Instrumentos de avaliação multidimensional aplicados ao cuidado de enfermagemda pessoa idosa hospitalizada / Multidimensional assessment instruments applied to nursing care for hospitalized elderly people

Objetivo: descrever os aspectos da avaliação multidimensional no cuidado de enfermagem para a pessoa idosa hospitalizada. Método: revisão integrativa, desenvolvida em seis etapas. Resultados: 55 artigos compuseram o corpus de análise, todos em inglês; sendo predominante: publicações na revista Biomedcentral Geriatrics (n=11); pesquisas realizadas em hospital (n=35); método quantitativo (n=31). Emergiram três conceitos de avaliação multidimensional (n=14): Avaliação Geriátrica, Avaliação Geriátrica Abrangente e Avaliação Multidimensional; e diversas escalas alinhadas a cuidados de enfermagem, destacando-se: avaliação da independência funcional (n=31); avaliação cognitiva (n=22); avaliação nutricional (n=16); fragilidade (n=13); aspectos psicossociais (n=11); comorbidade (n=8); delirium (n=6); riscos (n=3); medicamentos (n=2); anestesiologia (n=2); dor (n=2); lesão por pressão (n=2) e temáticas especificas. Conclusão: a avaliação multidimensional da pessoa idosa é estratégia para qualificação do cuidado e integralidade da assistência, podendo utilizar diversas escalas como ferramentas de avaliação clínica.(AU)

Objective: to describe the aspects of multidimensional assessment in nursing care for hospitalized elderly people. Method: integrative review, developed in six stages. Results: 55 articles made up the corpus of analysis, all in English; predominantly: publications in the journal Biomedcentral Geriatrics (n=11); research carried out in hospital (n=35); quantitative method (n=31). Three concepts of multidimensional assessment emerged (n=14): Geriatric Assessment, Comprehensive Geriatric Assessment and Multidimensional Assessment; and several scales aligned with nursing care, highlighting: assessment of functional independence (n=31); cognitive assessment (n=22); nutritional assessment (n=16); frailty (n=13); psychosocial aspects (n=11); comorbidity (n=8); delirium (n=6); risks (n=3); medications (n=2); anesthesiology (n=2); pain (n=2); pressure injury (n=2) and specific themes. Conclusion: Multidimensional assessment of the elderly is a strategy for improving care and providing comprehensive assistance, and various scales can be used as clinical assessment tools.(AU)

Objetivo: describir los aspectos de la evaluación multidimensional en los cuidados de enfermería a ancianos hospitalizados. Método: revisión integradora, desarrollada en seis etapas. Resultados: 55 artículos constituyeron el corpus de análisis, todos en inglés; predominaron: publicaciones en la revista Biomedcentral Geriatrics (n=11); investigación realizada en hospital (n=35); método cuantitativo (n=31). Surgieron tres conceptos de evaluación multidimensional (n=14): Valoración Geriátrica, Valoración Geriátrica Integral y Valoración Multidimensional; y varias escalas alineadas con los cuidados de enfermería, destacando: valoración de la independencia funcional (n=31); valoración cognitiva (n=22); valoración nutricional (n=16); fragilidad (n=13); aspectos psicosociales (n=11); comorbilidad (n=8); delirium (n=6); riesgos (n=3); medicación (n=2); anestesiología (n=2); dolor (n=2); lesiones por presión (n=2) y temas específicos. Conclusión: La evaluación multidimensional del anciano es una estrategia para cualificar los cuidados y proporcionar una asistencia integral, y varias escalas pueden utilizarse como instrumentos de evaluación clínica.(AU)

Impact of admitting department on the management of acute coronary syndrome after an out of hospital cardiac arrest.

