Sandro Gonçalves de Lima

Permanent Education in BLS and ACLS: impact on the knowledge of nursing professionals

BACKGROUND The theoretical knowledge and practical skills of the Basic Life Support (BLS) and the Advanced Life Support (ALS) are among the most important determining factors of the cardiopulmonary reanimation success rates. OBJECTIVE Assess the impact of a permanent training program in BLS and ALS on the knowledge of nursing professionals. METHOD Cross-sectional study. Population was made of nursing professionals of a tertiary level hospital. Assessments were carried out before and after training. The critical points of the International Liaison Committee on Resuscitation (ILCOR) analysis were addressed. RESULTS 213 professionals were assessed (76 nurses, 35.7%; 38 assistants, 17.8%; and 99 technicians, 46.7%). Pre-course assessment average grades were statistically different (p<0.001) among assistants (3.25), technicians (3.96) and nurses (4.69). Single professional without kids showed performance significantly superior to married professional with kids (p=0.02 and 0.004 respectively). Pre-training level of knowledge was inversely proportional to the time elapsed since the completion of undergraduate course or technical course. Main deficiencies were related to the initial approach of airways, to post-resuscitation cares and to the external cardiac massage technique. The post-course general average grade was 7.26. Assistants achieved a performance of 131.2%, technicians, of 78.9% and the nurses, of 85%, with no significant statistic difference (p=0.43). CONCLUSION The permanent training program in BLS and ALS resulted in important increment in the level of knowledge of nursing professionals.FUNDAMENTO: O conhecimento teorico e as habilidades praticas das equipes de Suporte Basico de Vida (SBV) e Suporte Avancado de Vida (SAV) estao entre os determinantes mais importantes das taxas de sucesso em reanimacao cardiopulmonar. OBJETIVO: Avaliar o impacto de um programa permanente de treinamento em SBV e SAV no conhecimento dos profissionais de enfermagem. METODO: Estudo de corte transversal. A populacao foi composta por profissionais de enfermagem de um hospital de nivel terciario. Foram realizadas avaliacoes antes e apos o treinamento. Abordaram-se pontos criticos das diretrizes do International Liaison Committee on Resuscitation (ILCOR). RESULTADOS: Foram avaliados 213 profissionais (76 enfermeiros, 35,7%; 38 auxiliares, 17,8%; e 99 tecnicos, 46,7%). As medias na avaliacao pre-curso foram estatisticamente diferentes (p<0,001) entre auxiliares (3,25), tecnicos (3,96) e enfermeiros (4,69). Os profissionais solteiros e sem filhos apresentaram desempenho significativamente superior ao dos casados e com filhos (p=0,02 e 0,004 respectivamente). O nivel de conhecimento pre-treinamento foi inversamente proporcional ao tempo transcorrido desde a conclusao da graduacao ou curso tecnico. As maiores deficiencias foram relacionadas a abordagem inicial das vias aereas, aos cuidados pos-ressuscitacao e a tecnica de massagem cardiaca externa. A media geral pos-curso foi 7,26. Os auxiliares alcancaram um desempenho de 131,2%, os tecnicos de 78,9% e os enfermeiros de 85%, sem diferenca estatisticamente significante (p=0,43). CONCLUSAO: O programa de treinamento permanente em SBV e SAV resultou em importante incremento no nivel de conhecimento dos profissionais de enfermagem.

Educação Permanente em SBV e SAVC: impacto no conhecimento dos profissionais de enfermagem

