RODRIGO DIAZ OLMOS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
DVCLME-62, Hospital Universitário
DVCLME-62, Hospital Universitário
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- The National Institute for Health Research (NIHR) Global Health Research Group on Atrial Fibrillation management(2019) LIP, Gregory Y. H.; GUO, Yutao; LOTUFO, Paulo; SURENTHIRAKUMARAN, Rajendra; HUMPHREYS, Lindsey; THOMAS, G. Neil; ARASALINGAM, Ajini; BENSENOR, Isabela; BROCKLEHURST, Peter; CHENG, Kar Keung; FENG, Mei; GOULART, Alessandra; GREENFIELD, Sheila; GUO, Yutao; GURUPARAN, Mahesan; GUSSO, Gustavo; HAO, Wang; HUMPHREYS, Lindsey; KUMARENDRAN, Balachandran; JOLLY, Kate; JOWETT, Sue; KIRCHHOF, Paulus; LANCASHIRE, Emma; LANE, Deirdre; LASSERSON, Dan; LI, Xuewen; LIP, Gregory Y. H.; LOBBAN, Trudie; MANSEKI-HOLLAND, Semira; MOORE, David; NIRANTHARAKUMAR, Krishnarajah; OLMOS, Rodrigo; SHANTSILA, Alena; SZMIGIN, Isabelle; SUBASCHANDREN, Kumaran; SURENTHIRAKUMARAN, Rajendra; THOMAS, G. Neil
conferenceObject Zero calcium scores is not reliable to rule out coronary artery disease in the emergency room(2012) STANIAK, Henrique L.; BITTENCOURT, Marcio S.; SHAROVSKY, Rodolfo; BENSENOR, Isabela; GOULART, Alessandra; CASTRO, Claudio C.; SANTOS, Itamar; OLMOS, Rodrigo; LOTUFO, PauloIntroduction: Several diagnostic tools have been proposed to investigate patients with acute chest pain in the emergency room. Recently, coronary computed angiotomography (CTA) has been studied for this purpose. Since CTA has some limitations including the use of ionizing radiation, iodine contrast and the need of drugs such as beta blockers and nitrates to achieve good image quality some authors have suggested that a negative calcium score would yield those patients with very low risk in which CTA could be safely avoided. Objectives: Evaluate the diagnostic accuracy of a negative calcium score when compared with CTA in the acute setting and subsequent downstream evaluation Methods: 65 patients (32 female) with acute chest pain, normal eletrocardiogram and cardiac biomarkers who underwent calcium score and CTA which had a negative calcium score were included. The exams were performed in a 64 detectors CT device with standard settings, and the CTA was performed using prospective acquisition, after beta blocker and nitrate unless contraindicated. The calcium score exams were compared to the CTA results. The CTA was considered positive if any lesion 50% was identified. Results: 65 patients were evaluated from February to August 2011. The mean age was 53.8 14.7 years and mean heart rate was 62 bpm. 2 of these zero calcium scores had non obstructive disease (50%), 3 of these zero calcium scores had obstructive disease and 1 patient had an invaluable CTA due to motion artifacts. These last 4 patients were furtherstratified with invasive coronary angiography and all 4 underwent coronary angioplasty. Conclusion: 8.2% of the patients with coronary artery disease would be misdiagnosed if coronary calcium score was used as the sole imaging strategy in this sample. Not only that, 4 patients which had an intervention performed would remain untreated.- Identifying and understanding the care pathway of patients with atrial fibrillation in Brazil and the impact of the COVID-19 pandemic: A mixed-methods study(2023) GOULART, Alessandra C.; VARELLA, Ana C.; GOODEN, Tiffany E.; LIP, Gregory Y. H.; JOLLY, Kate; THOMAS, G. Neil; LOTUFO, Paulo A.; GREENFIELD, Sheila; OLMOS, Rodrigo D.; BENSENOR, Isabela M.; MANASEKI-HOLLAND, SemiraBackground Atrial fibrillation (AF) is a major risk factor for stroke. To enable improvements to AF diagnosis and follow-up care, understanding current patient pathways and barriers to optimal care are essential. We investigated the patient care pathways and their drivers, and the impact of the COVID-19 pandemic on patient pathways in a middle-income country setting, Brazil. Methods This mixed-methods study in SAo Paulo, included adults (>= 18y) with AF from 13 primary/secondary healthcare facilities. Surveys using baseline, follow-up (administered >= two months after baseline) and COVID-19 questionnaires (quantitative), and three focus group discussions (FGDs) were conducted. Minimum sample size for the quantitative component was 236 and we aimed to reach saturation with at least three FGDs for the qualitative component. Descriptive statistics were used for quantitative data and a content analysis was used for qualitative data to identify themes related to AF diagnosis and follow-up care. Results 267 participants completed the baseline questionnaire: 25% were diagnosed in primary care, 65% in an emergency or inpatient department. At follow-up (n = 259), 31% visited more than one facility for AF care, and 7% had no follow-up. Intervals between international normalised ratio (INR) tests were increased during the pandemic, and the number of healthcare visits and availability of medication were reduced. Seventeen patients participated in three FGDs and revealed that AF diagnosis often occurred following a medical emergency and patients often delay care-seeking due to misconceptions about AF symptoms. Long waiting times, doctor/patient interactions and health system factors, such as doctor availability and the referral system, influence where participants visited for follow-up care. Conclusions Lack of public awareness and underdeveloped primary healthcare lead to delayed diagnosis, which impacts clinical outcomes and excess patient and healthcare system costs. Health system, care-provider, and pandemic factors disrupt timely and effective continuity of care.
