (PDI - Br)(2021) DONATO, Suzana Cristina Teixeira; CHIBA, Toshio; CARVALHO, Ricardo Tavares de; SALVETTI, Marina de GoesObjective: to perform the psychometric validation of the Brazilian version of the Patient Dignity Inventory (PDI - Br) in patients with advanced diseases in palliative care. Method: a methodological study to verify the psychometric properties of the Patient Dignity Inventory (PDI - Br) instrument, through validity and reliability tests. Results: the exploratory factor analysis showed a factorial solution with three factors, responsible for 40.9% of the explained variance, with adequate internal consistency for the Presence of Symptoms (a=0.859), Dependence (a=0.871), and Existential Suffering (a=0.759) domains. The test-retest was performed and indicated moderate to strong correlations. Convergent validity demonstrated a positive correlation between the Presence of Symptoms and the sadness (r=0.443) and anxiety (r=0.464) variables. Weak negative correlations were observed between the PDI - Br domains and functionality, spiritual well-being and quality of life. Conclusion: composed of three domains and 25 items, the PDI - Br instrument presented satisfactory psychometric properties for its use in our environment, through the evidence of validity and reliability.
- Evaluation of a New Triage Protocol for Palliative Care for Patients with COVID-19 in Brazil(2023) CORREA, Tulio Loyola; SIMAO, Aurea Maria Salomao; SOBREIRA, Joyce Veceli Barros; ANBAR, Fernanda Baeninger; YARSHELL, Flavia; BRANDAO, Ana Beatriz; ESTUQUE, Monica Queiros; ROCHA, Juraci Aparecida; CARVALHO, Ricardo Tavares deObjectives: To evaluate the implementation of a triage protocol for palliative care (PC) during the COVID-19 pandemic (PALI-COVID) at a referral center in Brazil.Methods: A retrospective observational study was conducted. Based on the triage protocol, patients were classified into a red group, a yellow group, and a green group (GG). Patients should receive PC as recommended for each group.Results: A total of 1517 patients were included in the analysis. About 11% (n = 162) of patients received PC. About 35% (n = 529) of all patients died. There was a significant difference in the mortality rate between the groups; the GG had the highest mortality rate. Most patients who died (77.1%) did not receive PC.Conclusion: PALI-COVID was effective in identifying patients who had a higher risk of death and needed end-of-life support. Despite the protocol, few patients received PC.
- PERCEPTION OF DIGNITY OF PATIENTS IN PALLIATIVE CARE(2019) FRANCO, Marinete Esteves; SALVETTI, Marina de Góes; DONATO, Suzana Cristina Teixeira; CARVALHO, Ricardo Tavares de; FRANCK, Ednalda MariaABSTRACT Objective: to understand the perception of dignity of patients in palliative care and to identify factors that may increase or decrease the sense of dignity. Method: an exploratory study with a qualitative approach, carried in a Palliative Care Center in São Paulo (Brazil), with the Chochinov’s Dignity Model as theoretical framework and content analysis as methodological framework. The participants of this study were 20 patients in palliative care, assessed through semi-structured interviews based on three questions: ""What is dignity for you?"", ""What increases your dignity?"", ""What decreases your dignity?"" The interviews were recorded with the patients’ authorization, from September to November 2017, and transcribed for content analysis. Results: the analysis of the perception of dignity allowed the identification of three categories: Correct person, Autonomy/independence and Socio-political factors. The factors that increased the sense of dignity were the following: Care, Independence/autonomy, Leisure/positive thinking/being with friends. And those that decreased it were the following: Behaviors/attitudes, Health status and Economic situation. Conclusion: the perception of dignity of patients in palliative care was influenced by health professionals and caregivers. Being a “correct person”, maintaining autonomy, being cared for and respected has increased the sense of dignity. Urban violence and the lack of compliance with accessibility policies have reduced the sense of dignity among palliative care patients.
- Palliative care consultation team: symptom relief in first 48 hours of hospitalization(2020) SILVA, Magda Aparecida dos Santos; DINIZ, Marcio Augusto; CARVALHO, Ricardo Tavares de; CHIBA, Toshio; MATTOS-PIMENTA, Cibele Andrucioli deABSTRACT Objective: To compare the relief of symptoms provided by palliative care consultation team (PCCT) compared to the traditional care team (TC), in patients with advanced cancer in the first 48 hours of hospitalization. Method: Allocated to PCCT Group and TC Group, this study assessed 290 patients according to the Edmonton Symptom Assessment System (ESAS) within the first 48 hours of hospitalization. The main outcome was a minimum 2-point reduction in symptom intensity. Results: At 48 hours, the PCCT Group had a 2-point reduction in the mean differences (p <0.001) in pain, nausea, dyspnea, and depression; and TC Group, on nausea and sleep impairment (p <0.001). Multiple Logistic Regression found for the PCCT Group a greater chance of pain relief (OR 2.34; CI 1.01-5.43; p = 0.049). Conclusion: There was superiority of the PCCT Group for pain relief, dyspnea and depression. There is a need for more studies that broaden the understanding of team modalities.
