RESUMO
A assistência odontológica é imprescindível para a prevenção de doenças infecciosas e para a manutenção da integridade da cavidade oral de pacientes internatos em unidades de terapia intensiva. O objetivo deste estudo foi avaliar o conhecimento e as práticas de higiene oral dos acadêmicos do curso de Enfermagem de uma instituição de ensino superior, que realizam estágio em hospital, no controle de higiene bucal de pacientes internados em ambiente hospitalar. Participaram do estudo 40 alunos, que responderam 14 perguntas com o intuito de avaliar o conhecimento e as práticas no controle de higiene bucal, realizadas por eles, em pacientes internados em ambiente hospitalar. Os resultados demonstraram que os acadêmicos entrevistados tinham idade média de 25,8 anos, sendo 95% do sexo feminino e apenas 5% do sexo masculino. Destes, 42,5% afirmaram não haver presença de um Cirurgião-Dentista em ambiente hospitalar e 82,5% responderam que o responsável pela saúde bucal dos pacientes é do técnico de enfermagem. Quanto aos cuidados em pacientes internados em UTI, 52,5% dos entrevistados relataram que estes pacientes recebem higienização bucal, porém 30% alegaram que esta pratica não era realizada e 17,5% não sabiam responder. Além disso, 47,5% dos entrevistados afirmam ter insegurança ao realizar os procedimentos de higiene bucal dos pacientes. Pode-se concluir que os acadêmicos entrevistados possuem bom conhecimento acerca da importância dos cuidados com a saúde bucal dos pacientes internados em ambiente hospitalar. No entanto, ainda existem muitas dúvidas relacionadas ao manejo clínico de procedimentos de promoção de saúde bucal, que poderiam ser solucionados com a presença de um profissional de Odontologia inserido em uma equipe multidisciplinar(AU)
Oral care is essential for the prevention of infectious diseases and for maintaining the integrity of the oral cavity of patients hospitalized in intensive care units. The objective of this study is to evaluate the knowledge and oral hygiene practices of Nursing students at a higher education institution, who carry out internships in a hospital, in controlling the oral hygiene of patients admitted to a hospital environment. 40 students participated in the study, who answered 14 questions with the aim of evaluating the knowledge and practices in controlling oral hygiene, carried out by them, on patients hospitalized in a hospital environment. The results demonstrated that the academics interviewed had an average age of 25.8 years, with 95% being female and only 5% being male. Of these, 42.5% stated that there was no presence of a Dental Surgeon in a hospital environment and 82.5% responded that the nursing technician is responsible for the patients' oral health. Regarding care for patients admitted to the ICU, 52.5% of those interviewed reported that these patients receive oral hygiene, however 30% claimed that this practice was not performed and 17.5% did not know how to answer. Furthermore, 47.5% of those interviewed say they are insecure when carrying out oral hygiene procedures for patients. It can be concluded that the academics interviewed have good knowledge about the importance of oral health care for patients hospitalized in a hospital environment. However, there are still many doubts related to the clinical management of oral health promotion procedures, which could be resolved with the presence of a dentistry professional within a multidisciplinary team(AU)
Assuntos
Humanos , Masculino , Feminino , Inquéritos e Questionários , Pacientes InternadosRESUMO
OBJECTIVE: This study examines the relationship between two frailty screening tools and 90-day all-cause mortality in geriatric inpatients. METHODS: The study included patients aged ≥60 years who were admitted to the geriatrics unit of a university hospital between June 2021 and August 2022 and whose mortality status and duration of hospitalization data were obtained from the Health Ministry System. During hospitalization, the patients were screened using two different frailty scales: the Simpler Modified Fried Frailty Scale (sMFS) and the Clinical Frailty Scale (CFS). Patients scoring ≥5 on the CFS and ≥3 on the sMFS were considered frail. RESULTS: A total of 84 participants with a mean age of 78.3±7.6 years were included in this study, of which 36.9% were male. Of the total, 60.7% and 89.3% were considered frail according to the CFS and sMFS, respectively, and the prevalence of all-cause mortality within 90 days was 19%. A univariate analysis using the Kaplan-Meier survival method revealed CFS scores to be statistically significantly related to 90-day all-cause mortality (p<0.001), while sMFS scores were not found to be statistically significant (p=0.849). Furthermore, a statistically significant relationship was identified between CFS score and all-cause mortality in multivariate analysis with Cox regression analysis [(p<0.001), hazard ratio (HR): 3.078; (95% confidence interval: 1.746-5.425)]. CONCLUSION: An evaluation of frailty in hospitalized older adults using two different scales revealed the CFS to be superior to the sMFS in predicting all-cause mortality within 90 days.
