Peripheral arterial disease in hemodialysis patients 10 years later.

BACKGROUND AND OBJECTIVE: Patients with chronic kidney disease (CKD) on hemodialysis present high cardiovascular comorbidity. Peripheral arterial disease (PAD) is associated with higher mortality and the interest in its early detection and treatment is increasing. The objective of this study is to determine the frequency and severity of symptomatic PAD, and to establish its relationship with mortality in HD patients that have received treated early and compare them with a cohort of our center already reported. MATERIAL AND METHODS: Retrospective study on a cohort of incident patients since 2014 and followed up until December 2019. Demographic data, cardiovascular risk, the presence of symptomatic PAD at baseline and during follow-up were collected. Trophic lesions were graded using the Rutherford scale. RESULTS: Initially, there were 91 patients and 7 cases that were not included in the study were lost to follow-up. Age 64 ±â€¯16 years, men 51.6% (47/91). The percentage of baseline PAD was 10.7% (9/84). During a median follow-up of 35 months (20-57), the diagnosis of PAD increased to 25% (21/84). Half of the patients with PAD 52.38% (11/21) obtained a score greater than 3 in the Rutherford Clinical Classification, which corresponds to severe disease. 13/21 patients required reoperation due to recurrence of symptoms (61.9% of cases with PAD). The development of PAD was significantly associated with: an elevated index of Charlson (3.9±2.1 vs. 7.7 ±â€¯3.5; P = 0.001),being male (19 vs. 2; P = 0.001), diabetic (no: 7; yes: 15; P = 0.001) and with a history of chronic ischemic heart disease (no: 13; yes: 8; P = 0.001), 38.1% (8/21) had ischemic heart disease in patients who developed PAD, while in the absence of PAD the presence of ischemic heart disease was 9.5% (6/63). Furthermore, more than half (66.7% [14/21]) of those who developed PAD were diabetic. Univariate analysis showed that age, C reactive protein, albumin, and number of surgical interventions, but not PAD, were associated with mortality. In the multivariate analysis adjusted for other factors, only C reactive protein was related to overall survival Exp ß: 2.17; P = 0.011; CI (1.19-3.97). Regarding cardiovascular mortality, in the multivariate Cox analysis, only PAD was related to mortality of cardiovascular origin Exp ß: 1.73; P = 0.006; CI (1.17-2.56). CONCLUSIONS: A significant number of patients on hemodialysis develop PAD requiring peripheral vascular surgery. PAD was not associated with overall mortality in our cohort, but it did show an association with cardiovascular mortality. Prospective studies with a larger sample size are necessary. New surgical treatments and Follow-up by vascular surgeons could improve the severity of PAD and the long-term prognosis.

Cut-off point, sensitivity and specificity for screening the reading fluency in children. / Pontos de corte, sensibilidade e especificidade para rastreamento da fluência leitora em crianças.

PURPOSE: to establish cut-off point for reading speed and accuracy, to obtain minimum values for comprehending texts, and allow classifying students from 2nd to 5th grade of elementary school according to good or poor reading performance. METHODS: 147 assessment protocols for oral reading and text comprehension of students from 3rd to 5th grade of Elementary School with and without reading difficulties were analyzed. The oral text reading rate and accuracy values were analyzed. ROC curves were constructed, and sensitivity and specificity calculated for each reading fluency parameter, and each school grade. RESULTS: Sensitivity and specificity for measures of rate and accuracy in text reading were calculated for the 3rd, 4th, and 5th grades. Rate and precision under the ROC curve did not differ statistically. The values for the 2nd grade were mathematically estimated. CONCLUSION: The cutoff values expected for students from 2nd to 3rd grade were identified, with recommendations for using the oral text reading rate for reading comprehension screening procedures.

OBJETIVO: estabelecer pontos de corte para valores de velocidade e acurácia de leitura, a fim de obter valores mínimos para compreensão de textos, e permitir classificar alunos de 2º a 5º ano do Ensino Fundamental, de acordo com bom ou pobre desempenho em leitura. MÉTODO: foram analisados ​​147 protocolos de avaliação de leitura oral e compreensão textual de escolares de 3º a 5º ano com e sem dificuldades de leitura. A taxa de leitura oral de texto e os valores de acurácia foram analisados. Curvas ROC foram construídas e a sensibilidade e a especificidade, calculadas para cada parâmetro de fluência de leitura por ano escolar. RESULTADOS: A sensibilidade e a especificidade para medidas de taxa e acurácia na leitura de texto foram calculadas para o 3º, 4º e 5º anos. A taxa e a precisão sob a curva ROC não diferiram estatisticamente. Os valores do 2º ano foram estimados matematicamente. CONCLUSÃO: Foram identificados os valores de corte esperados para escolares do 2º ao 5º ano, com recomendações de utilização da taxa de leitura de texto oral para procedimentos de rastreamento da compreensão leitora.

School and language performance in children born with low birth weight.

