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1.
Gac. méd. Méx ; 157(3): 327-331, may.-jun. 2021. tab
Article in Spanish | LILACS | ID: biblio-1346115

ABSTRACT

Resumen Introducción: Ante la pandemia de COVID-19, el apego a las medidas de higiene es un objetivo para disminuir la morbimortalidad. Objetivo: Evaluar el apego a la higiene de manos y medidas de protección durante la pandemia de COVID-19 en un hospital de tercer nivel. Métodos: Estudio transversal acerca del lavado de manos del personal de salud en los cinco tiempos recomendados por la Organización Mundial de la Salud, así como sobre el uso del equipo de protección personal específico. Resultados: Fueron observadas 117 oportunidades de higiene de manos en personal de salud: 40 (34 %) respecto al lavado de manos y 76 (65 %) respecto a su omisión; sobre el apego al uso de careta en cinco (4 %) y sobre la falta de apego en 112 (96 %). Se identificó apego al uso de mascarilla en 65 profesionales de enfermería (87 %), uso adecuado de mascarilla en 56 de ellos (60 %) y uso de careta en uno (1 %.) Conclusión: El personal mostró baja proporción de apego a la higiene de manos y al uso de equipo para la protección específica durante la pandemia de COVID-19.


Abstract Introduction: During the COVID-19 pandemic, adherence to hygiene measures is an objective aimed at reducing morbidity and mortality. Objective: To evaluate adherence to hand hygiene and protection measures during the COVID-19 pandemic in a tertiary care hospital. Methods: Cross-sectional study on health personnel handwashing at the five moments recommended by the World Health Organization, as well as on the use of specific personal protective equipment. Results: One hundred and seventeen hand hygiene opportunities were observed in health personnel. Hand washing was observed in 40 (34 %) and omission in 76 (65 %). Adherence to the use of face shield was observed in five (4 %), and lack of adherence in 112 (96%). Adherence to the use of face mask was observed in 65 nursing professionals (87 %), with appropriate use of the mask in 56 of them (60 %) and use of face shield in one (1 %). Conclusion: Health personnel showed low proportions of adherence to hand hygiene and use of equipment for specific protection during the COVID-19 pandemic.


Subject(s)
Humans , Male , Female , Personnel, Hospital/statistics & numerical data , Guideline Adherence/statistics & numerical data , Hand Hygiene/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , COVID-19/prevention & control , Personnel, Hospital/standards , Time Factors , Cross-Sectional Studies , Prospective Studies , Tertiary Care Centers , Hand Hygiene/standards
2.
Article in English | LILACS | ID: biblio-1252042

ABSTRACT

ABSTRACT Objective. Estimate the acceptability and adoption by health care workers of clinical practice guidelines and treatment protocols for women with preeclampsia/eclampsia and identify the facilitating factors and barriers to their implementation. Methods. A qualitative study was conducted, using semi-structured interviews and focus groups in five maternity hospitals. Interviews were compiled for analysis, and barriers and facilitators were characterized. Results. Seventy health professionals (52 female and 18 male) participated, representing different levels of the health system. The majority of workers and managers were aware of the existence and content of clinical practice guidelines (CPGs) for preeclampsia/eclampsia, especially the participants with more time in the health service. With respect to facilitating factors, both medical and nursing staff were positive about continued development and implementation of high-quality CPGs. There was consensus that limitations exist, especially with respect to a lack of the necessary medicines, supplies, and equipment to meet and implement the established recommendations. Discussion. The results of the study show the need to strengthen strategies that help close the gap between research and public policy. Studies suggest that research should focus on users, policymakers, and decisionmakers in the health system. The actors in the Dominican health system recognize the GRADE methodology as an appropriate instrument for the development and implementation of CPGs. Implementation barriers require systemic and comprehensive approaches.


RESUMEN Objetivo. Estimar la aceptabilidad y adopción de las guías de prática clínica (GPC) y protocolos de atención a la mujer con preeclampsia-eclampsia por parte del personal prestador de los servicios de salud, e identificar los factores facilitadores y las barreras para su implementación. Métodos. Se desarrolló un estudio cualitativo por medio de entrevistas semiestructuradas y grupos focales en cinco maternidades. Se recopilaron las entrevistas para su análisis y se caracterizaron las barreras y facilitadores. Resultados. Participaron 70 profesionales de la salud (52 de sexo femenino y 18 de sexo masculino) que se desempeñan en distintos niveles del sistema de salud, participaron. La mayoría de los prestadores y gerentes conocen la existencia de las GPC de eclampsia-preeclampsia y su contenido, sobre todo los participantes con más tiempo en el servicio. Para los facilitadores, se estableció una valoración positiva entre el personal médico y de enfermería ante el proceso de continuar con la elaboración e implementación de GPC de alta calidad. Hubo consenso en cuanto a la existencia de limitaciones, sobre todo, por la falta de medicamentos, insumos y equipos requeridos, para cumplir y aplicar las recomendaciones formuladas. Discusión. Los resultados del estudio exponen la necesidad de fortalecer estrategias que ayuden a cerrar la brecha entre la investigación y la política pública. Estudios fundamentan la investigación en priorizar la atención a los usuarios, y los encargados de formular políticas y los tomadores de decisiones en el sistema de salud. Los actores del sistema de salud dominicano reconocen la metodología GRADE como un instrumento apropiado para la formulación e implementación de GPC. Las barreras de implementación requieren de abordajes sistémicos e integrales.


RESUMO Objetivo. Estimar a aceitabilidade e a adoção de diretrizes de prática clínica (DPCs) e protocolos de atenção para mulheres com pré-eclâmpsia e eclâmpsia por profissionais da saúde e identificar os fatores facilitadores e barreiras à sua implementação. Métodos. Desenvolvemos um estudo qualitativo baseado em entrevistas semiestruturadas e grupos focais em cinco maternidades. As entrevistas foram coletadas para análise, sendo caracterizadas as barreiras e fatores facilitadores. Resultados. O estudo contou com a participação de 70 profissionais da saúde (52 mulheres e 18 homens) que trabalham em diferentes níveis do sistema de saúde. Em sua maioria, os profissionais e administradores estão cientes da existência de DPCs para pré-eclâmpsia e eclâmpsia e conhecem seu conteúdo, especialmente os que têm mais tempo de experiência. Em relação aos fatores facilitadores, os profissionais médicos e de enfermagem consideraram positivo o processo de elaboração e implementação de DPCs de alta qualidade. Houve consenso sobre a existência de limitações, especialmente no que diz respeito à falta de medicamentos, insumos e equipamentos necessários para cumprir e implementar as recomendações. Discussão. Os resultados do estudo deixam clara a necessidade de reforçar as estratégias que ajudam a estabelecer vínculos entre a pesquisa e as políticas públicas. A pesquisa futura deve priorizar a atenção aos usuários e o apoio aos decisores e responsáveis pela elaboração de políticas no sistema de saúde. Os atores do sistema de saúde dominicano reconhecem a metodologia GRADE como um instrumento apropriado para a formulação e implementação de DPCs. As barreiras à implementação exigem abordagens sistêmicas e abrangentes.


Subject(s)
Humans , Male , Female , Pregnancy , Pre-Eclampsia/therapy , Attitude of Health Personnel , Practice Guidelines as Topic , Guideline Adherence/statistics & numerical data , Eclampsia/therapy , Clinical Protocols , Dominican Republic
3.
Rev. chil. pediatr ; 91(2): 216-225, abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1098894

ABSTRACT

Resumen: Objetivo: describir las terapias utilizadas en lactantes con bronquiolitis aguda admitidos en 20 Uni dades de Cuidados Intensivos (UCI) pediátricos miembros de LARed en 5 países latinoamerica nos. Pacientes y Método: Estudio observacional retrospectivo, multicéntrico, de datos del Registro Latinoamericano de Falla Respiratoria Aguda Pediátrica. Se incluyeron niños menores de 2 años ingresados a UCI pediátrica por bronquiolitis aguda comunitaria entre mayo-septiembre 2017. Se recolectaron datos demográficos, clínicos, soporte respiratorio, terapias utilizadas y resultados clí nicos. Se realizó análisis de subgrupos según ubicación geográfica, tipo financiación y presencia de academia. Resultados: Ingresaron al registro 1155 pacientes con falla respiratoria aguda. Seis casos fueron excluidos por no tener formulario completo. De los 1147 pacientes, 908 eran menores de 2 años. De ellos, 467 tuvieron diagnóstico de bronquiolitis aguda, correspondiendo a la principal causa de ingreso a UCI pediátrica por falla respiratoria aguda (51,4%). Las características demográficas y de gravedad entre los centros fueron similares. El soporte máximo respiratorio más frecuente fue cánula nasal de alto flujo (47%), seguido por ventilación mecánica no invasiva (26%) y ventilación mecánica invasiva (17%), con un coeficiente de variación (CV) amplio entre los centros. Hubo una gran dispersión en uso de terapias, siendo frecuente el uso de broncodilatadores, antibióticos y corticoides, con CV hasta 400%. El análisis de subgrupos mostró diferencias significativas en soporte respiratorio y tratamientos utilizados. Un paciente falleció en esta cohorte. Conclusión: Detectamos gran variabilidad en el soporte respiratorio y tratamientos entre UCI pediátricas latinoamericanas. Esta variabilidad no es explicada por disparidades demográficas ni clínicas. Esta heterogeneidad de tratamientos debería promover iniciativas colaborativas para disminuir la brecha entre la evidencia científica y la práctica asistencial.