Assuntos
Idoso Fragilizado , Fragilidade , Avaliação Geriátrica , Humanos , Masculino , Feminino , Idoso , Avaliação Geriátrica/métodos , Fragilidade/mortalidade , Fragilidade/diagnóstico , Idoso de 80 Anos ou mais , Idoso Fragilizado/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Pacientes Internados/estatística & dados numéricos , Mortalidade Hospitalar , Causas de Morte , Fatores de Risco , Valor Preditivo dos Testes , Medição de Risco/métodos , Brasil/epidemiologiaRESUMO
OBJECTIVE: To examine the relationship between inpatient skin-to-skin care rates and neurodevelopmental scores measured at 12 months in very preterm (VPT) infants. STUDY DESIGN: From a retrospective review of medical records of 181 VPT infants (<32 weeks gestational age [GA] at birth), we derived skin-to-skin care rate, ie, total minutes of skin-to-skin care each infant received over the number of days of hospital stay. We used scores on the Capute Scales from routine follow-up assessments at 12 months to measure neurodevelopmental outcomes. RESULTS: Families averaged approximately 17 minutes/day of skin-to-skin care (2 days/week, 70 minutes/session), although there was substantial variability. Variation in skin-to-skin rate was positively associated with outcomes at 12 months corrected age (r = 0.25, P < .001). Skin-to-skin rate significantly predicted 6.2% unique variance in 12-month neurodevelopmental outcomes, after adjusting for GA, socioeconomic status (SES), health acuity, and visitation frequency. A 20-minute increase in skin-to-skin care per day was associated with a 10-point increase (0.67 SDs) in neurodevelopmental outcomes at 12 months. GA and infant health acuity did not moderate these relations. CONCLUSION: VPT infants who experienced more skin-to-skin care during hospitalization demonstrated higher scores on 12-month neurodevelopmental assessments. Results provide evidence that skin-to-skin care confers extended benefits to VPT infants through the first year of life. Skin-to-skin care offers promise as a family-centered intervention designed to promote positive developmental outcomes in at-risk infants.
Assuntos
Recém-Nascido Prematuro , Método Canguru , Humanos , Estudos Retrospectivos , Masculino , Recém-Nascido , Feminino , Lactente , Desenvolvimento Infantil/fisiologia , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Transtornos do Neurodesenvolvimento/etiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Idade Gestacional , Pacientes InternadosRESUMO
OBJECTIVE: To investigate the extent of extraskeletal manifestations along with inpatient outcomes and complications associated with osteogenesis imperfecta (OI). STUDY DESIGN: This cross-sectional study utilized the Kids' Inpatient Database as a part of the Healthcare Cost and Utilization Project to investigate inpatient hospital outcomes and management in patients with OI from 1997 through 2016. Data regarding hospital characteristics, cost of treatment, inpatient outcomes, and procedures were collected and analyzed. RESULTS: There were 7291 admissions that listed OI as a diagnosis in the Kids' Inpatient Database from 1997 through 2016. Unexpectedly, more than one-third of all admissions in these children with OI presented with an extraskeletal manifestation. The rate of major complications was 3.85%. The rate of minor complications was 19.4%, most commonly respiratory problems. The mortality rate was 18.2% in the neonatal period and 1.0% in all other admissions. Total charges of hospital stay increased over the years. CONCLUSIONS: We identified a striking prevalence of extraskeletal manifestations in OI along with inpatient outcomes and complications associated with OI, of which respiratory complications were predominant. We observed a significant financial burden for patients with OI and identified additional risks for financial crisis, in addition to disparities in care identified among socioeconomic groups. These data contribute to a more holistic understanding of OI from diagnosis to management.
Assuntos
Bases de Dados Factuais , Hospitalização , Osteogênese Imperfeita , Humanos , Osteogênese Imperfeita/complicações , Osteogênese Imperfeita/epidemiologia , Feminino , Masculino , Estudos Transversais , Criança , Pré-Escolar , Lactente , Estados Unidos/epidemiologia , Adolescente , Hospitalização/estatística & dados numéricos , Recém-Nascido , Pacientes Internados/estatística & dados numéricosRESUMO
BACKGROUND: Pneumococcal pneumonia (PP) is a serious infection caused by Streptococcus pneumoniae (pneumococcus), with a wide spectrum of clinical manifestations. The aim of this study was to analyze the comorbidity factors that influenced the mortality in patients with asplenia according to PP. METHODS: Discharge reports from the Spanish Minimum Basic Data Set (MBDS) was used to retrospectively analyze patients with asplenia and PP, from 1997 to 2021. Elixhauser Comorbidity Index (ECI) was calculated to predict in-hospital mortality (IHM). RESULTS: 97,922 patients with asplenia were included and 381 cases of PP were identified. The average age for men was 63.87 years and for women 65.99 years. In all years, ECI was larger for splenectomized than for non-splenectomized patients, with men having a higher mean ECI than women. An association was found between risk factors ECI, splenectomy, age group, sex, pneumococcal pneumonia, and increased mortality (OR = 0.98; 95% CI: 0.97-0.99; p < 0.001). The IHM increased steadily with the number of comorbidities and index scores in 1997-2021. CONCLUSIONS: Asplenia remain a relevant cause of hospitalization in Spain. Comorbidities reflected a great impact in patients with asplenia and PP, which would mean higher risk of mortality.
