Regina Marcia Cardoso de Sousa

Nursing workload and staff allocation in an intensive care unit: A pilot study according to Nursing Activities Score (NAS)

OBJECTIVES The objectives of the study were to identify the daily nursing workload in an intensive care unit (ICU) and to analyse the adequacy of nursing staff in a six hour shift according to the Nursing Activities Score (NAS). METHOD The sample consisted of 68 patients from a general 25-bed adult ICU in a private hospital with 250 beds in São Paulo, Brazil. The nursing workload of all patients admitted in the ICU over a one month period in 2004 were measured daily according to the NAS. For the analysis of nursing staff it was considered the number of nurses available in a six hour shift. Data were submitted to descriptive analyses. RESULTS Most patients were elderly and remained on average 12 (+/-16.4) days in the ICU. The mean NAS was 63.7 (+/-2.4%) and remained above 58.5% throughout the month. Apart from the 16th day of data collection there was an excess of nursing professionals in a six hour shift during the study period (range from 0.8 to 4.8 professionals). CONCLUSIONS The study results show the importance of nursing staff adequacy to workload fluctuations for reducing ICU costs.

Diagnóstico de lesões e qualidade de vida de motociclistas, vítimas de acidentes de trânsito

El estudio caracteriza motociclistas, victimas de accidentes de trafico, residentes en Maringa - Parana y atendidos en centros de referencia para tratamiento del trauma, segun gravedad del trauma, partes del cuerpo afectadas y region corporea de la lesion mas grave, ademas de identificar entre esas victimas, posibles diferencias en la calidad de vida de aquellos que presentaron trauma craneo-encefalico. El Injury Severity Score fue utilizado para el analisis de gravedad del trauma y el instrumento generico Medical Outcomes Study 36-Item Short-Form Health Survey, para evaluacion de la calidad de vida de las victimas. Con relacion a la gravedad de las lesiones, predominaron las victimas de trauma leve, 73,14%. La mayoria (59,70%) sufrio lesiones en los miembros inferiores, seguido por los miembros superiores (58,21%) y cabeza (31,34%). Los miembros se destacaron entre las demas regiones como los segmentos corporeos mas gravemente lesionados. En la comparacion de calidad de vida despues de trauma de las victimas, con y sin trauma craneoencefalico, no se evidenciaron diferencias.

Factors associated with treatment non-adherence in patients with epilepsy in Brazil

PURPOSE To investigate factors associated with treatment non-adherence in Brazilian patients with epilepsy. METHODS Prospective cross-sectional study. We evaluated 385 epilepsy outpatients in a tertiary referral center, 18 years or older, literate, without cognitive impairment or active psychiatric disorders, who were independent in daily living activities. Data were analyzed with correlation tests and conjoint analysis using multivariate logistic regression. RESULTS Non-adherence rate, measured by the Morisky-Green Test, was 66.2%, a moderate-to-low adherence level. Non-adherence was higher in men, in younger patients and in patients with uncontrolled seizures. Increasing treatment complexity was also associated with decreased treatment adherence. CONCLUSION Strategies designed to improve treatment adherence should address peculiarities associated with younger ages and male gender. Physicians should be made aware that prescription of less complex treatment regimens may result in better treatment adherence, and, therefore, better seizure control. The challenge in adjusting AED treatment in this population is to minimize treatment complexity, thus increasing chances for treatment adherence.

Patient Destination after Discharge from Intensive Care Units: Wards or Intermediate Care Units?

Este estudo teve como objetivos caracterizar os pacientes internados em unidade de terapia intensiva (UTI) de hospitais com unidades intermediarias, quanto aos dados demograficos e clinicos, e identificar os fatores relacionados a alta para essa unidade. E estudo prospectivo longitudinal, com 600 pacientes adultos, internados em UTIs gerais de quatro hospitais do municipio de Sao Paulo. Nos resultados, as caracteristicas demograficas e clinicas foram similares as descritas em outros estudos sobre pacientes em UTIs. Os fatores associados a alta para unidade intermediaria foram: idade ≥60 anos, antecedentes relacionados ao sistema nervoso, circulatorio ou respiratorio, procedencia da unidade intermediaria e valores do Simplified Acute Physiologic Score II (SAPS II), Logistic Organ Dysfunction (LODS) e Nursing Activities Score (NAS) na admissao e alta da UTI. Na analise de regressao logistica multipla a idade e o risco de morte na admissao, pelo SAPS II, destacaram-se como indicadores de alta para unidade intermediaria.This study characterizes patients hospitalized in Intensive Care Units (ICUs) of hospitals that have intermediate units (IU) regarding their demographic and clinical data and identifies factors related to discharge from these units. This prospective longitudinal study involved 600 adult patients hospitalized in general ICUs in four hospitals in São Paulo, SP, Brazil. Demographic and clinical characteristics were similar to those found in other studies addressing patients hospitalized in ICUs. Factors associated with discharge from ICU to IU were: age > or = 60 years, diseases related to the nervous, circulatory or respiratory systems, originated from the IU, and Simplified Acute Physiologic Score II (SAPS II), Logistic Organ Dysfunction (LODS) and Nursing Activities Scores (NAS) at admission and discharge from the ICU. Age and risk of death at admission in the ICU, according to SAPS II, stood out as indicators of discharge to IUs in the Multiple Logistic Regression analysis.

