Abstract in English:

ABSTRACT BACKGROUND: Oxygen is widely used to treat hypoxemia. OBJECTIVE: To determine the frequency of inappropriate oxygen administration in patients admitted to Internal Medicine (IM) wards and intensive care units (ICU). DESIGN AND SETTING: Single-center prospective, observational study in a tertiary university hospital in Ankara, Türkiye. METHODS: Patients who were hospitalized in the IM wards and ICU and were receiving oxygen were recruited. Every 6 hours, the oxygenation parameters were noted, and the averages over the first 24 hours of oxygen usage were recorded. Inappropriate usage was defined as oxygen flow rates > 6 L/min in the nasal cannula and < 5 L/min and > 10 L/min in the simple face mask, application of the simple face mask in chronic obstructive lung disease (COPD) exacerbation, SpO2 > 98% in general, or SpO2 > 92% in COPD exacerbation. RESULTS: Of the 397 patients, 20% in the IM wards and 50% of 124 in the ICU received oxygen. The oxygen method used was nasal cannula in 51%, simple face mask in 21%, and high-flow nasal cannula in 4% of the patients. Among the simple face mask applications, 46% were < 5 L/min and 5% were > 10 L/min. Among the 62% of patients with COPD exacerbations, the SpO2 was > 92%. CONCLUSION: The frequency of oxygen use was 20% among patients hospitalized in IM wards and 50% among patients in the ICU. Almost half of the simple face mask applications were inappropriate.

Abstract in English:

ABSTRACT BACKGROUND: The Surprise Question (SQ), “Would I be surprised if this patient were to die in the next 12 months?”, identifies patients at high risk of death who might benefit from palliative care (PC). However, little is known about its application in oncohematology. OBJECTIVES: To evaluate the performance of the SQ among inpatients with hematologic malignancies. DESIGN AND SETTING: A prospective cohort study was conducted between September and December 2021, including patients admitted to the Hematology Ward of the University Hospital in Salvador, Brazil. METHODS: Physicians answered the SQ (not surprised (SQ+) or surprised (SQ–)). Mortality data were assessed after one year. RESULTS: Eighty-one patients were included (56% SQ+ and 44% SQ–). At study closure, 36 patients (44%) had died. Median survival was 10.8 months (95%CI = 9.7–11.8) for SQ– and 5.6 months (95%CI = 4.1–7.1) for SQ+. Sensitivity was 86.1%, specificity 68.9%, positive predictive value 68.8%, negative predictive value 86.1%, and accuracy 76.5%. At the time of the interview, only 15 (18.5%) patients had consulted a PC specialist. By the study’s end, 48% had been referred to PC. These patients had poorer performance status (82% vs. 40%, P < 0.001) and more advance care planning records (87% vs. 14%, P < 0.001). CONCLUSIONS: Despite the prognostic uncertainty of hematologic malignancies, the SQ effectively estimates mortality and serves as a valuable tool for early PC integration in oncohematology.

Abstract in English:

ABSTRACT BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) represents a compelling cause of hospital morbidity and mortality in Brazil. There is low adherence to guideline-directed medical therapy (GDMT), which in turn, can result in higher morbidity and mortality. OBJECTIVES: The present study aims to evaluate adherence to GDMT in patients with HFrEF in a Brazilian University hospital service. DESIGN AND SETTINGS: Observational, cross-sectional, single-center study conducted at the Hospital Universitário Professor Edgard Santos (HUPES), Salvador, BA, Brazil. METHODS: The study was conducted with convenience sampling at the cardiology outpatient clinic of a university hospital service. Patients with left ventricular ejection fraction (LVEF) < 40% who had reverse remodeling were excluded. RESULTS: 289 patients were included, with mean age 63 years, 54.7% were male, 56,4% mixed-race and 27,7% had Chagasic cardiomyopathy. 93.1% were prescribed ACEi, ARB or ARNi, 95.8% betablockers, 69.2% spironolactone and 8% the combination hydralazine/isosorbide-dinitrate. 71,7% were using enalapril, losartan or ARNi above 50% of GDMT target doses; 81,2% were using beta-blockers and 100% were using spironolactone. Only 21,2% were prescribed GDMT target doses of enalapril, losartan or ARNi and 52,3% of beta-blockers. 98,5% of spironolactone prescriptions reached GDMT target doses. CONCLUSIONS: We found high frequencies of prescription of GDMT for HFrEF, considering the therapeutic goals recommended by cardiology guidelines, but, prescription of target doses were low in ACEi, ARB or ARNi and beta-blockers.