Acute kidney injury among hospitalised patients who died due to COVID-19 in the Eastern Cape, South Africa

Background: Acute kidney injury (AKI) commonly occurs in coronavirus disease 2019 (COVID-19) patients who have been hospitalised and is associated with a poor prognosis. This study aimed to determine the incidence of AKI among COVID-19 patients who died in a regional hospital in South Africa. Methods: This retrospective record review was conducted at the Mthatha Regional Hospital in South Africa's Eastern Cape province. Data were collected between 10 July 2020 and 31 January 2021. Results: The incidence of AKI was 38% among the hospitalised patients who died due to COVID-19. Most study participants were female, with a mean age of 63.3 ± 16 years. The most common symptom of COVID-19 at the time of hospitalisation was shortness of breath, followed by fever and cough. Half of the patients had hypertension, while diabetes, human immunodeficiency viruses (HIV) and tuberculosis (TB) were other comorbidities. At admission, the average oxygen saturation was 75.5% ± 17. Conclusion: The study revealed a high incidence of AKI among hospitalised patients who died due to COVID-19. It also found that those received adequate crystalloid fluids at the time of admission had a lower incidence of AKI. Contribution: Acute kidney injury can be prevented by adequate fluid management during early stage of COVID-19. Majority of COVID-19 patients were referred from lower level of care and primary care providers have their first encounter with these patients. Adequate fluid resuscitation in primary care settings can improve the outcome of hospitalised COVID-19 patients.

Integrating advance care planning as part of comprehensive geriatric assessment for hospitalised frail elderly patients: findings of a cross-sectional study

INTRODUCTION@#The integration of advance care planning (ACP) as part of the comprehensive geriatric assessment (CGA) of hospitalised frail elderly patients, together with the clinical and demographic factors that determine successful ACP discussion, has not been previously explored.@*METHODS@#A cross-sectional study on patients and family caregivers admitted under the geriatric medicine department of a tertiary hospital was conducted from October 2015 to December 2016.@*RESULTS@#Among 311 eligible patients, 116 (37.3%) patients completed ACP discussion while 166 (53.4%) patients declined, with 62 (37.3%) of the decliners providing reasons for refusal. Univariate logistic regression analysis showed that older age, higher Charlson Comorbidity Index, poorer functional status and cognitive impairment had statistically significant associations with agreeing to ACP discussion (p < 0.05). On multivariate logistic regression analysis, only poorer functional status was significantly associated (odds ratio 2.22 [95% confidence interval 1.27-3.87]; p = 0.005). Among those who completed ACP discussion, a majority declined cardiopulmonary resuscitation (79.3%), preferred limited medical intervention or comfort care (82.8%), and opted for blood transfusion (62.9%), antibiotics (73.3%) and intravenous fluid (74.1%) but declined haemodialysis (50.9%). Decision-making was divided for enteral feeding. Among decliners, the main reasons for refusal were 'not keen' (33.9%), 'deferring to doctors' decision' (11.3%) and 'lack of ACP awareness' (11.3%).@*CONCLUSION@#The feasibility and utility of integrating ACP as part of CGA has been demonstrated. Poorer functional status is significantly associated with successful ACP discussion. Greater public education on end-of-life care choices (besides cardiopulmonary resuscitation) and follow-up with decliners are recommended.

Adhesión insuficiente a la prevención de la enfermedad tromboembólica venosa en Hospitales Uruguayos. Un grave problema en salud / Insufficient adherence to the prevention of venous thromboembolic disease in Uruguayan Hospitals. A serious health problem / Insuficiente adesão à prevenção da doença tromboembólica venosa em hospitais uruguaios. Um sério problema de saúde

