Flávia Cortez Colósimo

O efeito de intervenções educativas no conhecimento da equipe de enfermagem sobre hipertensão arterial

Hypertension is one of the main risk factors for cardiovascular diseases. Nursing carries a large responsibility in care delivery to hypertensive individuals. Thus, the goal was to assess a nursing teams knowledge on hypertension and its treatment before and after educational interventions. A questionnaire was used, addressing theoretical aspects of hypertension knowledge among nurses (5), technicians (2), auxiliaries (11) and community agents (37) at two Basic Health Units in São Paulo City, Brazil. For statistical analysis, Students T test was used, as well as variance analysis and p < 0.05. A knowledge increase was verified after the educational interventions for the group constituted by nurses, technicians and nursing auxiliaries (84.6 +/- 12.0% vs. 92.7 +/- 15.0%, p < 0.05), while no significant change occurred for community health agents (80.8 +/- 12.2% vs. 83.5 +/- 24.0%). Thus, it was concluded that the educational actions were effective and must be put in practice in the nursing team, which they can influence the improvement of care delivery for hypertensive patients.A hipertensao arterial e um dos principais fatores de risco para as doencas cardiovasculares, sendo grande a responsabilidade da enfermagem na atencao aos hipertensos. Objetivou-se, portanto, avaliar o conhecimento sobre hipertensao e seu tratamento com a equipe de enfermagem, antes e apos onze intervencoes educativas. Utilizou-se questionario abordando aspectos teoricos ligados ao conhecimento sobre hipertensao em enfermeiros (5), tecnicos (2), auxiliares (11) e agentes comunitarios (37), de duas Unidades Basicas de Saude da cidade de Sao Paulo. Para analise estatistica utilizou-se o teste T de Student, analise da variância e p<0,05. Verificou-se aumento no conhecimento apos as intervencoes educativas para o grupo formado por enfermeiros, tecnicos e auxiliares de enfermagem (84,6±12,0% vs 92,7±15,0%, p<0,05), enquanto que para agentes comunitarios de saude nao houve mudanca significante (80,8±12,2% vs 83,5±24,0%). Portanto, conclui-se que as acoes educativas foram efetivas e que devem ser implementadas junto a equipe de enfermagem, considerando que elas podem influenciar no aprimoramento da assistencia as pessoas hipertensas.

Independent predictors of prolonged mechanical ventilation after coronary artery bypass surgery

OBJECTIVE To determine independent predictors of prolonged mechanical ventilation in patients undergoing coronary artery bypass graft surgery. METHODS Data of patients undergoing coronary artery bypass graft surgery were included prospectively from July 2009 to July 2010. All data were input into an electronic database. The resulting cohort included a total of 2952 patients of which 77 remained more than 48 hours on mechanical ventilation. Patients were divided into two groups: 1) a prolonged ventilation group, needing mechanical ventilation for more than 48 hours and 2) not prolonged ventilation group, undergoing a successful extubation within 48 hours. RESULTS After adjustment for confounding factors a multivariate analysis identified the following factors as independent predictors of prolonged mechanical ventilation: age (OR 1.06 95% CI 1.03 -1.09; P <0.001), chronic renal failure (OR 3.52 95% CI 1.84 - 6.74; P <0.001), chronic obstructive pulmonary disease (OR 2.65 95% CI 1.38 -5.09; P = 0.004), coronary artery bypass graft associated with other procedures (OR 3.33 95 % CI 1.89 - 5.58; P <0.001) and clamping time (OR 1.01 95% CI 1.00 -1.02; P = 0.018). CONCLUSION The identification of these predictors allows the development of preventive strategies that could reduce invasive ventilation time, since patients on prolonged mechanical ventilation present greater morbidity and mortality rates.