OBJECTIVES: To identify the impact of birth weight on the development of metalinguistic skills and performance in reading, writing, and arithmetic in students aged 6 to 10 years, enrolled from the 1st to the 4th grade of Elementary School in public schools of the metropolitan region of São Paulo. METHODS: The concurrent cohort included 315 students. Birth weight was the exposure variable, and the outcomes were performance in receptive and expressive language, oral metalinguistic skills, and performance in writing, arithmetic, and reading. The tools employed were the Test of Language Competence (TLC) and the School Performance Test (SPT). Students were grouped into quartiles by birth weight for data analysis (P1: < 2170 g, P2: from 2171 g to 2450 g, P3: from 2451 g to 3150 g, and P4: > 3150 g). RESULTS: The authors observed a tendency for the lower performance of the two groups with lower birth weights in listening comprehension and oral expression. The lower-weight group tended to perform poorly compared to the other groups vis-à-vis reading. In the global result of the SPT, worse performance was observed in the students in the first quartile compared to the others (p = 0.019). The multivariate analysis revealed no association between birth weight and results in the tests applied after adjusting for maternal schooling. CONCLUSIONS: Birth weight can interfere with oral and written language development. However, the determination of these processes occurs in the face of complex interaction that includes sociodemographic factors, especially family support and maternal schooling.

School and language performance in children born with low birth weight

Abstract Objectives To identify the impact of birth weight on the development of metalinguistic skills and performance in reading, writing, and arithmetic in students aged 6 to 10 years, enrolled from the 1st to the 4th grade of Elementary School in public schools of the metropolitan region of São Paulo. Methods The concurrent cohort included 315 students. Birth weight was the exposure variable, and the outcomes were performance in receptive and expressive language, oral metalinguistic skills, and performance in writing, arithmetic, and reading. The tools employed were the Test of Language Competence (TLC) and the School Performance Test (SPT). Students were grouped into quartiles by birth weight for data analysis (P1: < 2170 g, P2: from 2171 g to 2450 g, P3: from 2451 g to 3150 g, and P4: > 3150 g). Results The authors observed a tendency for the lower performance of the two groups with lower birth weights in listening comprehension and oral expression. The lower-weight group tended to perform poorly compared to the other groups vis-à-vis reading. In the global result of the SPT, worse performance was observed in the students in the first quartile compared to the others (p= 0.019). The multivariate analysis revealed no association between birth weight and results in the tests applied after adjusting for maternal schooling. Conclusions Birth weight can interfere with oral and written language development. However, the determination of these processes occurs in the face of complex interaction that includes sociodemographic factors, especially family support and maternal schooling.

Pontos de corte, sensibilidade e especificidade para rastreamento da fluência leitora em crianças / Cut-off point, sensitivity and specificity for screening the reading fluency in children

RESUMO Objetivo estabelecer pontos de corte para valores de velocidade e acurácia de leitura, a fim de obter valores mínimos para compreensão de textos, e permitir classificar alunos de 2º a 5º ano do Ensino Fundamental, de acordo com bom ou pobre desempenho em leitura. Método foram analisados ​​147 protocolos de avaliação de leitura oral e compreensão textual de escolares de 3º a 5º ano com e sem dificuldades de leitura. A taxa de leitura oral de texto e os valores de acurácia foram analisados. Curvas ROC foram construídas e a sensibilidade e a especificidade, calculadas para cada parâmetro de fluência de leitura por ano escolar. Resultados A sensibilidade e a especificidade para medidas de taxa e acurácia na leitura de texto foram calculadas para o 3º, 4º e 5º anos. A taxa e a precisão sob a curva ROC não diferiram estatisticamente. Os valores do 2º ano foram estimados matematicamente. Conclusão Foram identificados os valores de corte esperados para escolares do 2º ao 5º ano, com recomendações de utilização da taxa de leitura de texto oral para procedimentos de rastreamento da compreensão leitora.

ABSTRACT Purpose to establish cut-off point for reading speed and accuracy, to obtain minimum values for comprehending texts, and allow classifying students from 2nd to 5th grade of elementary school according to good or poor reading performance. Methods 147 assessment protocols for oral reading and text comprehension of students from 3rd to 5th grade of Elementary School with and without reading difficulties were analyzed. The oral text reading rate and accuracy values were analyzed. ROC curves were constructed, and sensitivity and specificity calculated for each reading fluency parameter, and each school grade. Results Sensitivity and specificity for measures of rate and accuracy in text reading were calculated for the 3rd, 4th, and 5th grades. Rate and precision under the ROC curve did not differ statistically. The values for the 2nd grade were mathematically estimated. Conclusion The cutoff values expected for students from 2nd to 3rd grade were identified, with recommendations for using the oral text reading rate for reading comprehension screening procedures

A simple score to predict early severe infections in patients with newly diagnosed multiple myeloma.