Resumen: Introducción: La Enfermedad Tromboembólica Venosa (ETV) es una complicación médica grave, frecuente y prevenible en el paciente hospitalizado. Si bien se ha demostrado la eficacia de su prevención (farmacológica y/o mecánica), su adhesión es insuficiente a nivel internacional y nacional. Objetivos: Contribuir al conocimiento de la realidad nacional sobre tromboprofilaxis en el paciente hospitalizado en vistas a optimizar su adherencia. Conocer la prevalencia del riesgo de ETV en la población analizada y evaluar la adherencia a la indicación de tromboprofilaxis. Metodología. Estudio observacional, descriptivo, transversal y multicéntrico de todos los pacientes médico-quirúrgicos internados en salas de cuidado moderado del Hospital de Clínicas, Hospital Maciel y Sanatorio Americano, durante el 26 y 27 de Abril 2017. Se estudiaron variables sociodemográficas y el porcentaje de pacientes en riesgo de ETV. En los pacientes de riesgo se valoró el porcentaje que reciben tromboprofilaxis farmacológica. Resultados. Se incluyeron 427 pacientes. 63% (269) presentaban patología médica y 37% (158) patología quirúrgica. 294 (68,9%) se encontraban en riesgo de ETV, de los cuales 55,8% (164) recibían profilaxis farmacológica. No la recibían por omisión 19,4% (57), por contraindicación 18,4% (54) y por estar anticoagulados 6,4% (19). Ninguno de los pacientes con contraindicación para tromboprofilaxis farmacológica recibía medidas mecánicas. La población de pacientes en riesgo que recibían tromboprofilaxis era estadísticamente mayor en los pacientes médicos (66,7%, 110/165) que en los quirúrgicos (41,9%, 54/129) p < 0,001. De los 130 pacientes que no tenían indicación de tromboprofilaxis farmacológica 9,3% (12) la recibían. Todos estos pacientes presentaban patología médica. Conclusiones: En nuestro estudio encontramos un 68,9 % de pacientes en riesgo, lo que confirma que es un problema grave y frecuente. Con respecto a la tromboprofilaxis, si bien objetivamos una franca mejoría con respecto a estudios nacionales previos, creemos que es aún insuficiente y debemos seguir trabajando esta línea.

Abstract: Introduction: Venous Thromboembolic Disease (VTE) is a serious, frequent and preventable medical complication in hospitalized patients. Although the efficacy of its prevention (pharmacological and / or mechanical) has been demonstrated, its adherence is insufficient at the international and national level. Objectives: Contribute to the knowledge of the national reality on thromboprophylaxis in hospitalized patients in order to optimize their adherence. To know the prevalence of the risk of VTE in the analyzed population and evaluate adherence to the indication of thromboprophylaxis. Methodology: Observational, descriptive, cross-sectional and multicenter study of all medical-surgical patients admitted to moderate care wards of Hospital de Clínicas, Hospital Maciel and Sanatorio Americano, during April 26 and 27, 2017. Sociodemographic variables and the percentage of patients were studied at risk of VTE. In patients at risk, the percentage who received pharmacological thromboprophylaxis was assessed. Results: 427 patients were included. 63% (269) presented medical pathology and 37% (158) surgical pathology. 294 (68.9%) were at risk of VTE, of which 55.8% (164) were receiving pharmacological prophylaxis. They did not receive it by omission 19.4% (57), due to contraindication 18.4% (54) and because they were anticoagulated 6.4% (19). None of the patients with a contraindication for pharmacological thromboprophylaxis received mechanical measures. The population of patients at risk who received thromboprophylaxis was statistically higher in medical patients (66.7%, 110/165) than in surgical patients (41.9%, 54/129) p <0.001. Of the 130 patients who did not have an indication for drug thromboprophylaxis, 9.3% (12) received it. All these patients presented medical pathology. Conclusions: In our study we found 68.9% of patients at risk, which confirms that it is a serious and frequent problem. With regard to thromboprophylaxis, although we observed a clear improvement compared to previous national studies, we believe that it is still insufficient and we must continue working on this line.