- Cerebrovascular risk factors and their time-dependent effects on stroke survival in the EMMA cohort study(2023) GOULART, A. C.; VARELLA, A. C.; TUNES, G.; ALENCAR, A. P.; SANTOS, I. S.; ROMAGNOLLI, C.; GOODEN, T. E.; THOMAS, G. N.; LIP, G. Y. H.; OLMOS, R. D.; LOTUFO, P. A.; BENSENOR, I. M.To investigate the time-dependent effects of traditional risk factors on functional disability in all-cause mortality post-stroke, we evaluated data from a long-term stroke cohort. Baseline cerebrovascular risk factors (CVRF) and functionality at 1 and 6 months were evaluated in survivors from a prospective stroke cohort using the modified Rankin scale (m-RS), which classifies participants as improvement of disability, unchanged disability (at least moderate), and worsening disability. Cox regression models considering baseline risk factors, medication use, and functionality 6 months after stroke were fitted to identify their time-dependent effects up to 12 years of follow-up. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) are presented. Among 632 survivors (median age 68, 54% male, 71% first-ever episode), age and functional disability (unchanged and worsening) 6 months after ischemic stroke had time-dependent effects on all-cause mortality risk up to 12 years of follow-up. The most impacting risk factors were unchanged (at least moderate) (HR, 2.99; 95%CI: 1.98-4.52) and worsening disability (HR, 2.85; 95%CI: 1.26-6.44), particularly in the first two years after a stroke event (Time 1: >= 6 mo to <2.5 y). Worsening disability also impacted mortality in the period from >= 2.5 to <7.5 years (Time 2) of follow-up (HR, 2.43 (95%CI: 1.03-5.73). Other baseline factors had a fixed high-risk effect on mortality during follow-up. Post-stroke and continuous medication use had a fixed protective effect on mortality. Functional disability was the main contributor with differential risks of mortality up to 12 years of follow-up.
- Shadow'' OSCE examiner. A cross-sectional study comparing the shadow'' examiner with the original OSCE examiner format(2019) RODRIGUES, Marcelo Arlindo Vasconcelos; OLMOS, Rodrigo Diaz; KIRA, Celia Maria; LOTUFO, Paulo Andrade; SANTOS, Itamar Souza; TIBERIO, Iolanda de Fatima Lopes CalvoOBJECTIVES: Feedback is a powerful learning tool, but a lack of appropriate feedback is a very common complaint from learners to teachers. To improve opportunities for feedback on objective structured clinical examinations (OSCEs), a modified examiner role, termed the ""shadow'' examiner, was tested. This study aims to present and analyze comparisons between the ""shadow'' examiner and the original OSCE examiner format. METHODS: In 2011, experiments were carried out with modifications to the examiner's role to define the ""shadow'' examiner format. From February 2012 to May 2014, research was conducted with 415 6th-year medical students. Of these students, 316 were randomly assigned to assessments by both ""shadow'' and ""fixed'' examiners. Pearson correlation analysis with linear regression, Student's t-tests and Bland-Altman plots were the statistical methods used to compare the assessment modes. To strengthen the analysis, checklist items were classified by domain. RESULTS: High correlations between the ""shadow'' and ""fixed'' examiners' global scores were observed. The results of the analysis of specific domains demonstrated higher correlations for cognitive scores and lower correlations for affective scores. No statistically significant differences between the mean examiner global scores were found. The Bland-Altman analysis showed that the ""shadow'' examiners' affective scores were significantly higher than those of the ""fixed'' examiners, but the magnitude of this difference was small. CONCLUSION: The modified examiner role did not lead to any important bias in the students' scores compared with the original OSCE examiner format. This new strategy may provide important insights for formative assessments of clinical performance.
