Terapia Ocupacional em contextos hospitalares: práticas em estágio supervisionado / Occupational therapy in hospital contexts: practical experiences in supervised internship / Terapia ocupacional en contextos hospitalarios: experiencias prácticas supervisadas

Contextualização: O presente artigo apresenta vivências práticas desenvolvidas no Estágio Supervisionado de Terapia Ocupacional em um hospital localizado no interior do Rio Grande do Sul. Processo de intervenção/acompanhamento: Foram realizados atendimentos a pacientes, pediátricos e adultos, acometidos por diversas patologias, com o objetivo de proporcionar escuta terapêutica, realização de atividades significativas para o paciente, medidas de conforto e alívio da dor, bem como o acolhimento dos familiares e cuidadores. Análise crítica da prática: As intervenções foram voltadas, principalmente, para a adaptação de lidar com o contexto hospitalar, causada pela interrupção da rotina e pelo afastamento de papéis ocupacionais assumidos antes da hospitalização, assim como o auxílio na minimização do estresse manifestado pela condição de adoecimento. Síntese das considerações: Assim, percebe-se a importante contribuição do Terapeuta Ocupacional nesse contexto, com foco na reorganização do cotidiano e na prevenção e promoção da saúde da pessoa hospitalizada.(AU)

Background: This article presents the practical experiences developed in the Supervised Internship of Occupational Therapy in a hospital located in the interior of Rio Grande do Sul. Intervention/follow-up process: Pediatric and adult patients affected by various pathologies were attended to, with the aim of providing therapeutic listening, performing meaningful activities for the patient, comfort measures and pain relief, as well as welcoming family members and caregivers. Critical analysis of the practice: The interventions were mainly aimed at adapting to deal with the hospital context, caused by the interruption of the routine and the removal of occupational roles assumed before hospitalization, and helping to minimize the stress manifested by the illness condition.Summary of considerations: TThus, we can see the important contribution of the Occupational Therapist in this context, focusing on the reorganization of daily life and on the prevention and health promotion of the hospitalized person.(AU)

Fundamento: Este artículo presenta las experiencias prácticas desarrolladas en el Internado Supervisado de Terapia Ocupacional en un hospital ubicado en el interior de Rio Grande do Sul. Proceso de intervención/seguimiento: Se atendió a pacientes pediátricos y adultos afectados por diversas patologías, con el objetivo de brindar escucha terapéutica, realizar actividades significativas para el paciente, medidas de confort y alivio del dolor, así como acogida de familiares y cuidadores.Análisis crítico de la práctica: Las intervenciones se orientaron principalmente a la adaptación al contexto hospitalario, provocado por la interrupción de la rutina y la eliminación de los roles ocupacionales asumidos antes de la hospitalización, y ayudar a minimizar el estrés manifestado por la condición de enfermedad. Resumen de consideraciones: Así, podemos ver la importante contribución del Terapeuta Ocupacional en este contexto, centrándose en la reorganización de la vida cotidiana y en la prevención y promoción de la salud de la persona hospitalizada.(AU)

Amikacin for the treatment of carbapenem-resistant Klebsiella pneumoniae infections: clinical efficacy and toxicity.

Infections by carbapenem-resistant Klebsiella pneumoniae (CRKp) are an increasing global threat with limited therapeutic options. Our objective was to evaluate clinical and microbiological outcomes of patients treated with amikacin for CRKp infections. We did a retrospective cohort of patients > 18 years old, with CRKp infections treated with amikacin in two tertiary care hospitals in Porto Alegre, Brazil. The impact of clinical factors, antibiotic treatment, and amikacin minimum inhibitory concentration (MIC) on patients' 30-day mortality was assessed. Microbiological clearance and nephrotoxicity (assessed by RIFLE score) were evaluated as secondary outcomes. A Cox regression analysis was done for mortality. We included 84 patients for analysis. Twenty-nine (34.5%) patients died in 30 days. Amikacin MIC values ranged from 0.125 to 8 µg/mL and did not influence on mortality, regardless of the prescribed dose of this antibiotic (P = 0.24). Bacterial clearance occurred in 17 (58.6%) of 29 patients who collected subsequent cultures. Two (16.6%) of the 12 persistently positive cultures changed the amikacin susceptibility profile from susceptible to intermediate. Twenty-nine (37.2%) patients developed acute kidney injury (AKI): risk 13, injury 11, and failure 5. Risk factors for AKI were higher baseline eGFR (P < 0.01) and combination therapy with colistin (P = 0.02). Comparing patients who received combination with colistin vs polymyxin B, AKI occurred in 60.0% vs 20.6%, respectively, P < 0.01. Fifteen of the 16 (16.6%) patients who developed renal injury or failure were receiving colistin. In conclusion, amikacin was an effective treatment for CRKp infections. Within susceptible range, amikacin MIC values did not influence on clinical outcomes. Combination therapy of amikacin and colistin was highly nephrotoxic and should be used with caution.

A abordagem da morte na formação de profissionais e acadêmicos da enfermagem, medicina e terapia ocupacional / Approaching death in the training of nursing, medicine and occupational therapy professionals

Objetivo: Este artigo decorreu de uma investigação sobre o significado da morte no cotidiano dos profissionais e acadêmicos da terapia ocupacional, medicina e enfermagem. Método: Discorre sobre dois eixos investigativos, que abordaram o significado da morte e o papel da formação acadêmica quanto ao preparo para lidar com a terminalidade da vida. Trata-se de uma pesquisa de abordagem qualitativa baseada nos pressupostos da investigação fenomenológica. Os dados foram coletados por meio de entrevista narrativa, norteada por uma matriz categorial e interpretados por meio da análise textual discursiva. Foram investigados três profissionais, residentes e acadêmicos de cada categoria profissional. Resultados: Os resultados mostraram que, embora a morte seja um fenômeno natural e inevitável da existência humana, tende a ser negado socialmente. Muitas pessoas buscam suporte na religião e espiritualidade. No que se refere à abordagem da morte na formação acadêmica, os dados evidenciaram a prioridade em relação ao cuidado e atenção à saúde e à vida. A população investigada aprendeu a conviver com a questão por meio de suas experiências pessoais de vida e de profissão, tanto no período de formação acadêmica quanto no exercício da profissão. Conclusão: O estudo contribuiu para ampliar a discussão sobre a importância do suporte à formação dos profissionais da saúde tanto no que se refere à aprendizagem da assistência voltada aos cuidados paliativos, quanto à necessidade de instrumentalizá-los e fortalecê-los em relação ao impacto que a morte exerce em seu cotidiano.

Objective: This work is part of a research that investigated the meaning of death in the daily routine of occupational therapy, medicine and nursing students and professionals. Method: Two investigative methods were used, approaching the meaning of death and its role in the academic training as a preparation for dealing with the theme. The study has qualitative approach and is based on assumptions of phenomenological research. Data was collected through a narrative interview guided by a categorical matrix and interpreted by means of a discursive textual analysis. Nine individuals were investigated, including professionals, residents and academic students from each area. Results: The results revealed that, although death is seen as a natural and inevitable phenomenon of human existence, it has been systematically denied by society. Many people find support in religion and spirituality. Regarding the role of death in the academic training, the data clearly showed that academy prioritizes the care and attention to health and life and it does not teach to deal with death nor prepares professionals to act in the logic of palliative care. The people investigated in this research learned to deal with death from personal and work experiences. Conclusion: This study contributed to expand the discussion about the importance of upport to the training of health professionals, both in terms of learning about assistance focused on palliative care, and of the need to instruct and strengthen them before the impact that death causes in their daily lives.