Infections remain a common complication in patients with multiple myeloma (MM) and are associated with morbidity and mortality. A risk score to predict the probability of early severe infection could help to identify the patients that would benefit from preventive measures. We undertook a post hoc analysis of infections in four clinical trials from the Spanish Myeloma Group, involving a total of 1347 patients (847 transplant candidates). Regarding the GEM2010 > 65 trial, antibiotic prophylaxis was mandatory, so we excluded it from the final analysis. The incidence of severe infection episodes within the first 6 months was 13.8%, and majority of the patients experiencing the first episode before 4 months (11.1%). 1.2% of patients died because of infections within the first 6 months (1% before 4 months). Variables associated with increased risk of severe infection in the first 4 months included serum albumin ≤30 g/L, ECOG > 1, male sex, and non-IgA type MM. A simple risk score with these variables facilitated the identification of three risk groups with different probabilities of severe infection within the first 4 months: low-risk (score 0-2) 8.2%; intermediate-risk (score 3) 19.2%; and high-risk (score 4) 28.3%. Patients with intermediate/high risk could be candidates for prophylactic antibiotic therapies.

Neuromodulation: A combined-therapy protocol for speech rehabilitation in a child with cerebral palsy.

INTRODUCTION: Transcranial direct current stimulation (tDCS) modulates cortical activity and potentiates functional gains achieved during therapeutic protocols. The aim of Integrative Speech Therapy Protocol is to rehabilitate speech in patients with impairments regarding neuropyschomotor development by combining oral motor stimuli, specific articulatory production, and the stimulation of phonological aspects of language. OBJECTIVE: Investigate the effect of transcranial direct current stimulation combined to integrative speech therapy in a child with cerebral palsy. METHODS: We performed a case study with tDCS and speech therapy in a patient with cerebral palsy and apraxia of speech. To assess the patient's speech, we used a parameterized test for the Brazilian Portuguese speech - ABFW. The CFCS and Vicking Speech Scales presented level IV and III, respectively. The patient underwent two periods with ten stimulation sessions each: first with anodal stimulation over Broca's area; and second over the left dorsolateral prefrontal cortex. Two indices were calculated: the percentage of consonants correct; and percentage of consonants correct-revised. Descriptive statistics were employed for the clinical data. For the outcomes, changes in each score were calculated as the difference in pre-intervention and post-intervention using Wilcoxon-Mann-Whitney test. RESULTS: Increases were found in percentage of correct consonants indices as well as to produce two-syllable and three-syllable words after both types of stimulation, characterized mainly by correct vowels that marked the presence of the syllable. Number of phonemes increased 0 to 4 at first the stimulation and 4 to 10 at the second. CONCLUSION: The combined-therapy program contributed to improve the speech rehabilitation results in a patient with cerebral palsy.

Programa de estimulação no ambiente educacional para aprimoramento de habilidades subjacentes à leitura / Stimulation program in an educational setting for improvement of skills underlying reading

RESUMO Objetivo elaborar e investigar o efeito de um programa de estimulação de habilidades cognitivo-linguísticas preditoras da decodificação leitora, orientado para a melhora das habilidades subjacentes à leitura. Métodos pesquisa prospectiva, de análise quantitativa. Participaram 124 crianças de 1º a 3º ano do Ensino Fundamental I de uma escola pública de São Paulo, distribuídas em: Grupo Pesquisa - 62 escolares que passaram por intervenção; Grupo Controle: 62 escolares que não receberam estimulação. Avaliaram-se individualmente (pré e pós-intervenção) parâmetros de fluência leitora (taxa e acurácia) em tarefa com palavras isoladas. O programa contou com tarefas destinadas a estimular a discriminação auditiva, conhecimento morfossintático, acesso fonológico ao léxico mental, consciência fonológica, conhecimento do código escrito, fluência leitora e o vocabulário visual de palavras e foi construído para aprimorar, em dez sessões de estimulação coletiva, a decodificação e reconhecimento automático de palavras. Resultados o Grupo Pesquisa apresentou maiores diferenças de acurácia e escore na leitura de palavras, quando comparados os resultados das avaliações pré e pós-intervenção com os do Grupo Controle. Conclusão: o programa promoveu a fluência leitora de escolares do 1º e 2º anos do Ensino Fundamental I. Incrementos significativos foram observados para a discriminação auditiva, consciência fonológica e automaticidade leitora, com variações em função do ano escolar.

ABSTRACT Purpose To develop and investigate the effect of a program that stimulates cognitive-linguistic skills predictive of phonological decoding skills aimed at improving of skills underlying reading. Methods The research design was a prospective cohort study with quantitative analysis. A total of 124 1st - 3rd grade children from a public Ensino Fundamental I school in São Paulo, participated in the study, divided into: Research Group - 62 students who underwent intervention; Control Group: 62 students who did not receive stimulation. Reading fluency parameters (rate and accuracy) were individually evaluated (pre- and post-intervention) in a task with isolated words. The program had tasks designed to stimulate auditory discrimination, morphosyntactic knowledge, phonological access to the mental lexicon, phonological awareness, knowledge of the written code, reading fluency and the visual vocabulary of words. It was built to improve decoding and automatic word recognition skills in ten sessions of collective stimulation. Results The Research Group showed greater differences in accuracy and score in word reading, when comparing the results of pre- and post-intervention assessments, than the Control Group. Conclusion The program promoted the reading fluency of 1st and 2nd grade students. Significant increments were observed for auditory discrimination, phonological awareness and reading automaticity with variations depending on the grade.