BACKGROUND The theoretical knowledge and practical skills of the Basic Life Support (BLS) and the Advanced Life Support (ALS) are among the most important determining factors of the cardiopulmonary reanimation success rates. OBJECTIVE Assess the impact of a permanent training program in BLS and ALS on the knowledge of nursing professionals. METHOD Cross-sectional study. Population was made of nursing professionals of a tertiary level hospital. Assessments were carried out before and after training. The critical points of the International Liaison Committee on Resuscitation (ILCOR) analysis were addressed. RESULTS 213 professionals were assessed (76 nurses, 35.7%; 38 assistants, 17.8%; and 99 technicians, 46.7%). Pre-course assessment average grades were statistically different (p<0.001) among assistants (3.25), technicians (3.96) and nurses (4.69). Single professional without kids showed performance significantly superior to married professional with kids (p=0.02 and 0.004 respectively). Pre-training level of knowledge was inversely proportional to the time elapsed since the completion of undergraduate course or technical course. Main deficiencies were related to the initial approach of airways, to post-resuscitation cares and to the external cardiac massage technique. The post-course general average grade was 7.26. Assistants achieved a performance of 131.2%, technicians, of 78.9% and the nurses, of 85%, with no significant statistic difference (p=0.43). CONCLUSION The permanent training program in BLS and ALS resulted in important increment in the level of knowledge of nursing professionals.FUNDAMENTO: O conhecimento teorico e as habilidades praticas das equipes de Suporte Basico de Vida (SBV) e Suporte Avancado de Vida (SAV) estao entre os determinantes mais importantes das taxas de sucesso em reanimacao cardiopulmonar. OBJETIVO: Avaliar o impacto de um programa permanente de treinamento em SBV e SAV no conhecimento dos profissionais de enfermagem. METODO: Estudo de corte transversal. A populacao foi composta por profissionais de enfermagem de um hospital de nivel terciario. Foram realizadas avaliacoes antes e apos o treinamento. Abordaram-se pontos criticos das diretrizes do International Liaison Committee on Resuscitation (ILCOR). RESULTADOS: Foram avaliados 213 profissionais (76 enfermeiros, 35,7%; 38 auxiliares, 17,8%; e 99 tecnicos, 46,7%). As medias na avaliacao pre-curso foram estatisticamente diferentes (p<0,001) entre auxiliares (3,25), tecnicos (3,96) e enfermeiros (4,69). Os profissionais solteiros e sem filhos apresentaram desempenho significativamente superior ao dos casados e com filhos (p=0,02 e 0,004 respectivamente). O nivel de conhecimento pre-treinamento foi inversamente proporcional ao tempo transcorrido desde a conclusao da graduacao ou curso tecnico. As maiores deficiencias foram relacionadas a abordagem inicial das vias aereas, aos cuidados pos-ressuscitacao e a tecnica de massagem cardiaca externa. A media geral pos-curso foi 7,26. Os auxiliares alcancaram um desempenho de 131,2%, os tecnicos de 78,9% e os enfermeiros de 85%, sem diferenca estatisticamente significante (p=0,43). CONCLUSAO: O programa de treinamento permanente em SBV e SAV resultou em importante incremento no nivel de conhecimento dos profissionais de enfermagem.

Sleep Quality and Quality of Life in Patients with Hypertrophic Cardiomyopathy

Objectives: To evaluate clinical predictors of poor sleep quality and quality of life (QOL) in patients with hypertrophic cardiomyopathy (HCM). Methods: Consecutive stable patients with HCM were evaluated for the risk of obstructive sleep apnea (OSA) by the Berlin Questionnaire, daytime sleepiness by the Epworth Sleepiness Scale, sleep quality by the Pittsburgh Sleep Questionnaire Index and QOL by the Minnesota Living with Heart Failure Questionnaire. Asymptomatic subjects without HCM were used as controls. Results: We studied 84 patients with HCM and 42 controls who were similar with regard to gender (49 vs. 50% males), age [52 (38–62) vs. 47 (33–58) years] and body mass index (27 ± 4 vs. 27 ± 5). HCM diagnosis, high risk for OSA and female gender were independently associated with poor sleep quality in the entire population. Among patients with HCM, poor QOL was independently associated with poor sleep quality, New York Heart Association functional class and diuretic therapy. Conclusion: Poor sleep quality is very common in patients with HCM and may have a negative impact on the QOL, which in turn is an important marker of prognosis in patients with cardiomyopathies.

Renin-angiotensin system: is it possible to identify hypertension susceptibility genes?

