Saberes da equipe de enfermagem sobre cuidados com cateter venoso central / Knowledge of the nursing team on care with central venous catheter

Objetivo: avaliar o conhecimento da equipe de enfermagem sobre as boas práticas de manutenção e curativo de cateter venoso central (CVC) em conformidade com o protocolo institucional. Método: estudo quantitativo, descritivo, exploratório, transversal, realizado com 107 profissionais da equipe de enfermagem nas unidades de internação clínica, terapia intensiva adulto e de transplante. A coleta de dados foi realizada por meio da aplicação de um questionário estruturado. O conhecimento do profissional foi classificado como suficiente quando ≥9 acertos (≥75%) e insuficiente quando ≤8 acertos. Resultados: dos participantes, 56%obtiveram abaixo de 75% de acertos, caracterizando conhecimento deficiente. Os profissionais enfermeiros obtiveram maior número de acertos quando comparados aos técnicos de enfermagem. Conclusão: o estudo evidenciou o desconhecimento dos profissionais sobre o correto manuseio do CVC. Desenvolver estratégias de educação permanente pode sensibilizar enfermeiros e técnicos de enfermagem e promover a adesão às boas práticas de manutenção e curativo desse dispositivo.

Comparison of high versus low-medium prednisone doses for the treatment of systemic lupus erythematosus patients with high activity at diagnosis.

OBJECTIVE: To compare the efficacy and safety of high vs. low-moderate oral doses of prednisone to treat patients with highly active lupus at diagnosis. PATIENTS AND METHODS: Patients from the Lupus-Cruces cohort with an SLEDAI score ≥6 at diagnosis and treated with regimes containing low-medium prednisone doses (≤30 mg/day) were identified (group M). They were matched by sex and SLEDAI score with historical patients treated with high doses (>30 mg/day) at diagnosis (group H). Patients with proliferative nephritis were excluded. The difference in SLEDAI scores between baseline (SLEDAI-0) and year one (SLEDAI-1) was the efficacy variable. Damage at 5 years was calculated using the SLICC damage index (SDI) and regarded as the safety variable. Glucocorticoid related damage was considered in the presence of cataracts, osteonecrosis, osteoporotic fractures and/or diabetes mellitus. RESULTS: 30 patients were included in each group. Patients in group H received 5-fold higher doses of prednisone, less hydroxychloroquine and less methyl-prednisolone pulses. SLEDAI improvement was similar in both groups. Patients in group H were more likely to accrue new damage (adjusted HR 3.85 (95% CI 1.03-14.2)). No patients in group M suffered glucocorticoid-related damage, vs. 5 patients in group H (p=0.02). The average daily prednisone dose during the first year predicted accrual of new damage (adjusted HR 1.03, 95% CI 1.0-1.07, p=0.056) and accrual of glucocorticoid-related damage (adjusted HR 1.06, 95% CI 1.01-1.13, p=0.03). Likewise, average doses of prednisone >7.5mg/day were an independent predictor of new damage (adjusted HR 4.8, 95% CI 1.2-19.1). CONCLUSION: Prednisone doses ≤30 mg/day are similarly effective and safer than higher doses for treating active lupus.

Endometriosis and Ascites: A Strategy to Achieve Pregnancy.

Deep endometriosis presenting with ascites and preserved fertility is an unusual combination. This report describes a unique case of deep endometriosis and primary infertility, with a successful pregnancy after an optimal surgical approach and personalized ovarian stimulation protocol for in vitro fertilization, which shows the importance of a multidisciplinary approach in these patients.