Reading Comprehension Tests for Children: Test Equating and Specific Age-Interval Reports.

Equating is used to directly compare alternate forms of tests. We describe the equating of two alternative forms of a reading comprehension test for Brazilian children (2nd to 5th grade), Form A (n = 427) and Form B (n = 321). We employed non-equivalent random groups design with internal anchor items. Local independence was attested via standardized residual Pearson's bivariate correlation. First, from 176 items, we selected 42 in each form (33 unique and 9 in common) using 2PL model, a one-dimensional item response theory (IRT) model. Using the equateIRT package for R, the anchor items were used to link both forms. Linking coefficients were estimated under two different methods (Haebara and Stocking-Lord), resulting in scores equating by two methods: observed score equating (OSE) and true score equating (TSE). We provided reference-specific age-intervals for the sample. The final version was informative for a wide range of theta abilities. We concluded that the forms could be used interchangeably.

Bilingualism and Rapid Automatized Naming: effects of language switching on lexical access and reading speed. / Bilinguismo e Nomeação Automática Rápida: efeitos da alternância de línguas sobre o acesso lexical e a velocidade de leitura.

PURPOSE: To assess whether bilingualism, on a language switching experiment, is associated with higher or lower accuracy and speed of the rapid automatized naming of objects and investigate the influence of language switching on reading speed. METHODS: The performance of 50 Brazilian bilingual children in the Rapid Automatized Naming Task, whose L1 was Brazilian Portuguese and who were exposed to English daily at school, was assessed. Forty-seven monolingual (Brazilian Portuguese) children were grouped according to age. RESULTS: Language switching interfered with the performance of the bilingual children in the Rapid Automatized Naming Task in terms of speed and accuracy. No correlations were found between the performance in the RAN task and Reading Speed. CONCLUSION: Brazilian bilingual students showed poor performance in the rapid naming task on the switch trial when compared to monolingual students, showing higher rates of mistakes, especially hesitations. Only the performance of bilingual students in the rapid naming task in L2 correlated with L1 reading speed.

OBJETIVO: Verificar se o bilinguismo, na condição de alternância de línguas, associa-se à maior ou menor velocidade e precisão na nomeação rápida de objetos e se essa condição se relaciona com a velocidade de leitura de texto. MÉTODO: Analisou-se o desempenho de 50 crianças bilíngues sequenciais brasileiras, cuja língua materna era o Português Brasileiro, expostas ao Inglês diariamente no ambiente escolar. O grupo monolíngue, composto por 47 crianças, foi agrupado de acordo com a faixa etária. Foram analisados desempenhos em tarefa de Nomeação Automática Rápida (RAN) e velocidade (palavras lidas por minuto) em prova de leitura oral de texto. RESULTADOS: Os resultados revelaram que a alternância de línguas se associou ao desempenho dos escolares bilíngues na prova de Nomeação Rápida no que diz respeito à velocidade e à precisão. Em condição de alternância de línguas, os escolares bilíngues despenderam mais tempo para nomear e cometeram mais erros. Somente se observou correlação entre o desempenho dos escolares bilíngues na prova de nomeação rápida em L2 e a taxa de leitura em L1. CONCLUSÃO: Escolares brasileiros bilíngues apresentaram pior desempenho em tarefa de nomeação rápida na situação de alternância de línguas quando comparados a escolares monolíngues, com maior número de erros, especialmente hesitações.

Trastornos persistentes de los sonidos del habla en niños con y sin alteraciones del lenguaje: características fonológicas y desempeño motor oral / Persistent speech sound disorders in children with and without language disorders: Phonological characteristics and oral motor performance

Objetivo: Identificar el desempeño motor oral y caracterizar el sistema fonológico de niños de enseñanza fundamental entre 8 a 12años de edad sin alteraciones de los sonidos del habla y/o del lenguaje oral y escrito, y de niños que presentan alteraciones del habla con o sin dificultades de lectura y escritura. Método: Participaron del estudio 79 niños de enseñanza fundamental, entre 8 y 12años, de escuelas públicas y del ambulatorio del Departamento de Fonoaudiología de la Unifesp. Se aplicó el protocolo de evaluación de ABFW (nominación) y, tras su análisis, los niños fueron divididos en tres grupos: GC (grupo de control) sin alteración del habla y del lenguaje escrito; GE1 (grupo de estudio1) con alteración del habla y sin alteración en la lectura y en la escritura, y GE2 (grupo de estudio2) con alteración del habla y de la lectura y escritura. Se calculó el índice PCC de los tres grupos. Las pruebas de diadococinesia, praxias y habilidades orales fueron aplicadas en todos los niños. Para la comparación del desempeño entre los grupos se utilizaron los test Kruskal-Wallis, con las comparaciones múltiples de Tukey, y el test Mann-Whitney. El nivel de relevancia de significación considerado fue de .05 (5%). Resultados: El test de nominación ABFW y el índice de PCC fueron semejantes para el GE1 y GE2. Las alteraciones más predominantes entre los dos grupos fueron un 65.78% de simplificación del encuentro consonántico, un 34.21% de simplificación de la consonante final y un 28.94% de simplificación de líquidas. El GE2 presentó el peor desempeño en las pruebas de diadococinesia. Las habilidades de praxia lingual presentaron el peor desempeño: el GC presentó un 11.36% de dificultades, mientras que el GE1 alcanzó un 41.17% y el GE2 un 57.14%. Conclusión: En los grupos GE1 y GE2 las alteraciones del habla predominantes fueron la simplificación del encuentro consonántico, simplificación de la consonante final y simplificación de las líquidas...(AU)