. Em que pese a inexistencia de um estudo de base populacional com representatividade nacional para HAS, indicadores de morbidade e mortalidade por doenca cerebrovascular podem mostrar, claramente, a relevância da HAS para a saude publica brasileira, uma vez que representa um fator de risco com expressiva forca de determinacao para doencas cardiovasculares

Pre-hospital attitudes adopted by patients faced with the symptoms of acute myocardial infarction.

Esta serie de casos teve o objetivo de avaliar as condutas adotadas pelos pacientes, durante a fase pre-hospitalar do infarto agudo do miocardio (IAM). Avaliaram-se 115 individuos portadores de IAM, com supradesnivelamento do segmento ST. Foi aplicado o teste qui-quadrado e o teste exato de Fisher. Os individuos que nao associaram os sintomas a doenca cardiovascular atribuiram, mais frequentemente, as seguintes origens: gastrointestinal (38%), osteomuscular (29,7%), intoxicacao alimentar e/ou medicamentosa (8,5%) e decorrentes do aparelho respiratorio (6,3%). A proporcao de desfechos maiores e de pacientes que chegaram a emergencia apos 12 horas foi mais elevada entre mulheres, individuos com renda mensal de ate um salario minimo, que usaram analgesicos e nao associaram os sintomas a doenca cardiovascular. Constatou-se que individuos em condicoes socio-conomicas desfavoraveis, que interpretaram os sintomas de forma incorreta, chegaram mais tardiamente a emergencia e apresentaram piores desfechos intra-hospitalares.This case series aimed to evaluate the behavior adopted by patients during the pre-hospital phase of acute myocardial infarction (AMI). A total of 115 AMI sufferers with ST-segment elevation were evaluated. The chi-square and Fishers exact tests were applied. The individuals that did not associate the symptoms with cardiovascular disease most often attributed them to the following sources: gastrointestinal (38%), musculoskeletal (29.7%), food and/or medication poisoning (8.5%) and arising from the respiratory apparatus (6.3%). The proportion of major outcomes and of patients that arrived in the emergency department after 12 hours was higher among women, individuals with monthly income of up to one minimum wage, those who used analgesics and did not associate the symptoms with cardiovascular disease. It was found that individuals in unfavorable socioeconomic conditions, who interpreted the symptoms incorrectly, arrived later at the emergency department and had worse intra-hospital outcomes.

