Publication year: 2023
Theses and dissertations in Portugués presented to the Fundação Antônio Prudente to obtain the academic title of Doutor. Leader: Aguiar Junior, Samuel
Introdução:
O câncer colorretal (CCR) é um problema de saúde pública mundial cujo controle depende do estabelecimento de políticas públicas e programas de prevenção e rastreamento eficazes. No Brasil estudos relacionados à adesão e preferências a diferentes métodos de rastreamento são pouco conhecidos. Objetivo:
Avaliar a associação de características demográficas, condição socioeconômica e variáveis clínicas na adesão para realização de testes de sangue oculto nas fezes (PSOF) dos tipos Imunoquimico Mecanizado (FIT) e Guaiaco (G-FOBT) em população de médio risco para o desenvolvimento de câncer colorretal. Método:
Estudo observacional transversal, com coleta prospectiva de dados. Entre março de 2015 e abril de 2016 1.254 indivíduos assintomáticos, com idade entre 50 e 75 anos, foram consecutivamente selecionados a partir de campanhas hospitalares de rastreamento para neoplasias conduzidas pelo AC Camargo Cancer Center. Todos os participantes foram convidados ao rastreamento do CCR mediante realização dos testes (G-FOBT) e (FIT) e responderam a um questionário com características demográficas, condição socioeconômica e variáveis clínicas. Análise estatística:
Para avaliar a independência entre variáveis qualitativas foi aplicado o teste de Qui-quadrado. As médias das variáveis quantitativas foram comparadas através do Teste t. Os resultados das análises univariadas foram utilizados para selecionar variáveis para os modelos de regressão logística múltipla, considerando-se valores de p≤0.20. As associações estão descritas por Odds Ratio (OR) e o intervalo de confiança adotado foi de 95% (95% CI). A significância considerada foi de 0.05. A partir dos resultados encontrados foi proposto um nomograma para a predição da probabilidade de adesão com base nas características dos indivíduos. Resultados:
As taxas de adesão foram 55,6% e 48,8%, respectivamente para os testes FIT e G-FOBT (p<0.001). As médias de anos de estudos foram diferentes entre os grupos aderentes e não aderentes nos métodos FIT e G-FOBT (8.4vs 9.0; p = 0.001). Nas análises univariadas, as variáveis idade, tipo de atividade ocupacional, crença religiosa e realização prévia de PSOF influenciaram as taxas de adesão aos dois tipos de testes. Nos modelos multivariados, respectivamente para os exames FIT e G-FOBT as variáveis idade 60-75 anos (OR = 1.39; 95%IC 1.06–1.81) e (OR = 1.49; 95%IC 1.16–1.49), presença de crença religiosa (OR = 1.99; 95%IC 1.27–3.11) e (OR = 1.70; 95% IC 1.11–2.60), PSOF (OR = 2.22; 95% IC 1.61– 3.05) e (OR = 1.26; 95% IC 1.26–2.20) e trabalho em tempo integral ou parcial (OR = 0.69; 95% IC 0.05–0.96) e (OR= 0.68; 95%IC 0.50–0.91) estiveram associadas de forma independente à adesão aos métodos de rastreamento do CCR. As variáveis, sexo, raça, estado civil, renda, presença de seguro saúde e distância da residência até o hospital não influenciaram na adesão aos exames FIT e G-FOBT. Conclusão:
Maior idade, presença de crença religiosa, ausência de atividade de trabalho formal e realização prévia de PSOF estão relacionados à maior adesão aos testes (FIT) e o (G-FOBT), na população estudada.
INTRODUCTION:
Colorectal surgeries are complex procedures, associated with higher rates of complications and readmissions than procedures at other surgical sites. Currently,
standardized procedures aim the early recovery of patients treated for colorectal surgeries
in order to reduce the length of hospital stay. The reduction in hospitalization time, however, despite being considered a positive result, may lead to a risk , since complications generally occur outside the hospital environment, making it difficult to assess and monitor these patients. OBJECTIVE:
The aim of the present study was to develop a mobile health app
, accessible on smartphones, to remotely monitor the signs and symptoms of patients in the
postoperative period of colorectal surgeries, evaluating the outcomes of admission rate in
the emergency department and rate of severe complications. (Clavien-Dindo 3 to 5) within a
fifteen-day postoperative period. METHODS:
The project was developed in two steps, the first being the structuring of the Digital Journey, with the creation of a platform with a decision algorithm for identifying symptoms and directing conducts, and the second the validation of the program in a pilot study. Patients aged between 18 and 80 years old, who were to undergo oncological colorectal surgeries, were included in the study. The study was conducted on the premises of the A.C.Camargo Cancer Center. Monitoring of patients and reporting of signs and symptoms by patients were performed via a remote monitoring platform, using a smartphone or computer. RESULTS:
In the pilot study, in each of the three evaluation phases of the data obtained, the decision algorithm and the instrument for data collection were restructured, aiming to achieve greater sensitivity and specificity in the detection of complications by the platform, as well as greater patient satisfaction. The ability to detect complications increased at each analysis and adjustment phase, and after the third and final phase of adjustments, 45 (71.4%) adverse events were reported, of which 12 (19%) were symptoms classified as high grade. In this sample, the digital solution was able to identify 3 (4.8%) real complications with a sensitivity of 75%, specificity of 84%, accuracy of 83%, positive predictive value of 25% and negative predictive value of 98%. We also had, 5(7.9%) errors in filling out detected and 1(1.6%) complications not detected by the platform, due to error in filling out the daily assessment questionnaire. Our rehospitalization rate by indication of the platform, in this sample was 2 (3.2%) and admission to the emergency room, considering referral or not from the platform, was 8 (12.7%). Complete adherence to the monitoring program was 83%, with an NPS score ranging from 69 to 95, the highest score obtained in the last evaluation phase. CONCLUSION:
The a mobile health app created was proved to be safe, with high adherence rates and good acceptance by patients, but it still needs to be adjusted with the intention of reducing costs of referral and admission to the emergency department.