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
5 resultados
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Agora exibindo 1 - 5 de 5
- 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.
- 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.
- 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).
- 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.