Ethics in research with human beings: from knowledge to practice

FUNDAMENTO: En Brasil, la resolucion 196/96 y sus complementaciones reglamentan la preservacion de los derechos, del respeto y de la dignidad de los seres humanos implicados en investigaciones. OBJETIVO: Analizar la adecuacion de los temas libres (TLs) presentados durante el XVIII Congreso Pernambucano de Cardiologia a la resolucion 196/96. METODOS: Estudio de Corte Transversal. Se realizaron entrevistas con autores de los TLs presentados. Se analizaron los resumenes de los trabajos con el objeto de identificar la necesidad de una previa aprobacion por un Comite de Etica en Investigacion (CEI). RESULTADOS: Se presentaron 90 TLs. La fuente de datos mas utilizada fueron prontuarios medicos (86,8%). Solamente un 23,1% de los TLs fueron sometidos a la evaluacion por un CEI y en el 15,4% se utilizo el Formulario de Consentimiento Informado (FCI). Entre los autores cuyos trabajos no se evaluaron por un CEI, el 65,6% afirmo que esta no era una conducta necesaria y el 18% de ellos desconocian la necesidad de llevar a cabo dicha evaluacion. La autorizacion escrita del responsable por la institucion donde los TLs fueron realizados no se obtuvo en un 56,6% de las investigaciones. La mayoria (80%) de los autores afirmo nunca haber leido la resolucion 196/96. La proporcion de los TLs sometidos a un CEI fue significativamente mayor entre autores que habian leido la resolucion 196/96 (p = 0,005). El diseno de los TLs influencio la no sumision de los trabajos a un CEI (p < 0,001). La mayoria de los TLs que fueron autorizados por el responsable de la institucion donde se llevaron a cabo fue sometida a un CEI (p < 0,001). CONCLUSION: La mayoria de los TLs presentados no se adecuo a las regulamentaciones brasilenas en etica en investigacion.BACKGROUND: In Brazil, resolution 196/96 and its amendments regulate the preservation of rights, respect and dignity of human beings involved in research. OBJECTIVE: To analyze the adequacy of Free Communications (FC) presented during the XVIII Congresso Pernambucano de Cardiologia to resolution 196/96. METHODS: During a cross-sectional study, interviews were carried out with the authors of the FC presented at the Congress and the abstracts of the studies were assessed in order to identify the need for previous approval by a Research Ethics Committee (REC). RESULTS: A total of 90 FC were presented and, in most of them (86.8%), medical files were the most commonly used source of data. Only 23.1% of the FC were submitted to the assessment of a REC and 15.4% of them used a Free and Informed Consent Form (FICF). Among the authors whose studies were not assessed by a REC, 65.6% stated that this conduct was not necessary and 18% of them were unaware of the need to submit the study to such assessment. The written authorization given by the institution where the FC were carried out was not obtained in 56.6% of the studies. Most of the authors (80.0%) stated that they had never read Resolution 196/96. The proportion of FC submitted to a REC was significantly higher among authors that had read Resolution 196/96 (p = 0.005). The FC design influenced the non-submission of the studies to a REC (p < 0.001). Most of the FC that were authorized by the institution where they were carried out were submitted to a REC (p < 0.001). CONCLUSION: Most of the FC presented at the Congress did not follow the Brazilian regulations concerning the ethics in research.BACKGROUND In Brazil, resolution 196/96 and its amendments regulate the preservation of rights, respect and dignity of human beings involved in research. OBJECTIVE To analyze the adequacy of Free Communications (FC) presented during the XVIII Congresso Pernambucano de Cardiologia to resolution 196/96. METHODS During a cross-sectional study, interviews were carried out with the authors of the FC presented at the Congress and the abstracts of the studies were assessed in order to identify the need for previous approval by a Research Ethics Committee (REC). RESULTS A total of 90 FC were presented and, in most of them (86.8%), medical files were the most commonly used source of data. Only 23.1% of the FC were submitted to the assessment of a REC and 15.4% of them used a Free and Informed Consent Form (FICF). Among the authors whose studies were not assessed by a REC, 65.6% stated that this conduct was not necessary and 18% of them were unaware of the need to submit the study to such assessment. The written authorization given by the institution where the FC were carried out was not obtained in 56.6% of the studies. Most of the authors (80.0%) stated that they had never read Resolution 196/96. The proportion of FC submitted to a REC was significantly higher among authors that had read Resolution 196/96 (p = 0.005). The FC design influenced the non-submission of the studies to a REC (p < 0.001). Most of the FC that were authorized by the institution where they were carried out were submitted to a REC (p < 0.001). CONCLUSION Most of the FC presented at the Congress did not follow the Brazilian regulations concerning the ethics in research.

Hipertensão arterial sistêmica no setor de emergência: o uso de medicamentos sintomáticos como alternativa de tratamento

OBJECTIVE: Compare the therapeutic response of symptomatic, hypertensive patients to symptomatic medication or anti-hypertensive drugs at the Emergency Unit. METHODS: A randomized, blind clinical trial involving 100 (one hundred) patients assisted at the Cardiology Emergency Unit at Oswaldo Cruz University Hospital (HUOC). All patients reported symptoms associated to systolic pressure (SBP) between 180 and 200 mmHg and/or diastolic pressure (DBP) between 110 and 120 mmHg. Patients were randomized for treatment with symptomatic (dipirone or diazepan) or anti-hipertensive drug (captopril). Those reporting any associated clinical condition and in need of immediate treatment at the Emergency Unit were excluded from the study. Patients reporting no symptoms, and systolic pressure reduced to levels under 180 mmHg and diastolic pressure under 110 mmHg after the 90-minute period were considered as having met discharge criteria. RESULTS: Mean age of population studied was 54.4 years old, most commonly females. Patients were chronic hypertensive, on irregular pharmacological treatment, with low compliance to non-pharmacologic actions, and classified as overweight and obese grade I. Headache, type D (non-angina) chest pain, and dyspnea were the most frequent complaints. The number of patients treated with symptomatic drug who reached discharge criteria was similar to that of patients treated with anti-hypertensive (p=0.165). No association was found between previous high blood pressure (HBP) diagnosis (p=0.192), pharmacological treatment (p=0.687), and non-pharmacological treatment and discharge criteria. CONCLUSION: Blood pressure (BP) was reduced below levels for discharge criteria for a (non-significant) higher rate of patients treated with symptomatic drug, who were turned into asymptomatic after the observation period.