AIM: This study aimed to analyze the influence of the hospital admitting department on adherence to the Guidelines of European Society of Cardiology for management of acute coronary syndromes in patients after out-of-hospital cardiac arrest (OHCA) of coronary etiology. METHODS: We studied retrospective-prospective register of 102 consecutive patients with OHCA as a manifestation of acute coronary syndrome (ACS). Patients were admitted to the coronary care unit (CCU) 52, general intensive care unit (GICU) 21, or GICU after initial Cath lab treatment (CAG-GICU) 29. This study compared the differences in the management of ACS in patients with OHCA of coronary etiology based on the admitting department in a tertiary care institution. RESULTS: Twelve of the 21 (57.1%) patients admitted to the GICU were evaluated as having ACS on-site where they experienced OHCA. In the CCU group, 50 out of 52 (96.2%) and 28 of 29 (100%) patients in the CAG-GICU group (P<0.001). Coronary angiography was performed in 10 of 21 patients (48%) admitted to the GICU. It was performed in 49 out of 52 (94%) CCU patients and, in the CAG-GICU group, 28 out of 29 patients. The mean time to CAG differed significantly across groups (that is, GICU 200.7 min., CCU 71.2 min., and CAG-GICU 7.5 min. (P<0.001)). Aspirin was used in 48% of GICU, 96% of CCU, and 79% of CAG-GICU patients (P<0.001), while in the pre-hospital phase, aspirin was used in 9.5% of GICU, 71.2% of CCU, and 50% of CAG-GICU patients (P<0.001). P2Y12 inhibitor prescriptions were lower in patients admitted to the GICU (33% vs. 89% CCU and 57% CAG-GICU, P<0.001). The department's choice significantly affected the time to initiation of antithrombotics, which was the longest in the GICU. CONCLUSION: The choice of admission department for patients with OHCA caused by ACS was found to affect the extent to which the recommended treatments were used. An examination of OHCA patients by a cardiologist upon admission to the hospital increased the likelihood of an early diagnosis of ACS as the cause of OHCA.

Marco legal de transparência na política estadual de regulação do sistema único de saúde - SUS, como ferramenta de otimização no complexo regulador do escritório regional de Peixoto de Azevedo / Legal framework for transparency in the state regulation policy of the single health system - SUS, as an optimization tool in the regulatory complex of the regional office of Peixoto de Azevedo

A transparência na Política Estadual de Regulação do Sistema Único de Saúde tem como marco legal o Decreto Estadual -MT, n° 670/2020, garantir acesso público de informações quanto à regulação do acesso e à taxa de ocupação hospitalar nas unidades hospitalares e UTIs credenciadas no Estado, bem como monitorar e organizar os pedidos de regulação ambulatorial e hospitalar solicitados pelos municípios, cujo serviços e atividades médicas são competências doEstado. Fragilidades recorrentes na regulação do acesso no atendimento do Hospital Regional de Peixoto de Azevedo, que é referência da região de Saúde do Vale do Peixoto, cuja missão é garantir a implantação/implementação das diretrizes do SUS.O projeto propõe minimizar possíveis fragilidades encontradas no processo regulação/agendamento de consultas/exames/procedimentos, utilizando-se como ferramenta principal o SISREG III. Objetivo:Estabelecer no âmbito do HRPAZ um mecanismo de melhorias na compreensão dos processos de transparência presentes na Política Estadual de Regulação do Sistema Único de Saúde.Metodologia: A metodologia utilizada na elaboração do projeto foi sistematizada em três principais eixos: 1. Identificação da oportunidade e relevância do tema; 2. Elaboração do diagnóstico utilizando a matriz 5W3H; 3. Análise e revisão de literatura com análise de artigos. Resultados:Na análise, torna-se necessário a adesão completa para garantir e melhorar a transparência nas atividades do setor de Regulação do ERS/PAZ, tendo a fragilidade e insegurança profissional como uma das principais causas a serem corrigidas. Conclusão. Os fatores limitantes da regulação demonstram que ferramentado projeto trouxe avanços quanto à integração da equipe, controle avaliação/regulação e divulgação da legislação, contudo, a problemática persiste e deverá ser um processo contínuo e sistemático na construção da resolutividade do acesso

Effect of holiday admission for acute aortic dissection on in-hospital mortality in Japan: A nationwide study.

BACKGROUND: Patients admitted on weekends have higher mortality than those admitted on weekdays. However, whether the "weekend effect" results in a higher mortality after admission for acute aortic dissection (AAD),-classified according to Stanford types-remains unclear. This study aimed to examine the association between admission day and in-hospital mortality in AAD Type A and B. METHODS: We used data from the Japanese registry of all Cardiac and Vascular Diseases Diagnostic Procedure Combination, a nationwide claim-based database with data from 953 certified hospitals, and enrolled in-patients with AAD admitted between April 1, 2012, and March 31, 2016. Based on the admission day, we stratified patients into groups (Weekdays, Saturdays, and Sundays/holidays). The influence of the admission day on in-hospital mortality was assessed via multi-level logistic regression analysis. We also performed a Stanford type-based stratified analysis. RESULTS: Among the included 25,641 patients, in-hospital mortality was 16.0%. The prevalence of patients admitted with AAD was relatively higher on weekdays. After adjustment for covariates, patients admitted on a Sunday/holiday showed an increased risk of in-hospital mortality (odds ratio [OR] 1.20; 95% confidence interval [CI] 1.07-1.33, p<0.001) than patients admitted on weekdays. Among patients admitted on a Sunday/holiday, only the subgroup of Stanford Type A showed a significantly increased risk of in-hospital mortality. (Stanford Type A, non-surgery vs. surgery groups: 95% CI 1.06-1.48 vs. 1.17-1.68, p<0.001 for both groups, OR 1.25 vs. 1.41, respectively, Stanford Type B, non-surgery vs. surgery groups: 95% CI 0.64-1.09 vs. 0.40-2.10; p = 0.182 vs. 0.846; OR 0.84 vs. 0.92). CONCLUSIONS: In conclusion, patients with AAD Type A admitted on a Sunday/holiday may have an increased in-hospital mortality risk.