Abstract: The objective of this study was to describe the management of infants with acute bronchiolitis admit ted to 20 pediatric intensive care units (PICU) members of LARed in 5 Latin American countries. Pa tients and Method: Retrospective, multicenter, observational study of data from the Latin American Registry of Acute Pediatric Respiratory Failure. We included children under 2 years of age admitted to the PICU due to community-based acute bronchiolitis between May and September 2017. Demo graphic and clinical data, respiratory support, therapies used, and clinical results were collected. A subgroup analysis was carried out according to geographical location (Atlantic v/s Pacific), type of insurance (Public v/s Private), and Academic v/s non-Academic centers. Results: 1,155 patients were included in the registry which present acute respiratory failure and 6 were excluded due to the lack of information in their record form. Out of the 1,147 patients, 908 were under 2 years of age, and out of those, 467 (51.4%) were diagnosed with acute bronchiolitis, which was the main cause of admission to the PICU due to acute respiratory failure. The demographic and severity characteristics among the centers were similar. The most frequent maximum ventilatory support was the high-flow nasal can nula (47%), followed by non-invasive ventilation (26%) and invasive mechanical ventilation (17%), with a wide coefficient of variation (CV) between centers. There was a great dispersion in the use of treatments, where the use of bronchodilators, antibiotics, and corticosteroids, representing a CV up to 400%. There were significant differences in subgroup analysis regarding respiratory support and treatments used. One patient of this cohort passed away. Conclusion: we detected wide variability in respiratory support and treatments among Latin American PICUs. This variability was not explained by demographic or clinical differences. The heterogeneity of treatments should encourage collabora tive initiatives to reduce the gap between scientific evidence and practice.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Practice Patterns, Physicians'/statistics & numerical data , Bronchiolitis/therapy , Intensive Care Units, Pediatric/statistics & numerical data , Guideline Adherence/statistics & numerical data , Critical Care/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Bronchiolitis/diagnosis , Registries , Acute Disease , Retrospective Studies , Practice Guidelines as Topic , Critical Care/methods , Latin America
4.
Rev. bras. ter. intensiva ; 32(1): 37-42, jan.-mar. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138451

ABSTRACT

RESUMO Objetivo: Avaliar a adesão ao protocolo de profilaxia de úlcera de estresse em pacientes críticos de um hospital universitário terciário. Métodos: Neste estudo de coorte prospectiva, incluímos todos os pacientes adultos admitidos às unidades de terapia intensiva clínica e cirúrgica de um hospital terciário acadêmico. Nosso único critério de exclusão foi a presença de sangramento gastrointestinal alto quando da admissão à unidade de terapia intensiva. Colhemos as variáveis basais e indicações de profilaxia de úlcera de estresse, segundo o protocolo institucional, assim como o uso de profilaxia. Nosso desfecho primário foi a adesão ao protocolo de profilaxia de úlcera de estresse. Os desfechos secundários foram uso apropriado da profilaxia de úlcera de estresse, incidência de sangramento gastrointestinal superior e fatores associados com o uso apropriado da profilaxia de úlcera de estresse. Resultados: Foram incluídos 234 pacientes no período compreendido entre 2 de julho e 31 de julho de 2018. Os pacientes tinham idade de 52 ± 20 anos, sendo 125 (53%) deles cirúrgicos, e o SAPS 3 médio foi de 52 ± 20. No seguimento longitudinal, foram estudados 1.499 pacientes-dias; 1.069 pacientes-dias tiveram indicação de profilaxia de úlcera de estresse, e 777 pacientes-dias tiveram uso profilático (73% de adesão ao protocolo de profilaxia de úlcera de estresse). Dentre os 430 pacientes-dias sem indicações de profilaxia de úlcera de estresse, 242 envolveram profilaxia (56% de uso impróprio de profilaxia de úlcera de estresse). O total de uso apropriado de profilaxia de úlcera de estresse foi de 64%. Fatores associados com prescrição adequada de profilaxia de úlcera de estresse foram ventilação mecânica, com RC 2,13 (IC95% 1,64 - 2,75), e coagulopatia, com RC 2,77 (IC95% 1,66 - 4,60). A incidência de sangramento do trato gastrointestinal superior foi de 12,8%. Conclusão: A adesão ao protocolo de profilaxia de úlcera de estresse foi baixa, e o uso inadequado de profilaxia de úlcera de estresse foi frequente nesta coorte de pacientes críticos.


ABSTRACT Objective: To evaluate adherence to the stress ulcer prophylaxis protocol in critically ill patients at a tertiary university hospital. Methods: In this prospective cohort study, we included all adult patients admitted to the medical and surgical intensive care units of an academic tertiary hospital. Our sole exclusion criterion was upper gastrointestinal bleeding at intensive care unit admission. We collected baseline variables and stress ulcer prophylaxis indications according to the institutional protocol and use of prophylaxis. Our primary outcome was adherence to the stress ulcer prophylaxis protocol. Secondary outcomes were appropriate use of stress ulcer prophylaxis, upper gastrointestinal bleeding incidence and factors associated with appropriate use of stress ulcer prophylaxis. Results: Two hundred thirty-four patients were enrolled from July 2nd through July 31st, 2018. Patients were 52 ± 20 years old, 125 (53%) were surgical patients, and the mean SAPS 3 was 52 ± 20. In the longitudinal follow-up, 1499 patient-days were studied; 1069 patient-days had stress ulcer prophylaxis indications, and 777 patient-days contained prophylaxis use (73% stress ulcer prophylaxis protocol adherence). Of the 430 patient-days without stress ulcer prophylaxis indications, 242 involved prophylaxis (56% inappropriate stress ulcer prophylaxis use). The overall appropriate use of stress ulcer prophylaxis was 64%. Factors associated with proper stress ulcer prophylaxis prescription were mechanical ventilation OR 2.13 (95%CI 1.64 - 2.75) and coagulopathy OR 2.77 (95%CI 1.66 - 4.60). The upper gastrointestinal bleeding incidence was 12.8%. Conclusion: Adherence to the stress ulcer prophylaxis protocol was low and inappropriate use of stress ulcer prophylaxis was frequent in this cohort of critically ill patients.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Peptic Ulcer/prevention & control , Guideline Adherence/statistics & numerical data , Peptic Ulcer/complications , Prospective Studies , Cohort Studies , Critical Illness , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/epidemiology
5.
Rev. chil. pediatr ; 91(1): 46-50, feb. 2020. tab
Article in Spanish | LILACS | ID: biblio-1092786

ABSTRACT

Resumen: Introducción: La migraña abdominal (MA) es infrecuente y poco estudiada. Nuestro objetivo fue investigar el diagnóstico y tratamiento de niños y adolescentes con MA y compararlos entre gastroen terólogos y neurólogos pediatras. Pacientes y Método: Todos los cuadros de MA (1-18 años) de un hospital de EE. UU, con diagnóstico de MA o sus variantes (ICD-9 346.2 o IC-10 G43.D, G43.D0, G43.D1) entre 2011-2017 fueron revisados. La información sobre diagnóstico, intervalo desde inicio de síntomas, criterios diagnósticos, pruebas diagnósticas, tratamiento y resultado se analizaron. Re sultados: Sesenta y nueve historias médicas fueron identificadas. La edad media al diagnóstico fue 9,7 años. El 48% de los pacientes fueron del sexo femenino. Cincuenta (72,4%) pacientes fueron tratados solo por gastroenterólogos pediatras, y 10/69 (14,5%) por neurológos pediatras exclusivamente. 6/69 (8,7%) fueron inicialmente evaluados por gastroenterología y posteriormente referidos a neurología, y 2/69 (2,9%) fueron inicialmente evaluados por neurología y luego referidos a gastroenterología. 3/10 (30%) de las MA diagnosticadas por neurólogos no mencionaban que el paciente tuviera dolor abdominal, sin embargo, todos los diagnósticos realizados por gastroenterólogos presentaron dicho síntoma (p=0,0035). 5/50 (10%) de las historias médicas de gastroenterología y ninguna de las histo rias de neurología mencionaban los criterios de Roma. Conclusiones: La mayoría de los niños fueron diagnosticados por pediatras gastroenterólogos. Los gastroenterólogos rara vez utilizaron los criterios de Roma. Pacientes evaluados por neurología son frecuentemente diagnosticados con MA, incluso sin presentar dolor abdominal (criterio necesario para el diagnóstico). Se recomienda educación para el correcto y oportuno diagnóstico de la migraña abdominal.


