Utilization of a Neonatal Early-Onset Sepsis Calculator to Guide Initial Newborn Management.

Within our hospital system, all infants born to mothers with chorioamnionitis were directly admitted to the neonatal intensive care unit (NICU) for evaluation and treatment of presumed sepsis for a minimum of 48 hours, regardless of clinical appearance. Implementation of a risk-stratification system for thesWe high-risk infants based on the early onset sepsis (EOS) calculator may decrease NICU admissions and antibiotics exposure in well-appearing neonates. METHODS: We used The Model for Improvement as a framework for designing this initiative. Participants were inborn infants 35 weeks and older born to mothers with chorioamnionitis and/or fever. Plan Do Study Act (PDSA) cycles were utilized to educate staff, monitor for sepsis, and follow adherence to the calculator in the newborn nursery. RESULTS: From June 2015 to June 2016, there were 312 at-risk infants identified and evaluated on the EOS calculator. Of these 312 infants, 228 did not require admission to the NICU based on their risk assessment using the online calculator. Implementation of the Kaiser EOS calculator protocol for at-risk infants decreased NICU admission rates, decreased practitioner practice variability, decreased the number of painful procedures, promoted family bonding, resulted in higher breastfeeding rates at hospital discharge, diminished financial burden, and promoted antibiotic stewardship. CONCLUSION: This study demonstrates that the implementation of the sepsis risk calculator at an academic medical center can decrease the number of asymptomatic infants transferred to the NICU for empiric antibiotic treatment.

O rei e a omelete de amoras / The king and the blackberry omelet / El rey y la tortilla de zarzamoras

A autora fala da dificuldade no atendimento de alguns casos difíceis e da necessidade da escrita do analista para a elaboração posterior de aspectos contratransferenciais e sua utilização nestes atendimentos. Traz um caso de uma paciente terminal, que vive uma doença dramática e usa a análise para tentar manter-se minimamente organizada. Fica evidente o enorme trabalho psíquico que deverá ser feito pela dupla, analista e analisando, para lidar com a morte próxima da paciente, quando passa a haver uma grande expansão libidinal, assim como um aumento do seu apetite relacional, enquanto se desenvolve uma relação transferencial profundamente regressiva, exigindo do analista uma boa capacidade de rêverie.

This paper is about the difficulty in treating some difficult cases. The author writes about the need of psychoanalyst's notes, in order to further elaborate countertransferential aspects, and to use it in those therapy sessions. The author brings a case of a terminal patient, who has been suffering from a terrible disease. That patient has used her therapy as a way to keep herself (her mind) reasonably organized. It's evident the very hard psychic work that must have been done by both, therapist and patient, in order to deal with that patient's imminent death. At that time, a great libidinal expansion happened to exist, and the patient's relational appetite started increasing, while a deeply regressive transferential relationship has been developed, which has required from the therapist a great ability of rêverie.

La autora habla de la dificultad de la atención en algunos casos difíciles y de la necesidad de la escritura del analista para la elaboración posterior de los aspectos contratransferenciales y su utilización en esos casos. Presenta el caso de una paciente terminal, que vive una enfermedad dramática, y utiliza el análisis para tratar de mantenerse mínimamente organizada. Es evidente el inmenso trabajo psíquico que deberá ser hecho por la pareja, analista y analizado, para lidiar con la muerte próxima del paciente, cuando empieza una gran expansión libidinal así como un aumento de su apetito de relacionarse, mientras se desarrolla una relación de transferencia profundamente regresiva que requiere del analista una buena capacidad de rêverie.

"Preciso te contar uma coisa: eu vou morrer"

O presente trabalho trata do sentimento de desamparo que vivenciamostodos ao falar, viver e escrever sobre a morte, tantas são as representaçõesacionadas quando nos aproximamos do tema. Somos obrigados a lidar com a nossafinitude, impotência, frustração e medo diante de algo tão determinado na vidade todos. A autora fala da clínica de alguns pacientes muito graves, obrigados aenfrentar a morte, bem como da dificuldade dos profissionais nesses atendimentos.A constatação é de que de verdade não é sobre a morte que temos dificuldade emescrever, desconforto em tratar, desamparo ao viver, mas sim sobre as inúmerassituações da vida que incluem tanto ela quanto o sofrer. Por fim, a autora traz orelato de alguns casos clínicos em que, de forma consciente ou não, os pacientestentam contar ao outro e a si próprios esta verdade tão dura e tão certa.(AU)

The present work deals with the feeling of abandonment that we all experience whenspeaking, reading and writing about death, given the amount of representations that cometo mind when approaching this issue. It also addresses the constant necessity to deal with ourfinitude, helplessness, frustration and fear before something that is so determined in everyone’slives. The author talks about her experience with some very serious patients who must facedeath, as well as the professional difficulties in caring for these patients. Moreover, she discussesthe realization that it is not really death that we have trouble writing about, caring for or livingwith, but the countless situations of life that include it and the suffering involved. Finally, theauthor narrates a few clinical cases in which the patients, consciously or not, try to tell othersand themselves about such a harsh and yet so certain truth.(AU)

El presente trabajo trata del sentimiento de desamparo que vivimos todos al hablar,vivir y escribir sobre la muerte, tantas son las representaciones provocadas cuando nosacercamos al tema. Siempre necesitamos lidiar con nuestra finitud, impotencia, frustración ymiedo ante algo tan determinado en la vida de todos. La autora habla de la clínica de algunospacientes muy graves, obligados a lidiar con la muerte y la dificultad de los profesionales enestos tratamientos. La constatación de que en verdad no es sobre la muerte que tenemosdificultad en escribir, incomodidad en tratar, desamparo al vivir, sino las innumerablessituaciones de la vida que incluyen a ella y el sufrimiento. Por último, la autora trae el relato dealgunos casos clínicos en que, de forma consciente o no, los pacientes intentan contar al otro yincluso a si mismos esta verdad tan dura y tan segura.(AU)