The effect of educational interventions on nursing team knowledge about arterial hypertension

Hypertension is one of the main risk factors for cardiovascular diseases. Nursing carries a large responsibility in care delivery to hypertensive individuals. Thus, the goal was to assess a nursing teams knowledge on hypertension and its treatment before and after educational interventions. A questionnaire was used, addressing theoretical aspects of hypertension knowledge among nurses (5), technicians (2), auxiliaries (11) and community agents (37) at two Basic Health Units in São Paulo City, Brazil. For statistical analysis, Students T test was used, as well as variance analysis and p < 0.05. A knowledge increase was verified after the educational interventions for the group constituted by nurses, technicians and nursing auxiliaries (84.6 +/- 12.0% vs. 92.7 +/- 15.0%, p < 0.05), while no significant change occurred for community health agents (80.8 +/- 12.2% vs. 83.5 +/- 24.0%). Thus, it was concluded that the educational actions were effective and must be put in practice in the nursing team, which they can influence the improvement of care delivery for hypertensive patients.A hipertensao arterial e um dos principais fatores de risco para as doencas cardiovasculares, sendo grande a responsabilidade da enfermagem na atencao aos hipertensos. Objetivou-se, portanto, avaliar o conhecimento sobre hipertensao e seu tratamento com a equipe de enfermagem, antes e apos onze intervencoes educativas. Utilizou-se questionario abordando aspectos teoricos ligados ao conhecimento sobre hipertensao em enfermeiros (5), tecnicos (2), auxiliares (11) e agentes comunitarios (37), de duas Unidades Basicas de Saude da cidade de Sao Paulo. Para analise estatistica utilizou-se o teste T de Student, analise da variância e p<0,05. Verificou-se aumento no conhecimento apos as intervencoes educativas para o grupo formado por enfermeiros, tecnicos e auxiliares de enfermagem (84,6±12,0% vs 92,7±15,0%, p<0,05), enquanto que para agentes comunitarios de saude nao houve mudanca significante (80,8±12,2% vs 83,5±24,0%). Portanto, conclui-se que as acoes educativas foram efetivas e que devem ser implementadas junto a equipe de enfermagem, considerando que elas podem influenciar no aprimoramento da assistencia as pessoas hipertensas.

Avaliação do tempo de permanência hospitalar em cirurgia de revascularização miocárdica segundo a fonte pagadora

OBJECTIVE The length of hospital stay (LOS) allows for the evaluation of the efficiency of a given hospital facility, as well as providing a basis for measuring the number of hospital beds required to provide assistance to the population in a specific area. METHODS A retrospective survey was conducted on a database of 3,010 patients submitted to coronary artery bypass graft (CABG) from July, 2009 to July, 2010. RESULTS Among 2,840 patients that met the inclusion criteria, 92.1% had their surgery paid by the Brazilian Unified Health System (Sistema Único de Saúde - SUS) and 7.9% by health plans or themselves (non-SUS). 70.2% were male, the average age was 61.9 years old, and the average risk score (EuroScore) was 2.9%. The SUS and the non-SUS groups did not differ regarding the waiting time for surgery (WTS) (2.59± 3.10 vs. 3,02±3,70 days for SUS and non-SUS respectively; p=0.790), but did differ with respect to the length of stay in intensive care unit (2.17±3.84 vs. 2.52±2.72 days for SUS and non-SUS respectively; p < 0.001), the postoperative period (8.34±10.32 vs. 9,19±6.97 days for SUS and non-SUS respectively; p < 0.001), and the total LOS (10.93±11.08 vs. 12.21±8.20 days for SUS and non-SUS respectively; p < 0.001). The non-SUS group had more events of non-elective surgery (p=0.002) and surgery without cardiopulmonary bypass (p=0.012). The groups did not differ regarding the associated valve procedure (p=0.057) nor other non-valve procedures (p=0.053), but they did differ with respect to associated non-cardiac procedures (p=0.017). ICU readmission (p=0.636) and postoperative complications rates were similar in both groups (p=0.055). CONCLUSION The Non-SUS group showed longer LOS compared to the SUS group.

Nursing actions increases the control of hypertensive patients and reduces white-coat effect