Resumo: Introdução: A Doença Tromboembólica Venosa (TEV) é uma complicação médica grave, frequente e evitável em pacientes hospitalizados. Embora a eficácia da sua prevenção (farmacológica e / ou mecânica) tenha sido demonstrada, a sua adesão é insuficiente a nível internacional e nacional. Objetivos: Contribuir para o conhecimento da realidade nacional sobre tromboprofilaxia em pacientes hospitalizados de forma a otimizar a sua adesão. Conhecer a prevalência de risco de TEV na população analisada e avaliar a adesão à indicação de tromboprofilaxia. Metodologia: Estudo observacional, descritivo, transversal e multicêntrico de todos os pacientes médico-cirúrgicos internados em unidades de cuidados moderados do Hospital de Clínicas, Hospital Maciel e Sanatorio Americano, durante os dias 26 e 27 de abril de 2017. Foram estudadas variáveis sociodemográficas e o percentual de pacientes em risco de TEV. Em pacientes de risco, foi avaliada a porcentagem que recebeu tromboprofilaxia farmacológica. Resultados: 427 pacientes foram incluídos. 63% (269) apresentavam patologia médica e 37% (158) patologia cirúrgica. 294 (68,9%) estavam em risco de TEV, dos quais 55,8% (164) recebiam profilaxia farmacológica. Não o receberam por omissão 19,4% (57), por contra-indicação 18,4% (54) e por estarem anticoagulados 6,4% (19). Nenhum dos pacientes com contra-indicação para tromboprofilaxia farmacológica recebeu medidas mecânicas. A população de pacientes em risco que recebeu tromboprofilaxia foi estatisticamente maior em pacientes médicos (66,7%, 110/165) do que em pacientes cirúrgicos (41,9%, 54/129) p <0,001. Dos 130 pacientes que não tinham indicação de tromboprofilaxia medicamentosa, 9,3% (12) a receberam. Todos esses pacientes apresentavam patologia médica. Conclusões: Em nosso estudo encontramos 68,9% de pacientes em risco, o que confirma que se trata de um problema grave e frequente. No que se refere à tromboprofilaxia, embora tenhamos observado uma clara melhora em relação aos estudos nacionais anteriores, acreditamos que ainda é insuficiente e devemos continuar trabalhando nessa linha.

Profile of respiratory pathogens causing acute respiratory infections in hospitalised children at Rajasthan a 4 year's study

Introduction: Various pathogens cause respiratory tract infections in children of <5 years of age causing severe morbidity and mortality. The profile of causative agents varies from place to place. Aims: The objectives of our study were to detect the profile and trends of respiratory pathogens causing acute respiratory tract infection in children using a custom multiplex real-time polymerase chain reaction (RT-PCR) and to develop a diagnostic algorithm. Materials and Methods: A total of 997 children with clinical manifestations of respiratory infections were included in the study. Their nasopharyngeal aspirate and throat swab samples were subjected to nucleic acid extraction followed by multiplex RT-PCR for eighteen viruses and six bacteria. Statistical Analysis Used: Chi-square test was employed to study the P value of different viruses and bacteria. Results: A total of 765 (76.73%) samples were found to be positive for one of the respiratory pathogens. Viruses were detected in 598 (59.98%) and bacteria in 167 (41.85%) samples, respectively. The prevalence of single and co-infections among viruses and bacteria were 77.76% and 22.24%, 81.44% and 18.56% each, respectively. Respiratory syncytial virus (RSV) A/B and Streptococcus pneumoniae were the most predominant pathogens detected in the study and were associated with lower respiratory tract infections. Conclusion: RSV and S. pneumoniae were the most common pathogens detected, higher prevalence was observed in children <1 year of age. Viruses were predominant during winter months. The study helped to prepare diagnostic algorithm which will help in reducing diagnostic costs. However, further studies are required to assess whether viruses are bystander or real pathogens and include larger panel of bacteria and viruses for diagnosis.

OVERVIEW OF DENGUE AND DENGVAXIA®—OPTIMISING THE USE OF DENGVAXIA®

Dengue is the most rapidly spreading mosquito-borneviral disease in the world, associated with high morbidityand mortality. It is caused by the transmission of thedengue virus (DENV) through the bite of the infectedmosquito vector, Aedes aegypti. There are 4 serotypes ofDENV (1–4), and all of them circulate in Singapore.Pre-adolescents and young adults are at the highest riskof dengue in this region. In Singapore, the dengue vaccineis approved for the prevention of dengue caused by DENV1–4 in individuals aged 12–45 years living in endemic areas.The vaccine is effective in reducing symptomatic, severeand hospitalised dengue, with clear benefits inseropositive individuals.

