Prevalence of low calf circumference in hospitalized patients classified by raw or body mass index-adjusted values.

BACKGROUND: Adiposity can influence the estimation of muscle mass using calf circumference (CC) and underestimate the frequency of low CC. An adjustment for CC using body mass index (BMI) was proposed to reduce this effect. We aimed to compare the low CC frequency in hospitalized patients when considering raw and BMI-adjusted values and explore data by sex, age, and race (white and non-white). METHODS: Secondary analysis from two cohort studies conducted with adult hospitalized patients using BMI and CC data collected in the first 72 h after hospital admission. We classified low CC by two approaches: (1) raw CC; (2) BMI-adjusted CC for patients with BMI ≥ 25. Cutoff values for low CC were ≤34 cm (men) and ≤33 cm (women). RESULTS: Among 1272 patients (54.1 ± 15.3 years old; 51.7% women; 82.1% White race), low CC frequency was 30.6% and low BMI-adjusted CC was 68.9%. For all elevated BMI categories, the low CC frequency was higher when considering BMI-adjusted values (P < 0.001). Low CC was more frequent (P < 0.001) in older adults (38.7% by raw; 79.1% by BMI-adjusted value) than in younger adults (27.6% by raw; 65.2% by BMI-adjusted value) and it was not associated with race. Low CC by raw values was more frequent in men than in women (35.0% versus 26.4%; P = 0.001), but did not differ between sexes when classified by BMI-adjusted values (70.7% versus 67.1%; P = 0.184). CONCLUSION: Low CC BMI adjusted was 2.2 times more frequent in comparison with raw CC values, and it was identified in >60% of patients with BMI ≥ 25.

In vitro activity of sanitizers against mono- and polymicrobial biofilms of C. parapsilosis and S. aureus.

The emergence of disinfectant-resistant microorganisms poses a significant threat to public health. These resilient pathogens can survive and thrive in hospital settings despite routine disinfection practices, leading to persistent infections and the potential for outbreaks. In this study, we investigated the impact of 11 different commercial sanitizers at various concentrations and exposure times on biofilms consisting of clinical and nosocomial environmental isolates of Candida parapsilosis and Staphylococcus aureus. Among the sanitizers tested, 0.5% and 2.0% chlorhexidine (CLX), 10% polyvinyl pyrrolidone (PVP-I), a disinfectant based on quaternary ammonium compound (QAC), 2% glutaraldehyde, and 0.55% orthophthalaldehyde (OPA) demonstrated efficacy against both C. parapsilosis and S. aureus in monospecies and mixed biofilms. Analysis showed that 0.5% CLX and 10% PVP-I had fungicidal and bactericidal activity against all biofilms. However, the sanitizer based on QAC and 0.55% OPA proved to be bacteriostatic and fungicidal against both monospecies and mixed biofilms. In mixed biofilms, despite the last four sanitizers exerting fungicidal action, the reduction of fungal cells was approximately 4 log10 CFU/mL compared to monospecies biofilms, showing that the interaction provided more resistance of the yeast to the sanitizer. Formation of mixed biofilms in hospital settings can create an ecological niche that enhances the survival of pathogens against routine sanitization procedures. Therefore, effective sanitization practices, including regular cleaning with effective sanitizers, should be implemented to prevent C. parapsilosis/S. aureus biofilm formation in healthcare settings.

Economic impact of pharmaceutical interventions in a medium complexity Brazilian university hospital

Abstract Clinical pharmacists have been increasing their participation mainly through actions aimed at patient care, with international studies demonstrating favorable cost-benefit ratio from pharmacists interventions. However, there are few studies carried out in Brazil about the subject. This study aims to assess the economic impact of pharmaceutical interventions (PIs) in a hospital setting performed in October 2018. Each performed PI was registered and associated with the direct cost of drugs for economic impact analysis. A total of 185 PIs were evaluated, comprising 106 patients. The most intervened drugs were antibiotics, presenting the greatest economic impact, R$2,370. The total economic impact was R$2,578, mainly in the Pediatric Intensive Care Unit that represented R$1,701. Regarding the economic impact by PI as the "Suspension of drug without indication" saved R$1,360 while the "Inclusion of required drugs" cost R$807. It was estimated that the savings would be R$30,936 and, if PIs were performed at day zero, the savings would be R$79,728 per year. An average of 1.75 PI per patient was performed with an economic impact of R$14 per PI. Our results showed that clinical pharmacist's role in the evaluation of pharmacotherapy is important for patients' health and represents a positive economic impact.