Cenário epidemiológico da Covid-19 no estado do Rio de Janeiro Período de Análise: março/2020 a abril/2021 / Epidemiological scenario from Covid-19 in the state of Rio de Janeiro Analysis Period: March/2020 to April/2021

O Estado do Rio de Janeiro vem monitorando a evolução das variantes da Covid-19 por meio de três processos de seleção de amostras. O primeiro é o monitoramento realizado pelos municípios que notifica e solicita o sequenciamento, seguindo os critérios e fluxos descritos na Nota técnica da SES-RJ Nº 09/2021. O segundo faz parte da Vigilância Genômica organizada pelo Ministério da Saúde, onde três amostras aleatórias são enviadas pelo Lacen/RJ para FUNED/MG, de acordo com os critérios estabelecidos pela SVS/ FUNED. O terceiro é através de um estudo com financiamento da Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) que iniciou em março de 2021 e irá realizar a genotipagem de um total de 4.800 amostras nos próximos seis meses, sendo 400 a cada 15 dias. Por fim, a Secretaria de Estado de Saúde tem envidado esforços em ações de redução de risco, como a vacinação, ampliação de testagem, monitoramento genômico e promoção de saúde em todo o estado do Rio de Janeiro. E é recomendado manter as medidas de proteção à vida: como evitar aglomeração, usar de máscara, lavar as mãos e fazer higienização das mãos com álcool 70°.

Psiquiatria, segregação e punições: análises a partir de Michel Foucault / Psychiatry, segregation and punishments: analyzes from Michel Foucault

OBJETIVOS: Este artigo visa, por meio de um ensaio teórico, pensar relações entre Psiquiatria, espaços de segregação nos estudos de Foucault, a partir de cursos, conferências, entrevistas, aulas, livros e por meio de alguns comentadores de Michel Foucault, no Brasil. MÉTODOS: Analisar os espaços de controle dos corpos em hospitais e prisões fez parte dos objetivos deste texto, considerando uma análise conceitual como metodologia. As práticas punitivas e psiquiátricas são entrecruzadas nesta analítica sob o eixo das relações de poder e saber ligadas ao espaço. CONCLUSÕES PROVISÓRIAS: Problematizar este campo de uma história política da verdade, no presente, é um ponto de preocupação e ativação da escrita operatória deste artigo com análises teórico-conceituais com a interface da Psiquiatria com os espaços de segregação, internação e aprisionamento.

OBJECTIVES: This article aims, through a theoretical essay, to think about relations between Psychiatry, spaces of segregation in Foucault's studies, from courses, conferences, interviews, classes, books, and through some commentators by Michel Foucault, in Brazil. METHODS: Analyzing the control spaces of bodies in hospitals and prisons as part of the objectives of this text, considering a conceptual analysis as a methodology. Punitive and psychiatric practices are intertwined in this analysis under the axis of power and knowledge relations linked to space. PROVISIONAL CONCLUSIONS: To problematize this field of the political history of truth, at present, is a point of concern and activation of the operative writing of this article with theoreticalconceptual analyzes with the interface of Psychiatry with the spaces of segregation, hospitalization, and imprisonment.

Association between hospital admissions and healthcare provider communication for individuals with sickle cell disease.

Objective: To test the hypothesis that caregivers' or adult participants' low ratings of provider communication are associated with more hospital admissions among adults and children with sickle cell disease (SCD), respectively. Secondarily, we determined whether there was an association between the caregivers' or participants' health literacy and rating of providers' communication. Methods: Primary data were collected from participants through surveys between 2014 and 2016, across six sickle cell centers throughout the U.S. In this cross-sectional cohort study, 211 adults with SCD and 331 caregivers of children with SCD completed surveys evaluating provider communication using the Consumer Assessment of Healthcare Providers and Systems (CAHPS), healthcare utilization, health literacy, and other sociodemographic and behavioral variables. Analyses included descriptive statistics, bivariate analyses, and logistic regression. Results: Participants with better ratings of provider communication were less likely to be hospitalized (odds ratio (OR) = 0.54, 95% confidence interval (CI) = [0.35, 0.83]). Positive ratings of provider communication were associated with fewer readmissions for children (OR = 0.23, 95% CI = [0.09, 0.57]). Participants with better ratings of provider communication were less likely to rate their health literacy as lower (regression coefficient (B) = -0.28, 95% CI = [-0.46, -0.10]). Conclusions: Low ratings of provider communication were associated with more hospitalizations and readmissions in SCD, suggesting the need for interventions targeted at improving patient-provider communication which could decrease hospitalizations for this population.