A randomized comparative study was performed to evaluate the control of hypertension with use of home blood pressure measurement (HBPM) and casual blood pressure measurement, and analyze the white coat effect. Hypertensive patients in primary health care units were randomly divided into two groups: group I, participating of the educational activities and group II that followed the routine treatment. The hypertensive patients from group I realized HBPM at the beginning and the end of the study. White-coat effect was evaluated by the difference between the casual blood pressure measurement and HBPM. The study included 290 hypertensive patients, but realized HBPM 82 hypertensive patients. There was increase in blood pressure control from the beginning to end of study in hypertensive patients from group I (p < 0.05) measured by HBP (60% to 68.3%) and casual measurement (62% to 71%) and in group II, HMBP hypertension control was higher than the casual blood pressure measurement (63% vs 50%). The white coat effect was greater in hipertensive patients from group II.Realizou-se estudo comparativo randomizado para avaliar o controle de hipertensos, com uso da medida residencial da pressao arterial (MRPA) e medida casual, bem como para analisar o efeito do avental branco. Hipertensos atendidos em unidades basicas de saude foram divididos aleatoriamente em: grupo I, participante das atividades educativas, e grupo II, que seguiu a rotina de atendimento. Os hipertensos do grupo I realizaram MRPA no inicio e final do estudo. Efeito do avental branco foi avaliado pela diferenca entre a medida casual e MRPA. Foram incluidos 290 hipertensos, porem realizaram MRPA 82 hipertensos. Houve aumento no controle da pressao do inicio ao final do estudo nos hipertensos do grupo I (p < 0,05) avaliado pela MRPA (60% para 68,3%) e pela medida casual (62% para 71%); no grupo II o controle foi maior na MRPA do que na medida casual (63% vs 50%). O efeito do avental branco foi maior no grupo II.

Evaluation of the conditions of use of sphygmomanometers in hospital services

Objective: To evaluate the conditions of sphygmomanometers in use at public and private hospitals. Methods: A descriptive study using a quantitative approach, undertaken in four major hospitals in the State of Sao Paulo, in the period between 2009 and 2010. The aneroid manometers were tested against a calibrated mercury manometer. They were considered out of calibration when the differences were ≥ 4 mmHg. Results: We assessed 162 sphygmomanometers (78 in a public hospital and 84 from philanthropic and private institutions) and 98.1% were of the aneroid type. It was verified that 56.2% of the manometers were not calibrated (48.6% of private hospitals and 63.1% of public hospitals). Analyzing the mean differences of negative decalibration, there was a significant difference between the manometers of the private hospital and the public hospitals (-6.14 ± 2.66 mmHg vs. -8.97 ± 6.74 mmHg, respectively, p <0.05). It was also observed that in 70.2% there was no periodic evaluation made, 26.7% had aged rubber extension, 20.5% presented leaking valves, and 27% of the manometers did not rest with the pointer on the zero mark. Conclusion: The decalibration of the aneroid sphygmomanometers was significant and may lead to incorrect evaluation of blood pressure.OBJECTIVE: To evaluate the conditions of sphygmomanometers in use at public and private hospitals. METHODS: A descriptive study using a quantitative- approach, undertaken in four major hospitals in the State of Sao Paulo, in the period between 2009 and 2010. The aneroid manometers- were tested against a calibrated mercury manometer. They were considered out of calibration when the differences were > 4 mmHg. RESULTS: We assessed 162 sphygmomanometers (78 in a public hospital and 84 from philanthropic and private institutions) and 98.1% were of the aneroid type.- It was verified that 56.2% of the manometers were not calibrated (48.6% of private hospitals and 63.1% of public hospitals). Analyzing the mean- differences of negative decalibration, there was a significant difference between the manometers of the private hospital and the public hospitals (-6.14- ± 2.66 mmHg vs. -8.97 ± 6.74 mmHg, respectively, p <0.05). It was also observed that in 70.2% there was no periodic evaluation made, 26.7% had- aged rubber extension, 20.5% presented leaking valves, and 27% of the manometers did not rest with the pointer on the zero mark. CONCLUSION: The decalibration of the aneroid sphygmomanometers was significant and may lead to incorrect evaluation of blood pressure.

Atuação da enfermeira eleva o controle de hipertensos e diminui o efeito do avental branco