Assuntos
Comorbidade , Mortalidade Hospitalar , Pneumonia Pneumocócica , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Pneumonia Pneumocócica/mortalidade , Pneumonia Pneumocócica/epidemiologia , Espanha/epidemiologia , Idoso , Estudos Retrospectivos , Fatores de Risco , Esplenectomia , Streptococcus pneumoniae/isolamento & purificação , Adulto , Idoso de 80 Anos ou mais , Pacientes Internados/estatística & dados numéricos , Hospitalização/estatística & dados numéricosRESUMO
The November 2013 online publication of ARUBA, the first multi-institutional randomized controlled trial for unruptured brain arteriovenous malformations (AVMs), has sparked over 100 publications in protracted debates METHODS: This study sought to examine inpatient management patterns of brain AVMs from 2009 to 2016 and observe if changes in U.S. inpatient management were attributable to the ARUBA publication using interrupted time series of brain AVM studies from the National Inpatient Sample data 2009-2016. Outcomes of interest were use of embolization, surgery, combined embolization and microsurgery, radiotherapy, and observation during that admission. An interrupted time series design compared management trends before and after ARUBA. Segmented linear regression analysis tested for immediate and long-term impacts of ARUBA on management. RESULTS: Elective and asymptomatic patient admissions declined 2009-2016. In keeping with the ARUBA findings, observation for unruptured brain AVMs increased and microsurgery decreased. However, embolization, radiosurgery, and combined embolization and microsurgery also increased. For ruptured brain AVMs, treatment modality trends remained positive with even greater rates of observation, embolization, and combined embolization and microsurgery occurring after ARUBA (data on radiosurgery were scarce). None of the estimates for the change in trends were statistically significant. CONCLUSIONS: The publication of ARUBA was associated with a decrease in microsurgery and increase in observation for unruptured brain AVMs in the US. However, inpatient radiotherapy, embolization, and combined embolization and surgery also increased, suggesting trends moved counter to ARUBA's conclusions. This analysis suggested that ARUBA had a small impact as clinicians rejected ARUBA's findings in managing unruptured brain AVMs.
Assuntos
Embolização Terapêutica , Análise de Séries Temporais Interrompida , Malformações Arteriovenosas Intracranianas , Humanos , Malformações Arteriovenosas Intracranianas/terapia , Estados Unidos , Embolização Terapêutica/métodos , Feminino , Pacientes Internados , Microcirurgia , Masculino , Radiocirurgia/tendências , Adulto , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Key performance indicators (KPIs) are quantifiable measures used to monitor the quality of health services. Implementation guidelines for clinical pharmacy services (CPS) do not specify KPIs. AIM: To assess the quality of the studies that have developed KPIs for CPS in inpatient hospital settings. METHOD: A systematic review was conducted by searching in Web of Science, Scopus, and PubMed, supplemented with citation analyses and grey literature searches, to retrieve studies addressing the development of KPIs in CPS for hospital inpatients. Exclusions comprised drug- or disease-specific studies and those not written in English, French, Portuguese, or Spanish. The Appraisal of Indicators through Research and Evaluation (AIRE) instrument assessed methodological quality. Domain scores and an overall score were calculated using an equal-weight principle. KPIs were classified into structure, process, and outcome categories. The protocol is available at https://doi.org/10.17605/OSF.IO/KS2G3 . RESULTS: We included thirteen studies that collectively developed 225 KPIs. Merely five studies scored over 50% on the AIRE instrument, with domains #3 (scientific evidence) and #4 (formulation and usage) displaying low scores. Among the KPIs, 8.4% were classified as structure, 85.8% as process, and 5.8% as outcome indicators. The overall methodological quality did not exhibit a clear association with a major focus on outcomes. None of the studies provided benchmarking reference values. CONCLUSION: The KPIs formulated for evaluating CPS in hospital settings primarily comprised process measures, predominantly suggested by pharmacists, with inadequate evidence support, lacked piloting or validation, and consequently, were devoid of benchmarking reference values.
Assuntos
Pacientes Internados , Serviço de Farmácia Hospitalar , Indicadores de Qualidade em Assistência à Saúde , Serviço de Farmácia Hospitalar/normas , Humanos , Indicadores de Qualidade em Assistência à Saúde/normasRESUMO
BACKGROUND: Existing mobility scales for hospitalized patients do not include assessment of tasks for the right and left side, ability to transfer from sitting to lying and from standing to sitting, ability to climbing steps and pick up an object from the floor in the same instrument. OBJECTIVE: Evaluate the reliability and validity of the hospital mobility assessment scale (HMob) according to the Consensus-based standards for the selection of health measurement instruments (COSMIN). METHODS: Study conducted in three inpatient units (cardiology, neurology, and gastrohepatology) and one adult intensive care unit in a hospital. Patients of both sexes were included; age >18 years; collaborative and who obeyed commands, with different medical diagnoses and clinical release to leave their bed (provided by the doctor). Special populations such as those with burns and orthopedics were excluded. RESULTS: The sample consisted of 130 patients; 20 from the pilot study and 110 to assess the clinimetric properties of the HMob. Cronbach alpha coefficient was 0.949. Relative intra- (A1-A2) and inter-rater (A1-B; A2-B) reliability was excellent (A1-A2: ICC = 0.982, p-value < 0.0001; A1-B: ICC = 0.993, p-value < 0.0001; A2-B: ICC = 0.986, p-value < 0.0001.) The convergent criterion validity of HMob in relation to the ICU Functional Status Score was 0.967 (p-value < 0.0001) and for Functional Independence measure (MIF) was 0.926 (p-value < 0.0001). CONCLUSION: The HMob scale showed excellent internal consistency, intra- and inter-rater reliability, and concurrent validity in the motor domain, which suggests that it can be used in daily practice to measure mobility in hospitalized patients.