Elderly Patients With Isolated Hip Fracture Requiring Surgical Intervention: Does Admitting Service Matter?

The American College of Surgeons requires trauma centers to track the number of injured patients admitted to a surgical service as well as nonsurgical admissions (NSAs) as a quality marker. We aim to compare the relationship between admitting service and outcomes in patients with isolated hip fracture (IHF). A 4-year retrospective cohort review of data collected from a single institution's trauma registry for adult patients with IHF was done. Patients were stratified into 2 groups based on admission to a surgical service versus NSA. Demographic and outcome variables including age, gender, Injury Severity Score (ISS), intensive care unit length of stay (ICU-LOS), deep venous thrombosis (DVT), and mortality rates were compared. Analysis of variance and χ test were used for data analysis with statistical significance defined as p < .05. A total of 629 patients with IHF were admitted. Of those, 30 (4.8%) were admitted to a surgical service and 599 (95.2%) were NSAs. Patients admitted to a surgical service were younger but average ISS was similar in both groups. Those admitted to a surgical service had a significantly shorter ICU-LOS than NSA patients (2.97 days vs. 4.91, p < .001). Readmission rate at 30 days (3.3% vs. 1.2%, p > .05) and DVT rates (0% vs. 0.4%, p > .05) were similar between groups. Mortality rates did not differ between groups (3.3% vs. 2.2%, p > .05). Patients with hip fracture requiring surgical intervention admitted to a trauma service have a shorter ICU-LOS than those admitted to nonsurgical services. Other quality markers were similar.

Derivaciones de profesionales de la salud al Equipo de Psicopedagogía del Hospital General Carlos G. Durand / Referrals from health professionals to the psychopedagogy team of the General Hospital Carlos G. Durand

Proyecto de investigación de residentes de tercer año de Psicopedagogia en el Hospital General de Agudos Carlos Durand, de la Ciudad de Buenos Aires, centrado en el espacio de admisión, y en las expectativas de sus profesionales, al indicar admisión al Servicio de Psicopedagogía, en el período 2017-2019.

Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital.

BACKGROUND: Intensive care is care for critically ill patients with potentially reversible conditions. Patient selection for intensive care should be based on potential benefit but since demand exceeds availability, rationing is needed. In Tanzania, the availability of Intensive Care Units (ICUs) is very limited and the practices for selecting patients for intensive care are not known. The aim of this study was to explore doctors' experiences and perceptions of ICU referral and admission processes in a university hospital in Tanzania. METHODS: We performed a qualitative study using semi-structured interviews with fifteen doctors involved in the recent care of critically ill patients in university hospital in Tanzania. Inductive conventional content analysis was applied for the analysis of interview notes to derive categories and sub-categories. RESULTS: Two main categories were identified, (i) difficulties with the identification of critically ill patients in the wards and (ii) a lack of structured triaging to the ICU. A lack of critical care knowledge and communication barriers were described as preventing identification of critically ill patients. Triaging to the ICU was affected by a lack of guidelines for admission, diverging ideas about ICU indications and contraindications, the lack of bed capacity in the ICU and non-medical factors such as a fear of repercussions. CONCLUSION: Critically ill patients may not be identified in general wards in a Tanzanian university hospital and the triaging process for the admission of patients to intensive care is convoluted and not explicit. The findings indicate a potential for improved patient selection that could optimize the use of scarce ICU resources, leading to better patient outcomes.

Whole-body computed tomography: a new point of view in a hospital check-up unit? Our experience in 6516 patients.

BACKGROUND: There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated. AIM: To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. MATERIALS AND METHODS: We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40 years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used. RESULTS: WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%). CONCLUSION: The most common WB-CT findings in asymptomatic subjects are benign. However, this examination allows identifying an important number of relevant and precocious findings that significantly increase with age, involving changes in lifestyle and precocious treatment.

Acute circulatory complications in people with diabetes mellitus type 2: How admission varies between urban and rural Victoria.