- Atrial fibrillation in low- and middle-income countries: a narrative review(2020) SANTOS, Itamar S.; GOULART, Alessandra C.; OLMOS, Rodrigo D.; THOMAS, G. Neil; LIP, Gregory Y. H.; LOTUFO, Paulo A.; BENSENOR, Isabela M.Preventing premature non-communicable disease mortality necessitates a thorough review of one of the most important risk factors for stroke, which is atrial fibrillation (AF). The latter and AF-related stroke are still considered to be problems of high-income countries and are frequently overlooked in low- and middle-income countries (LMICs). In this narrative review, we provide an overview of studies that evaluated at least one of the following determinants of AF burden in LMICs: current epidemiology and trends, stroke prevention, health outcomes, and economic burden. Studies focusing on samples close to the general population (including community- and primary care-based samples) indicate sex-specific prevalence rates up to 7.4% in LMICs. Although AF prevalence is still higher in high-income countries than LMICs, the gap in AF burden between these two groups has been reducing in the past three decades. Oral anticoagulant (OAC) therapy for stroke prevention is underused in LMICs, and there are little data on OAC therapy in relation to stroke risk scores, such as CHA(2)DS(2)-VASc. Available data also points to higher morbidity and mortality for patient with AF in LMICs than their counterparts in high-income countries. Data on the consequent economic burden in LMICs is scarce, but it is reasonable to consider it will follow the same trend as that observed for health outcomes. Raising the visibility of AF as a public health problem in LMICs is necessary as a first step to providing adequate care for patients with this condition.
- Health care professionals' perceptions about atrial fibrillation care in the Brazilian public primary care system: a mixed-methods study(2022) PASCHOAL, Elisabete; GOODEN, Tiffany E.; OLMOS, Rodrigo D.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; MANASEKI-HOLLAND, Semira; LIP, Gregory Y. H.; THOMAS, G. Neil; JOLLY, Kate C.; LANCASHIRE, Emma; LANE, Deirdre A.; GREENFIELD, Sheila; GOULART, Alessandra C.Background: Atrial fibrillation (AF) negatively impacts health systems worldwide. We aimed to capture perceptions of and barriers and facilitators for AF care in Brazilian primary care units (PCUs) from the perspective of healthcare professionals (HCPs).Methods: This mixed-methods, cross-sectional study utilised an exploratory sequential design, beginning with the quantitative data collection (up to 18 closed questions) immediately followed by a semi-structured interview. HCPs were recruited from 11 PCUs in the Sao Paulo region and included managers, physicians, pharmacists, nurses and community health agents. Descriptive statistics were used to present findings from the quantitative questionnaire and inductive analysis was used to identify themes from the qualitative data.Results: One hundred seven HCPs were interviewed between September 2019 and May 2020. Three main themes were identified that encapsulated barriers and facilitators to AF care: access to care (appointments, equipment/tests and medication), HCP and patient roles (HCP/patient relationship and patient adherence) and the role of the organisation/system (infrastructure, training and protocols/guidelines). Findings from the qualitative analysis reinforced the quantitative findings, including a lack of AF-specific training for HCPs, protocols/guidelines on AF management, INR tests in the PCUs, patient knowledge of AF management and novel oral anticoagulants (NOACs) as key barriers to optimal AF care.Conclusions: Development and implementation of AF-specific training for PCU HCPs are needed in Brazil, along with evidence-based protocols and guidelines, educational programmes for patients, better access to INR tests for patients taking warfarin and availability of NOACs.