Dynamic of High-Risk Acinetobacter baumannii Major Clones in a Brazilian Tertiary Hospital During a Short Time Period.

We characterized by whole-genome sequencing (WGS) six carbapenem-resistant Acinetobacter baumannii strains isolated from a Brazilian tertiary hospital during a 14-day period. The ISAba1-blaOXA-23 structure was found in the chromosome of five isolates, whereas blaOXA-72 was inserted in a 16.6-kb plasmid in two isolates. The presence of ISAba1-blaADC-like justified the high broad-spectrum cephalosporins minimal inhibitory concentrations (MICs) (MIC50, > 512 mg/L) verified in all isolates. Only minocycline (MIC50, ≤ 0.5 µg/mL), polymyxin B (MIC50, 0.5 µg/mL), and tigecycline (MIC50, 0.5 µg/mL) were in vitro active against such isolates. A diversity of other antimicrobial resistance determinants (aph(3')-VIa, aadA1, aac(3')-IIa, strA, strB, sul2, drfA1, mph(E), msr(E), tetB, and floR) was also observed, which may confer resistance to at last six distinct antimicrobial classes. Four distinct pulsed-field gel electrophoresis (PFGE) profiles were observed during the study period, which belonged to ST79/ST258 (n = 2; IC5), ST25/ST229 (n = 2; IC7), ST1 (n = 1; IC1), and ST162/ST235 (n = 1; IC4). Although the ST1 isolate that carried blaOXA-23 and blaOXA-72 was introduced in this hospital setting by a transferred patient, two clonally related ST79/ST258 isolates carrying either one of these carbapenemase encoding genes were recovered from two patients who were hospitalized within the same period of time in the same hospital unit. Finally, a good correlation between PFGE/MLST, blaOXA-51 variant, and single nucleotide polymorphisms was also observed. Here we demonstrated that distinct extensively drug-resistant A. baumannii clones can circulate in the same hospital setting during a short time period, illustrating a very complex epidemiological scenario for this priority pathogen.

A broad-spectrum beta-lactam-sparing stewardship program in a middle-income country public hospital: antibiotic use and expenditure outcomes and antimicrobial susceptibility profiles.

BACKGROUND: Antimicrobial stewardship programs are an efficient way to reduce inappropriate use of antimicrobials and costs; however, supporting data are scarce in middle-income countries. The aim of this study was to evaluate antibiotic use, bacterial susceptibility profiles, and the economic impact following implementation of a broad-spectrum beta-lactam-sparing antimicrobial stewardship program. METHODS: An interrupted time-series analysis was performed to evaluate antibiotic use and expenditure over a 24-month period (12 months before the antimicrobial stewardship program and in the 12 months after implementation of the antimicrobial stewardship program). Antibiotics were classified into one of two groups: beta-lactam antibiotics and beta-lactam-sparing antibiotics. We also compared the antimicrobial susceptibility profiles of key pathogens in each period. RESULTS: Beta-lactam antibiotics use decreased by 43.04 days of therapy/1000 patient-days (p=0.04) immediately following antimicrobial stewardship program implementation, whereas beta-lacta-sparing antibiotics use increased during the intervention period (slope change 6.17 days of therapy/1000 patient-days, p<0.001). Expenditure decreased by $2089.99 (p<0.001) immediately after intervention and was maintained at this level over the intervention period ($-38.45; p=0.24). We also observed that a greater proportion of pathogens were susceptible to cephalosporins and aminoglycosides after the antimicrobial stewardship program. CONCLUSIONS: The antimicrobial stewardship program significantly reduced the use of broad-spectrum beta-lactam-antibiotics associated with a decrease in expenditure and maintenance of the susceptibility profile in Gram-negative bacteria.