OBJECTIVE: To identify the extent to which rurality influences the admission and mortality rates for acute circulatory complications among people with type 2 diabetes mellitus. DESIGN: Retrospective study. SETTING: All Victorian hospitals. PARTICIPANTS: State-wide hospital admissions from 1 July 2010 to 30 June 2015 using the Victorian Admitted Episodes Dataset. Data included patients with type 2 diabetes mellitus and diagnosis of acute cardiovascular events, acute cerebrovascular haemorrhage or infarction, acute peripheral vascular events or hypertensive diseases. MAIN OUTCOME MEASURE: Rates of admission and mortality were calculated for local government areas and Department of Health regions. Regression analysis identified the influence between admission rates and various predictor variables. RESULTS: In total, 5785 emergency hospital admissions occurred during the study period, with the highest and lowest mortality and admission rates occurring in rural areas. Moderately high admission rates were identified in urban areas. Cardiovascular events far outnumbered other acute circulatory admissions. Regression analysis identified a number of significant socioeconomic variables, primarily for metropolitan residents. Socioeconomic disadvantage was the only significant factor in rural areas. CONCLUSION: Victorian admission and mortality rates for acute circulatory complications are greatest in rural areas; yet, there is considerable heterogeneity in the admission rates within both rural and metropolitan areas. Furthermore, socioeconomic status is more influential than remoteness in determining emergency admissions. Further research needs to investigate the particular variables that lead to poorer outcomes rurally, investigate socioeconomic disadvantage in rural areas and have greater emphasis on peripheral vascular disease prevention.

Enfermagem forense: homens vítimas de violências interpessoais e o cuidar/cuidados de Enfermagem / Forensic nursing: men victims of interpersonal violence and care/nursing care

O estudo defendeu a tese de que os homens vítimas de violências interpessoais admitidos no Cotidiano do Pronto-socorro apresentam necessidades forenses, porém, não são tecidas maneiras específicas de cuidar com base num saber/fazer de Enfermagem com perfil forense, capaz de fornecer vestígios ao sistema judiciário para que se obtenham as comprovações dos fatos dos quais a vítima se envolveu. Destacamos como objeto do estudo o Cuidar e os cuidados de Enfermagem Forense. As questões que nortearam o estudo foram: Quem são os homens vítimas de violências interpessoais atendidos no Pronto-socorro?; Quais são as tipologias das violências interpessoais sofridas pelos homens? Quais são os cuidados de Enfermagem com perfil forense realizados no Pronto-socorro aos homens vítimas de violências interpessoais? Quais são as possibilidades da implantação da prática da Enfermagem Forense no Pronto-socorro? Em face do exposto, estabeleceu-se como objetivos para o estudo: Caracterizar sociodemograficamente os homens vítimas de violências interpessoais que são atendidos no Pronto-socorro; identificar a tipologia das violências interpessoais sofridas por homens; analisar a tipologia de cuidados de Enfermagem com perfil forense realizados no Pronto-socorro a homens vítimas de violência interpessoais; discutir as implicações para a implantação da prática da Enfermagem Forense no Pronto-socorro; e elaborar uma aplicação para dispositivos móveis que permita a fotodocumentação e os registros de vestígios forenses por enfermeiros. Trata-se de um estudo dialético crítico com abordagem qualitativa. Os participantes foram os homens na faixa etária de 18 a 59 anos vítimas de violências interpessoais admitidos em um Pronto-socorro de um Hospital na região Centro Sul Fluminense no estado do Rio de Janeiro e 20 enfermeiras/os atuantes no cenário de estudo. A coleta de dados foi realizada em 4 etapas, a saber: 1a Etapa ­ realizou-se a apresentação do pesquisador para a equipe de enfermagem, seguida de orientação aos profissionais quanto aos objetivos do estudo e ao percurso metodológico estabelecido; posteriormente foi realizada a ambiência/descrição do cenário de estudo. 2a Etapa ­ procedeu-se a consulta aos livros de ocorrência do setor e boletim de atendimento médico com carimbo de ocorrência policial (OP), das fichas do Sistema de Informação de Agravos de Notificação (SINAN) e dados dos atendimentos contidos no Sistema TOTVS, referente ao recorte temporal de 01 de janeiro de 2015 a 31 de dezembro de 2017. A 3a etapa compreendeu a observação dos cuidados recebidos pelos homens vítimas de violências e a entrevista com eles. Na 4a etapa foi realizada a entrevista com a equipe de Enfermagem. Os dados foram analisados por meio do conteúdo das entrevistas com as/os enfermeiras/os e das entrevistas com os homens vítimas de violências interpessoais. Foi analisado o total de 413 fichas de registros de atendimentos de homens vítimas de violência, dos quais foram identificados 49% na faixa etária de 18-29 anos. Observou-se, quanto à cor, que 21,1% são brancos e 19,6% negros. Houve predomínio da ocorrência dos casos de violência durante os finais de semana sendo domingo o dia de maior pico e durante a noite de 20h às 23h:59min, o local de maior ocorrência foi a via pública. Quanto à tipologia das violências 95% foram do tipo físico, sendo que 62,5% utilizaram como meio de violência a força corporal/espancamento. Quanto à região do corpo, em 34,1% dos casos, foi a cabeça e pescoço. Sobre os agressores, 43% foram do sexo masculino, sendo 22,5% conhecidos. Percebe-se que muitos homens são vistos como agressores e pouco como vítimas, tornando invisíveis como sujeitos que necessitam de cuidados. No que tange ao ambiente, corpo e cuidados de Enfermagem Forense identificou-se que as salas dos Pronto-socorro não se apresentam de forma adequada para atender às necessidades forenses dos homens vítimas de violências interpessoais, pois podem ocorrer contaminação e, consequentemente, a deterioração dos vestígios biológicos, morfológicos, entomológicos, químicos, físicos e microvestígios. Quanto ao corpo da/o enfermeira/o identificou-se que é o instrumento do cuidado de Enfermagem Forense, sendo necessária a paramentação adequada para evitar contaminações; identificou-se reduzido número de enfermeiras/os para identificar as necessidades forenses dos homens e estabelecer o cuidar e os cuidados de Enfermagem Forense. Assim, percebeu- se a necessidade de capacitações para as/os enfermeiras/os realizarem com qualidade a coleta e a preservação de vestígios forenses. Identificou-se que a/o enfermeira/o realiza a tessitura de cuidar/cuidados de Enfermagem Forense aos homens vítimas de violências interpessoais por meio de 14 maneiras de cuidar/cuidados forenses a saber: admissional forense, registro forense, identificação forense, eletrônico forense, conexão forense, ambiente forense, acolher forense, de cadeia de custódia, dinâmico forense, margem social forense, multifaces forense, circadiano forense, alta forense e com o corpo morto forense. Identificou-se que a/o enfermeira/o precisa adotar um modelo integrado de cuidar/cuidados de Enfermagem Forense, compreendendo que o homem vítima de violência interpessoal apresenta necessidades forenses, sendo fundamental deter atenção para os aspectos micromoleculares e macromoleculares. Entendeu-se que o cuidado de Enfermagem Forense é dialético, pois envolve estabelecer o cuidar e os cuidados com maneiras diferenciadas às vítimas e ao perpetrador com base no saber- fazer com perfil forense.

