Suchergebnisse

Background:Tele-rehabilitation (TR) may be an effective alternative or complement to centre-based cardiac rehabilitation (CBCR) with heart failure (HF) patients, helping overcome accessibility problems to CBCR. The aim of this study is to systematically review the literature in order to assess the clinical effectiveness of TR programs in the management of chronic HF patients, compared to standard of care and standard rehabilitation (CBCR).Methods and Results:We conducted a systematic review and meta-analysis of randomized controlled trials on the effect and safety of TR programs in HF patients, regarding cardiovascular death, heart failure-related hospitalizations, functional capacity and quality of life. We searched 4 electronic databases up until May 2020, reviewed references of relevant articles and contacted experts. A quantitative synthesis of evidence was performed by means of random-effects meta-analyses. We included 17 primary studies, comprising 2206 patients. Four studies reported the number of hospitalizations (TR: 301; Control: 347). TR showed to be effective in the improvement of HF patients' functional capacity in the 6 Minute Walk-Test (Mean Difference (MD) 15.86; CI 95% [7.23; 24.49]; I2 = 74%) and in peak oxygen uptake (pVO2) results (MD 1.85; CI 95% [0.16; 3.53]; I2= 93%). It also improved patients' quality of life (Minnesota Living with Heart Failure Questionnaire: MD −6.62; CI 95% [−11.40; −1.84]; I2= 99%). No major adverse events were reported during TR exercise.Conclusion:TR showed to be superior than UC without CR on functional capacity improvement in HF patients. There is still scarce evidence of TR impact on hospitalization and cv death reduction. Further research and more standardized protocols are needed to improve evidence on TR effectiveness, safety and cost-effectiveness.

O presente artigo tem por objetivo refletir sobre o que se aprendeu com a pandemia da COVID-19. O método utilizado foi o teórico-reflexivo baseado em literatura nacional, internacional e na vivência de campo. As considerações se baseiam em três áreas temáticas: Vivenciar a COVID-19; O impacto para os idosos; e A Enfermagem Gerontológica. O vivenciar a pandemia apresenta a vivencia de uma enfermeira especialista em enfermagem gerontogeriátrica e mostra o assistir na pandemia, seu processo de contaminar-se, bem como o retorno assistencial em um necessário se reinventar. No impacto aos idosos tem-se as questões dos isolamento e distanciamento, o idoso vulnerável, a solidariedade, a importância da iniciativa privada, o olhar sobre as instituições de longa permanência e as experiências de idosos na pandemia. Na Enfermagem Gerontológica tem-se que o conhecimento e atualização são necessários e o reafirmar da especialidade na Enfermagem, bem como que o cuidar é um ato significativamente pessoal e compreende assumir a importância da existência do outro.