A broad-spectrum beta-lactam-sparing stewardship program in a middle-income country public hospital: antibiotic use and expenditure outcomes and antimicrobial susceptibility profiles

ABSTRACT Background: Antimicrobial stewardship programs are an efficient way to reduce inappropriate use of antimicrobials and costs; however, supporting data are scarce in middle-income countries. The aim of this study was to evaluate antibiotic use, bacterial susceptibility profiles, and the economic impact following implementation of a broad-spectrum beta-lactam-sparing antimicrobial stewardship program. Methods: An interrupted time-series analysis was performed to evaluate antibiotic use and expenditure over a 24-month period (12 months before the antimicrobial stewardship program and in the 12 months after implementation of the antimicrobial stewardship program). Antibiotics were classified into one of two groups: beta-lactam antibiotics and beta-lactam-sparing antibiotics. We also compared the antimicrobial susceptibility profiles of key pathogens in each period. Results: Beta-lactam antibiotics use decreased by 43.04 days of therapy/1000 patient-days (p = 0.04) immediately following antimicrobial stewardship program implementation, whereas beta-lacta-sparing antibiotics use increased during the intervention period (slope change 6.17 days of therapy/1000 patient-days, p < 0.001). Expenditure decreased by $2089.99 (p < 0.001) immediately after intervention and was maintained at this level over the intervention period ($−38.45; p = 0.24). We also observed that a greater proportion of pathogens were susceptible to cephalosporins and aminoglycosides after the antimicrobial stewardship program. Conclusions: The antimicrobial stewardship program significantly reduced the use of broad-spectrum beta-lactam-antibiotics associated with a decrease in expenditure and maintenance of the susceptibility profile in Gram-negative bacteria.

Feasibility Assessment of a New Surveillance Tool for Respiratory Protective Devices Used in U.S. Healthcare.

BACKGROUND: Respiratory protective devices (RPDs) are used for infection prevention in healthcare settings during routine patient care and public health emergencies. In recent years, healthcare systems have experienced shortages of RPDs during outbreaks of infectious diseases, in part due to a lack of information about their availability. New tools to track RPD inventories may improve accessibility during an emergency. Investigators at Vanderbilt University have identified four major themes that influence RPD use for infection prevention: hospital preparedness, responsiveness to airborne pathogens, potential exposure outcomes, and infection control practices related to respirator effectiveness. Based on these findings, an RPD surveillance tool (RST) was developed to collect and share near real-time data about RPD supplies in healthcare facilities. The objective of this study was to conduct a feasibility assessment of this RST. METHODS: The new online surveillance tool was implemented at four large, urban, acute care U.S. hospitals in January 2014; data was collected about RPD inventory, tracking systems, hospital characteristics, and utility of gathered information. RESULTS: The RST was implemented successfully and without difficulty at hospitals that had 78 to 90 percent occupancy rates. Participating hospitals reported that the RST (1) provided value for benchmarking their RPD supply, (2) promoted understanding about RPD accessibility among hospital systems engaged in infection control, and (3) served as a means to assess RPD program quality. CONCLUSION: Implementation of this newly developed RST is feasible and appears to have utility in U.S. hospitals for tracking and understanding RPD use for routine healthcare delivery and public health emergencies.