Abstract: Introduction: Abdominal migraine (AM) is uncommon and understudied. Our objective was to investigate the diagnosis and treatment of children and adolescents with AM and compare with that of pediatric gastroenterologists and neurologists. Patients and Method: All AM cases (1-18 years) from a USA hospital with diagnosis of abdominal migraine or its variants (ICD-9 346.2 or IC-10 G43.D, G43.D0, G43.D1) between 2011 and 2017 were reviewed. Information on diagnosis, interval from onset of symptoms, diagnostic criteria, diagnostic tests, treatment, and outcome were analyzed. Results: 69 medical records were identified. The mean age at diagnosis was 9.7 years, and 48% of patients were female. 50/69 (72.4%) patients were exclusively treated by a pediatric gastroenterologist and 10/69 (14.5%) exclusively by a pediatric neurologist. 6/69 (8.7%) were initially evaluated by gas troenterology and referred to neurology, and 2/69 (2.9%) were initially evaluated by neurology and then referred to gastroenterology. 3/10 (30%) of the AM diagnosed by neurologists did no report ab dominal pain (AP), however, all diagnoses made by gastroenterologists did (p = 0.0035). 5/50 (10%) of the gastroenterology medical records and no neurology medical records mentioned Rome criteria. Conclusions: Most of the children were diagnosed by pediatric gastroenterologists. Gastroenterolo gists rarely use the Rome criteria. Patients evaluated by neurologists are frequently diagnosed with AM even without AP (a criterion that is required for its diagnosis). Education is recommended for the correct and timely diagnosis of AM.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Practice Patterns, Physicians'/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Gastroenterology , Migraine Disorders/diagnosis , Migraine Disorders/therapy , Neurology , Referral and Consultation , United States , Abdominal Pain/etiology , Follow-Up Studies , Practice Guidelines as Topic , Guideline Adherence/statistics & numerical data , Diagnosis, Differential , Diagnostic Errors , Migraine Disorders/complications
6.
J. bras. pneumol ; 46(4): e20180325, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1090818

ABSTRACT

RESUMO Objetivo Este estudo visou avaliar a adequação da prescrição de profilaxia de tromboembolismo venoso (TEV) após a implementação do protocolo. Métodos Trata-se de um estudo antes e depois realizado em um hospital de cuidados terciários no Rio Grande do Sul, Brasil. Pacientes clínicos e cirúrgicos internados, com 18 anos ou mais, foram avaliados para o risco de TEV e, posteriormente, para adequação da tromboprofilaxia, de acordo com o risco. As avaliações ocorreram antes e depois de uma estratégia de implementação de protocolo, que consistiu em uma plataforma on-line para acessar o protocolo, uma postagem pública do diagrama do protocolo, alertas clínicos na sala de convívio médico, alertas de e-mail e alertas pop-up no sistema informatizado de prescrição médica. O Desfecho principal foi a adequação da prescrição de profilaxia do TEV de acordo com o protocolo. Resultados Foram avaliados 429 pacientes para adequação da tromboprofilaxia (213 antes e 216 depois). A prevalência de adequação aumentou de 54% para 63% (pré e pós-intervenção, respectivamente) e após o ajuste por tipo de paciente e fase do estudo, a razão de prevalência atingiu (RP) = 1,20, intervalo de confiança de 95% (IC) 1,02-1,42. Conclusões os resultados mostraram que a adequação geral da prescrição de tromboprofilaxia foi discretamente melhorada. Apesar desses resultados, este estudo fornece evidências, até o momento, de uma série de estratégias para implementar o protocolo em instituições privadas em países de renda média com uma equipe médica aberta, pois há poucas pesquisas investigando esse tipo de intervenção simples e pragmática.


ABSTRACT Objective This study aimed to assess the adequacy of venous thromboembolism (VTE) prophylaxis prescription after a protocol implementation. Methods This was a before-and-after study conducted in a tertiary care hospital in Rio Grande do Sul, Southern Brazil. Medical and surgical inpatients aged 18 years or older were assessed for VTE risk and subsequently for thromboprophylaxis adequacy, according to their risk. The evaluations occurred before and after the protocol strategy implementation; it consisted of an online platform to access the protocol, a public posting of the protocol diagram, clinical alerts on the medical staff TV, e-mail alerts, and pop-up alerts on the computerized physician order entry system. The main outcome measure was the adequacy of VTE prophylaxis prescription according to the protocol. Results A total of 429 patients were evaluated for thromboprophylaxis adequacy (213 before and 216 after). The prevalence of adequacy increased from 54% to 63% (pre and post-intervention, respectively), and after adjustment for patient type and phase of the study, the prevalence ratio reached (PR)=1.20, 95% confidence interval (CI) 1.02-1.42. Conclusion The results showed that the overall appropriateness of thromboprophylaxis prescription was weakly improved. Despite these results, this study provides evidence to date a bunch of strategies for protocol implementations in private institutions in middle-income countries with an open medical staff, as there are few studies investigating these simple and pragmatic interventions.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Postoperative Complications/prevention & control , Guideline Adherence/statistics & numerical data , Venous Thromboembolism/prevention & control , Anticoagulants/administration & dosage , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Brazil/epidemiology , Prevalence , Prospective Studies , Risk Factors , Venous Thromboembolism/etiology , Venous Thromboembolism/epidemiology , Hospitalization , Anticoagulants/therapeutic use
7.
Einstein (Säo Paulo) ; 18: eAO4995, 2020. tab, graf
Article in English | LILACS | ID: biblio-1090037

ABSTRACT

ABSTRACT Objective To describe antiretroviral treatment regimens prescribed and their compliance with the Clinical Protocol and Therapy Guidelines of the Ministry of Health for the management of HIV infection. Methods Observational and descriptive study. Secondary data of the state of Paraná (Brazil) on drugs, treatment regimens, lines of treatment and number of individuals on treatment, from January to June 2018, were accessed at the Antiretroviral Agents Logistic Control System. Combinations of antiretroviral drugs (treatment regimens) were compared according to the current Clinical Protocol and Therapy Guidelines and non-compliances were classified and quantified. Results In Paraná, 35,127 individuals with HIV were treated with 253 different treatment regimens. Of the prescribed regimens, 19.1% were first-line, 27.4% second-line and 48.5% third-line. Among non-compliances, the most prevalent were absence of association of protease inhibitors and ritonavir (42.8%), low efficacy triple therapy (36.9%), double therapy (26.1%), monotherapy (20.3%), and triple therapy of nucleoside analog reverse transcriptase inhibitors (17.1%). Conclusion Most individuals receiving HIV treatment in the state of Paraná are on treatment regimens established in the current Clinical Protocol and Therapy Guidelines, which contributes to successful therapy. However, associations not provided by the current Clinical Protocol and Therapy Guidelines were identified in the initial treatment lines, which could lead to ineffectiveness, virologic failure and viral resistance.


RESUMO Objetivo Descrever esquemas terapêuticos de antirretrovirais prescritos e sua conformidade com o Protocolo Clínico e Diretrizes Terapêuticas, do Ministério da Saúde, para manejo da infecção pelo HIV. Métodos Estudo observacional e descritivo. Os dados do estado do Paraná sobre medicamentos que compõem os esquemas terapêuticos, linhas de tratamento e número de pessoas em uso destes foram acessados no Sistema de Controle Logístico de Medicamentos Antirretrovirais no período de janeiro a junho de 2018. As combinações de antirretrovirais (esquemas terapêuticos) foram comparadas conforme o Protocolo Clínico e Diretrizes Terapêuticas vigente, e as inconformidades foram categorizadas e quantificadas. Resultados No Paraná, 35.127 pessoas com HIV foram tratadas com 253 esquemas terapêuticos distintos. Dentre os esquemas prescritos, 19,1% eram de primeira linha, 27,4% de segunda linha e 48,5% de terceira linha. Nas inconformidades, predominaram a não associação entre inibidores da protease e ritonavir (42,8%), terapia tripla de baixa eficiência (36,9%), terapia dupla (26,1%), monoterapia (20,3%) e terapia tripla de inibidores da transcriptase reversa análogos de nucleosídeos (17,1%). Conclusão Maior parte das pessoas em tratamento do HIV no Paraná utilizam esquemas terapêuticos previstos no Protocolo Clínico e Diretrizes Terapêuticas vigente, o que contribui para o sucesso terapêutico. Entretanto, associações não previstas foram identificadas nas linhas de tratamento iniciais, podendo ocasionar inefetividade, falha virológica e resistência viral.