- SUSCEPTIBILITY TO ANTIBIOTICS IN URINARY TRACT INFECTIONS IN A SECONDARY CARE SETTING FROM 2005-2006 AND 2010-2011, IN SAO PAULO, BRAZIL: DATA FROM 11,943 URINE CULTURES(2014) MIRANDA, Erique Jose Peixoto De; OLIVEIRA, Gerson Sobrinho Salvador De; ROQUE, Felicio Lopes; SANTOS, Silvia Regina Dos; OLMOS, Rodrigo Diaz; LOTUFO, Paulo AndradeIntroduction: Urinary tract infection (UTI) has a high incidence and recurrence, therefore, treatment is empirical in the majority of cases. Objectives: The aim of this study was to analyze the urine cultures performed at a secondary hospital, during two periods, 2005-2006 and 2010-2011, and to estimate the microbial resistance. Patients and methods: We analyzed 11,943 aerobic urine cultures according to basic demographic data and susceptibility to antibiotics in accordance with the Clinical and Laboratory Standards Institute (CLSI) for Vitek 1 and 2. Results: Most of our cohort consisted of young adult females that were seen at the Emergency Department. E. coli was the most frequent (70.2%) among the 75 species isolated. Resistance of all isolates was = 20% for trimethoprim/sulfamethoxazole (TMP/SMX), norfloxacin, nitrofurantoin, cefazolin and nalidixic acid. Although E. coli was more susceptible (resistance = 20% for TMP/SMX and nalidixic acid) among all of the isolates, when classified by the number and percentage of antibiotic resistance. Global resistance to fluoroquinolones was approximately 12%. Risk factors for E. coli were female gender and an age less than 65 years. Men and patients older than 65 years of age, presented more resistant isolates. Extended spectrum beta-lactamases (ESBL) were identified in 173 out of 5,722 Gram-negative isolates (3.0%) between 2010 and 2011. Conclusion: E. coli was the most frequent microbe isolated in the urine cultures analyzed in this study. There was a significant evolution of bacterial resistance between the two periods studied. In particular, the rise of bacterial resistance to fluoroquinolones was concerning.
- Cardiovascular medications and long-term mortality among stroke survivors in the Brazilian Study of Stroke Mortality and Morbidity (EMMA)(2022) SOUZA, Karla A. S.; VARELLA, Ana C.; OLMOS, Rodrigo D.; ROMAGNOLLI, Carla; GOODEN, Tiffany E.; THOMAS, G. Neil; LIP, Gregory Y. H.; SANTOS, Itamar S.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; GOULART, Alessandra C.Aim To investigate the association between medication use and long-term all-cause mortality in a Brazilian stroke cohort. Methods Both ischemic and hemorrhagic stroke were evaluated. Medication use was assessed as: never, only pre-stroke, only post-stroke, and continuous use. We evaluated anti-hypertensives, anti-diabetics, lipid-lowering drugs, anti-platelets, and anti-coagulants. Cox regression models were adjusted for sociodemographic and cardiovascular risk factors. Results Among 1173 incident stroke cases (median age: 68; 86.8% were ischemic, 70% first-ever stroke), medication use was low (overall: 17.5% pre-stroke, 26.4% post-stroke, and 40% were under continuous use). Anti-hypertensives and anti-platelets (aspirin) were the continuous cardiovascular medications used most often, at 83.5% and 72%, respectively, while statins (39.7%) and anti-diabetics (31.3%) were the least used. Medication use (pre-stroke, post-stroke and continuous use) was associated with a reduction in all-cause mortality risk, particularly among those under continuous use (multivariable hazard ratio, 0.52; 95% confidence interval (CI), 0.46-0.66) compared with never-users. Among ischemic stroke patients, this effect was similar (multivariable hazard ratio, 0.52; 95% CI, 0.40-0.68). No significant associations were evident among hemorrhagic stroke patients. Conclusions The risk of all-cause mortality was reduced by 48% among those with ischemic stroke under continuous use of medications. Secondary prevention should be emphasized more strongly in clinical practice. Geriatr Gerontol Int 2022; center dot center dot: center dot center dot-center dot center dot.
- Hypothyroidism in the elderly: diagnosis and management(2012) BENSENOR, Isabela M.; OLMOS, Rodrigo D.; LOTUFO, Paulo A.Thyroid disorders are highly prevalent, occurring most frequently in aging women. Thyroid-associated symptoms are very similar to symptoms of the aging process; thus, improved methods for diagnosing overt and subclinical hypothyroidism in elderly people are crucial. Thyrotropin measurement is considered to be the main test for detecting hypothyroidism. Combined evaluations of thyroid stimulating hormone (TSH) and free-thyroxine can detect overt hypothyroidism (high TSH with low free-thyroxine levels) and subclinical hypothyroidism (high TSH with normal free-thyroxine levels). It is difficult to confirm the diagnosis of thyroid diseases based only on symptoms, but presence of symptoms could be an indicator of who should be evaluated for thyroid function. The most important reasons to treat overt hypothyroidism are to relieve symptoms and avoid progression to myxedema. Overt hypothyroidism is classically treated using L-thyroxine; elderly patients require a low initial dose that is increased every 4 to 6 weeks until normalization of TSH levels. After stabilization, TSH levels are monitored yearly. There is no doubt about the indication for treatment of overt hypothyroidism, but indications for treatment of subclinical disease are controversial. Although treatment of subclinical hypothyroidism may result in lipid profile improvement, there is no evidence that this improvement is associated with decreased cardiovascular or all-cause mortality in elderly patients. In patients with a high risk of progression from subclinical to overt disease, close monitoring of thyroid function could be the best option.