Do acolhimento ao encaminhamento: O atendimento às tentativas de suicídio nos contextos hospitalares / From reception to triage: Care of suicide attempts in hospital emergencies / De la recepción a derivación: Intentos de suicidio en las urgencias hospitalarias

Este estudo teve como objetivo investigar o acolhimento, o atendimento e os encaminhamentos feitos aos usuários atendidos por tentativa de suicídio, em duas urgências e duas emergências hospitalares de um município do Sul do Brasil. De caráter qualitativo, foram entrevistados 16 profissionais de saúde de nível superior, de diferentes categorias profissionais. Os resultados mostraram o predomínio do atendimento ao sexo feminino, as intoxicações como método mais frequente e o uso da tentativa de suicídio como forma de chamar a atenção. Ainda, evidenciou-se a existência de protocolos mínimos de atendimento, que, contudo, apresentam dificuldades nos encaminhamentos pós-alta para a rede de saúde. Ressalta-se, assim, a necessidade de capacitação dos profissionais para lidar com esta demanda bem como de melhor articulação do Sistema de Saúde e outras políticas para acolher os usuários após sua alta.

This study aimed to investigate the reception, care and referrals given to users attended for suicide attempts in two urgency and two emergency services of a city in the south of Brazil. Qualitatively, sixteen health professionals of higher education from different professional categories were interviewed. The results show the predominance of the female sex, intoxication as the most frequent method and the use of the attempted suicide as a way to call attention. The existence of minimum care protocols is perceived. There is, however, a difficulty in post-discharge referrals to other health services. Thus, it highlights the need of capacitation for professionals to deal with this demand and a better articulation between the Health System and other policies to receive users after discharge as well.

Este estudio tuvo como objetivo investigar la recepción, atención y derivación de usuários atendidos por intento de suicidio en dos servicios de emergencia y dos servicios de urgencias de un gran municipio del sur de Brasil. De caracter cualitativo, fueron encuestados dieciséis profesionales de salud de nivel superior, de categorias distintas. Los resultados muestran el predominio del sexo femenino, la intoxicación como método más frecuente y el intento de suicidio como una forma de llamar la atención. También pone de relieve la existencia de protocolos mínimos de atención, sin embargo, al post alta hay dificultades para las derivaciones a la red. Así, destaca la necesidad de capacitar a los profesionales para manejar esta demanda, así como articular mejor el sistema de salud y otras políticas para dar cabida a los usuarios al post alta.

Burnout e sua relação com o clima organizacional em funcionários de um hospital / Burnout and organizational climate relationships in hospital workers

INTRODUÇÃO: Em contextos em que os contatos interpessoais são intensos, os profissionais estão sujeitos a diversas situações de estresse. A síndrome de burnout advém do contato com estressores interpessoais crônicos provenientes do ambiente de trabalho, e seu desenvolvimento é influenciado por alguns aspectos, entre eles, os socioambientais. OBJETIVO: Entender como se dá a interação entre os sintomas da síndrome de burnout e algumas variáveis do clima organizacional no ambiente hospitalar. MÉTODOS: A amostra foi composta por 565 profissionais de um hospital do interior do estado de São Paulo. A idade variou de 18 a 63 anos, sendo 72,2% do sexo feminino. Os dados foram coletados no ambiente hospitalar,no período de outubro a dezembro de 2012, respeitando-se os devidos procedimentos éticos. Para a análise dos dados, foram realizadas as estatísticas descritivas, assim como teste t de Student e correlação de Pearson. RESULTADOS: Os resultados mostraram que o fator exaustão emocional do MBI-HSS teve correlações estatisticamente significativas e negativas com todas as dimensões da CLIMOR, sendo elas moderadas com os fatores comunicação, integração e satisfação (r=-0,45); desenvolvimento profissional e benefícios (r=-0,46); e pontuação total (r=-0,52). As correlações dos fatores despersonalização e realização profissional do MBIHSS foram de magnitudes baixas com todas as dimensões da CLIMOR. CONCLUSÃO: Os dados corroboram a relação entre o clima organizacional e alguns sintomas do burnout. Há necessidade de que novas pesquisas sejam realizadas com delineamento e análises estatísticas mais sofisticadas e, ainda, que tenham grupos equiparados de pessoas com e sem síndrome de burnout.