Human Microsporidiosis In Malaysia: Review Of Literatures

The purpose of this study is to review the literature on microsporidiosis in various high-risk groups among the Malaysian population, i.e., HIV/AIDS, cancer, hospitalised patients and Orang Asli, and to update information with regards to microsporidia prevalence, diagnosis and association of the disease with gastrointestinal symptoms in Malaysia. Hospitalised patients showed the highest prevalence (28.3%) of microsporidiosis compared to other risk groups. This review did not find any direct correlations between gastrointestinal symptoms and microsporidiosis. Since microsporidiosis is an emerging threat to the high-risk groups, greater awareness should be instilled among clinicians to consider microsporidiosis in their differential diagnosis if no other causes can be defined.

Segurança do paciente no cuidado à criança hospitalizada: evidências para enfermagem pediátrica / Seguridad del paciente en la atención al niño hospitalizado: evidencia para la enfermería pediátrica / Patient safety in the care of hospitalised children: evidence for paediatric nursing

RESUMO Objetivos Descrever evidências na literatura internacional para o cuidado seguro da criança hospitalizada após a criação da Aliança Mundial para a Segurança do Paciente e elencar contribuições do referencial teórico geral da segurança do paciente para a enfermagem pediátrica. Método Revisão integrativa da literatura entre 2004 e 2015 nas bases de dados PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science e Wiley Online Library, utilizando os descritores Safety or Patient safety, Hospitalized child, Pediatric nursing e Nursing care. Resultados Foram analisados 32 artigos, a maioria norte-americanos, com delineamento descritivo. A qualidade do registro das informações no prontuário, o emprego de checklists e a formação profissional contribuem para o cuidado seguro na enfermagem pediátrica, bem como para melhorias no processo medicamentoso e na parceria com os pais. Conclusão As informações gerais disponíveis sobre a segurança do paciente devem ser incorporadas no cuidado de enfermagem pediátrica.

RESUMEN Objetivos Describir la evidencia de la literatura internacional para el cuidado seguro de los niños hospitalizados después de la creación de la Alianza Mundial para la Seguridad del Paciente y listar las contribuciones del marco teórico general de la seguridad del paciente para la enfermería pediátrica. Método Una revisión integradora de la literatura entre 2004 y 2015 fue realizada en las bases de datos PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science y Wiley Online Library, utilizando los descriptores Seguridad o Seguridad del paciente, Niño hospitalizado, Enfermería pediátrica y cuidado de enfermería. Resultados Se analizaron 32 artículos, la mayoría de América, con diseño descriptivo. La calidad de los registros de la información en la historia clínica, el uso de listas de control y la formación profesional contribuyen a la atención segura en enfermería pediátrica, así como mejoras en el proceso de la medicación y la asociación con los padres. Conclusión La información general disponible sobre la seguridad del paciente debe ser incorporada en la atención de enfermería pediátrica.

ABSTRACT Objectives To describe evidence of international literature on the safe care of the hospitalised child after the World Alliance for Patient Safety and list contributions of the general theoretical framework of patient safety for paediatric nursing. Method An integrative literature review between 2004 and 2015 using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and Wiley Online Library, and the descriptors Safety or Patient safety, Hospitalised child, Paediatric nursing, and Nursing care. Results Thirty-two articles were analysed, most of which were from North American, with a descriptive approach. The quality of the recorded information in the medical records, the use of checklists, and the training of health workers contribute to safe care in paediatric nursing and improve the medication process and partnerships with parents. Conclusion General information available on patient safety should be incorporated in paediatric nursing care.