Subject(s)
Humans , Clinical Protocols/standards , Guideline Adherence/standards , Anti-Retroviral Agents/administration & dosage , Brazil , HIV Infections/drug therapy , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/therapeutic use , Guideline Adherence/statistics & numerical data , Anti-Retroviral Agents/therapeutic use , Drug Therapy, Combination/standards , Drug Therapy, Combination/statistics & numerical data , Medication Adherence/statistics & numerical data
8.
Rev. Col. Bras. Cir ; 47: e20202429, 2020. graf
Article in English | LILACS | ID: biblio-1136545

ABSTRACT

ABSTRACT Objectives : to identify surgeons' knowledge and compliance rate to the Safe Surgery Protocol, as well as to assess the incidence of surgery-related adverse events, including patients' knowledge about the protocol. Methods: this is a cross-sectional and prospective study. An instrument was developed to collect the socio-graphic characteristics of sixty-eight surgeons and residents, their knowledge and adherence to the safe surgery protocol. Eighty-two patients were assessed regarding their awareness about the surgical procedure. The operating environment was also evaluated. Descriptive statistics and the odds ratio are presented. Results: the surgeons, despite their previous contact with the protocol throughout the graduation period, were poorly compliant with it. Adverse events such as the use of uncalibrated equipments or the presence of foreign bodies in several equipments such as drills and cautery pens were identified. In addition, some of the adverse events were identified and fixed, after patients had already been anesthesized, but before the beginning of the surgical procedure. Patients demonstrated knowledge about the operation they would undergo, but they did not know about its duration, and they were not introduced to the surgical team. Conclusion: there were failures in the dynamics and compliance regarding some phases of the protocol, which may impact the laterality errors and patient safety.


RESUMO Objetivo: identificar o conhecimento e a taxa de adesão ao Protocolo de Cirurgia Segura pelos cirurgiões, assim como a incidência de eventos adversos relacionados à operação, além do conhecimento dos pacientes sobre o protocolo. Métodos: estudo transversal, prospectivo com caráter quantitativo. Para a coleta de dados, foi elaborado, pelos autores, um instrumento que coletou o perfil sócio gráfico de sessenta e oito cirurgiões e residentes, o conhecimento e a adesão destes ao protocolo de cirurgia segura. Oitenta e dois pacientes foram entrevistados, e o ambiente de cirurgia avaliado. Os dados foram analisados de maneira descritiva e teste Razão das Chances com Índice de Confiança (IC) de 95%. Resultados: parte dos cirurgiões demonstraram que apesar do contato com o protocolo durante o período de formação, houve deficiência à adesão, ocasionando eventos adversos como o uso de equipamentos não calibrados ou presença de corpos estranhos nos equipamentos, como brocas e canetas. Além disso, foi constatado que em pacientes já anestesiados, as falhas foram percebidas e reparadas antes do começo do procedimento. No caso dos pacientes, estes demonstraram conhecimento quanto à cirurgia que iriam realizar, porém não sabiam a duração da mesma ou tinham sido introduzidos à equipe cirúrgica. Conclusão: houve falhas na dinâmica e na adesão de algumas etapas do protocolo, prejudicando a lateralidade no processo e a segurança do paciente.


Subject(s)
Humans , Male , Female , Adult , Aged , Young Adult , Operating Room Nursing/standards , Practice Patterns, Physicians'/standards , Guideline Adherence/statistics & numerical data , Patient Safety/standards , Surgeons/standards , Practice Patterns, Physicians'/statistics & numerical data , Cross-Sectional Studies , Prospective Studies , Surveys and Questionnaires , Safety Management , Checklist , Surgeons/statistics & numerical data , Middle Aged
9.
Rev. saúde pública (Online) ; 54: 42, 2020. tab, graf
Article in English | LILACS, BBO | ID: biblio-1101857

ABSTRACT

ABSTRACT OBJECTIVE To describe students protected by laws and exposed to soft drinks sales and assess whether forbidding laws are associated with lower availability of these beverages. METHODS We identified laws forbidding non-government administered cafeterias or sales of soft drinks in schools in the 27 Brazilian state capitals. Data on soft drinks sales were obtained from Pesquisa Nacional de Saúde do Escolar 2015 (PeNSE - National Survey of School Health 2015), for a representative sample of 9th graders from public and private schools. Students were attributed with the status of their school regarding the law and sale of soft drinks. Co-variables were school status (public or private), school size, geographic regions, mother's educational level, score of goods and services. We performed multivariate analyses using Poisson regression. RESULTS The total of 23 laws forbidding sales of soft drinks covered 63.0% of capitals, comprising 56.9% of students. Law coverage was higher among students from more developed regions (67.6%) and in public schools (60.6%), compared with those from less developed regions (38.0%) and private schools (45.8%). Soft drinks were available for 33.9% of students. Students attending public schools in less developed regions had the lowest availability of soft drinks, regardless of law coverage (14.8%; 12.0%); while students attending private schools in these regions had a high availability, regardless of law coverage (82.1%; 73.4%). Restrictive laws were associated with lower sales of soft drinks in more developed regions, and restrictions had a greater association with the availability of soft drinks in public schools (PR = 0.25; 95%CI = 0.15-0.41), compared with private schools (PR = 0.48; 95%CI = 0.35-0.66). CONCLUSION Laws restricting soft drinks in schools were associated with fewer sales in more developed regions. Private schools were less compliant with the law than public schools. A broadly enforced national law could reduce the availability of soft drinks in schools.


Subject(s)
Humans , Schools/legislation & jurisprudence , Carbonated Beverages , Commerce/legislation & jurisprudence , Schools/statistics & numerical data , Students/statistics & numerical data , Brazil , Surveys and Questionnaires , Public Sector/legislation & jurisprudence , Private Sector/legislation & jurisprudence , Guideline Adherence/statistics & numerical data
10.
Rev. bras. enferm ; 73(supl.2): e20200316, 2020. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1115410

ABSTRACT

ABSTRACT Objective: to perform a situational diagnosis of the behavior of health professionals concerning hand hygiene practices in highly-complex sectors. Methods: this quantitative and retrospective study was based on reports (2016 and 2017) of Adult and Pediatric ICUs of a Federal hospital in Rio de Janeiro. Results: one thousand two hundred fifty-eight opportunities for hand hygiene were analysed. The chance of professionals sanitizing hands in Pediatric ICUs is 41.61% higher than in Adult ICUs. Concerning proper hand hygiene, the medical team had a 39.44% lower chance than the nursing team. Others had a 30.62% lower chance when compared to the nursing team. The moment "after contact with the patient" presented 4.5275 times the chance in relation "before contact with the patient". Conclusion: in front of hand hygiene recommendations to control COVID-19, diagnostic assessment and previous analysis of the behavior of professionals proved to be positive.


RESUMEN Objetivo: realizar un diagnóstico situacional del comportamiento de los profesionales de la salud con respecto a las prácticas de higiene de manos en sectores altamente complejos. Métodos: estudio cuantitativo, retrospectivo, basado en informes (años 2016 y 2017) de los sectores de UCI Adultos y Pediátricos de un hospital federal en Rio de Janeiro. Resultados: se analizaron 1.258 oportunidades de higiene de manos. La posibilidad de un lavado de manos profesional en la UCI Pediátrica es 41.61% mayor que en la UCI Adultos. Con respecto a la higiene de las manos, el equipo médico tuvo una probabilidad 39.44% menor que el equipo de enfermería y otros tuvieron una probabilidad 30.62% menor en comparación con el equipo de enfermería. El momento "después del contacto con el paciente" fue 4.5275 veces mayor que "antes del contacto con el paciente". Conclusión: contra la recomendación de higiene de manos en el control de COVID-19, la evaluación diagnóstica y el análisis previo del comportamiento de los profesionales resultaron ser positivos.