This study defended the thesis that the men who are victims of interpersonal violence and who are admitted to the Emergency Room have forensic needs. However, there are no specific caring procedures grounded on forensic nursing expertise, which would be capable of providing the Judiciary with evidence, so as to obtain proof of the events in which the victim is involved. We highlight, as the object of this study, Forensic Nursing Caring and procedures. The questions that orientated the study are as follows: who are the male victims of interpersonal violence assisted at the Emergency Room?; what are the typologies of the interpersonal violence experienced by these men? What are the procedures realized at the Emergency Room regarding the male victims of interpersonal violence? What are the possibilities of implementing Forensic Nursing in the Emergency Room? In this scenario, the following study objectives have been established: to characterize sociodemographicallythe male victims of interpersonal violence who are admitted to the Emergency Room; to identify the typology of the interpersonal violence experienced by men; to analyze the typology of Forensic Nursing procedures conducted to male victims of interpersonal violence at the Emergency Room; to discuss the implications for implementing the practice of Forensic Nursing at the Emergency Room; and to elaborate a mobile device application that allows nurses to photo-document and record forensic evidence. This is a critical dialectic study of a qualitative approach. The participants of this study were men aging from 18 to 59 years old, who were victims of interpersonal violence and admitted to the Emergency Room in the Center-South Region of the state of Rio de Janeiro, and the 20 nurses working at the research context. Data collection was conducted in 4 stages, namely: 1st Stage ­ the researcher introduced himself to the nursing staff, and afterwardsprovided the professionals with guidance regarding the objectives of the study and the established methodological path. Subsequently, the ambience/description of the research context was carried out. 2nd Stage ­ the following documents were queried: the sector's incident reporting books and the medical report cards stamped as police reports (PR), the SINAN's (National Disease Notification System) files and data from the medical services contained in the TOTVS System, pertaining to the timeline between January 1, 2015 and December 31, 2017. The 3rd stage comprised the observation of the medical care received by the men who were victims of violence and interviews with them. In the 4th stage, an interview with the nursing staff was conducted. The data were analyzed by means of the content of the interviews with the nurses and of the interviews with the male victims of interpersonal violence. A total of 413 medical service files was analyzed, which pointed out that 49% of the males aged 18-29. It was observed that, as for their color/race, 21.1% are white and 19.6% are black. The cases of violence occurred predominantly at weekends, having a peak occurrence on Sundays from 20:00 to 23:59. The most common place was the public highway. As for the typology of the violence, 95% of the cases were physical, out of which 62.5% had physical strength/beating as their means of perpetration. Regarding body region, in 34.1% of the cases the head and neck were hit. Concerning the attackers, 43% were male, out of whom 22.5% were known to the victims. It is noticeable that many men are regarded mostly as attackers and seldom as victims, which render them invisible as subjects who need care. As for the Forensic Nursing environment, body and staff, it was possible to identify that the ER rooms were not adequate to meet the forensic needs of the male victims of interpersonal violence, since there can be contamination, and, consequently, deterioration of the biological, morphological, entomological, chemical and physical evidence and microevidence.Regarding the nurse's body, it was identified as the Forensic Nursing caring instrument, which makes sterile gowning necessary so as to avoid contamination. It was also identified that a reduced number of nurses carries out the identification of the males' forensic needs and performs the Forensic Nursing care and caring. Thus, this scenario made perceptible the need to train the nurses to conduct quality collection and preservation of forensic evidence. It was identified that the nurse performs the Forensic Nursing care/caring to the male victims of interpersonal violence by means of 14 forensic care/caring ways, namely: forensic admission, forensic record, forensic identification, forensic electronics, forensic connection, forensic environment, forensic accommodation, forensic chain of custody, forensic dynamics, forensic social margin, forensic multifaces, forensic circadian, forensic discharge and the forensic dead body. It was identified that the nurse must adopt an integrated model of Forensic Nursing care/caring, with an understanding that the male victim of interpersonal violence has forensic needs, which makes it fundamental to direct attention to the micromolecular and macromolecular aspects.It was understood that the Forensic Nursing care is dialectical, since it entails handling the caring and care differently to the victims and to the perpetrator, based on forensic expertise.