Objective: To identify oral motor performance skills and characterize the phonological system of primary school children aged between 8 and 12years without alterations in speech sounds and/or oral and written language, and in children who present speech changes with or without reading and writing difficulties. Method: The study included 79 elementary school children between 8 and 12years from public schools and the outpatient clinic of Unifesp's Department of Speech and Hearing Therapy. The ABFW evaluation protocol (naming) was applied and, after analysis, the children were divided into three groups: CG (control group) with no change in speech and written language, GE1 (research group1) with speech impairment and no change in reading and writing, and GE2 (research group2) with speech and reading and writing impairment. The PCC index of the three groups was calculated. Tests for diadochokinesia, praxis and oral skills were applied in all children. Kruskal-Wallis tests, with multiple comparisons of Tukey, and the Mann-Whitney test were used to compare the performance between the groups. The significance level considered was .05 (5%). Results: The ABFW naming test and the PCC index were similar for GE1 and GE2, although GE2 showed 5 children with mild and 1 with moderately severe speech impairment. The others presented only mild alterations. The most predominant alterations between the two groups were 65.78% simplification of the consonant encounter, 34.21% simplification of the final consonant and 28.94% liquid simplification. The GE2 presented the worst performance in the diadochokinesis tests. Lingual praxia abilities showed the worst performance, with the CG presenting 11.36% of difficulties, while GE1 presented 41.17% and GE2 57.14%. Conclusion: In groups GE1 and GE2, the predominant speech changes were simplification of the consonant encounter, simplification of the final consonant and liquid simplification...(AU)

Bilinguismo e Nomeação Automática Rápida: efeitos da alternância de línguas sobre o acesso lexical e a velocidade de leitura / Bilingualism and Rapid Automatized Naming: effects of language switching on lexical access and reading speed

RESUMO Objetivo Verificar se o bilinguismo, na condição de alternância de línguas, associa-se à maior ou menor velocidade e precisão na nomeação rápida de objetos e se essa condição se relaciona com a velocidade de leitura de texto. Método Analisou-se o desempenho de 50 crianças bilíngues sequenciais brasileiras, cuja língua materna era o Português Brasileiro, expostas ao Inglês diariamente no ambiente escolar. O grupo monolíngue, composto por 47 crianças, foi agrupado de acordo com a faixa etária. Foram analisados desempenhos em tarefa de Nomeação Automática Rápida (RAN) e velocidade (palavras lidas por minuto) em prova de leitura oral de texto. Resultados Os resultados revelaram que a alternância de línguas se associou ao desempenho dos escolares bilíngues na prova de Nomeação Rápida no que diz respeito à velocidade e à precisão. Em condição de alternância de línguas, os escolares bilíngues despenderam mais tempo para nomear e cometeram mais erros. Somente se observou correlação entre o desempenho dos escolares bilíngues na prova de nomeação rápida em L2 e a taxa de leitura em L1. Conclusão Escolares brasileiros bilíngues apresentaram pior desempenho em tarefa de nomeação rápida na situação de alternância de línguas quando comparados a escolares monolíngues, com maior número de erros, especialmente hesitações.

ABSTRACT Purpose To assess whether bilingualism, on a language switching experiment, is associated with higher or lower accuracy and speed of the rapid automatized naming of objects and investigate the influence of language switching on reading speed. Methods The performance of 50 Brazilian bilingual children in the Rapid Automatized Naming Task, whose L1 was Brazilian Portuguese and who were exposed to English daily at school, was assessed. Forty-seven monolingual (Brazilian Portuguese) children were grouped according to age. Results Language switching interfered with the performance of the bilingual children in the Rapid Automatized Naming Task in terms of speed and accuracy. No correlations were found between the performance in the RAN task and Reading Speed. Conclusion Brazilian bilingual students showed poor performance in the rapid naming task on the switch trial when compared to monolingual students, showing higher rates of mistakes, especially hesitations. Only the performance of bilingual students in the rapid naming task in L2 correlated with L1 reading speed.