RESUMO Objetivo: realizar um diagnóstico situacional do comportamento de profissionais de saúde quanto às práticas de higienização das mãos em setores de alta complexidade. Métodos: estudo quantitativo, retrospectivo, baseado em relatórios (anos de 2016 e 2017) dos setores CTI Adulto e Pediátrico de um hospital Federal do Rio de Janeiro. Resultados: analisaram-se 1.258 oportunidades para higiene das mãos. A chance de um profissional higienizar as mãos no CTI Pediátrico é 41,61% maior que no CTI Adulto. Quanto higienizar as mãos adequadamente, a equipe médica obteve chance 39,44% menor que a equipe de enfermagem e outros tiveram chance 30,62% menor quando comparada à equipe da enfermagem. O momento "após o contato com o paciente" apresentou 4,5275 vezes a chance em relação a "antes do contato com o paciente". Conclusão: frente à recomendação da higiene das mãos no controle da COVID-19, avaliação diagnóstica e análise prévia do comportamento dos profissionais demonstrou ser positiva.


Subject(s)
Humans , Male , Female , Adult , Pneumonia, Viral/prevention & control , Hand Disinfection/standards , Health Personnel/education , Practice Guidelines as Topic , Coronavirus Infections/prevention & control , Guideline Adherence/statistics & numerical data , Pandemics/prevention & control , Betacoronavirus , Intensive Care Units/standards , Brazil , Retrospective Studies , Middle Aged
11.
Rev. bras. enferm ; 72(3): 774-779, May.-Jun. 2019. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1013555

ABSTRACT

ABSTRACT Objective: To evaluate the compliance of the care process involving insertion of central vascular catheter (CVC) in hemodialysis. Method: Cross-sectional quantitative approach developed at the hemodialysis service of a reference hospital in Sergipe, Brazil. Sample consisting of 1,342 actions evaluated, corresponding to 122 forms for monitoring and control of CVC insertion. Data collection was held from July to December 2016. Results: The adherence rate to the use of the insertion form was 54.9%. The procedure evaluated achieved 93% overall compliance. Of the 11 specific actions observed, seven (64%) presented 100% compliance. The density of the overall incidence of primary bloodstream infections reduced from 10.6 to 3.1 infections per 1,000 patients/day. Conclusion: Although the observed actions reached specific desired conformities, the use of the checklist was lower than expected. Strategies for monitoring, coaching and educational and organizational actions can contribute to safe care.


RESUMEN Objetivo: Evaluar la conformidad del proceso asistencial relacionada a inserción del catéter venoso central(CVC) en hemodiálisis. Método: Enfoque cuantitativo, corte transversal, realizado en el servicio de hemodiálisis de un hospital de referencia del estado de Sergipe, Brasil. Muestra constituida por 1342 acciones evaluadas, que corresponden a 122 formularios para monitoreo y control de la inserción de CVC. La recolección de datos fue realizada de julio a diciembre del 2016. Resultados: La tasa de adhesión al uso del formulario de inserción fue del 54,9%. El procedimiento evaluado obtuvo un 93% de conformidad general. De 11 acciones específicas observadas,7(64%) presentaron 100% de conformidad. Se observó reducción en la incidencia global de infecciones primarias de corriente sanguínea de 10,6 para 3,1 por 1000 pacientes/día. Conclusión: Aunque las acciones observadas tuvieron conformidades específicas, el uso de la lista de verificación fue inferior a lo esperado. Estrategias para monitoreo, coaching y acciones educativas podrian contribuir para una asistencia segura.


RESUMO Objetivo: Avaliar a conformidade do processo assistencial envolvendo a inserção do cateter vascular central (CVC) em hemodiálise. Método: Abordagem quantitativa, de corte transversal, desenvolvida no serviço de hemodiálise de um hospital de referência do estado de Sergipe, Brasil. Amostra constituída por 1.342 ações avaliadas, correspondendo a 122 formulários para monitoramento e controle da inserção de CVC. A coleta de dados ocorreu de julho a dezembro de 2016. Resultados: A taxa de adesão ao uso do formulário de inserção foi de 54,9%. O procedimento avaliado alcançou 93% de conformidade geral. Das 11 ações específicas observadas, sete (64%) apresentaram 100% de conformidade. Observou-se redução da densidade de incidência global das infecções primárias da corrente sanguínea de 10,6 para 3,1 infecções por 1.000 pacientes/dia. Conclusão: Apesar das ações observadas alcançarem conformidades específicas desejadas, a utilização do checklist foi aquém do esperado. Estratégias para monitoramento, coaching e ações educativas e organizacionais podem contribuir para uma assistência segura.


Subject(s)
Humans , Male , Female , Adult , Infection Control/standards , Guideline Adherence/standards , Central Venous Catheters/adverse effects , Quality Assurance, Health Care/methods , Brazil , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Cross-Sectional Studies , Renal Dialysis/instrumentation , Renal Dialysis/methods , Infection Control/statistics & numerical data , Guideline Adherence/statistics & numerical data , Central Venous Catheters/statistics & numerical data
12.
Rev. méd. Chile ; 147(5): 602-611, mayo 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1014269

ABSTRACT

Background: Clinical practice guidelines (CPGs) promote better quality and equity in health care and potentially they could improve patients' outcomes. However, their implementation is hindered by a number of factors including some related to health care professionals. Aim: To assess the perceptions and attitudes of primary care physicians regarding CPGs developed by the Chilean Ministry of Health in the context of the Health Sector Reform. Material and Methods: An adaptation of the survey "Knowledge, perceptions and attitudes towards Clinical Practice Guidelines" was sent to 1,264 primary care physicians in Chile and answered completely by 354. The analysis assessed the attitudes towards CPG, their use in primary care and their relationship with socio demographic features of respondents. Results: Eighty two percent of respondents reviewed the flowcharts of the guidelines, 85% consulted their online version. The classification of evidence levels and the strength of recommendations generated a high level of confidence with the guidelines in 70 and 64% of respondents. Eighty five percent considered that CPG could help to standardize clinical practice. The most relevant barrier hindering CPG use was the lack of a brief, simple and easy to access format in 63% of respondents. The three dimensions of the theory of planned behavior (attitude toward behavior, subjective norms, and perceived behavioral control) were associated with a greater frequency of guideline use. A higher age and not being Chilean were associated with a lower frequency of use. Conclusions: The identified factors associated with CPG use should be considered in future guideline design.


Subject(s)
Humans , Male , Female , Adult , Primary Health Care/standards , Practice Patterns, Physicians'/standards , Health Knowledge, Attitudes, Practice , Practice Guidelines as Topic , Physicians, Primary Care/standards , Practice Patterns, Physicians'/statistics & numerical data , Attitude of Health Personnel , Chile , Cross-Sectional Studies , Surveys and Questionnaires , Guideline Adherence/standards , Guideline Adherence/statistics & numerical data , Physicians, Primary Care/statistics & numerical data
13.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(2): 140-148, Apr.-June 2019. tab
Article in English | LILACS | ID: biblio-1013293

ABSTRACT

ABSTRACT Objective: To describe the structure and the processes of care for pregnant women/newborn infants, including the Essential Newborn Care (ENC), in maternity hospitals in Sergipe State, Brazil. Methods: A cross-sectional study carried out between June 2015 and April 2016 in all maternity hospitals of Sergipe with more than 500 deliveries/year (n=11). A questionnaire on the existing structure and work processes was administered to the managers. Subsequently, a representative number of postpartum women from these hospitals were interviewed (n=768). Their medical records, as well as newborn infants' records, were also analyzed. Results: Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 beds of Intermediate Care Unit (IMCU) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for high-risk parturient care. Regarding the ENC components, only 41% (n=315) of the women had early skin-to-skin contact with their babies, 33.1% (n=254) breastfed in the first hour of life, and 18% (n=138) had a companion always during birth. Conclusions: The distribution of NICU beds between capital city and other cities of the State is adequate, considering Brazilian guidelines. However, there was a low adherence to the protocols for hypertensive and hemorrhagic emergencies, and a low coverage of humanization policies, pregnancy risk classification and ENC practices, especially breastfeeding in the first hour of life, and companion always during birth.


