Comparaçäo da avaliaçäo nutricional subjetiva global X avaliaçäo nutricional objetiva / Comparison of the subjective global nutrition assessment X objective nutrition evaluation

A avaliaçäo nutricional subjectiva global (ANSG), introduzida por Destsky et al. (1987), avalia a perda de peso corpóreo, gordura e massa muscular e mudanças na ingestäi dietética, sendo eficaz para o diagnóstico de desnutriçäo protéico-calórica do adulto hospitalizado. OBJETIVO. Comparar a eficiência do emprego da ANSG em nosso meio, com as medidas tradicionais de avaliaçäo nutricional (antropometria, exames laboratoriais e testes cutâneos de hipersensibilidade tardia). MÉTODO. Realizou-se um estudo prospectivo em 100 pacientes do hospital da Beneficiência Portuguesa de Säo Paulo. Admitidos consecutivamente em 3/91 a 5/91. Comparou-se a aplicaçäo do questionário sistematizado por Destky et al (1987), com as medidas antropométricas (peso e altura corporais, prega cutânea truciptal e circunferência do braço) e bioquímica (albumina sérica, hemoglobina, hematócrito e linfócitos de sangue periférico). A ANSG e avaliaçäo antropométrica foram realizadas pela mesma, observadora (LZC), treinada e capacitada para essa funçäo. RESULTADOS. Dos 100 pacientes avaliados pela ANSG, 83 por cento foram categorizados como normais, 14 por cento desnutridos moderados e 3 por cento desnutridos graves. Observaram-se associaçöes estatisticamente significantes (p<0,05) entre albumina (<3,5), hemoglobina (<13,9g/mL), prega cutânea triciptal (<10mm) e circunferência muscular do braço (<23,3cm) com a presença de desnutriçäo moderada e grave estabelecidas pela ANSG. O diagnóstico de suporte nutricional enteral e parenteral...

[Comparison of the subjective global nutrition assessment x objective nutrition evaluation]. / Comparação da avaliação nutricional subjetiva global x avaliação nutricional objetiva.

OBJECTIVE: Nutritional Assessment methods (ONA) are traditionally employed in hospitalized patients (anthropometry, laboratorial exams and immunological tests). The Subjective Global Assessment (SGA) estimates weight loss and changes in dietetic intake as being allegedly efficient for protein-caloric malnutrition diagnosis of the hospitalized adult. PURPOSE: Compare the efficacy of SGA against the traditional ONA. METHODS: The prospective study was done with 100 hospitalized patients from 3/90-5/90 at the Hospital Beneficência Portuguesa de São Paulo. The Detsky et al. questionnaire was applied besides anthropometric measurements (body weight, triceps skinfold thickness-TSF, mirdam circumference MCA) and laboratorial examinations (serun albumin, hemoglobin, peripheral blood lymphocytes) all of them in the first 3 days of admission. SGA always preceded ONA, and was always done by the same observer. RESULTS: There was a significant reduction on the average values of anthropometric and laboratorial measurements with the progressive worsening of nutritional status assessed by SGA. There were significant associations (p < 0.05) between hypoalbuminemia (< 3.5 g/dL) loss of TSF (< 10 mm) and MAC (< 23.3 cm) in those patients classified as moderately and severely malnourished by SGA (14%). Hypoalbuminemia, low TSF and SGA malnutrition were all significantly associated to mortality (p < 0.05). CONCLUSION: SGA in our hospital is a reliable diagnostic method for the diagnosis of malnutrition of hospitalized adult patients and malnutrition of hospitalized adult patients and keeps prognostic association with mortality.

Scabies epidemic: price and prejudice.

Scabies epidemics are not unusual, and the recommended way of stopping them is by simultaneous treatment of everybody in the facility; this has been known since the last century, when Norwegian scabies was a problem in Norway. When this is not done, scabies epidemics can smolder for months. Scabies should not spread with good infection control measures, but we learned that a good infection control service is not enough. Efforts have to be done to educate everybody in the hospital, including laundry workers, and to improve work conditions.

[The use of the pupillometric gauge by the nurses' aide]. / Utilização da espátula pupilômetro pelo auxiliar de enfermagem.

