Alexandre Lins Werneck

Death in patients with tuberculosis and diabetes: Associated factors

AIMS Identify factors associated with death in patients with tuberculosis and diabetes. METHOD The descriptive - analytic epidemiologic study using secondary data of tuberculosis cases reported in TBWEB from 1996 to 2014 is used. The profile analysis of the variables in relation to death controlled by the cure of the patients was performed by the software R, the independent variables that could be associated with the dependent variable in a 20% significance level, using the chi-square test. The analysis was performed on an unconditional logistic regression model. Odds ratio (OR) adjusted measures were obtained in order to evaluate the strength of association between independent variables. RESULTS Looking into the database TBWEB, from 1996 to 2014, 5361 cases of TB were reported, and from these cases, 4447 contained information about the closure and were complete. Patients with TB and DM represented 306 cases (6.35%). In relation to death, protective factors were: diabetes with OR: 0.69; follow up received during the treatment of medium and high complexity services, with OR: 0.51 and the other type with OR: 0.56. CONCLUSION Diabetes appeared as a protective factor for death in patients with tuberculosis in this study. The development of studies like this allows the expansion of knowledge on the TB-DM association.

Complications in patients after percutaneous aortic valve replacement

Objective Identify the profile of patients undergoing percutaneous aortic valve replacement and check the main complications after the implantation, as well as the associated comorbidities and death. Methods This is a retrospective and quantitative study carried out at a Public Institution in the city of Sao Paulo. The inclusion criterion was patients undergoing percutaneous aortic valve replacement at Institution department of hemodynamics from 2009 to 2012. Our baseline sample consisted of 85 patients. We excluded 14 patients who underwent the implant in the hybrid operating room, which could present discrepancy between the results. Thus, from our sample of 71 patients, data collection was possible only on 65 individuals, because some of the medical records were not available at the time of collection. Results Patients’ profiles were elderly, with a mean age of 82 ± 6.9 years, female, widowed, with low education, and retired. During implantation, arrhythmias were the major complication. In the immediate postoperative period, the most prevalent complications were vascular injury, psychomotor agitation, and confusional state. In late post-implantation, complications were vascular injury, skin injury by medical adhesive tape, hyperglycemia, loss of temporary pacemaker, 21.5% of the patients died. Conclusion The adoption of this new technology should be consolidated for elderly patients with formal contraindications to conventional surgery with the improvement of the implantation technique, better selection of candidates, and decrease of mortality.Objective Identify the profile of patients undergoing percutaneous aortic valve replacement and check the main complications after the implantation, as well as the associated comorbidities and death. Methods This is a retrospective and quantitative study carried out at a Public Institution in the city of Sao Paulo. The inclusion criterion was patients undergoing percutaneous aortic valve replacement at Institution department of hemodynamics from 2009 to 2012. Our baseline sample consisted of 85 patients. We excluded 14 patients who underwent the implant in the hybrid operating room, which could present discrepancy between the results. Thus, from our sample of 71 patients, data collection was possible only on 65 individuals, because some of the medical records were not available at the time of collection. Results Patients’ profiles were elderly, with a mean age of 82 ± 6.9 years, female, widowed, with low education, and retired. During implantation, arrhythmias were the major complication. In the immediate postoperative period, the most prevalent complications were vascular injury, psychomotor agitation, and confusional state. In late post-implantation, complications were vascular injury, skin injury by medical adhesive tape, hyperglycemia, loss of temporary pacemaker, 21.5% of the patients died. Conclusion The adoption of this new technology should be consolidated for elderly patients with formal contraindications to conventional surgery with the improvement of the implantation technique, better selection of candidates, and decrease of mortality.

Incidence of phlebitis in adult patients

ABSTRACT Objective: to verify the incidence of phlebitis in adult patients associated with sociodemographic characteristics, hospitalization and venous puncture. Method: quantitative, descriptive, retrospective study performed at a sentinel hospital, reporting adverse events in the electronic medical record, totaling 176. The mean and standard deviation for the quantitative variables were calculated. The incidence of phlebitis was calculated using absolute numbers and percentage. Opinion 1,050,829. Results: the mean incidence of phlebitis was 14.66 at 12 months. The majority of the patients were men aged between 61 and 80 years, white, married, with incomplete elementary school, retired, Catholic, of the Unified Health System, with hospitalization <15 days and peripheral venous puncture with time <72h of insertion. Most nurses did not specify the prescribed drug. Conclusion: phlebitis occurred in patients with time of hospitalization <15 days and venous puncture <72h. Most of the drugs were not specified but, when described, it was irritating. The procedure was to remove and replace the puncture and the patients were discharged. This study demonstrated the need for correct notification of phlebitis by nurses in order to assess risks to improve patient safety. Descritores : Notification; Phlebitis; Patient; Nursing: Hospitals, Teaching; Nursing Care. RESUMO Objetivo : verificar a incidencia de flebites em pacientes adultos associando com caracteristica sociodemografica, internacao hospitalar e puncao venosa. Metodo : estudo quantitativo, descritivo, retrospectivo, realizado em um hospital da rede sentinela, por meio da notificacao de eventos adversos no prontuario eletronico, totalizando 176. Foram calculados a media e o desvio padrao para as variaveis quantitativas. A incidencia de flebites foi calculada usando-se numeros absolutos e porcentagem. Parecer 1.050.829. Resultados : a incidencia media de flebite foi 14,66 em 12 meses. A maioria dos pacientes era de homens, entre 61 e 80 anos, branca, casada, com ensino fundamental incompleto, aposentada, catolica, do Sistema Unico de Saude, com internacao <15 dias e puncao venosa periferica com tempo <72h de insercao. A maioria dos enfermeiros nao especificou a droga prescrita. Conclusao : a flebite ocorreu em pacientes com tempo de internacao <15 dias e puncao venosa <72h. A maioria das drogas nao foi especificada, mas, quando descrita, era irritante. A conduta foi a retirada e a troca da puncao e os pacientes receberam alta hospitalar. Este estudo demonstrou a necessidade da notificacao correta de flebite pelos enfermeiros a fim de avaliar os riscos para melhorar a seguranca do paciente. Descritores : Notificacao; Flebite; Paciente; Enfermagem; Hospital de Ensino; Assistencia de Enfermagem. RESUMEN Objetivo: verificar la incidencia de flebitis en pacientes adultos asociando con caracteristica sociodemografica, internacion hospitalaria y puncion venosa. Metodo: estudio cuantitativo, descriptivo, retrospectivo, realizado en un hospital de la red centinela, por medio de la notificacion de eventos adversos en el prontuario electronico, totalizando 176. Se calcularon la media y la desviacion estandar para las variables cuantitativas. La incidencia de flebitis fue calculada, usando numeros absolutos y porcentaje. Dictamen 1.050.829 . Resultados : la incidencia media de flebitis fue 14,66 en 12 meses. La mayoria de los pacientes eran hombres, entre 61 y 80 anos, blancas, casadas, con ensenanza fundamental incompleta, jubilada, catolica, del Sistema Unico de Salud, con internacion <15 dias y puncion venosa periferica con tiempo <72h de insercion. La mayoria de las enfermeras no especifico la droga prescrita. Conclusion: la flebitis ocurrio en pacientes con tiempo de internacion <15 dias y puncion venosa <72h. La mayoria de las drogas no fueron especificadas, pero cuando se describian eran irritantes. La conducta fue retirada y el intercambio de la puncion y los pacientes recibieron alta hospitalaria. Este estudio demostro la necesidad de la notificacion correcta de flebitis por los enfermeros, a fin de evaluar los riesgos para mejorar la seguridad del paciente . Descritores : Notificacion; Flebitis; Paciente; Enfermeria; Hospitales de Ensenanza; Atencion de Enfermeria.