RESUMO Objetivo: Descrever a estrutura e os processos de atendimento a gestante/recém-nascido, incluindo os componentes do Essential Newborn Care (ENC), das maternidades de Sergipe, Brasil. Métodos: Estudo transversal realizado entre junho de 2015 e abril de 2016 em todas as maternidades de Sergipe (n=11) com mais de 500 partos/ano. Foi aplicado um questionário aos gestores sobre a estrutura e os processos de trabalhos existentes. Posteriormente, um número representativo de puérperas desses hospitais foi entrevistado (n=768) e seus prontuários, bem como o dos recém-nascidos, foram analisados. Resultados: Sergipe conta com 78 leitos de Unidade de Terapia Intensiva Neonatal (UTIN) e 90 de Unidade Intermediária (UI) para atendimento da demanda espontânea e programada. Somente seis maternidades (54,5%) realizam a classificação de risco e quatro (36,3%) possuem protocolos para atendimento das parturientes de alto risco. No que se refere aos componentes do ENC, apenas 41% (n=315) das mulheres tiveram contato pele a pele precoce com seu filho, 33,1% (n=254) amamentaram na primeira hora de vida e 18% (n=138) tiveram a presença do acompanhante em todos os momentos do parto. Conclusões: A distribuição de leitos de UTIN entre capital/interior é adequada no Estado, levando-se em consideração a legislação vigente no país. Entretanto, houve baixa adesão aos protocolos das emergências hipertensivas e hemorrágicas, e baixa cobertura das políticas de humanização, da classificação de risco para a gestante e das práticas do ENC, principalmente quanto à amamentação na primeira hora de vida e à presença do acompanhante na parturição.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Intensive Care Units, Neonatal/standards , Clinical Protocols , Guideline Adherence/statistics & numerical data , Patient Care Management/methods , Patient Care Management/organization & administration , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/organization & administration , Brazil , Cross-Sectional Studies , Pregnancy, High-Risk , Perinatal Care/methods , Perinatal Care/organization & administration , Health Services Needs and Demand , Hospitals, Maternity/standards , Hospitals, Maternity/statistics & numerical data
14.
Rev. méd. Chile ; 147(2): 190-198, Feb. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1004332

ABSTRACT

Background: Gestational diabetes (GD) impacts maternal and fetal morbidity. In 2012, the World Diabetes Foundation provided financing project in Barranquilla (Colombia), aimed to implement a clinical guide for the diagnosis and treatment of this condition. Aim: To estimate the adherence of the guide in primary care centers. Material and Methods: A Cross-sectional study of pregnant women suspected of having gestational diabetes. Pregnant women were classified according to the week of admission to the prenatal control program: < week 24 or later. Women with a fasting blood glucose over 92 mg/dL and under 126 mg/dL or with some positive result to the oral glucose tolerance test were included. Results: Nine percent (1,887 women) of 21,699 registries of pregnant women, were at risk for gestational diabetes. Of these, 1,880 registries with complete data were analyzed. Sixty nine entered the program at less than 24 weeks of pregnancy and 71% had had a fasting blood glucose measured in the first control. In 69.2% of these women, criteria for gestational diabetes was met. A glucose tolerance test was suggested to women with a blood glucose below 92 mg/dl. Among 72% of the latter, the glucose tolerance test met the criteria for gestational diabetes. Among the 498 women who entered the program after 24 weeks of gestation, 68% met the criteria for gestational diabetes with the fasting blood glucose levels. In 90 women, a glucose tolerance test was performed and 80% met the criteria for gestational diabetes. Conclusions: An adequate adherence to guidelines favors the detection of pregnant women with gestational diabetes.


Subject(s)
Humans , Female , Pregnancy , Adult , Primary Health Care/standards , Mass Screening/standards , Diabetes, Gestational/diagnosis , Practice Guidelines as Topic/standards , Guideline Adherence/statistics & numerical data , Prenatal Care/standards , Prenatal Care/statistics & numerical data , Primary Health Care/statistics & numerical data , Blood Glucose/analysis , Cross-Sectional Studies , Gestational Age , Diabetes, Gestational/epidemiology , Colombia/epidemiology , Guideline Adherence/standards
15.
Rev. chil. pediatr ; 90(1): 44-51, 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-990885

ABSTRACT

INTRODUCCIÓN: La anafilaxia es una emergencia. De acuerdo con las últimas recomendaciones internacionales el reconocimiento de los criterios clínicos y el tratamiento temprano con adrenalina intramuscular se asocian a mayor sobrevida. OBJETIVO: Determinar el conocimiento de los médicos pediatras de un Hospital Pediátrico de tercer nivel sobre los criterios diagnósticos y el tratamiento de la anafilaxia. MATERIAL Y MÉTODO: Estudio descriptivo transversal que considera diseño, aplicación y validación de una encuesta anónima a médicos con residencia completa en pediatría que realizan guardias en un hospital de tercer nivel. Los ítems de la Encuesta comprendieron tres dimensiones, experiencia del operador (2 ítems), manejo farmacológico (3 ítems) e identificación del cuadro (4 ítems). El análisis estadístico utilizó el programa SPSS v.21, presentando medidas de tendencia central (mediana, rango y tabla de frecuencias) y para su comparación prueba de Chi cuadrado. Se consideró significativo un valor de p < 0,05. RESULTADOS: Se encuestaron 71 médicos con una mediana de 3 años transcurridos desde el fin de la residencia. 35% identificó todos los criterios clínicos; 99% (70) indicó adrenalina, 73% por vía intramuscular y 55% a dosis correcta (solo el 48% contestó la dosis y vía correctamente). En forma global la adecuación para identificación más manejo correcto fue del 21%. Los médicos con menos de 5 años de experiencia tuvieron mejor desempeño en la administración de adrenalina intramuscular (83% vs 52% p = 0,005) y en la detección de síntomas gastrointestinales (60%vs35% p = 0,043). CONCLUSIONES: Existen dificultades para la identificación y el manejo apropiado de la anafilaxia por pediatras de un Hospital de tercer nivel en un escenario teórico. Aunque la mayoría eligió la adrenalina como droga de primera línea, la mitad no la indicó de forma correcta y solo un tercio reconoció el cuadro en todos sus escenarios.


INTRODUCTION: Anaphylaxis is an emergency condition. According to the latest international guide lines, early recognition and treatment with intramuscular epinephrine are associated with increased survival. OBJECTIVE: To determine the level of knowledge of pediatricians in a tertiary Pediatric Hos pital about the diagnostic criteria and treatment of anaphylaxis. MATERIAL AND METHOD: A cross-sec tional descriptive study was conducted, designing, applying, and validating an anonymous survey to physicians with complete residency in pediatrics who are on call at a third level hospital. The statisti cal analysis was made using the SPSS v.21 software, presenting measures of central tendency (median, range, and frequency table) and Chi-square test for comparison. A value of p < 0.05 was considered significant. RESULTS: 71 physicians completed the survey with a median of three years after the end of residency.35% of them identified all clinical criteria, 99% (70) indicated epinephrine, 73% chose the intramuscular route, and 55% indicated the correct dose. Only 48% of responders chose the dose and administration route correctly. In general, 21% recognized anaphylaxis and used epinephrine correctly. Physicians with less than five years of experience performed better in the intramuscular administration of epinephrine (83% vs 52% p = 0.005) and in the detection of gastrointestinal symp toms (60% vs 35% p = 0.043). CONCLUSIONS: There are difficulties in the identification and proper management of anaphylaxis by pediatricians of a tertiary Pediatric Hospital in a theoretical clinical setting. Although most of pediatricians chose epinephrine as a first-line drug, half of them did not indicate it correctly, and only one-third recognized anaphylaxis in all scenarios.


Subject(s)
Humans , Child , Sympathomimetics/therapeutic use , Practice Patterns, Physicians'/statistics & numerical data , Epinephrine/therapeutic use , Clinical Competence/statistics & numerical data , Guideline Adherence/statistics & numerical data , Anaphylaxis/diagnosis , Anaphylaxis/drug therapy , Argentina , Practice Patterns, Physicians'/standards , Cross-Sectional Studies , Practice Guidelines as Topic , Health Care Surveys , Emergencies , Pediatricians/standards , Pediatricians/statistics & numerical data , Hospitals, Pediatric , Injections, Intramuscular
16.
Rev. gaúch. enferm ; 40(spe): e20180270, 2019. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1004104

ABSTRACT

Resumo OBJETIVO Avaliar a conformidade da execução da lista de verificação de segurança cirúrgica. MÉTODOS Estudo avaliativo, observacional, transversal e descritivo, com abordagem quantitativa, realizado com 431 cirurgias pediátricas, em hospital público do Distrito Federal, entre agosto de 2017 e fevereiro de 2018. Os dados foram coletados por observação não participante e analisados por estatística descritiva. RESULTADOS O checklist foi realizado em 90,3% das cirurgias, no entanto, a completude do instrumento e a adesão verbal a todos os itens não foram observadas em nenhum procedimento. 95,4% das cirurgias prosseguiram mesmo com a identificação de falhas em processos de segurança. Observou-se checagens inapropriadas, inexatidão do momento de aplicação, execução na ausência de profissionais essenciais e falta de participação ativa. CONCLUSÕES O estudo revelou inconformidades na adesão ao checklist e na execução de práticas seguras, configurando um alerta para o risco sistemático sofrido pelo paciente cirúrgico e para a necessidade de intervenções imediatas.


