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Advisor(s)
Abstract(s)
A Cirrose Hepática é uma doença crónica progressiva que tem uma variedade de
manifestações clínicas e complicações, algumas das quais podem ameaçar a vida dos doentes.
Esta doença é considerada a décima causa de morte nos Estados Unidos da América e
diminui de forma significativa a qualidade de vida dos doentes, principalmente devido às suas
numerosas complicações. As 3 complicações mais importantes são a ascite, a encefalopatia
hepática e a hemorragia das varizes esofágicas.
A Telemedicina, nomeadamente a Telemonitorização, tem sido usada recentemente
como uma ferramenta para o acompanhamento em ambulatório de doentes com patologias
como Hipertensão Arterial, Insuficiência Cardíaca e DPOC. Na maioria destes estudos, o
método de monitorização mais utilizado foram as intervenções telefónicas. No entanto, novos
métodos estão a surgir, à medida que há uma melhoria das tecnologias disponíveis.
Não foram encontrados estudos acerca do acompanhamento de doentes com Cirrose
Hepática por Telemedicina. Sendo assim, o objetivo principal deste trabalho é a elaboração
de um protocolo de vigilância do estado de saúde de doentes cirróticos em ambulatório,
através de técnicas de Telemonitorização disponíveis hoje em dia. A hipótese que se coloca é
a de melhorar a qualidade de vida e promover a sobrevivência destes doentes, promovendo o
controlo antecipado das complicações.
Nesse sentido, elaborou-se um protocolo para o seguimento destes doentes, com a
criação de um questionário que aborda os sintomas mais comuns de descompensação da
Cirrose Hepática. Deu-se ênfase especial à presença de encefalopatia, hemorragia e ascite,
visto serem os sintomas de maior preocupação e que predizem um pior prognóstico.
Foi criada uma versão simplificada deste questionário de modo a facilitar a
compreensão dos doentes no seu preenchimento em casa. Esta versão adaptada foi utilizada
num projeto piloto com 5 doentes, que a experimentaram de modo a detetar dificuldades que
tivessem. O objetivo foi melhorar ao máximo este questionário para que seja aplicado num
estudo futuro.
Na secção de Resultados e Discussão é justificada a utilização de cada um dos
critérios do questionário e discutida a sua validade clínica no contexto de acompanhamento
de doentes com Cirrose Hepática. Nesta secção é também apresentdo o feedback dos doentes
relativamente ao projeto piloto, que levou à decisão de não se fazerem alterações no
questionário, assim como as limitações encontradas durante a elaboração do protocolo. Com este trabalho concluiu-se que a Telemonitorização tem o potencial para ser um
bom método de acompanhamento destes doentes, com vantagens já conhecidas e que foram
confirmadas quando foi realizado o projeto piloto aplicando este questionário. No entanto, é
fundamental aplicar este protocolo no futuro, de modo a testar tanto a sua viabilidade, como
a possibilidade de ter um efeito benéfico na evolução de doentes com CH.
Cirrhosis is a progressive liver disease with a variety of symptoms and complications and some can even threat the pacients life. This is a disease that decreases significantly the patients’ quality of life, particularly bacause of its numerous complications. The 3 more important ones are ascites, hepatic encephalopathy and variceal bleeding. Telemedicine, particularly Telemonitoring, has been used recently as a way to acompany pacients with Hypertension, Congestive Heart Failure and COPD through ambulatory care. In the majority of the studies with this kind of patients, the most common monitoring method was telephone interventions. However, new methods are arising as new technologies become available. No studies were found on telemonitoring with cirrhotic pacients. The main goal of this paper is the elaboration of a protocol for the monitoring of pacients with Cirrhosis with the new telemonitoring techniques available nowadays. The hypothesis is to improve the quality of life of these pacients and their survival rates, promoting the early detection of complications. This way, the protocol was created with the construction of a questionnaire focusing on the most common symtoms of cirrhotic decompensation. The presence of encephalopathy, bleeding and ascites had special emphasis since they are the symptons that cause more distress to the medical team and predict a worst outcome. A simplified version of this questionnaire was then created to facilitate the pacients comphrehension. That adapted version was used in a pilot project with 5 pacients, in which the goal was to test the questionnaire for any difficulties in its filling and improve it the most so that it can be applied in the future. There is a scientific justification for all the criteria in the questionnaire and their clinical validity is discussed. The feedback from the patients that took part in the pilot project is also discussed as the reason no changes were made in the questionnaire, as well as the limitations of this study. With this paper we reached the conclusion that Telemonitoring has the potencial to become a good method of monitoring in pacients with Cirrhosis of the liver, with advantages that were known from other studies and were confirmed in the pilot project with this questionnaire. However, it is important to apply this protocol in a future study to test its viability and the possibility of it having a positive effect in the evolution of these pacients.
Cirrhosis is a progressive liver disease with a variety of symptoms and complications and some can even threat the pacients life. This is a disease that decreases significantly the patients’ quality of life, particularly bacause of its numerous complications. The 3 more important ones are ascites, hepatic encephalopathy and variceal bleeding. Telemedicine, particularly Telemonitoring, has been used recently as a way to acompany pacients with Hypertension, Congestive Heart Failure and COPD through ambulatory care. In the majority of the studies with this kind of patients, the most common monitoring method was telephone interventions. However, new methods are arising as new technologies become available. No studies were found on telemonitoring with cirrhotic pacients. The main goal of this paper is the elaboration of a protocol for the monitoring of pacients with Cirrhosis with the new telemonitoring techniques available nowadays. The hypothesis is to improve the quality of life of these pacients and their survival rates, promoting the early detection of complications. This way, the protocol was created with the construction of a questionnaire focusing on the most common symtoms of cirrhotic decompensation. The presence of encephalopathy, bleeding and ascites had special emphasis since they are the symptons that cause more distress to the medical team and predict a worst outcome. A simplified version of this questionnaire was then created to facilitate the pacients comphrehension. That adapted version was used in a pilot project with 5 pacients, in which the goal was to test the questionnaire for any difficulties in its filling and improve it the most so that it can be applied in the future. There is a scientific justification for all the criteria in the questionnaire and their clinical validity is discussed. The feedback from the patients that took part in the pilot project is also discussed as the reason no changes were made in the questionnaire, as well as the limitations of this study. With this paper we reached the conclusion that Telemonitoring has the potencial to become a good method of monitoring in pacients with Cirrhosis of the liver, with advantages that were known from other studies and were confirmed in the pilot project with this questionnaire. However, it is important to apply this protocol in a future study to test its viability and the possibility of it having a positive effect in the evolution of these pacients.
Description
Keywords
Cirrose Hepática Gastroenterologia Telemedicina Telemonitorização