Tracheal cuff pressure change before and after the performance of nursing care

OBJECTIVE Verify the changes of endotracheal cuff pressure before and after oral hygiene, head-of-bed elevation at 0º, 30º, and 60º, change in body position, aspiration of the endotracheal tube, and in-bed bathing. METHOD The study sample was composed of 88 patients. We performed 3,696 checks from July to September 2014. RESULTS Pressure values were analyzed in seven nursing care in the morning. Six of them were significantly altered before and after nursing procedure. In the afternoon, five of the health care provided were altered, and in the evening, only two. Most of pressure values were below recommended. CONCLUSION There were differences before and after health care provided, showing changes in cuff pressure. In-bed bathing and head-of-bed elevation at 30º were the ones that most altered pressure values in the three working shifts. Therefore, it is necessary to measure cuff pressure at least twice per working shift, preferably after bathing.

DIAGNÓSTICO DE SEPSE EM PACIENTES APÓS INTERNAÇÃO EM UNIDADE DE TERAPIA INTENSIVA

Introduction: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Patients with sepsis (formerly called severe sepsis) should still be identified by the same organ dysfunction criteria (including lactate level greater than 2 mmol/L). Organ dysfunction may also be identified in the future using the quick Sepsis-Related Organ Failure Assessment (qSOFA). Currently, sepsis is one of the main causes of mortality in Intensive Care Units. In 2003, the Sepsis Surviving Campaign was created, elaborating a schedule of actions to reduce the incidence of sepsis, especially in intensive care units. Objective: To know the clinical characteristics and outcome of patients who developed sepsis during Intensive Care Units admission. Material and Methods: This is a retrospective, descriptive study using a quantitative approach performed at the Intensive Care Units. Data were obtained through an electronic medical record. The software Epi Info, version 7.2.1.0 was used to analyze data. Results: The largest number of patients hospitalized was male, aged from 51 to 70 years. The most common comorbidities were Systemic Hypertension, Diabetes Mellitus, alcoholism, smoking, and heart disease. The most analyzed post-sepsis outcome was discharge from Intensive Care Units, and the patients were considerably males. Conclusion: We conclude that the patients who most developed sepsis were men (62%), aged ranging from 51 to 70 years (36%). The main comorbidity was systemic hypertension (42%) and the most observed outcome was discharge from the Intensive Care Units (67%). Descriptors: Sepsis, Diagnosis, Intensive Care Units, Patients, Hospitalization.

IDENTIFICAÇÃO E AVALIAÇÃO DA PERCEPÇÃO DOS PROFISSIONAIS DE ENFERMAGEM EM RELAÇÃO A DOR/DESCONFORTO DO RECÉM-NASCIDO

Introduction: Despite the breakthrough in the clinical issue of pain, it is known that there is a major flaw in recognizing it when discussing about caring of newborns. Objective: To analyze the knowledge of nursing professionals in the process of identifying, evaluating, and acting in pain management in hospitalized infants at three Neonatal Intensive Care Units, in order to get more information for assistance planning. Patients and Methods: This is a qualitative research using a content analysis method according to Bardin’s theory, accomplished by semi-structured interviews. These were carried out with 29 nursing professionals working at three Neonatal Intensive Care units, at Hospital de Base de Sao Jose do Rio Preto. This research was carried out on 1 st -20 th September 2013. Results: The results indicate the use of crying, facial expression, body language, and physiological changes as parameters to painful stimulus indications in the neonate. Conclusion: Despite considering the evaluation of pain on newborns as an important subject, most of the nursing professionals still do not use scales for this kind of evaluation, as well as there are no standard medicines to ease pain. Descriptors: Pain; Infant, Newborn; Evaluation; Nursing.