Percepción de los adolescentes sobre el ingreso hospitalario: Importancia de la humanización de los hospitales infantiles / Survey of adolescent perception of hospital admission: The importance of hospital humanisation

Introducción: La humanización de la asistencia sanitaria conlleva considerar al paciente como un ser integral, y proporcionar asistencia más allá de los cuidados médicos, abarcando áreas como la social, emocional, espiritual y relacional. Objetivo: Conocer las necesidades de los adolescentes hospitalizados y los déficits percibidos por estos en la asistencia sanitaria. Sujetos y método: Estudio transversal descriptivo realizado a través de una encuesta anónima, dirigido a pacientes ingresados de entre 12-16 años. La encuesta estaba formada por 2 partes: preguntas abiertas para exponer sus necesidades, indicar aspectos positivos o negativos de la hospitalización, y sugerencias de mejora, y preguntas cerradas con posibles respuestas afirmativas o negativas, y escalas numéricas del 1 al 10 para cuantificar los resultados. Se llevó a cabo un pilotaje previo en 6 pacientes adolescentes como prueba de factibilidad y de comprensión de todos los apartados. Resultados: Se obtuvieron un total de 39 encuestas de pacientes, con una mediana de edad de 14 años. La experiencia más desagradable percibida durante el ingreso fue la realización de pruebas invasivas. El 95% de ellos padeció dolor y el 17% sintió en algún momento que se iba a realizar algún procedimiento sin su pleno conocimiento. Más del 75% demandaba más entretenimiento, siendo la no disponibilidad de Wi-Fi el elemento más reclamado. Conclusiones: La población estudiada mostró necesidades que deben ser consideradas en el momento de la hospitalización, destacando: cognitivas (necesidad de obtener información clara y extensa), sociales (mantener el contacto y las relaciones con el exterior, familiares y amigos), emocionales (la enfermedad y sus procesos diagnóstico-terapéuticos crearán alteraciones en el estado anímico) y prácticas (los aspectos ambientales y arquitectónicos pueden mejorar o empeorar la percepción del ingreso hospitalario). Todos estos factores han demostrado que pueden contribuir al restablecimiento de la salud de una forma más temprana.

Introduction: The humanisation of health care involves considering the patient as an integral human being, providing assistance beyond medical care, and covering other fields such as social, emotional, spiritual, or relational areas. Objective: To evaluate the requirements and concerns of the hospitalised children. Subjects and method: A cross-sectional, descriptive study was conducted using an anonymous questionnaire on children aged 12-16. Results: The study included 39 patients, with a median age of 14 years. The most unpleasant experience during the hospitalisation was the invasive procedures. Almost all (95%) of patients suffered from pain, and 17% of them felt at some point that a procedure was performed without them being fully aware. More than 75% of children asked for more entertainment, with the lack of Wi-Fi being the more demanded item. Conclusions: The needs of the population included in this survey, showed the importance to consider cognitive (necessity of obtaining clear and extensive information), social (maintaining everyday relationships), emotional (illness and its diagnostic and therapeutic procedures often generate mood disorders), and practical (environmental and architectural aspects can lead to either an improvement or a worsening of the hospitalisation perception) factors. All of these factors have shown a beneficial contribution, leading to an earlier recovery of health.

Contribuição do brinquedo terapêutico estruturado em um modelo de cuidado de enfermagem para crianças hospitalizadas / Contribución del juego terapéutico estructurado en un modelo de atención en el cuidado de niños hospitalizados / Contribution of structured therapeutic play in a nursing care model for hospitalised children

RESUMO Objetivo Analisar como o Brinquedo Terapêutico estruturado em um Modelo de Cuidado de Enfermagem contribui no cuidado à criança hospitalizada. Método Trata-se de uma Pesquisa Convergente Assistencial (PCA), de abordagem qualitativa. Participaram do estudo sete crianças. A coleta de dados foi realizada entre setembro e outubro de 2014, por meio de entrevista aberta e de observação participante de sessões de BT dramático e/ou instrucional através das etapas “Acolhendo/Brincando/Finalizando” do Modelo de Cuidado de Enfermagem Cuidar Brincando. Os dados foram analisados de acordo com as fases de análise e interpretação da PCA. Resultados Três categorias: Significados atribuídos pela criança à hospitalização e sua influência no cuidado de enfermagem, Percepção quanto aos procedimentos terapêuticos por meio do brinquedo terapêutico e Importância da inserção da família no cuidado. Considerações finais Conclui-se que aplicar o BT estruturado em um Modelo de Cuidado pode contribuir para um cuidado de enfermagem sistematizado e especializado.

