RODRIGO DIAZ OLMOS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
DVCLME-62, Hospital Universitário
DVCLME-62, Hospital Universitário
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- 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.- 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.
- Calcium Score to Evaluate Chest Pain in the Emergency Room(2013) STANIAK, Henrique Lane; BITTENCOURT, Marcio Sommer; SHAROVSKY, Rodolfo; BENSENOR, Isabela; OLMOS, Rodrigo Diaz; LOTUFO, Paulo A.Some authors have suggested that a zero calcium score (CAC) can be used to rule out the diagnosis of acute coronary syndrome. Objective this study is to evaluate the diagnostic accuracy of a zero CAC when compared to the coronary computed tomography angiography (CCTA) at the emergency department. 135 symptomatic patients with no previous coronary heart disease (CHD) who presented to the emergency department were submitted to CAC and CCTA to rule out CHD. All patients had normal electrocardiogram and cardiac biomarkers and were TIMI risk score 0 to 2. The CCTA was considered positive if any obstructive lesion (> 50%) was identified. The mean age was 51.7 +/- 13.6 years with 50.6% of men. Seventy-three (54.1%) patients had a calcium score of zero. Of them, 3 (4.1%) had an obstruction > 50% and underwent invasive coronary angiography. Calcium score showed a sensitivity of 92.9%, specificity of 75.3%, positive and negative predictive values of, respectively, 62.9% and 95.9%. Positive and negative likelihood ratios were respectively of 3.7 and 0.09 to detect lesions greater than 50% in the CCTA. A negative likelihood ratio of 0.09 is very good to rule out most cases of significant coronary obstruction in epidemiologic studies. However, it is important to understand that in a clinical scenario, all evidence including history, clinical examination, data from eletrocardiogram and myocardial biomarkers have to be interpreted together. In our study, three cases with a zero CAC score had coronary obstruction higher than 50% at the CCTA.