Assuntos
Hospitalização , Humanos , Reprodutibilidade dos Testes , Unidades de Terapia Intensiva , Pacientes InternadosRESUMO
BACKGROUND: Understanding the epidemiology of Streptococcus pneumoniae (S. pneumoniae) isolates is important for pneumonia treatment and prevention. This research aimed to explore the epidemiological characteristics of S. pneumoniae isolated from pediatric inpatients and outpatients during the same period. METHODS: S. pneumoniae were isolated from unsterile samples of inpatients and outpatients younger than five years old between March 2013 and February 2014. The serotypes were determined using diagnostic pneumococcal antisera. The resistance of each strain to 13 antibiotics was tested using either the E-test or the disc diffusion method. The Sequence Types (STs) were analyzed via Multilocus Sequence Typing (MLST). RESULTS: The dominant serotypes obtained from inpatients were 19F (32.9 %), 19A (20.7 %), 23F (10.7 %), 6A (10.0 %), and 14 (8.6 %), while those from outpatients were 19F (13.6 %), 23F (12.9 %), 6A (10.0 %), 6B (10.0 %), and 19A (7.9 %). The coverage rates of 13-valent Pneumococcal Conjugate Vaccine (PCV) formulations were high in both groups. The nonsusceptibility to penicillin, cefuroxime, imipenem, erythromycin, and trimethoprim-sulfamethoxazole among the inpatient isolates was 7.1 %, 92.8 %, 65.7 %, 100 %, and 85.0 %, respectively, while that among the outpatient isolates was 0.7 %, 50.0 %, 38.6 %, 96.4 %, and 65.7 %, respectively. There were 45 and 81 STs detected from the pneumococci isolated from inpatients and outpatients, respectively. CC271 was common among both inpatients and outpatients (43.6 % and 14.3 %). CONCLUSIONS: Pneumococcal vaccine-related serotypes are prevalent among both inpatients and outpatients, especially among inpatients, who exhibit more severe antibiotic resistance. Therefore, universal immunization with PCV13 would decrease the hospitalization rate due to S. pneumoniae and the antibiotic resistance rate of S. pneumoniae.
Assuntos
Antibacterianos , Pacientes Internados , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Pacientes Ambulatoriais , Infecções Pneumocócicas , Sorogrupo , Streptococcus pneumoniae , Humanos , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/genética , Pré-Escolar , Pacientes Ambulatoriais/estatística & dados numéricos , Lactente , Antibacterianos/farmacologia , Masculino , Feminino , Pacientes Internados/estatística & dados numéricos , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/epidemiologia , Hospitais Pediátricos , Farmacorresistência Bacteriana , Pequim/epidemiologia , Sorotipagem , Vacinas Pneumocócicas/imunologiaRESUMO
Background and Objectives: bacterial resistance is an important public health problem worldwide and is related to the indiscriminate use of antimicrobials, limiting the available therapeutic options. The COVID-19 pandemic aggravated this scenario, since the lack of a standardized therapy led to a considerable increase in the prescription of these drugs. Therefore, we proposed to investigate the prevalence of bacterial infections and the profile of antimicrobial resistance in patients diagnosed with COVID-19 as well as to point out possible risk factors. Methods: a retrospective study based on the analysis of medical records of patients hospitalized with COVID-19 over the age of 18. Information such as age, gender, length of stay, hospitalization unit, bacterial species and resistance profile and previous use of antimicrobials by patients diagnosed with COVID-19 were collected and analyzed using Excel® 2016. Results: of the 268 patients with COVID-19, 162 had suspected bacterial infections, and 26 patients (9.7%) were confirmed from positive cultures. Furthermore, around 80% of these patients underwent empirical treatment with antimicrobials, the majority of whom were male and admitted to the Intensive Care Unit. A total of 32 bacterial isolates were recovered, of which 59.4% were resistant to at least one class of antimicrobials, with 21.8% being multidrug resistant. Conclusion: despite the low percentage found of patients with COVID-19 who had bacterial infections and of these 21.8% were by multidrug-resistant bacteria, the reinforcement in infection prevention policies and the adequate management in the release of antimicrobials is necessary to reduce the hospital dissemination rates of such bacteria.(AU)