RESUMEN Objetivo Objetivo de analizar como Juego Terapéutico estructurado en un modelo de atención de enfermería ayuda en el cuidado de niños hospitalizados. Método Se trata de una investigación cualitativa del tipo convergente asistencial. Participaron del estudio siete niños. Los datos fueron recolectados entre septiembre y octubre de 2014, por medio de entrevistas abiertas y observación participante de sesiones de juguete terapéutico dramático y de instrucción por los pasos “Acogiendo/Jugando/Finalizando” del Modelo de Atención de Enfermería Cuidar Jugando”. Los datos se analizaron de acuerdo a las fases de análisis e interpretación. Resultados Tres categorías: Significados atribuidos por el niño a la hospitalización y su influencia en los cuidados de enfermería, Percepción acerca de los procedimientos terapéuticos a través del juego y La Importancia de la inserción de la familia en la atención terapéutica. Consideraciones finales La aplicación de la BT estructurada en un modelo de atención puede contribuir a un cuidado de enfermería especializada y sistematizadas.

ABSTRACT Objective To analyse how therapeutic play structured in a nursing care model contributes to the care of hospitalised children. Method This is a qualitative study based on convergent care research (CCR). Seven children participated in the study. Data were collected in September and October of 2014 by means of interviews with open-end questions and participant observation of therapeutic and dramatic play sessions and/or instructional play sessions based on the stages “Welcoming/Playing/Concluding” of the nursing model Care with Play. Data were analysed according to the analysis and interpretation stages of the CCR. Results The following three categories emerged: Meanings attributed by the child to hospitalisation and its influence on nursing care; Perception of the therapeutic procedures through therapeutic play, and Importance of the family in care. Final considerations It is concluded that the application of therapeutic play structured in the care model contributes to systematic and specialised nursing care.

Prevalence of Geriatric Malnutrition and its Associated Factors at the Hospital Universiti Sains Malaysia, Kelantan

Introduction: Identified parameters associated with geriatric malnutrition add greatly to the knowledge of clinical nutrition and facilitate patient-centred nutritional care management. Methods: A six-month cross-sectional study with the aims of deterrninine the prevalence of malnutrition and its associated parameters was conducted among hospitalised geriatrics admitted to Hospital USM. A total of 130 (49 men, 81 women) eligible participants with a mean age of 69.7 (6.99) were recruited for this study. Anthropometric tests, biochemical tests, and subjective global assessments (SGA) were applied in this study to assess the nutritional status of the participants. Meanwhile, socio-demographics, nutritional risk factors, and clinical elements were examined to identify the associated factors of malnutrition. Results: The findings of this study revealed that 35.4% of the participants were malnourished based on SGA ratings of B (26.2%) and C (9.2%), with women having a significantly higher proportion (43.5%) compared to men (22 4%) with p<0.05. Multivariate analysis revealed that loss of appetite (p<0.001), low body mass index (EMI) (p<0.001), albumin (p<0.05), and surgical procedures (p<0.05) were significantly associated with malnutrition. Conclusion: The associated parameters were found to be practicable in facilitating the identification process of malnutrition, and thus enable earlier nutritional intervention to improve the overall disease progress.

Prevalence of Geriatric Malnutrition and its Associated Factors at the Hospital Universiti Sains Malaysia, Kelantan