Resumen OBJETIVO Evaluar la conformidad de ejecución de la lista de verificación de la seguridad de la cirugía. MÉTODOS Estudio evaluativo, observacional, transversal y descriptivo, con abordaje cuantitativo, realizado con 431 cirugías pediátricas, en un hospital público del Distrito Federal, entre agosto de 2017 y febrero de 2018. Se recolectaron los datos a través de la observación no participante y estos se analizaron por medio de la estadística descriptiva. RESULTADOS El checklist se realizó en 90,3% de las cirugías, sin embargo, no se pudo observar el uso total de la herramienta, así como la adhesión verbal a todos los elementos en ningún procedimiento. 95,4% de las cirugías prosiguieron aún con fallas en los procesos de seguridad. Se pudo observar controles inapropiados, inexactitud del momento de uso, ejecución en ausencia de profesionales cruciales y falta de participación activa. CONCLUSIONES El estudio reveló inconformidades en la adhesión al checklist y en la ejecución de prácticas seguras, configurando una alerta para el riesgo sistemático sufrido por el paciente quirúrgico y para la necesidad de intervenciones inmediatas.


Abstract OBJECTIVE To evaluate compliance with the surgical safety checklist. METHODS Evaluative, observational, cross-sectional and descriptive study with a quantitative approach, performed in 431 pediatric surgeries, in a public hospital in the Federal District, between August 2017 and February 2018. Data were collected by non-participant observation and analyzed by descriptive statistics. RESULTS The checklist was performed in 90.3% of the surgeries, however, the completeness of the instrument and the verbal adherence to all the items were not observed in any procedure. 95.4% of the surgeries continued even with the identification of failures in safety processes. Inappropriate checks, inaccuracy of timing, performance in the absence of key professionals, and lack of active participation were observed. CONCLUSIONS The study showed the existence of nonconformities in the adherence to the checklist and in the execution of safe practices, being an alert for the systematic risk suffered by the surgical patient and for the need for immediate interventions.


Subject(s)
Humans , Child , Surgical Procedures, Operative/standards , Checklist , Patient Safety/standards , Patient Safety/statistics & numerical data , Cross-Sectional Studies , Guideline Adherence/statistics & numerical data
17.
ABCD arq. bras. cir. dig ; 32(4): e1477, 2019. tab, graf
Article in English | LILACS | ID: biblio-1054599

ABSTRACT

ABSTRACT Background: Perioperative care multimodal protocol significantly improve outcome in surgery. Aim: To investigate risk factors to various endpoints in patients submitted to elective colorectal operations under the ACERTO protocol. Methods: Cohort study analyzing through a logistic regression model able to assess independent risk factors for morbidity and mortality, patients submitted to elective open colon and/or rectum resection and primary anastomosis who were either exposed or non-exposed to demographic, clinical, and ACERTO interventions. Results: Two hundred thirty four patients were analyzed and submitted to 156 (66.7%) rectal and 78 (33.3%) colonic procedures. The length of hospital postoperative stay (LOS) ≥ 7 days was related to rectal surgery and high NNIS risk index; preoperative fasting ≤4 h (OR=0.250; CI95=0.114-0.551) and intravenous volume of crystalloid infused > 30ml/kg/day (OR=0.290; CI95=0.119-0.706). The risk of postoperative site infection (SSI) was approximately four times greater in malnourished; eight in rectal surgery and four in high NNIS index. The duration of preoperative fasting ≤4 h was a protective factor by reducing by 81.3% the risk of surgical site infection (SSI). An increased risk for anastomotic fistula was found in malnutrition, rectal surgery and high NNIS index. Conversely, preoperative fasting ≤4 h (OR=0.11; CI95=0.05-0.25; p<0.0001) decreased the risk of fistula. Factors associated with pneumonia-atelectasis were cancer and rectal surgery, while preoperative fasting ≤ 4 h (OR=0.10; CI95=0.04-0.24; p<0.0001) and intravenous crystalloid ≤ 30 ml/kg/day (OR=0.36; CI95=0.13-0.97, p=0.044) shown to decrease the risk. Mortality was lower with preoperative fasting ≤4 h and intravenous crystalloids infused ≤30 ml/kg/day. Conclusion: This study allows to conclude that rectal procedures, high NNIS index, preoperative fasting higher than 4 h and intravenous fluids greater than 30 ml/kg/day during the first 48 h after surgery are independent risk factors for: 1) prolonged LOS; 2) surgical site infection and anastomotic fistula associated with malnutrition; 3) postoperative pneumonia-atelectasis; and 4) postoperative mortality.


RESUMO Racional: Protocolos multimodais de cuidados perioperatórios melhoram significativamente resultados na cirurgia. Objetivo: Investigar fatores de risco para vários desfechos clínicos em pacientes submetidos às operações colorretais eletivas com o emprego do protocolo ACERTO. Métodos: Coorte analisando indivíduos expostos ou não expostos às variáveis de risco demográficas, clínicas e intervenções ACERTO, através de um modelo de regressão logística, determinando fatores independentes de risco para morbidade e mortalidade. Resultados: Duzentos e trinta e quatro pacientes foram submetidos a 156 (66,7%) operações retais e 78 (33,3%) colônicas. Mantiveram relação com tempo de internação ≥7 dias operação retal e escore NNIS alto; jejum pré-operatório > 4h e volume de cristalóides >30 ml/kg/dia. O risco de infecção de sítio cirúrgico foi aproximadamente quatro vezes maior em desnutridos; oito em operações retais; e quatro com NNIS alto. Tempo de jejum pré-operatório ≤4 h reduziu em 81,3% o risco de infecção de sitio cirúrgico. Risco aumentado para fístula ocorreu em desnutridos, operação retal e escore NNIS elevado. Tempo de jejum pré-operatório ≤4 h constituiu fator de proteção para ocorrência de fístulas. Os fatores associados à pneumonia/atelectasia foram câncer e operação retal, enquanto que tempo de jejum pré-operatório ≤4 h e volume de cristalóides intravenoso ≤30 ml/kg/dia foram fatores de proteção. Mortalidade foi menor com jejum ≤4 h e fluidos endovenosos ≤30 ml/kg/dia. Conclusão: Este estudo permite concluir que operações retais, presença de fator de risco NNIS, tempo de jejum pré-operatório superior a 4 h e fluidoterapia com cristaloides endovenosos superior a 30 ml/kg/dia nas primeiras 48 h de pós-operatório constituem-se em fatores de risco independentes e aplicáveis para: 1) tempo de internação pós-operatória prolongada; 2) para infecção do sítio cirúrgico e fístula anastomótica associadas à desnutrição; 3) para pneumonia/atelectasia no pós-operatório; e 4) para mortalidade pós-operatória.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Postoperative Complications/prevention & control , Colorectal Surgery/methods , Guideline Adherence/statistics & numerical data , Perioperative Care/methods , Prospective Studies , Risk Factors , Cohort Studies , Colorectal Surgery/adverse effects , Length of Stay
18.
Rev. bras. enferm ; 71(4): 1963-1969, Jul.-Aug. 2018. tab
Article in English | LILACS, BDENF | ID: biblio-958689

ABSTRACT

ABSTRACT Objective: to analyze the adhesion of the nursing team to the practice of hands hygiene (HH) and the use of latex gloves in a hemodialysis service. Method: this is a descriptive-exploratory study with a quantitative approach, performed between August and October 2016 in a hemodialysis service in the countryside of São Paulo State, Brazil, where the nursing team adhered to HH and the use of gloves. All ethical aspects have been contemplated. Results: there were 1090 opportunities for HH, with the adhesion rate being only 16.6%. Regarding the use of gloves, of the 510 opportunities observed, there was correct use in 45%, reuse in 25% and absence of latex gloves in 29% of the time. Conclusion: the rate of HH and adherence to gloves is far from ideal, contributing to the increased risk of infection for both the user and the professional.


RESUMEN Objetivo: analizar la adhesión del equipo de enfermería a la práctica de higienización de las manos (HM) y al uso de guantes en un servicio de hemodiálisis. Método: el estudio descriptivo-exploratorio y cuantitativo, realizado entre agosto y octubre de 2016 en un servicio de hemodiálisis del interior del estado de São Paulo, Brasil, donde se observó la adhesión del equipo de enfermería a la HM y al uso de guantes. Todos los aspectos éticos fueron contemplados. Resultados: se observó 1090 oportunidades de HM, siendo la tasa de adhesión de apenas el 16,6%. En cuanto al uso de guantes, de las 510 oportunidades observadas, hubo utilización correcta en un 45%, la reutilización en un 25% y ausencia del uso de guantes en un 29%. Conclusion: la tasa de HM y la adhesión al uso de guantes están muy por debajo del ideal, contribuyendo al aumento del riesgo de infección, tanto para el usuario y para el profesional.