Fístula ilioureteral por stent ureteral en paciente con reconstrucción del tracto urinario tipo bricker / Ilioureteral fistula caused by ureteral stent in a patient with a bricker unirary diversion

No disponible

Manejo y uso de medicamentos por catéter venoso central a pacientes en estado crítico / Management and use of medicines by central venous catheter to critically ill patients

Introducción: el manejo y uso de medicamentos es un sistema crítico en la seguridad del paciente, para proporcionar una farmacoterapéutica segura. Objetivo: describir el manejo y uso de medicamentos por catéter venoso central a pacientes en estado crítico. Material y métodos: estudio descriptivo y transversal. La Muestra fue no probabilística, de 70 pacientes adultos en estado crítico, para evaluar el manejo y uso de medicamentos por catéter venoso central, en terapia intensiva, hospitalización y urgencias. Se realizó observación directa con una guía basada en 3 rubros y se analizaron los datos con el paquete estadístico SPSS versión 22. Resultados: se evaluó el manejo y empleo de los medicamentos con cumplimiento de 98.7%, en cuanto a la utilización de lúmenes del catéter venoso central, se identificó cumplimiento adecuado 92%, encontrando el uso de lumen distal y proximal con infusiones invertidas; asimismo, el indicador de calidad presentó 82%, con omisiones en etiquetado de medicinas intermitentes, fechas en equipos de infusión y llaves de 3 vías. La calidad técnica en el manejo y uso de medicamentos por catéter venoso central fue: inadecuada 40%, regular 34.3% y adecuada 25.7%. Conclusión: conforme a los resultados de calidad se debe capacitar e impulsar la mejora a partir de estandarizar el uso de lúmenes para ministrar medicamentos, reforzar el etiquetado de fármacos intermitentes y rotulación de fechas, ya que impacta en el sistema de seguridad del paciente.

Reading comprehension assessment: effect of order of task application.

PURPOSE: To investigate the influence of order of reading tasks application on the reading comprehension performance by students with and without reading difficulties. METHODS: 40 students (4th and 5th grade) were classified according to the presence (Research Group-RG) or absence (Control Group-CG) of reading difficulties. RG-r and CG-r - 20 students (10 for each group) who retold the read text and responded to open-ended questions; RG-q and CG-q - 20 students (10 for each group) who responded to open-ended questions and then retold the read text. The analysis quantified the main idea, details and inferences retold, causal links and retelling reference standard (3-0) was also established from the best to the worst performance. Open-ended questions received one point for each correct answer. RESULTS: Open-ended questions influenced only the retelling performance of good readers. A better performance of CG-q was noted for the number of second level links retold (U=50.50, p=0.155), total of links retold (U=23,00, p=0.038) and retelling reference standard (U=24.50, p=0.039). Reading-monitoring strategies are laborious and tend to be less used by students with reading difficulties. This is because these compete directly with low-level skills (decoding and microstructure processing), losing efficiency or being abandoned in the very course of reading. CONCLUSION: There was improvement on the retelling performance of students without reading difficulties when this task was preceded by the open-ended questions, possibly because of the use of monitoring strategies that allowed a better understanding of the link between the retained ideas, improving links and retelling reference standard.

Consistência interna e fatores latentes na variabilidade da competência sintática no ensino fundamental I / Internal consistency and latent factors in the variability of syntactic competence in elementary school students

RESUMO Objetivo Apresentar o estudo de consistência interna e de fatores latentes responsáveis pela variabilidade de respostas a uma tarefa de avaliação de competências sintáticas, aplicada em crianças escolares do 2º ciclo do ensino fundamental I. Métodos Elaborou-se uma prova de complementação oral de sentenças, a partir de 30 orações subordinadas adverbiais. Participaram 113 escolares típicos (55,7% sexo feminino), entre 9 anos e 11 anos e 1 mês (média de idade = 9,5; desvio padrão = 0,6), matriculados no 4º (59,3%) e 5º (40,7%) anos do ensino fundamental da rede pública. Foram avaliados quanto à discriminação e processamento auditivo, memória fonológica, vocabulário expressivo e complementação oral de sentenças. Três juízes (dois fonoaudiólogos e um linguista) avaliaram 3390 respostas. Analisou-se por coeficiente Kappa de Fleiss (α=0,6), coeficiente de Alpha de Cronbach (α=0,4) e realizou-se análise fatorial com coeficiente Phi (α=0,7), com método de componentes principais. Resultados A concordância entre os três juízes mostrou k=0,61<x>1 para 6 itens. A análise dos dois fonoaudiólogos mostrou concordância perfeita para 2 itens e k=0,69<x>0,89 para 23 itens. Na análise da consistência interna, as categorias condicional e final mostraram α=0,43 e α=0,47, respectivamente. As demais categorias não mostraram consistência. Dos 13 fatores latentes identificados, apenas 1 mostrou ser responsável (12%) pela variância total de respostas. Conclusão A concordância entre juízes fonoaudiólogos foi substancial, os itens de teste não se mostraram correlacionados dentro da mesma categoria gramatical. O uso do modo subjuntivo na resposta complementar à oração principal parece ser um fator latente, condutor da variabilidade de resposta dos escolares.