Exaggerated blood pressure response during exercise treadmill testing: functional and hemodynamic features, and risk factors

The factors which contribute to an exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) are not wholly understood. The association between the insertion/deletion polymorphisms of the angiotensin-converting enzyme (ACE) and M235T of the angiotensinogen with EBPR during ETT still remains unstudied. To identify and compare the risk factors for hypertension between normotensive subjects with EBPR and those who exhibit a normal curve of blood pressure (BP) during ETT. In a series of EBPR cases from a historical cohort of normotensive individuals, a univariate analysis was performed to estimate the association of the studied factors with BP behavior during ETT. Additionally, logistic multivariate regression was conducted to analyze the joint effects of the variables. P-values above 0.05 were considered statistically significant. From a total of 10 027 analyzed examinations, only 219 met the criteria employed to define EBPR, which resulted in a prevalence of 12.6%. For the systolic component of the BP, hyperreactive subjects displayed a mean age and body mass index (BMI) significantly higher than the others (P=0.002 and <0.001, respectively). No association was observed between the polymorphisms cited above and EBPR. An analysis of the joint effect of variables has indicated that only age (P< 0.001) and BMI (P=0.001) were specifically associated with systolic BP during exercise. Age and BMI were the only factors that independently influenced EBPR during ETT.

Ética em pesquisas com seres humanos: do conhecimento à prática

FUNDAMENTO: En Brasil, la resolucion 196/96 y sus complementaciones reglamentan la preservacion de los derechos, del respeto y de la dignidad de los seres humanos implicados en investigaciones. OBJETIVO: Analizar la adecuacion de los temas libres (TLs) presentados durante el XVIII Congreso Pernambucano de Cardiologia a la resolucion 196/96. METODOS: Estudio de Corte Transversal. Se realizaron entrevistas con autores de los TLs presentados. Se analizaron los resumenes de los trabajos con el objeto de identificar la necesidad de una previa aprobacion por un Comite de Etica en Investigacion (CEI). RESULTADOS: Se presentaron 90 TLs. La fuente de datos mas utilizada fueron prontuarios medicos (86,8%). Solamente un 23,1% de los TLs fueron sometidos a la evaluacion por un CEI y en el 15,4% se utilizo el Formulario de Consentimiento Informado (FCI). Entre los autores cuyos trabajos no se evaluaron por un CEI, el 65,6% afirmo que esta no era una conducta necesaria y el 18% de ellos desconocian la necesidad de llevar a cabo dicha evaluacion. La autorizacion escrita del responsable por la institucion donde los TLs fueron realizados no se obtuvo en un 56,6% de las investigaciones. La mayoria (80%) de los autores afirmo nunca haber leido la resolucion 196/96. La proporcion de los TLs sometidos a un CEI fue significativamente mayor entre autores que habian leido la resolucion 196/96 (p = 0,005). El diseno de los TLs influencio la no sumision de los trabajos a un CEI (p < 0,001). La mayoria de los TLs que fueron autorizados por el responsable de la institucion donde se llevaron a cabo fue sometida a un CEI (p < 0,001). CONCLUSION: La mayoria de los TLs presentados no se adecuo a las regulamentaciones brasilenas en etica en investigacion.BACKGROUND: In Brazil, resolution 196/96 and its amendments regulate the preservation of rights, respect and dignity of human beings involved in research. OBJECTIVE: To analyze the adequacy of Free Communications (FC) presented during the XVIII Congresso Pernambucano de Cardiologia to resolution 196/96. METHODS: During a cross-sectional study, interviews were carried out with the authors of the FC presented at the Congress and the abstracts of the studies were assessed in order to identify the need for previous approval by a Research Ethics Committee (REC). RESULTS: A total of 90 FC were presented and, in most of them (86.8%), medical files were the most commonly used source of data. Only 23.1% of the FC were submitted to the assessment of a