Os efeitos das alterações comportamentais das vítimas de trauma crânio-encefálico para o cuidador familiar

This study aimed to identify alterations in the intensity at which the negative behaviors of the victims of traumatic brain injury (TBI) affect the main family caregiver comparing the periods before and after the trauma and to verify the relation between the intensity of these alterations and time passed after the traumatic event. Participants were 50 caregivers of victims with different levels of dependence after TBI. The effect of the victims behaviors on the caregiver was measured by means of a Likert scale, in view of eleven negative behaviors cited in literature. According to the caregiver, the victim was more aggressive, anxious, dependent, depressed, irritated, and forgetful after the trauma, with a more explosive temperament, more self-centered, impulsive, with greater social inadequacy and mood oscillation. The first six cited behaviors were the ones that affected the caregiver more negatively. No relation was found between the passed time and the effect of the behavioral alterations.This study aimed to identify alterations in the intensity at which the negative behaviors of the victims of traumatic brain injury (TBI) affect the main family caregiver comparing the periods before and after the trauma and to verify the relation between the intensity of these alterations and time passed after the traumatic event. Participants were 50 caregivers of victims with different levels of dependence after TBI. The effect of the victim’s behaviors on the caregiver was measured by means of a Likert scale, in view of eleven negative behaviors cited in literature. According to the caregiver, the victim was more aggressive, anxious, dependent, depressed, irritated, and forgetful after the trauma, with a more explosive temperament, more self-centered, impulsive, with greater social inadequacy and mood oscillation. The first six cited behaviors were the ones that affected the caregiver more negatively. No relation was found between the passed time and the effect of the behavioral alterationsO estudo teve como objetivos identificar alteracoes na intensidade que os comportamentos negativos das vitimas de Trauma Craniencefalico (TCE) afetavam o cuidador familiar principal, comparando o periodo anterior ao posterior ao trauma e verificar a relacao entre intensidade dessas alteracoes e tempo decorrido apos o evento traumatico. Incluiu 50 cuidadores de vitimas com diferentes niveis de dependencia apos TCE. Os efeitos dos comportamentos da vitima para o cuidador foram mensurados por meio da escala Likert, tendo em vista onze comportamentos negativos citados em literatura. Na visao do cuidador, a vitima ficou mais agressiva, ansiosa, dependente, deprimida, irritada, esquecida, com temperamento mais explosivo, apos o trauma, alem de mais egocentrica, impulsiva, com maior inadequacao social e oscilacao de humor. Os seis primeiros comportamentos citados eram os que afetaram mais negativamente o cuidador. Nao houve relacao entre o tempo decorrido e os efeitos das alteracoes comportamentais.

Advanced life support: care provided to motor vehicle crash victims

OBJECTIVE To analyze the performance of Advanced Life Support care mode (ALS) applied to car crash victims using indicators by means of the Revised Trauma Score (RTS) in prehospital phase. METHODS It were analyzed 643 reports of car crash victims cared by public ALS services that occurred in highways of the city of São Paulo, from April 1999 to April 2000. Time intervals assessed were: response time, on-scene time, transport time, and total time. Correct screening decision analysis considered RTS< or = 1 for tertiary hospitals. Changes in RTS and its parameters were observed using the following equation: RTSfinal - RTSinitial. RESULTS AND CONCLUSIONS Of 643 victims, 90.8% were RTS=12 and 5.2% were RTS < or = 0. The response time ranged from 8 to 9 minutes, while on-scene and transport time were higher in RTS < or = 0 cases. Of RTS < or = 0 victims, 45.5% were correctly transported to tertiary hospitals. Screening decision misjudgments were identified. Maintenance or improvement of RTS values occurred in 98.8% of the cases. Respiratory rate was the parameter that showed better improvement followed by systolic blood pressure.

