ABSTRACT
RESUMO Objetivo: Relatar a prevalência e os desfechos da sepse em crianças admitidas em hospitais públicos e privados na América Latina. Métodos: Análise post-hoc dos dados do Latin American Pediatric Sepsis Study (LAPSES), um estudo de coorte que avaliou a prevalência e os desfechos da sepse em crianças admitidas em 21 unidades de terapia intensiva pediátricas de cinco países latino-americanos. Resultados: Dentre os 464 pacientes com sepse, 369 (79,5%) foram admitidos em hospitais públicos e 95 (20,5%) em privados. Em comparação com os admitidos em hospitais privados, os pacientes com sepse admitidos em hospitais públicos não diferiram em termos de idade, sexo, condição de imunização, tempo de permanência no hospital ou tipo de admissão, porém tiveram incidência mais alta de choque séptico, escores Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality 2 (PIM 2) e Pediatric Logistic Organ Dysfunction (PELOD) mais altos e taxas mais elevadas de doenças de base e analfabetismo materno. A proporção entre pacientes admitidos a partir de enfermarias pediátricas e mortalidade relacionada à sepse foi mais alta nos hospitais públicos. A análise multivariada não mostrou qualquer correlação entre mortalidade e tipo de hospital, porém, nos hospitais públicos, a mortalidade se associou com níveis mais altos de gravidade no momento da admissão à unidade de terapia intensiva. Conclusão: Nesta amostra de crianças admitidas em condições críticas em cinco países latino-americanos, a prevalência de choque séptico nas primeiras 24 horas da admissão e a mortalidade relacionada à sepse foram mais elevadas em hospitais públicos do que nos privados. A mortalidade relacionada à sepse mais elevada em crianças admitidas em unidades de terapia intensiva pediátrica de hospitais públicos se associou com maior gravidade por ocasião da admissão à unidade de terapia intensiva, porém não com o tipo de hospital. São necessários novos estudos para elucidar as causas da maior prevalência e mortalidade de sepse pediátrica em hospitais públicos.
ABSTRACT Objective: To report the prevalence and outcomes of sepsis in children admitted to public and private hospitals. Methods: Post hoc analysis of the Latin American Pediatric Sepsis Study (LAPSES) data, a cohort study that analyzed the prevalence and outcomes of sepsis in critically ill children with sepsis on admission at 21 pediatric intensive care units in five Latin American countries. Results: Of the 464 sepsis patients, 369 (79.5%) were admitted to public hospitals and 95 (20.5%) to private hospitals. Compared to those admitted to private hospitals, sepsis patients admitted to public hospitals did not differ in age, sex, immunization status, hospital length of stay or type of admission but had higher rates of septic shock, higher Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality 2 (PIM 2), and Pediatric Logistic Organ Dysfunction (PELOD) scores, and higher rates of underlying diseases and maternal illiteracy. The proportion of patients admitted from pediatric wards and sepsis-related mortality were higher in public hospitals. Multivariate analysis did not show any correlation between mortality and the type of hospital, but mortality was associated with greater severity on pediatric intensive care unit admission in patients from public hospitals. Conclusion: In this sample of critically ill children from five countries in Latin America, the prevalence of septic shock within the first 24 hours at admission and sepsis-related mortality were higher in public hospitals than in private hospitals. Higher sepsis-related mortality in children admitted to public pediatric intensive care units was associated with greater severity on pediatric intensive care unit admission but not with the type of hospital. New studies will be necessary to elucidate the causes of the higher prevalence and mortality of pediatric sepsis in public hospitals.
Subject(s)
Humans , Child , Sepsis/epidemiology , Intensive Care Units, Pediatric , Prevalence , Cohort Studies , Hospitals, Private , Hospital Mortality , Latin America/epidemiologyABSTRACT
Objective:To study and design a disaster recovery backup system that not only can meet the continuous requirement of medical services but also can ensure data so as to achieve a data center plan that has maximum utilization ratio of resources. Methods: Face to the current situation of constructing data center of hospital, the cloud computing, virtualization technique, dual-active storage and database cluster were combined in the research, and through established calculation, storage, network, desktop and safety to finally achieve five private cloud included of producing cloud, testing cloud, disaster recovery cloud, desktop cloud and secure cloud. And then, based on above design to establish a plan about dual-active data center of private cloud included of recovery point objectives(RPO)=0 and recovery time objective(RTO)≈0.Results: This research has designed a dual-data center of private cloud with high availability, high performance, high expansion and high convenience management. It has realized simple and convenient management and operation for all data centers, and enhanced the utilization ratio of data resources.Conclusion: The dual-active data center of private cloud can farthest realize full use for resource and save investment and construction costs of IT infrastructure under the preconditions of meeting the continuous requirement of medical services.
ABSTRACT
OBJETIVO: Analisar o ambiente de trabalho em Unidades de Terapia Intensiva em hospitais privados e públicos. MÉTODOS: Estudo transversal realizado em quatro unidades de terapia intensiva do qual participaram 66 enfermeiros. Utilizou-se dois instrumentos de pesquisa, um para caracterização socioeconômica e as subescalas do Nursing Work Index Revised versão brasileira validadas (B-NWI-R). RESULTADOS: Os enfermeiros consideraram que as unidades de terapia intensivapossuem ambientes de trabalho favoráveis ao exercício da prática profissional em enfermagem (média geral= 1,95 e dp=0,40).Ao comparar as UTI dos hospitais privados e públicos observa-se que o escore geral do B-NWI-R alcançou os valores de 1,91 (dp=0,39) e 1,99 (dp=0,42) respectivamente com p=0,459. CONCLUSÃO: As quatro UTI analisadas apresentaram ambientes favoráveis à prática profissional em enfermagem. O fato de pertencer a hospitais privados e públicos não foi significativo na análise.
OBJECTIVE: To analyze the work environment in intensive care units from public and private hospitals. METHODS: This was a cross-sectional study conducted with 66 nurses in four intensive care units. Two questionnaires were used for data collection, one for the socioeconomic profile and the other composed by the subscales of the validated Brazilian version of the Nursing Work Index-Revised (B-NWI-R). RESULTS: The nurses reported a favorable work environment for the exercise of professional nursing practices in the intensive care units (overall mean = 1.95 and SD = 0.40). By comparing private and public hospitals it was observed that the overall score of the B-NWI-R reached values of 1.91 (SD = 0.39) and 1.99 (SD = 0.42), respectively, with a p-value of 0.459. CONCLUSION: The four intensive care units analyzed in this study presented favorable work environments for nursing practices. The fact of belonging to private or public hospitals was not significant in the analysis.