REC and 15.4% of them used a Free and Informed Consent Form (FICF). Among the authors whose studies were not assessed by a REC, 65.6% stated that this conduct was not necessary and 18% of them were unaware of the need to submit the study to such assessment. The written authorization given by the institution where the FC were carried out was not obtained in 56.6% of the studies. Most of the authors (80.0%) stated that they had never read Resolution 196/96. The proportion of FC submitted to a REC was significantly higher among authors that had read Resolution 196/96 (p = 0.005). The FC design influenced the non-submission of the studies to a REC (p < 0.001). Most of the FC that were authorized by the institution where they were carried out were submitted to a REC (p < 0.001). CONCLUSION: Most of the FC presented at the Congress did not follow the Brazilian regulations concerning the ethics in research.BACKGROUND In Brazil, resolution 196/96 and its amendments regulate the preservation of rights, respect and dignity of human beings involved in research. OBJECTIVE To analyze the adequacy of Free Communications (FC) presented during the XVIII Congresso Pernambucano de Cardiologia to resolution 196/96. METHODS During a cross-sectional study, interviews were carried out with the authors of the FC presented at the Congress and the abstracts of the studies were assessed in order to identify the need for previous approval by a Research Ethics Committee (REC). RESULTS A total of 90 FC were presented and, in most of them (86.8%), medical files were the most commonly used source of data. Only 23.1% of the FC were submitted to the assessment of a REC and 15.4% of them used a Free and Informed Consent Form (FICF). Among the authors whose studies were not assessed by a REC, 65.6% stated that this conduct was not necessary and 18% of them were unaware of the need to submit the study to such assessment. The written authorization given by the institution where the FC were carried out was not obtained in 56.6% of the studies. Most of the authors (80.0%) stated that they had never read Resolution 196/96. The proportion of FC submitted to a REC was significantly higher among authors that had read Resolution 196/96 (p = 0.005). The FC design influenced the non-submission of the studies to a REC (p < 0.001). Most of the FC that were authorized by the institution where they were carried out were submitted to a REC (p < 0.001). CONCLUSION Most of the FC presented at the Congress did not follow the Brazilian regulations concerning the ethics in research.

Preinfarction angina and in-hospital outcome of elderly patients with acute myocardial infarction

BACKGROUND Preinfarction angina (PIA) may be a marker of ischemic preconditioning. A decrease in infarct size, ventricular remodeling, congestive heart failure, cardiogenic shock or death was demonstrated in the presence of preinfarction angina. These findings were more evident in adults, but not in the elderly. OBJECTIVE To assess the relationship between PIA and the clinical course of elderly patients with acute myocardial infarction (AMI). METHODS This was a case-series study with a comparison group. A total of 36 patients with ST-segment elevation AMI were included in the study and divided into two groups: group A (21 patients with PIA) and group B (15 patients without PIA). RESULTS Mean age of the study population was 70.5 years, and there was a predominance of males (73%). Mean body mass index was 25.3 Kg/m2. Hypertension was present in 77.8%, diabetes in 27.8% and dyslipidemia in 32.4%. Type-A chest pain was reported by 71.4% of patients, and the majority of them (72.2%) were in Killip class I. Clinical endpoints for groups A and B were as follows: postinfarction angina 9.5% versus 20%, p = 0.630; heart failure 23.8% versus 13.3%, p = 0.674; urgent revascularization 4.8% versus 6.7%, p = 1; and cardiac arrhythmia 0% versus 6.7%, p = 0.417. There was no case of reinfarction, cardiogenic shock or death within 30 days of follow up in either group. CONCLUSION In this case series, preinfarction angina was not associated with better clinical course in elderly patients with AMI.