Justificativa e Objetivos: a resistência bacteriana é um importante problema de saúde pública mundial relacionado ao uso indiscriminado de antimicrobianos, limitando as opções terapêuticas disponíveis. A pandemia de COVID-19 agravou esse cenário, uma vez que a falta de uma terapia padronizada resultou no aumento considerável na prescrição desses fármacos. Diante disso, propôs-se investigar a prevalência de infecções bacterianas e o perfil de resistência aos antimicrobianos em pacientes diagnosticados com COVID-19, bem como apontar possíveis fatores de risco. Métodos: estudo retrospectivo baseado na análise de prontuários de pacientes internados com COVID-19 com idade superior a 18 anos. Informações como idade, gênero, tempo de internação, unidade de internação, espécie bacteriana e perfil de resistência e uso prévio de antimicrobianos pelos pacientes diagnosticados com COVID-19 foram coletadas e analisadas pelo software Excel® 2016. Resultados: dos 268 pacientes com COVID-19, 162 apresentaram suspeitas de infecções bacterianas, sendo 26 pacientes (9,7%) confirmados a partir de culturas positivas. Ainda, cerca de 80% desses pacientes realizaram tratamento empírico com antimicrobianos, sendo a maioria do sexo masculino e internados em Unidade de Terapia Intensiva. Foram recuperados um total de 32 isolados bacterianos, dos quais 59,4% apresentaram resistência a pelo menos uma classe de antimicrobianos, sendo 21,8% multidroga resistente. Conclusão: apesar do baixo percentual encontrado de pacientes com COVID-19 que apresentaram infecções bacterianas e, desses, 21,8% serem causados por bactérias multirresistentes, o reforço nas políticas de prevenção de infecções e o adequado gerenciamento na liberação de antimicrobianos se fazem necessários para a redução das taxas de disseminação hospitalar de tais bactérias.(AU)
Justificación y Objetivos: la resistencia bacteriana es un importante problema de salud pública en todo el mundo y está relacionada con el uso indiscriminado de antimicrobianos, lo que limita las opciones terapéuticas disponibles. La pandemia por COVID-19 agravó este escenario, ya que la falta de una terapia estandarizada llevó a un aumento considerable en la prescripción de estos fármacos. Por ello, nos propusimos investigar la prevalencia de infecciones bacterianas y el perfil de resistencia antimicrobiana en pacientes diagnosticados de COVID-19, así como señalar posibles factores de riesgo. Métodos: estudio retrospectivo basado en el análisis de historias clínicas de pacientes hospitalizados con COVID-19 mayores de 18 años. Información como edad, sexo, duración de la estadía, unidad de hospitalización, especies bacterianas y perfil de resistencia y uso previo de antimicrobianos por parte de pacientes diagnosticados con COVID-19 fueron recopiladas y analizadas mediante el software Excel® 2016. Resultados: de los 268 pacientes con COVID-19, 162 tenían sospecha de infección bacteriana, con 26 pacientes (9,7%) confirmada a partir de cultivos positivos. Además, alrededor del 80% de estos pacientes recibieron tratamiento empírico con antimicrobianos, la mayoría de los cuales eran hombres e ingresaron en la Unidad de Cuidados Intensivos. Se recuperaron un total de 32 aislados bacterianos, de los cuales el 59,4% eran resistentes a al menos una clase de antimicrobianos y el 21,8% eran resistentes a múltiples fármacos. Conclusión: a pesar del bajo porcentaje encontrado de pacientes con COVID-19 que presentaron infecciones bacterianas, y de éstas cerca del 21,8% fueron por bacterias multirresistentes, es necesario reforzar las políticas de prevención de infecciones y una gestión adecuada en la liberación de antimicrobianos para reducir las tasas de diseminación hospitalaria de dichas bacterias.(AU)
Assuntos
Humanos , Infecções Bacterianas , Resistência Microbiana a Medicamentos , Infecção Hospitalar , COVID-19/complicações , Pacientes InternadosRESUMO
Objective: To assess the quality of sleep among surgical inpatients and to determine the associated clinical, environmental, and psychological factors. Method: A cross-sectional observational study using descriptive correlation analysis was conducted on 150 surgical inpatients at a Portuguese hospital center. A sociodemographic and clinical questionnaire and the Pittsburgh Sleep Quality Index - Portuguese version (PSQI-PT) were administered. Result: Most participants seemed to experience poor sleep quality (PSQI > 5 = 89.3%) during hospitalization.Factors associated with poor sleep quality include several clinical variables whose scores were significantly worse among cancer patients, patients undergoing colorectal surgery or esophagogastroduodenoscopies, those with longer hospital stays, and those experiencing pain and health-related complications. Variables related to sleep disturbances included noise, persistent changes in sleeping position, feelings of anxiety, and health concerns. Conclusion: Findings revel a high prevalence of poor sleep quality during hospitalization caused by an increased sleep latency period, a decline in total sleep time, and lower sleep efficiency