El estudio defendió la tesis de que los hombres víctimas de violencias interpersonales admitidos en el Cotidiano del Puesto de Primeros Auxilios presentan necesidades forenses, pero no hay formas específicas de atención basadas en los conocimientos de enfermería con perfil forense, capaces de ofrecer rastros al sistema judicial para que se obtengan evidencias de los hechos de la participación de la víctima. Destacamos como objeto del estudio el Cuidar y la Atención de la Enfermería Forense. Las preguntas que guiaron el estudio fueron: ¿Quiénes son los hombres víctimas de violencias interpersonales tratados en la Sala de Emergencias? ¿Cuáles son las tipologías de violencia interpersonal sufridas por estos hombres? ¿Cuáles son los cuidados de Enfermería con perfil forense llevados a cabo en la sala de emergencias a los hombres víctimas de violencias interpersonales? ¿Cuáles son las posibilidades de implementar la práctica de Enfermería Forense en la sala de emergencias? En vista de lo anterior, se establecieron los siguientes objetivos para el estudio: caracterizar sociodemográficamentea los hombres víctimas de violencias interpersonales que son tratados en la sala de emergencias; identificar la tipología de las violencias interpersonalessufridas por los hombres; analizar la tipología de cuidados de Enfermería con perfil forense realizados en salas de emergencias para hombres víctimas de violencias interpersonales; discutir las implicaciones para la implementación de la práctica de Enfermería Forense en la sala de emergencias; y diseñar una aplicación para dispositivos móviles que permita a las enfermeras documentar en fotos y registrar los rastros forenses. Se trata de un estudio dialéctico crítico con un enfoque cualitativo. Los participantes eran hombres de 18 a 59 años víctimas de violencias interpersonales, admitidos en una sala de emergencias de un hospital en la región del Centro Sur Fluminense, en el estado de Rio de Janeiro, y 20 enfermeros/as que trabajan en el escenario del estudio. La recopilación de datos se realizó en cuatro etapas: Paso 1: se realizó la presentación del investigador al equipo de enfermería, seguido de orientación a los profesionales sobre los objetivos del estudio y el curso metodológico establecido; posteriormente, se realizó la ambientación/descripción del escenario de estudio. Paso 2: se realizó la consulta a los libros de ocurrencia del sector y el boletínmédico con el sello de ocurrencias policiales (OP), los formularios del Sistema de Información de Agraves de Notificación (SINAN) y los datos de las asistencias contenidas en el Sistema TOTVS, refiriéndose al plazo del 1o de enero de 2015 al 31 de diciembre de 2017.El paso 3 consistió en la observación de la atención recibida por los hombres que fueron víctimas de violencias interpersonales y las entrevistas con ellos. En el Paso 4, se realizó la entrevista con el equipo de Enfermería. Los datos fueron analizados a través del contenido de entrevistas con enfermeros/as y de las entrevistas con hombres víctimas de violencias interpersonales. Un total de 413 registros de atención a hombres víctimas de violencia fue analizado, de los cuales se identificó el 49% en el grupo con edad entre 18 a 29 años. En cuanto al color, el 21,1% son blancos y el 19,6%, negros. Hubo un predominio de casos de violencia en los fines de semana, siendo el domingo el día con más ocurrencias durante la noche, de 20h a 23h59min, el lugar más frecuente fue la vía pública. Con respecto a la tipología de la violencia, el 95% eran físicas y el 62,5% usaban la fuerza corporal/golpes como un medio de violencia. En cuanto a la región del cuerpo, en el 34,1% de los casos, hubo predominio de la cabeza y el cuello. Sobre los agresores, el 43% eran hombres, siendo el 22,5% de personas conocidas de las víctimas.Se observa que muchos hombres son vistos como agresores y poco como víctimas, lo que los hace invisibles como sujetos que necesitan atención. Con respecto al medio ambiente, el cuerpo y el cuidado de la Enfermería Forense, se identificó que las habitaciones de la sala de emergencias no son adecuadas para satisfacer las necesidades forenses de los hombres víctimas de violencias interpersonales, ya que pueden ocurrir contaminaciones y, en consecuencia, la deterioración de los trazos biológicos, morfológicos, entomológicos, químicos, físicos y de micro trazos. En cuanto al cuerpo delprofesional de enfermería, se identificó que es el instrumento de atención en Enfermería Forense, siendo necesaria la prenda adecuada para evitar contaminación; se observó un pequeño número de enfermeros/as para identificar las necesidades forenses de los hombres y establecer la atención y el cuidado de la Enfermería Forense. Por lo tanto, era necesario capacitar a los profesionales para realizar una recolección de calidad y preservar los rastros forenses. Se identificó que el/la enfermero/a realiza el tejido de atención/cuidado de Enfermería Forense a los hombres víctimas de violencias interpersonales a través de 14 formas de atención/cuidado forense, cuales sean: admisión forense, registro forense, identificación forense, electrónica forense, conexión forense, escenario forense, acogida forense, cadena de custodia, dinámicoforense, margen socialforense, multifacéticoforense, circadianoforense, alta forense y cadáver forense. Se identificó que el/la enfermero/a necesita adoptar un modelo integrado de atención de Enfermería Forense, entendiendo que el hombre víctima de violencia interpersonal presenta necesidades forenses, siendo esencial prestar atención a los aspectos micro moleculares y macromoleculares. Se entendió que la atención de Enfermería Forense es dialéctica, ya que implica establecer el cuidar y la atención de diferentes maneras para las víctimas y los perpetradores con base en el saber-hacer con perfil forense.