- Reflections concerning the conduction of interviews with bereaved widows in qualitative survey(2018) BATISTA, Marina Picazzio Perez; REBELO, Josi Eduardo; CARVALHO, Ricardo Tavares de; ALMEIDA, Maria Helena Morgani de; LANCMAN, SelmaIntroduction: Considering the vulnerability of the bereaved people, it is important to perceive aspects concerning qualitative studies conducted with this population. Objective: This article aimed to reflect on the implications of conducting individual interviews with widows in bereavement. Method: It is a qualitative exploratory and descriptive study. Its target population was women, whose spouses have died within the past 2-6 months due to cancer and were over the age of 60 and had been attended by the Palliative Care Service during the period May - October 2015. The widows that agree to participate in the study were invited to a private interview. For its conduction, a semi-structured guideline was used. The content of the interviews was recorded, transcribed and analyzed by the coding process, generating comprehensive themes. Results: The widows cited benefits for participating in the interviews: it was the first opportunity to talk about their loss; it allowed them to share her distress, favoring some relief; increased confidence in their abilities; contributed to their empowered by talking about his daily life; allowed reflection on the way of living their everyday life. Conclusion: Conducting interviews with bereaved encourages attentive and uninterrupted listening, allowing them to share their experience. Considering the benefits pointed out by the widows, as they shared their experiences in the context of a qualitative research with interviews, it is possible to infer the relevance of the provision of bereavement support services, favoring bereaved to have space for sharing, in accordance with their singular demands.
- End-of-life use of antibiotics: a survey on how doctors decide(2022) CRISPIM, Douglas H.; SILVA, Ivaldo Olimpio da; CARVALHO, Ricardo Tavares de; LEVIN, Anna S.OBJECTIVES: Infections are the main complications in terminal diseases. Many patients die using antibiotics, which raises questions about their real usefulness and role in unnecessary prolongation of suffering. This survey evaluated how doctors use antibiotics in palliative care. METHODS: From June to August of 2016, an online survey was conducted with 224 doctors who provide palliative care. They had to decide whether to initiate antibiotics in fictitious scenarios involving patients with suspected infections (urinary tract infection, pneumonia, sepsis) in end-of-life (from cancer, dementia, malignant stroke with sequelae, advanced COPD, multiple organ failure). Then, they had to decide whether to stop, maintain, or extend antibiotics after non-response in 72 hours. RESULTS: 88-100% of doctors decided to initiate antibiotics in all situations, except in advanced dementia (45%), and most of them decided to maintain/extend antibiotics inadequately. Factors associated with maintaining/extending antibiotics inadequately were: longer time since graduation (over 13 years; significant in all 7 clinical situations; OR range: 2.45-10.11), and not having formal specialization in palliative care (statistically significant in 3 of 7 situations). CONCLUSIONS: Most palliative care physicians in this study decided to initiate and maintain/extend antibiotics at the end-of-life. (C) 2021 The Author(s).
- Aspectos demográficos e acesso aos projetos pedagógicos dos cursos de Medicina no Brasil(2023) MORAES, Rodrigo dos Santos; JACOB-FILHO, Wilson; CARVALHO, Ricardo Tavares deAbstract Introduction: The expansion of higher education in Brazil is recent. In the medical field, with the advent of the “Mais Médicos” Program, this expansion became feasible and culminated with the publication of new National Curricular Guidelines (DCN, Diretrizes Curriculares Nacionais) for undergraduate medical courses. The Pedagogical Course Project (PCP) translates what is accomplished in the course and works as an instrument of communication between the institution and society. The analysis of the PCPs of Higher Education Institutions provides the identification of elements that point to the convergence or move away from the changes proposed by the DCN 2014. Objective: To describe demographically in Brazil the number of public and private medical courses by state and region of the federation, the number of available vacancies, and access to the PCPs of these schools through a systematized methodology. Method: A study was carried out in all institutions with medical courses in Brazil by the year 2021. The search for the PCPs was carried out in the institutional website. In case of lack of information, an electronic message was sent to the medical course coordination. When it was not possible to contact the coordinator directly through the institutional website, a message was sent to the coordinator by accessing their curriculum lattes. Results: A total of 336 medical schools were identified, 115 (34.2%) of which were public and 226 (65.8%) private ones. A higher concentration of courses was observed in the southeast region (41.3%), followed by the northeast region (24.6%). Of the public institutions, the northeast region has the highest concentration of schools (35.6%), followed by the southeast region (26%). The opposite was observed regarding the private institutions. A total of 134 PCPs were obtained (39.8% of the total), 83% from public schools and 17% from private ones. Conclusion: Although the availability of the pedagogical information document on the institution’s website is an obligation, this was not verified in reality, which makes it necessary to implement policies for valuing and monitoring PCP availability, thus facilitating its access by the most interested parties: students, the academic community and researchers in the field of medical education.
- Clinical significance of palliative care assessment in patients referred for urgent intensive care unit admission: A cohort study(2017) RAMOS, Joao Gabriel Rosa; CORREA, Mario Diego Teles; CARVALHO, Ricardo Tavares de; JONES, Daryl; FORTE, Daniel NevesPurpose: To evaluate clinical characteristics of patients with palliative care (PC) and urgent intensive care unit (ICU) referrals in the same hospital admission. Methods: All urgent ICU referrals at an academic, tertiary hospital, and the co-occurrence and timing of PC assessment were retrieved from a prospectively collected database. Results: From May 2014 to May 2015, 2476 patients were analyzed and 179 (7%) had co-occurrence of PC assessment and urgent ICU referral in the same hospital admission. Hospital mortality was higher (odds ratio, 8.3; 95% confidence interval, 5.4-12.7) and ICU admission was lower (odds ratio, 0.54; 95% confidence interval, 0.40-0.74) in patients with PC assessment, compared with patients without concurrent PC and ICU referrals. Variables associated with PC assessment were older age, diagnosis of cancer, depressed level of consciousness, nonsurgical admission, lower performance status, physician's subjective prognosis of poor outcome, and length of hospitalization before ICU referral. Conclusion: In this cohort of patients with urgent ICU referral, clinical characteristics at the moment of ICU referral were associated with co-occurrence of PC assessment in the same hospital admission. These characteristics might guide the development of instruments to enhance early referral of high-risk patients to PC services.