Objetivo: Avaliar a qualidade de sono do doente cirúrgico internado e determinar os fatores clínicos, ambientais e psicológicos associados. Método: Estudo observacional com matriz transversal e análise descritivo-correlacional, realizado com 150 doentes internados para procedimento cirúrgico, num centro hospitalar português. Foi aplicado um questionário para caracterização sociodemográfica e clínica, bem como o Índice de Qualidade do Sono de Pittsburgh versão portuguesa (PSQI-PT). Resultado: A maioria dos participantes apresentou uma má qualidade de sono (PSQI > 5 = 89,3%) durante o internamento. Os fatores associados à má qualidade de sono incluem variáveis clínicas com piores escores nos doentes oncológicos, submetidos a cirurgia colorretal e esofagogastroduodenal, maior tempo de internamento, presença de dor e complicações. Como variáveis perturbadoras do sono destacam-se o ruído, a alteração da posição para dormir, sentir-se ansioso e a preocupação com a própria saúde. Conclusão: Observou-se uma elevada prevalência da má qualidade de sono, resultante do aumento do período de latência, diminuição do tempo total de sono e da sua eficiência durante o internamento
Assuntos
Humanos , Sono , Emoções , Latência do Sono , Qualidade do Sono , Duração do Sono , Hospitalização , Ansiedade , Dor , Pacientes , Psicologia , Procedimentos Cirúrgicos Operatórios , Saúde , Prevalência , Inquéritos e Questionários , Endoscopia do Sistema Digestório , Eficiência , Hospitais , Pacientes Internados , Tempo de Internação , Métodos , NeoplasiasRESUMO
OBJECTIVE: To adapt the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH) to the Brazilian language and culture and to assess its psychometric properties. RESULTS: The scale was evaluated by 15 experts, and 239 patients from three tertiary hospitals in Rio de Janeiro. All participants signed a consent form. Data have shown adequacy of the model (KMO=0.839, Bartlett's test of sphericity: χ2(171) = 2241.3, p = 0.000010), good adjusted content validity (CVCa ≥ 0.90), internal consistency and reliability, such as α = 0.927. DISCUSSION: CuPDPH is a rating scale on observable professional attitudes. Illnesses change lives and impose adaptation to a new situation, perceived as depersonalization, leading patients to try to regain control of their lives. Patients expressed "ill will" to fill out the scale. Psychiatric patients' scale filling time was higher than others. A sample from three Rio de Janeiro third-level hospitals may not reflect the country's population; also, this adaptation may not comprise all linguistic variations of Brazilian Portuguese and Portuguese-speaking countries. CONCLUSION: The Portuguese version of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient (CuPDPH), a 19-item, six-component version is a reliable instrument to measure the perception of internal medicine, surgical, and psychiatric patients on the maintenance of their dignity in Rio de Janeiro, Brazil. This knowledge could be used in advancing research on patients' perception of dignity, as well as professional ethical competencies, staff-patient relationship skills, and leadership development in medical and other healthcare professional education.
Assuntos
Comparação Transcultural , Pacientes Internados , Humanos , Brasil , Estudos Transversais , Inquéritos e Questionários , Psicometria , Respeito , Reprodutibilidade dos Testes , Idioma , Percepção , TraduçõesRESUMO
BACKGROUND: Omicron has become the dominant variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since first reported in November 2021. From the initially detected Wuhan lineage, sublineages BA.2, BA.4, BA.5, BQ, XAG, and XBB have emerged over time and are dominant in many countries. Therefore, the aim is to evaluate which variants are circulating and the clinical characteristics of inpatients infected with the Omicron variant. METHODS: This retrospective cohort study selected hospitalized patients admitted with respiratory symptoms to a hospital in the state of Rio Grande do Sul, Brazil, between June and July 2022. SARS-CoV-2 results were analyzed together with clinical outcomes and vaccination status. A viral genome library was prepared and forwarded to the Illumina MiSeq Platform for sequencing. RESULTS: In total, 37 genomes were sequenced. Concerning the Omicron sublineages, our study detected: BA.1 (21 K), BA.2 (21 L), BA.4 (22A), BA.5 (22B), BA.2.12.1 (22C), BQ.1 (22E), XBB (22F), and XAG recombinant. Omicron BA.5 (30%), BA.2 (19%), and BQ.1 (19%) were the most frequent sublineages, respectively. In total, 38% of patients present hypertension, and the most common symptoms were coughing (62%). Analyzing the COVID-19 vaccination, 30% of patients were fully vaccinated, 49% had a partial vaccination status, and 21% were unvaccinated (no dose). CONCLUSIONS: BA.5 was the most prevalent sublineage in our study and surpassed the predominance of BA.2, as reported by the national genomic surveillance program. BQ.1 was diagnosed earlier in this study than it was officially reported in the state. Current data have demonstrated that the Omicron variant causes less severe infections, with the high rate of transmissibility and mutational landscape causing the rapid emergence of new sublineages.