Introduction: Identified parameters associated with geriatric malnutrition add greatly to the knowledge of clinical nutrition and facilitate patient-centred nutritional care management. Methods: A six-month cross-sectional study with the aims of deterrninine the prevalence of malnutrition and its associated parameters was conducted among hospitalised geriatrics admitted to Hospital USM. A total of 130 (49 men, 81 women) eligible participants with a mean age of 69.7 (6.99) were recruited for this study. Anthropometric tests, biochemical tests, and subjective global assessments (SGA) were applied in this study to assess the nutritional status of the participants. Meanwhile, socio-demographics, nutritional risk factors, and clinical elements were examined to identify the associated factors of malnutrition. Results: The findings of this study revealed that 35.4% of the participants were malnourished based on SGA ratings of B (26.2%) and C (9.2%), with women having a significantly higher proportion (43.5%) compared to men (22 4%) with p<0.05. Multivariate analysis revealed that loss of appetite (p<0.001), low body mass index (EMI) (p<0.001), albumin (p<0.05), and surgical procedures (p<0.05) were significantly associated with malnutrition. Conclusion: The associated parameters were found to be practicable in facilitating the identification process of malnutrition, and thus enable earlier nutritional intervention to improve the overall disease progress.

Prevalence and antimicrobial resistance pattern of multidrug-resistant enterococci isolated from clinical specimens.

Purpose: Vancomycin-resistant enterococci (VRE) pose an emerging problem in hospitals worldwide. The present study was undertaken to determine the occurrence, species prevalence, antibacterial resistance, and phenotypic and genetic characteristics of VRE isolated in Riyadh hospitals, KSA. Materials and Methods: Two hundred and six isolates of enterococcal species were obtained from clinical samples. The antibiotic susceptibility of isolates and minimum inhibitory concentration (MIC) tests for vancomycin and teicoplanin were determined. Molecular typing of VRE isolates was carried out by using pulsed field gel electrophoresis (PFGE) and the resistance genotype was determined by polymerase chain reaction (PCR). Results: VRE accounted for 3.9% of the isolates and were detected mostly in urine, wound and blood specimens isolated from ICU, internal medicine and surgical wards. All strains were identified to species level and were found to consist of E. faecalis (69.2%), E. faecium (11.3%), E. avium (2.1%), E. hirae (0.8%), E. casseliflavus (1.3%) and E. gallinarum (1.3%) species. According to the susceptibility data obtained, 8 (3.9%) out of 206 isolates were found to be VRE (MICs > 32 μg/ml). The vanA, vanB and vanC gene fragments of E. faecalis, E. faecium and E. gallinarum were amplified from isolates and were detected. PFGE patterns of the VRE isolates revealed homogenous patterns with dominant clone suggesting that the strains intrinsic resistance is independent. Conclusions: This study shows an emergence of VRE along with increased rate of multidrug-resistant enterococci in the area of the study. Regular surveillance of antimicrobial susceptibilities should be done regularly and the risk factors should be determined.

Percepções da equipe de enfermagem acerca da importância da presença do familiar/acompanhante no hospital / Percepciones del equipo de enfermería acerca de la importancia de la presencia del familiar/acompañante en el hospital / Nursing team’s perceptions of the relative/companion’s presence at the hospital

O estudo teve por objetivo identificar a percepção da equipe de enfermagem de unidade de pediatria acerca da importância da permanência do familiar/acompanhante junto à criança hospitalizada. Trata-se de estudo exploratório e descritivo, com abordagem qualitativa. Os dados foram coletados através de entrevistas semiestruturadas com cinco enfermeiras, três técnicas de enfermagem e duas auxiliares de enfermagem, no segundo semestre de 2006, na unidade de pediatria de um hospital universitário, do Estado do Rio Grande do Sul. Mediante o método hermenêutico-dialético, foi possível apreender que a equipe de enfermagem reconhece a importância da permanência do familiar/acompanhante junto à criança hospitalizada e seu papel como cuidador desse cliente. Conclui-se que a equipe de enfermagem percebe o familiar/acompanhante como alguém que favorece o estabelecimento de um clima emocional desejável para a criança e colabora no desenvolvimento do trabalho da equipe de enfermagem na realização dos cuidados.

This study aimed at investigating the perception the nursing team at the Paediatrics Ward has of the relative/companion’s permanence with the hospitalised child. It is an exploratory and descriptive study, with qualitative approach. Data were collected through semi structured interviews, with five nurses, three nursing technicians, and two nursing assistants in the second semester of 2006, at the paediatrics ward at a university hospital, in the state Rio Grande do Sul, Brazil. The use of the dialectic-hermeneutic method showed that the nursing team acknowledges the importance of the relative/companion’s stay with the child during its hospitalisation as well as their role as caregivers at the hospital. Conclusions show that the nursing team identifies the relative/companion as the provider of a desirable emotional atmosphere to the child and as the facilitator of the nursing team’s care giving job.