Mudanças nos papéis sociais: uma conseqüência do trauma crânio-encefálico para o cuidador familiar

The purpose was to study changes in the caregivers social roles after traumatic brain injury (TBI), relating them with the degree of importance of these roles and with the condition of the victim six months or more after the TBI. The research was developed at the Brain Trauma Clinic of the University of São Paulo Hospital das Clínicas with 50 caregivers and 50 victims of TBI, by means of interviews and patient file analysis. A checklist was used for the interview with the caregiver, in order to identify the changes and importance of their social roles. The roles that had suffered most interruption due to the trauma were: friend, amateur/entertainment, family member and worker. The role of being a caregiver was the one that presented more modification. No association was found between change of role and the variables: condition of victim after TBI and importance of the social roles for the caregiver.El objetivo del estudio fue conocer los cambios en los roles sociales del cuidador despues del trauma craneo-encefalico (TCE), relacionandolos con el grado de importancia de esos roles y con la condicion de la victima seis meses o mas despues del TCE. La investigacion fue desarrollada en el Ambulatorio de Trauma de Craneo del Hospital das Clinicas de la Universidad de Sao Paulo con 50 cuidadores y 50 victimas de TCE, por medio de entrevistas y analisis de prontuarios. Fue utilizado en la entrevista con el cuidador un checklist para identificar los cambios y la importancia de los roles sociales por ellos desempenados. Se concluye que los roles que mas sufrieron interrupcion en razon del trauma fueron: amigo, amador/pasatiempo, miembro de familia y trabajador. El rol de cuidador fue el que mas presento modificacion. No hubo asociacion entre el cambio de los roles y las variables de: condicion de la victima despues del TCE y importancia de los roles sociales para el cuidador.

Retorno à atividade produtiva de motociclistas vítimas de acidentes de trânsito

Objective: To characterize motorcyclists who have been victims of traffic accidents in Maringá, Paraná regarding their occupation, rehabilitation, or disability. Methods: A sample of 61 subjects participated in the study. Data were collected in February and March, 1999 though interviews and review of medical records. Results: Prior to the accident, the majority of subjects (45,9%) were employed. A great number of them (45.9%) were performing work-related activities in the moment of the accident. Among the remainder of victims, 29.5% were performing leisure activities. Nine to twelve months post accident, 20.4% of the victims had altered productive activities. Conclusion: There was a significant statistical association between productive activities and injury severity score, between productive activities and new injury severity score, and between productive activities and perception of health.

Ten years of new injury severity score (NISS): is it a possible change?

The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). Databases were searched using the keyword NISS, with 42 articles, 23 of which didn’t compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables) than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.

Sobrevivência após acidentes de trânsito: impacto das variáveis clínicas e pré-hospitalares

OBJECTIVE To assess clinical and prehospital variables associated with survival of motor vehicle crash victims. METHODS Study carried out in the city of São Paulo (Southeastern Brazil), from 1999 to 2003. Data from 175 patients, who were aged between 12 and 65 years and had been motor vehicle crash victims, were analyzed. Kaplan-Meier Survival Analysis was used to approach the results at the accident scene with victims scoring <11, according to the Revised Trauma Score. Variables analyzed were: sex, age, injury mechanisms, basic and advanced support procedures, Revised Trauma Score parameters and fluctuations, time elapsed in the prehospital phase and trauma severity according to the Injury Severity Score and Maximum Abbreviated Injury Scale. RESULTS Analysis revealed that victims who were less likely to survive during the hospitalization period showed serious lesions in the abdomen, thorax, or lower limbs, with negative fluctuation of respiratory frequency and Revised Trauma Score in the prehospital phase. In addition, they needed specialized interventions or thoracic compressions. Brain lesions were associated with late death. CONCLUSIONS Recognition of variables involved in the survival of motor vehicle crash victims may help to determine protocols and to make decisions in order to perform pre- and in-hospital interventions and, consequently, maximize survival.OBJETIVO: Analisar as variaveis clinicas e pre-hospitalares associadas a sobrevivencia de vitimas de acidente de trânsito. METODOS: Estudo realizado no municipio de Sao Paulo, SP, de 1999 a 2003. Foram analisados dados de 175 pacientes, entre 12 e 65 anos, vitimados por acidente de trânsito. A Analise de Sobrevivencia de Kaplan-Meier foi utilizada na abordagem dos resultados na cena do acidente com as vitimas de escore <11 segundo o Revised Trauma Score. As variaveis analisadas foram: sexo, idade, mecanismos do acidente, procedimentos de suporte basico e avancado realizados, parâmetros e flutuacoes do Revised Trauma Score, tempo consumido na fase pre-hospitalar e gravidade do trauma segundo o Injury Severity Score e a Maximum Abbreviated Injury Scale. RESULTADOS: A analise identificou que as vitimas que tiveram menor probabilidade de sobrevivencia durante todo periodo de internacao hospitalar apresentaram: lesoes graves no abdome, torax ou membros inferiores, com flutuacao negativa da frequencia respiratoria e do Revised Trauma Score na fase pre-hospitalar e necessitaram de intervencoes avancadas ou compressoes toracicas. As lesoes encefalicas foram associadas ao obito tardio. CONCLUSOES: O reconhecimento das variaveis envolvidas na sobrevivencia de vitimas de acidentes de trânsito pode auxiliar na determinacao de protocolos e na tomada de decisao para a realizacao de intervencoes pre e intra-hospitalares e consequentemente maximizar a sobrevivencia.