Assuntos
Vacinas contra COVID-19 , Pacientes Internados , Humanos , Brasil/epidemiologia , Estudos Retrospectivos , TosseRESUMO
OBJECTIVE: To verify the characteristics of safety incident reports resulting in moderate and severe harm to pediatric patients in two hospitals during the COVID-19 pandemic. METHOD: Cross-sectional study conducted in two hospitals in southern Brazil. The sample consisted of 137 notifications from March 2020 to August 2021. The data were collected through the electronic records of the institutions' notification systems and analyzed using descriptive and inferential statistics. RESULTS: The most prevalent incidents were related to clinical processes or procedures (41.6%), affecting slightly more females (49.6%) and infants (39.4%). The majority of incidents (48.2%) occurred in inpatient units. The event sector (p=0.001) and the shift (p=0.011) showed statistically significant associations in both hospitals. CONCLUSION: The characteristics of the notifications are similar between the institutions surveyed, with a low number of moderate and severe incidents.
Assuntos
COVID-19 , Segurança do Paciente , Lactente , Feminino , Humanos , Criança , Estudos Transversais , Pandemias , COVID-19/epidemiologia , Gestão de Riscos/métodos , Pacientes InternadosRESUMO
OBJECTIVE: The present study aimed to evaluate the association between muscle mass variation, estimated by different equations, during hospitalization with the energy and protein intake and clinical and nutrition outcomes of patients using nutrition support. METHODS: A prospective observational study with patients older than 18 years in use of enteral and/or parenteral nutrition therapy and monitored by the Nutritional Therapy Committee between December 14, 2021, and December 14, 2022. Data were collected from the electronic records and were applied in 11 equations to estimate the four different portions of muscle mass of patients receiving nutrition support at the beginning and the end of hospitalization. RESULTS: A total of 261 patients were evaluated, with a median age of 61.0 (49.0-69.75) years, and 106 were women (40.6%). According to the nutrition diagnosis, several participants had severe malnutrition (39.5%). The most muscle mass estimation equations indicated a reduction of muscle mass during hospitalization. All patients presented negative energy and protein balances during hospitalization, but greater protein intake increased the lean soft tissue. Also, the greater the number of infections, metabolic complications, and scheduled diet interruption, the greater was the chance of losing muscle mass. CONCLUSION: There can be an association between the variation in muscle mass and energy and protein intake during hospitalization of patients using nutrition support. In addition, variation in muscle mass was associated with complications from nutrition support. The results emphasize the importance of anthropometric measurements to estimate muscle mass when other methods are not available.
Assuntos
Proteínas Alimentares , Ingestão de Energia , Hospitalização , Pacientes Internados , Músculo Esquelético , Estado Nutricional , Apoio Nutricional , Humanos , Feminino , Estudos Prospectivos , Masculino , Pessoa de Meia-Idade , Idoso , Apoio Nutricional/métodos , Proteínas Alimentares/administração & dosagem , Pacientes Internados/estatística & dados numéricos , Nutrição Enteral/métodos , Desnutrição/etiologia , Composição Corporal , Estudos de Coortes , Nutrição Parenteral/métodosRESUMO
BACKGROUND: Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia. METHODS: This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events. RESULTS: Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups. CONCLUSION: Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19.
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COVID-19 , Demência , Sepse , Humanos , Idoso , Brasil/epidemiologia , Estudos de Coortes , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/epidemiologia , SARS-CoV-2 , Pacientes Internados , Demência/diagnóstico , Demência/epidemiologia , Demência/terapiaRESUMO
BACKGROUND: In 2018, the National Health System released the 'Guide to reducing long hospital stays' to stimulate improvement and decrease length of stay (LOS) in England hospitals. The SAFER patient flow bundle and Red2Green tool were described as strategies to be implemented in inpatient wards to reduce discharge delays. OBJECTIVE: To verify if implementing the SAFER patient flow bundle and Red2Green days tool is associated with LOS reduction in the internal medicine unit (IMU) wards of a university hospital in Brazil. METHODS: In this pre post study, we compared the LOS of patients discharged from the IMU wards in 2019, during the implementation of the SAFER bundle and Red2Green tool, to the LOS of patients discharged in the same period in 2018. The Diagnosis-Related Group Brazil algorithm compared groups according to complexity and resource requirements. In-hospital mortality, readmission rates, the number of hospital acquired conditions and the number and causes of inappropriate hospital days were also evaluated. RESULTS: Two hundred and eight internal medicine patients were discharged in 2018, and 252 were discharged in 2019. The median hospital LOS was significantly lower during the intervention period (14.2 days (IQR, 8-23) vs 19 days (IQR, 12-32); p<0.001). In-hospital mortality, 30-day mortality, readmission in 30 days and the number of hospital acquired conditions were the same between groups. Of the 3350 patient days analysed, 1482 (44.2%) were classified as green and 1868 (55.8%) as red. The lack of senior review was the most frequent cause of a red day (42.4%). CONCLUSION: The SAFER patient flow bundle and Red2Green days tool implementation were associated with a significant decrease in hospital LOS in a university hospital IMU ward. There is a considerable improvement opportunity for hospital LOS reduction by changing the multidisciplinary team's attitude during patient hospitalisation using these strategies.