INTRODUCTION: In contexts in which interpersonal contactsare intense, professionals are subjected to various stresssituations. The burnout disorder comes from contact withchronic interpersonal stressors from the work environment andits development is influenced by some aspects, among them,the social and environmental factors. OBJECTIVE: To understand how is the interaction between the symptoms of burnout andsome variables of organizational climate in the hospital setting. METHOD: The sample consisted of 565 professionals from a hospital in the country region of the state of São Paulo. Theage ranged from 18 to 63, and 72.2% were female. Data were collected in the hospital setting, from 2012 October to 2012 December, following the ethical procedures. Data analysis consisted in descriptive and t-test and Pearson correlation. RESULTS: The results showed that emotional exhaustion factor of the MBI-HSS showed correlations statistically significant and negative with all dimensions of CLIMOR, which were moderatecorrelations with the factors communication, integration and satisfaction (r=-0,45); professional development and benefits (r=-0.46); and total score (r=-0.52). Correlations of factors depersonalization and personal accomplishment of the MBIHSS were low with all dimensions of the CLIMOR. CONCLUSION: The data corroborate the relationship between organizational climate and some symptoms of burnout. There is need forfurther research to be carried out with more sophisticated experimental design and statistical analyzes, and yet, using similar groups of people with and without burnout.

A promoção da saúde de crianças em espaço hospitalar: refletindo sobre a prática fisioterapêutica / Health promotion among children in a hospital setting: reflections on physiotherapy practice / La promoción de la salud de los niños en el espacio hospitalario: reflexión sobre la práctica fisioterapéutica

Analisa-se a inserção da promoção de saúde na prática do profissional fisioterapeuta em ações voltadas para a atenção à saúde integral da criança em um ambiente hospitalar. Estudo de foco qualitativo, baseado na perspectiva hermenêutica-dialética. Para coleta dos dados, utilizaram-se as técnicas de observação participante e entrevista semiestruturada, e análise a partir de princípios do método de interpretação de sentidos. O estudo foi realizado com fisioterapeutas do Instituto Nacional de Saúde da Mulher, Criança e Adolescente Fernandes Figueira. Três eixos temáticos sintetizam a discussão dos resultados: a criança como foco da fisioterapia; a promoção da saúde por parte da fisioterapia pediátrica em ambiente hospitalar; e desafios da fisioterapia para a promoção da saúde das crianças. Este estudo aponta para algumas peculiaridades da prática fisioterapêutica, destacando seus limites e possibilidades, voltada para a promoção da saúde...

It was analyzed the place of health promotion in professional physiotherapy practice in relation to actions aimed towards comprehensive child healthcare in hospital settings. This study had a qualitative focus based on a dialectical hermeneutic perspective. The techniques of participant observation and semi-structured interviews were used for data gathering. The principles of the method of interpretation of meanings were used in the analysis. The study was conducted among the physiotherapists at the “Fernandes Figueira” National Institute of Women’s, Children’s and Adolescents’ Health. The discussion on the results was summarized into three thematic strands: children as the focus of physiotherapy; health promotion within the pediatric physiotherapy sector in the hospital setting; and challenges of physiotherapy regarding health promotion among children. The study revealed some peculiarities of physiotherapy practice, emphasizing limits and possibilities with regard to health promotion...

Buscase analizar la inserción de la promoción de la salud en la práctica del fisioterapeuta en la atención para la salud total del niño en un ambiente hospitalario. Estudio fue basado en la hermenéutica-dialéctica. Se utilizaron técnica de observación participante y entrevista semi-estructurada y el análisis a partir de principios del método de interpretación de sentidos. El estudio se realizó con fisioterapeutas del Instituto Nacional de la Salud de la Mujer, del Niño y del Adolescente Fernandes Figueira. Tres ejes temáticos sintetizan la discusión: el niño como enfoque de la fisioterapia, la promoción de la salud por parte de la fisioterapia pediátrica en un ambiente hospitalario y desafíos de la fisioterapia para la promoción de la salud de los niños. Este estudio señala algunas peculiaridades de la práctica fisioterapéutica, destacando límites y posibilidades en la promoción de la salud...