To test the use of the "pupillometer tongue depressor" by auxiliary nursing was the goal of this study. The same evaluation used by nurses was performed in this group. After explaining the use of the device, each auxiliary nursing registered on a "Card-test" the value of the two circles, which diameters were equal or unequal. Afterward, a pair of the auxiliary nursing evaluates the pupil diameter of one patient. The accuracy of the millimeter circles was very high but not the effectiveness of the pupil diameter measurement. Nearly 1/3 of the auxiliary nursing referred difficulties in performing this evaluation.

[Risk factors for infection after heart surgery]. / Fatores de risco para infecção após cirurgia cardíaca.

A consecutive series of 84 patients operated by the same surgical team was studied in order to identify risk factors for post operative infection. Female sex and longer antibiotic prophylaxis were significantly associated with higher infection risk; the risk of dying of infection was more pronounced with infected men than with infected women. Diabetes, undernutrition, low albumin serum level in the first or in the fifth day post-operatively, asthma or pneumonia in the past did not correlate with infectious risk, as well as use of antibiotic before surgery or longer hospitalization before surgery.

Imunoprofilaxia da hepatite B: vacinacao em um hospital geral de Sao Paulo com adequacao da metodologia utilizada a nossa realidade socio-economica / Immunoprophylaxis of hepatitis B: vaccination at a general hospital in Sao Paulo with adequacy of methodology used in our socioeconomic reality

Estudou-se comparativamente o programa de vacinacao contra hepatite B implantando no Hospital da Real Sociedade Portuguesa de Beneficiencia com outros programas descritos na literatura em varias instituicoes quanto a aceitacao e extensao da corbertura vacinal; 554 individuos escolhidos para receberem a vacinacao iniciaram a serie de tres doses, dos quais 520 completaram todo o programa 93,6 por cento) um resultado comparavel as melhores series internacionalmente publicadas. Como se trata de um recurso caro a perda vacinal por individuos que nao completam o esquema precisa ser minimizada, e as razoes deste bom resultado nos parecem ser a restricao da vaciana a profissionais com baixo "turn over"no mercado de trabalho do hospital e o fornecimento de vacinas sem obrigar o vacinado a nenhum trabalho extra, incluindo vacina-lo no seu local de trabalho durante o expediente.

[Immunoprophylaxis of hepatitis B: vaccination at a general hospital in São Paulo using methods adapted to our socioeconomic reality]. / Imunoprofilaxia da hepatite B: vacinação em um hospital geral de São Paulo com adequação da metodologia utilizada a nossa realidade sócio-econômica.

The vaccination program against hepatitis B at the hospital of the "Real Sociedade Portuguesa de Beneficiência" in São Paulo was carried out successfully. Out of 554 persons that received the initial 3 vaccine doses 520 completed the program (93.86%) which is an achievement comparable to the best ones of the published series. Since the anti hepatitis B vaccine is expensive we feel that it should be given only to the hospital employees for whom we have a certain guarantee that they will complete the program. Our good results were possible only because we vaccinated only persons having stable relationship with the hospital and because the vaccination was carried out in the hospital during the working hours.

[Hospital infection: seven years of systematic research at a general hospital in São Paulo]. / Infecção hospitalar: sete anos de Pesquisa sistemática num hospital geral em São Paulo.

A seven year analysis with established adequate methods of reporting and confirming hospital acquired infections shows a surprising statistically significant relationship between the frequency of hospital acquired infections and the number of infected patients admitted to this hospital: hospital acquired infections comprised 2% to 3.7% of all admissions, and patients already infected admitted were 5.3% to 8.4%. Surgical wound infections were the most frequent acquired infections. Followed by respiratory infections and urinary tract infections. During the 7 years period there was a very pronounced drop in the number of cases with infectious diseases acquired inside the hospital and a fall in infections acquired after cardiac surgery.

Ensino de campo: sua importancia na formacao do enfermeiro. / Clinical teaching: its importance in nurse's education

As autoras abordam o ensino de campo como elemento essencial na formacao de enfermeiros, dando suas caracteristicas, vantagens e requisitos