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Hospitalização , Pacientes Internados , Humanos , Tempo de Internação , Hospitais Universitários , Doença IatrogênicaRESUMO
BACKGROUND: Nutritional risk situations related to decreased food intake in the hospital environment hinder nutritional care and increase malnutrition in hospitalized patients and are often associated with increased morbidity and mortality. The objective of this study is to develop and test the reliability and data similarity of a mobile application as a virtual instrument to assess the acceptability and quality of hospital diets for inpatients. METHODS: This intra- and interobserver development and reliability study investigated an in-hospital food intake monitoring application based on a validated instrument for patients with infectious diseases who were treated at the Evandro Chagas National Institute of Infectious Diseases (INI/FIOCRUZ). The instrument was sequentially administered to patients 48 h after admission to INI hospital units using the printed instrument (paper) and the digital application (ARIETI) simultaneously. The tested reliability factor was the consistency of the method in the digital platform, checking whether the application provided equivalent data to the paper instrument, and finally, a statistical analysis plan was performed in the R platform version 4.2.0. This project was authorized by the FIOCRUZ/INI Research Ethics Committee. RESULTS: The ARIETI was developed and tested for reliability in 70 participants, showing a similar ability to calculate caloric intake in Kcal, protein intake (g), the proportion of caloric intake and protein intake relative to the prescribed goal. These instrument comparison analyses showed statistical significance (p < 0.001). The application was superior to the paper-based instrument, accelerating the time to perform the nutritional risk diagnosis based on food intake by approximately 250 s (average time). CONCLUSIONS: The ARIETI application has demonstrated equivalent reliability compared to the original instrument. Moreover, it optimized the time between the diagnosis of nutritional risk related to dietary intake and the nutritionist's decision making, showing an improved ability to maintain information quality compared to the paper-based instrument.
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Doenças Transmissíveis , Aplicativos Móveis , Humanos , Pacientes Internados , Reprodutibilidade dos Testes , Dieta , Ingestão de AlimentosRESUMO
INTRODUCTION: The purpose of this study was to determine the prevalence of pluripathology and polypharmacy among hospitalized patients in internal medicine wards at an acute care hospital, including their sociodemographic and clinical characteristics. METHODS: Observational, prospective, longitudinal, descriptive and analytical study. All patients hospitalized in the internal medicine ward at Hospital Tornú from May to September 2019 were included through consecutive sampling. Data from medical records were collected. Functional dependency and prognosis were assessed using the Barthel, Charlson and PROFUND Indexes. RESULTS: 170 patients (58% male) were registered. Women were significantly older. Pluripathology prevalence: 32%; polypharmacy 38%; high BP: 48%; diabetes: 27%; cognitive impairment 15%; heart failure: 14%; stroke: 12%; anemia: 24%; CKD 10%. Total readmissions 10% (94% with early readmissions; 94% with readmissions related to a previous hospitalization). Global Mortality: 12%. Patients with pluripathology were elderly (78% > 65 years old) with a higher polypharmacy frequency (p < 0.0001) and functional dependence (p = 0.001). Mortality in patients with pluripathology (22%) was higher than in others (p = 0.0095) with higher Charlson and PROFUND scores (p < 0.0001). There were no significant differences in terms of hospital stay or readmissions. CONCLUSIONS: Pluripathological patients are common in our inpatient hospital department. This study reveals the importance of considering this type of patients in public hospitals due to its frequency, characteristics and healthcare utilization and costs.
Introducción: El objetivo del trabajo fue determinar prevalencia de pluripatología y polifarmacia entre internados en salas de clínica médica de un hospital de agudos, sus características sociodemográficas y clínicas. Métodos: estudio observacional, prospectivo, longitudinal, descriptivo y analítico. Se incluyeron los pacientes internados en clínica médica del Hospital Tornú entre mayo y septiembre, 2019 mediante muestreo consecutivo. Se relevaron datos de las historias clínicas. Se evaluó dependencia funcional y pronóstico mediante índices Barthel, Charlson y score PROFUND. Resultados: Se registraron 170 pacientes (58% masculinos). La edad de mujeres fue significativamente mayor (mediana 79 años; p= 0.002). Prevalencia de pluripatología 32%; polifarmacia 38%; hipertensión 48%; diabetes 27%; deterioro cognitivo 15%; insuficiencia cardíaca 14%; accidente cerebrovascular 12%; anemia 24%; enfermedad renal crónica 10%. Reingresos 10% (94% con reinternación precoz; 94% con motivo de reingreso relacionado con internación previa). Mortalidad general: 12%. Los pacientes pluripatológicos presentaron edad elevada (78% > 65 años), mayor frecuencia de polifarmacia (p < 0.0001) y de dependencia (p = 0.001). La mortalidad en pluripatológicos (22%) fue mayor que en el resto (p = 0.0095) y presentaron valores más elevados índice de Charlson y score PROFUND (p < 0.0001). No hubo diferencias significativas en estadía hospitalaria ni en reinternaciones. Conclusiones: La presencia de pacientes con pluripatología se presenta como una realidad cotidiana en nuestros servicios de internación. Este estudio revela la importancia de la consideración de este tipo de pacientes en el ámbito público debido a su frecuencia y características, demandas sanitarias y costes.