El estudio tuvo por objetivo identificar la percepción del equipo de enfermería de unidad de pediatría acerca de la importancia de la permanencia del familiar/acompañante cerca del niño hospitalizado. Se trata de estudio exploratorio y descriptivo, con enfoque cualitativo. Los datos fueron colectados a través de entrevistas semiestructuradas con cinco enfermeras, tres técnicas de enfermería y dos auxiliares de enfermería, en el segundo semestre de 2006, en la unidad de pediatría de un hospital universitario, del Estado de Rio Grande do Sul, Brasil. A través del método hermenéutico-dialéctico, fue posible entender que el equipo de enfermería reconoce la importancia de la permanencia del familiar/acompañante con el niño durante su hospitalización y su papel como cuidador de ese cliente. Se concluyó que el equipo de enfermería percibe el familiar/acompañante como alguien que favorece el establecimiento de un clima emocional deseable para el niño y ayuda en el desarrollo del trabajo del equipo de enfermería y en la realización de los cuidados.

Assistência de enfermagem à criança hospitalizada: breve retrospectiva / Nursing care of child: short retrospection / Asistencia de enfermería al niño: breve retrospectiva

O estudo enfoca o panorama da política de saúde infantil, em destaque no contexto hospitalar, na cidade do Rio de Janeiro, tendo como propósito descrever a assistência de enfermagem à criança hospitalizada na primeira metade do século. Trata-se de um estudo histórico, cujas fontes primárias escritas correspondem aos artigos publicados na Revista Brasileira de Enfermagem no período em estudo. As fontes secundárias estão constituídas pela literatura pertinente à temática. No início do século XX, o setor saúde deixa o caráter social e filantrópico para ser subsidiado pelo governo. Em relação a assistência à criança, inúmeros hospitais são inaugurados nos anos 30 e 40, apesar da política nacional de saúde caracterizar-se por ações preventivas. Conclui-se que a assistência à criança até os anos 50 caracteriza-se por transformações técnico-científicas no cenário hospitalar, favorecendo a construção do saber da enfermagem na área de pediatria.

This study focuses on the overview of the childhood health policy, highlighted in the context of a hospital, in the city of Rio de Janeiro, aiming at describing the nursing assistance provided to children in hospitals in the first half of the century. It is a historical study, the primary written sources of which correspond to articles published in the Revista Brasileira de Enfermagem during the period under scrutiny. The secondary sources are made up of literature relevant to the topic. In the beginning of the 20th century, health care loses its social and philanthropic character to be subsidized by the government. Concerning childhood assistance, numerous hospitals opened in the 30's and 40's, even though the national healthcare policy was based on preventive actions. It may be concluded that childhood assistance up to the 50's was characterized by technical and scientific transformations in the hospital scenario, encouraging the construction of nursing knowledge in the area of paediatrics.

El estudio enfoca el panorama de la política de la salud infantil, en el contexto hospitalario en Rio de Janeiro. El propósito es describir la asistencia de enfermería a los niños en los hospitales. Es un estudio histórico, cuyas fuentes primarias escritas corresponden a los artículos publicados en la Revista Brasileña de Enfermería durante la primera mitad del siglo. Las fuentes secundarias se constituyen por la literatura sobre esa temática. A principios del siglo XX, el sector de la salud deja de tener un carácter social y filantrópico y pasa a ser subvencionado por el gobierno. Respecto a la asistencia infantil, innumerables hospitales se inauguran en los años 30 y 40, a pesar de que la política nacional de salud se caracterizaba por acciones preventivas. Se concluye que la asistencia a los niños hasta los años 50 está caracterizada por unas transformaciones técnico-científicas en el escenario de los hospitales y con ello favorece la construcción del saber de enfermería en el campo de la pediatría.