A randomized comparative study was performed to evaluate the control of hypertension with use of home blood pressure measurement (HBPM) and casual blood pressure measurement, and analyze the white coat effect. Hypertensive patients in primary health care units were randomly divided into two groups: group I, participating of the educational activities and group II that followed the routine treatment. The hypertensive patients from group I realized HBPM at the beginning and the end of the study. White-coat effect was evaluated by the difference between the casual blood pressure measurement and HBPM. The study included 290 hypertensive patients, but realized HBPM 82 hypertensive patients. There was increase in blood pressure control from the beginning to end of study in hypertensive patients from group I (p < 0.05) measured by HBP (60% to 68.3%) and casual measurement (62% to 71%) and in group II, HMBP hypertension control was higher than the casual blood pressure measurement (63% vs 50%). The white coat effect was greater in hipertensive patients from group II.Realizou-se estudo comparativo randomizado para avaliar o controle de hipertensos, com uso da medida residencial da pressao arterial (MRPA) e medida casual, bem como para analisar o efeito do avental branco. Hipertensos atendidos em unidades basicas de saude foram divididos aleatoriamente em: grupo I, participante das atividades educativas, e grupo II, que seguiu a rotina de atendimento. Os hipertensos do grupo I realizaram MRPA no inicio e final do estudo. Efeito do avental branco foi avaliado pela diferenca entre a medida casual e MRPA. Foram incluidos 290 hipertensos, porem realizaram MRPA 82 hipertensos. Houve aumento no controle da pressao do inicio ao final do estudo nos hipertensos do grupo I (p < 0,05) avaliado pela MRPA (60% para 68,3%) e pela medida casual (62% para 71%); no grupo II o controle foi maior na MRPA do que na medida casual (63% vs 50%). O efeito do avental branco foi maior no grupo II.

Avaliação das condições de uso de esfigmomanômetros em serviços hospitalares

Objective: To evaluate the conditions of sphygmomanometers in use at public and private hospitals. Methods: A descriptive study using a quantitative approach, undertaken in four major hospitals in the State of Sao Paulo, in the period between 2009 and 2010. The aneroid manometers were tested against a calibrated mercury manometer. They were considered out of calibration when the differences were ≥ 4 mmHg. Results: We assessed 162 sphygmomanometers (78 in a public hospital and 84 from philanthropic and private institutions) and 98.1% were of the aneroid type. It was verified that 56.2% of the manometers were not calibrated (48.6% of private hospitals and 63.1% of public hospitals). Analyzing the mean differences of negative decalibration, there was a significant difference between the manometers of the private hospital and the public hospitals (-6.14 ± 2.66 mmHg vs. -8.97 ± 6.74 mmHg, respectively, p <0.05). It was also observed that in 70.2% there was no periodic evaluation made, 26.7% had aged rubber extension, 20.5% presented leaking valves, and 27% of the manometers did not rest with the pointer on the zero mark. Conclusion: The decalibration of the aneroid sphygmomanometers was significant and may lead to incorrect evaluation of blood pressure.OBJECTIVE: To evaluate the conditions of sphygmomanometers in use at public and private hospitals. METHODS: A descriptive study using a quantitative- approach, undertaken in four major hospitals in the State of Sao Paulo, in the period between 2009 and 2010. The aneroid manometers- were tested against a calibrated mercury manometer. They were considered out of calibration when the differences were > 4 mmHg. RESULTS: We assessed 162 sphygmomanometers (78 in a public hospital and 84 from philanthropic and private institutions) and 98.1% were of the aneroid type.- It was verified that 56.2% of the manometers were not calibrated (48.6% of private hospitals and 63.1% of public hospitals). Analyzing the mean- differences of negative decalibration, there was a significant difference between the manometers of the private hospital and the public hospitals (-6.14- ± 2.66 mmHg vs. -8.97 ± 6.74 mmHg, respectively, p <0.05). It was also observed that in 70.2% there was no periodic evaluation made, 26.7% had- aged rubber extension, 20.5% presented leaking valves, and 27% of the manometers did not rest with the pointer on the zero mark. CONCLUSION: The decalibration of the aneroid sphygmomanometers was significant and may lead to incorrect evaluation of blood pressure.

Coronary Artery Bypass Graft Surgery Cost Coverage by the Brazilian Unified Health System (SUS)

Introduction Cost management has been identified as an essential tool for the general control and evaluation of health organizations. Objectives To identify the coverage percentage of transferred funds from the Unified Health System for coronary artery bypass grafts in a philanthropic hospital having a consolidated costing system in the municipality of São Paulo. Methods A quantitative, descriptive and cross-sectional research with information provided from a database composed of 1913 patients undergoing coronary artery bypass graft from March 13 to September 30, 2012, including isolated elective coronary artery bypass graft with the use of extracorporeal circulation. It excluded 551 (28.8%) patients, among them 76 (4.0%) deaths and 8 hospitalized patients, since the cost was compared according to the length of hospital stay. Therefore, the sample consisted of 1362 patients. Results The average total cost per patient was

Arterial hypertension and associated factors in patients submitted to myocardial revascularization

7,992.55. The average fund transfer by the Unified Health System was