ABSTRACT Purpose Present a study on the internal consistency and latent factors that promote response variability in an assessment task of syntactic competence applied to Elementary School students. Methods An oral sentence complementation task containing 30 main adverbial subordinate clauses was prepared. Participants were 113 students with typical development (55.7% girls), aged 9 years to 11 years and 1 month (M=9.5; SD=0.6), regularly enrolled in the 4th (59.3%) and 5th (40.7%) grades of a public Elementary School. The schoolchildren were evaluated with respect to auditory discrimination and processing (simplified assessment), phonological short-term and working memory, expressive vocabulary, and oral sentence complementation. Data were analyzed using the Fleiss' Kappa (α=0.6) and Cronbach's Alpha (α=0.4) coefficients. Phi coefficient (α=0.7) factor analysis with the principal components method was also performed. Results Inter-rater concordance between the three judges was α=0.61<x>1 for six clauses. Concordance between the two speech-language pathologists was perfect for two clauses and k=0.69<x>0.89 for 23 clauses. In the internal consistency analysis, the condition and purpose subordinate clause categories showed α=0.43 and α=0.47, respectively. Of the 13 latent factors identified, only one (12%) promoted total response variance. Conclusion Inter-rater concordance between the speech-language pathologists was significant, task items were not correlated within the same grammatical category, and the use of the subjunctive mood in the complementation response to the main clause seems to be a latent factor promoting the response variability of students.

Reading comprehension assessment: effect of order of task application / Avaliação da compreensão leitora: efeito da ordem de aplicação das tarefas

ABSTRACT Purpose To investigate the influence of order of reading tasks application on the reading comprehension performance by students with and without reading difficulties. Methods 40 students (4th and 5th grade) were classified according to the presence (Research Group-RG) or absence (Control Group-CG) of reading difficulties. RG-r and CG-r - 20 students (10 for each group) who retold the read text and responded to open-ended questions; RG-q and CG-q - 20 students (10 for each group) who responded to open-ended questions and then retold the read text. The analysis quantified the main idea, details and inferences retold, causal links and retelling reference standard (3-0) was also established from the best to the worst performance. Open-ended questions received one point for each correct answer. Results Open-ended questions influenced only the retelling performance of good readers. A better performance of CG-q was noted for the number of second level links retold (U=50.50, p=0.155), total of links retold (U=23,00, p=0.038) and retelling reference standard (U=24.50, p=0.039). Reading-monitoring strategies are laborious and tend to be less used by students with reading difficulties. This is because these compete directly with low-level skills (decoding and microstructure processing), losing efficiency or being abandoned in the very course of reading. Conclusion There was improvement on the retelling performance of students without reading difficulties when this task was preceded by the open-ended questions, possibly because of the use of monitoring strategies that allowed a better understanding of the link between the retained ideas, improving links and retelling reference standard.

RESUMO Objetivo Estudar a influência da resposta a questões sobre o desempenho na tarefa de reconto após leitura realizada por escolares com e sem dificuldades de leitura. Método Foram agrupados 40 escolares do 4º e 5º ano do Ensino Fundamental segundo a presença (Grupo Pesquisa-GP) ou ausência (Grupo Controle-GC) de alteração na compreensão leitora: GP-r e GC-r - 20 escolares (10 de cada grupo) que responderam a questões abertas e depois recontaram oralmente o texto lido. A análise quantificou no reconto: total de ideias centrais, detalhe e inferências; enlaces e classificou o padrão de compreensão leitora (3-0) do melhor para o pior desempenho. As questões abertas computaram um ponto para cada acerto. Resultados Questões abertas favoreceram apenas o desempenho de bons leitores no reconto. Melhor desempenho foi identificado para GC-r quando considerados os enlaces de segundo nível (U=50.50, p=0.155); total de enlaces (U=23.00, p=0.038) e de padrão do reconto (U=24.50, p=0.039). Estratégias de monitoramento de leitura são laboriosas e tendem a ser menos utilizadas por escolares com dificuldades de leitura. Isso porque essas estratégias competem diretamente com as habilidades de baixa ordem na leitura (decodificação e processamento da microestrutura). Conclusão O desempenho de escolares sem queixas em tarefa de reconto após leitura melhorou quando precedida por respostas a questões abertas, possivelmente por causa das estratégias de automonitoramento da compreensão, que permitiram melhor entendimento das relações entre as ideias retidas.