RESUMO Objetivo: analisar a adesão da equipe de enfermagem à prática de higienização das mãos (HM) e ao uso de luvas em um serviço de hemodiálise. Método: estudo descritivo-exploratório de abordagem quantitativa, realizado entre agosto e outubro de 2016 em um serviço de hemodiálise do interior do Estado de São Paulo, Brasil, onde foi observada a adesão da equipe de enfermagem à HM e ao uso de luvas. Todos os aspectos éticos foram contemplados. Resultados: observou-se 1090 oportunidades de HM, sendo a taxa de adesão de apenas 16,6%. Quanto ao uso de luvas, das 510 oportunidades observadas, houve utilização correta em 45%, a reutilização em 25% e ausência do uso de luvas em 29% das vezes. Conclusão: a taxa de HM e a adesão ao uso de luvas estão muito aquém do ideal, contribuindo para o aumento do risco de infecção, tanto para o usuário como para o profissional.


Subject(s)
Humans , Renal Dialysis/nursing , Gloves, Protective/statistics & numerical data , Hand Hygiene/standards , Patient Care Team/statistics & numerical data , Brazil , Guideline Adherence/standards , Guideline Adherence/statistics & numerical data , Hand Hygiene/methods , Hand Hygiene/statistics & numerical data , Personal Protective Equipment/statistics & numerical data
19.
Rev. bras. enferm ; 71(2): 259-264, Mar.-Apr. 2018.
Article in English | LILACS, BDENF | ID: biblio-898451

ABSTRACT

ABSTRACT Objective: To investigate the perception and attitude of health professionals (HPs) about the patient participation in hand hygiene (HH). Method: A cross-sectional study with 150 HPs from a university hospital in Brazil. A descriptive analysis was conducted. Results: Simple hand hygiene was the preferred method of HPs, rather than hand rubbing with alcohol-based solutions. A total of 83.3% of the HPs supported the patient participation in reminding them about HH, but 48% reported that they would feel uncomfortable; 45.3%, comfortable; and 20.7% were familiar with the "Patients for Patient Safety" program. Conclusion: HPs showed limited knowledge about HH, opposing recommendations on the topic. The contradiction between the HPs acceptance and attitude when questioned by the patient regarding HH was revealed, reflecting a lack of knowledge about the WHO program and the need to implement educational practices in health.


RESUMEN Objetivo: Investigar la percepción y actitud de profesionales de salud (PS) sobre la participación del paciente en la higienización de manos (HM). Método: Estudio transversal, realizado con 150 PS de un hospital universitario de Brasil. Se realizó un análisis descriptivo. Resultados: La higiene simple de manos fue el método preferido de los PS, en detrimento de la fricción con preparación alcohólica. De los PS, 83,3% apoyaban a la participación del paciente en recordarlos sobre la HM, pero 48% relataron que se sentirían incómodos; 45,3%, confortables; y 20,7% conocían el programa "Pacientes en Defensa de su Seguridad". Conclusión: Los PS mostraron conocimiento limitado sobre HM, contraponiendo las recomendaciones sobre el tema. Además, revelaron contradicción entre su aceptación y actitud a respecto de que sean cuestionados por el paciente sobre la HM, refletando desconocimiento del programa de la OMS y la necesidad de implementación de prácticas educativas en salud.


RESUMO Objetivo: Investigar a percepção e atitude dos profissionais de saúde (PS) sobre a participação do paciente na higienização das mãos (HM). Método: Estudo transversal, realizado com 150 PS de um hospital universitário do Brasil. Realizou-se uma análise descritiva. Resultados: A higiene simples das mãos foi o método preferido dos PS, em detrimento da fricção com preparação alcoólica. Dos PS, 83,3% apoiavam à participação do paciente em lembrá-los sobre a HM, mas 48% relataram que se sentiriam desconfortáveis; 45,3%, confortáveis; e 20,7% conheciam o programa "Paciente Pela Segurança do Paciente". Conclusão: PS mostraram conhecimento limitado sobre a HM, contrapondo as recomendações sobre o tema. Revelou-se a contradição entre a aceitação e atitude dos PS em serem questionados pelo paciente a respeito da HM, refletindo desconhecimento do programa da OMS e a necessidade de implementação de práticas educativas em saúde.


Subject(s)
Humans , Male , Female , Adult , Patient Participation/methods , Health Personnel/standards , Guideline Adherence/standards , Hand Hygiene/methods , Patient Participation/psychology , Patient Participation/statistics & numerical data , Brazil , Attitude of Health Personnel , Cross-Sectional Studies , Surveys and Questionnaires , Health Personnel/psychology , Health Personnel/statistics & numerical data , Guideline Adherence/statistics & numerical data , Hand Hygiene/standards , Hand Hygiene/statistics & numerical data , Middle Aged
20.
Rev. latinoam. enferm. (Online) ; 26: e3000, 2018. tab, graf
Article in English | LILACS, BDENF | ID: biblio-901929

ABSTRACT

ABSTRACT Objectives: to analyze the internal consistency of the evaluation instrument of the adherence to the good practices of childbirth and birth care in the professionals, through Cronbach's Alpha Coefficient for each of the dimensions and for the total instrument. Method: this is a descriptive and cross-sectional study performed in obstetric centers of eleven public hospitals in the Federal District, with a questionnaire applied to 261 professionals who worked in the delivery care. Results: The study was attended by 261 professionals, 42.5% (111) nurses and 57.5% (150) physicians. The reliability evaluation of the instrument by the Cronbach Alfa resulted in 0.53, 0.78 and 0.76 for dimensions 1, 2 and 3, after debugging that resulted in the exclusion of 11 items. Conclusions: the instrument obtained Cronbach's alpha of 0.80. There is a need for improvement in the items of dimension 1 that refer to attitudes, knowledge, and practices of the organization of the network of care to gestation, childbirth, and birth. However, it can be applied in the way it is used to evaluate practices based on scientific evidence of childbirth care.


RESUMO Objetivo: analisar a consistência interna do instrumento de avaliação da adesão dos profissionais às boas práticas de atenção ao parto e nascimento por meio do Coeficiente Alfa de Cronbach para cada uma das dimensões e para o instrumento total. Método: estudo descritivo e transversal, realizado em centros obstétricos de onze hospitais públicos do Distrito Federal, com aplicação de questionário a 261 profissionais que atuavam na atenção ao parto. Resultados: participaram do estudo 261 profissionais, sendo 42,5% (111) enfermeiros e 57,5% (150) médicos. A avaliação da confiabilidade do instrumento pelo Alfa de Conbrach resultou em 0,53, 0,78 e 0,76 para as dimensões 1, 2 e 3, após depurações que resultarama na exclusão de 11 itens. Conclusões: o instrumento obteve Alfa de Cronbach de 0,80. Há necessidade de aperfeiçoamento nos itens da dimensão 1 que se referem a atitudes, conhecimentos e práticas de organização da rede de atenção à gestação, parto e nascimento. Todavia, pode ser aplicado na forma como está para avaliação das práticas baseadas em evidências científicas de atenção ao parto.


RESUMEN Objetivos: analizar la consistencia interna del instrumento de evaluación de la adhesión de los profesionales a las buenas prácticas de atención al parto y nacimiento, por medio del Coeficiente Alfa de Cronbach para cada una de las dimensiones y para el instrumento total. Método: estudio descriptivo y transversal, realizado en centros obstétricos de once hospitales públicos del Distrito Federal, con aplicación de cuestionario a 261 profesionales que actuaban en la atención al parto. Resultados: Participaron del estudio 261 profesionales, siendo 42,5% (111) enfermeros y 57,5% (150) médicos. La evaluación de la confiabilidad del instrumento por el Alfa de Conbach resultó en 0,53, 0,78 y 0,76 para las dimensiones 1, 2 y 3, después de depuraciones que resultaron en la exclusión de 11 ítems. Conclusiones: el instrumento obtuvo Alfa de Cronbach de 0,80. Hay necesidad de perfeccioamiento en los ítems de la dimensión 1 que se refieren a actitudes, conocimientos y prácticas de organización de la red de atención a la gestación, parto y nacimiento. Todavía puede ser aplicado en la forma como está para evaluación de las prácticas basadas en evidencias científicas de atención al parto.


Subject(s)
Humans , Male , Female , Pregnancy , Adult , Benchmarking/methods , Guideline Adherence/statistics & numerical data , Delivery Rooms/standards , Cross-Sectional Studies , Reproducibility of Results
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