Efeito da simplificação sintática sobre a compreensão de leitura de crianças do ensino fundamental / Effects of syntactic simplification on reading comprehension of Elementary School students

RESUMO Objetivo Investigar o efeito da estratégia de simplificação sintática de textos sobre o desempenho em compreensão leitora de escolares de 20 a 40 ano do ensino fundamental. Métodos Estudo transversal, analítico, caso controle. Participaram 112 escolares do ensino público, do 20 ao 40 ano escolar. Os participantes foram distribuídos em Grupo TO - expostos ao texto expositivo original e Grupo TS - expostos ao texto simplificado. Os grupos foram pareados segundo acurácia e não diferiram quanto à capacidade de compreensão leitora. O texto original foi submetido às seguintes modificações sintáticas: divisão de sentenças complexas, simplificação de marcadores discursivos, supressão de voz ativa e anáforas, inversão na ordem de cláusulas, com deslocamento da sentença principal para o início e utilização exclusiva da ordenação sujeito-verbo-objeto. Para atestar a simplificação, utilizou-se a ferramenta computadorizada CohMetrix-Port. A análise da compreensão por meio dos recontos dos textos lidos computou o total de ideias (centrais, detalhes) e de enlaces recontados. Resultados A análise comparativa dos grupos identificou diferenças quanto ao total de ideias centrais (U=1029,5, p=0,001), de detalhe (U=599,5, p=0,000) e total de ideias recontadas (U=1247,5, p=0,041), com melhor desempenho para o Grupo TS. A análise da escolaridade mostrou que o 30 e o 40 ano mais se beneficiaram da simplificação sintática. Conclusão A simplificação dos textos, atestada pelos parâmetros do CohMetrix-Port, produziu efeitos de facilitação sobre o processamento microestrutural do texto de escolares do 30 e 40 anos do ensino fundamental, promovendo maior retenção das ideias.

ABSTRACT Purpose To investigate the effects of Syntactic text simplification on the reading comprehension performance of Elementary School students. Methods Cross-sectional, analytical, case-control study. Study participants were 112 students regularly enrolled in the 2nd-4th grades of public Elementary Schools. Participants were divided into two groups: Group OT - students exposed to the original expository text and Group ST - students exposed to the simplified expository text. The groups were matched for accuracy and did not differ with respect to reading comprehension capacity. The simplified text was obtained by submitting the original text to the following syntactic modifications: separation of complex sentences, simplification of discursive markers, suppression of active voice and anaphora, inversion of clause order with displacement of the main clause to the beginning of the sentence, and exclusive use of the subject-verb-object order. Text simplification was verified using the Coh-Metrix-Port computational tool. Comprehension analysis through retell of the texts read determined the total of ideas (central and detailed) and retold links. Results Comparative analysis of the groups identified differences between the total of central, detailed and retold ideas, with the best performance observed in the Group ST. Students from 3rd and 4th grades benefitted the most from syntactic simplification. Conclusion Text syntactic simplification, verified by the Coh-Metrix-Port parameters, facilitated the micro-structural text processing of 3rd and 4th grade students, promoting greater retention of ideas.

Noun phrase dictation as a writing assessment instrument: a psychometric analysis. / Ditado de sintagmas nominais para avaliação da escrita: análise psicométrica.

Purpose Prepare a list of noun phrases able to characterize the writing performance of schoolchildren according to school year. Methods A list of 25 noun phrases intended for dictation was prepared and applied to 275 Elementary School students (2nd to 5thgrades). The unidimensionality underlying the proposed items was analyzed using Item Response Theory. Results The list enabled differentiation between the performance of schoolchildren attending the 2nd and 3rd years and that of students attending the 4 th and 5th years. Items on the list presented moderate difficulty level and medium discrimination capacity. Conclusion The model showed good fit and was able to differentiate the performance of 2nd to 3rd grade students from that of 4th to 5thgrade students. The list of noun phrases assessed writing in 4th to 5th grade students more accurately.

Speech perception task with pseudowords. / Tarefa de discriminação de fala com pseudopalavras.

Purpose Prepare a list of pseudowords in Brazilian Portuguese to assess the auditory discrimination ability of schoolchildren and investigate the internal consistency of test items and the effect of school grade on discrimination performance. Methods Study participants were 60 schoolchildren (60% female) enrolled in the 3rd (n=14), 4th (n=24) and 5th (n=22) grades of an elementary school in the city of Sao Paulo, Brazil, aged between eight years and two months and 11 years and eight months (99 to 136 months; mean=120.05; SD=10.26), with average school performance score of 7.21 (minimum 5.0; maximum 10; SD=1.23). Forty-eight minimal pairs of Brazilian Portuguese pseudowords distinguished by a single phoneme were prepared. The participants' responses (whether the elements of the pairs were the same or different) were noted and analyzed. The data were analyzed using the Cronbach's Alpha Coefficient, Spearman's Correlation Coefficient, and Bonferroni Post-hoc Test at significance level of 0.05. Results Internal consistency analysis indicated the deletion of 20 pairs. The 28 items with results showed good internal consistency (α=0.84). The maximum and minimum scores of correct discrimination responses were 34 and 16, respectively (mean=30.79; SD=3.68). No correlation was observed between age, school performance, and discrimination performance, and no difference between school grades was found. Conclusion Most of the items proposed for assessing the auditory discrimination of speech sounds showed good internal consistency in relation to the task. Age and school grade did not improve the auditory discrimination of speech sounds.