L'étude a défendu la thèse selon laquelle les hommes victimes de violence interpersonnelle admis au quotidien des salles d'urgence présentent des besoins en médecine légale, mais on n'y met pas en place de méthodes spécifiques de prise en charge basées sur un savoir-faire infirmier à profil médico-légal, capable de fournir des traces au système judiciaire pour obtenir la preuve des faits avec lesquels la victime était impliquée. Nous soulignons comme objet d'étude l'acte de soigner et les soins infirmiers médico-légaux. Les questions ayant guidé l'étude étaient les suivantes: qui sont les hommes victimes de violence interpersonnelle traités dans les salles d'urgence? Quelles sont les typologies des violences interpersonnelles subies par les hommes? Quels sont les prises en charge en soins infirmiers médico-légaux fournis dans la salle d'urgence pour les hommes victimes de violence interpersonnelle? Quelles sont les possibilités d'implantation de la pratique de la médecine légale en salle d'urgence? Compte tenu de ce qui précède, les objectifs suivants ont été définis pour l'étude: caractériser sur le plan sociodémographique les hommes victimes de violences interpersonnelles traités à l'urgence; identifier la typologie des violences interpersonnelles subies par des hommes; analyser la typologie des soins infirmiers à profil médico-légal réalisés en salle d'urgence pour les hommes victimes de violence interpersonnelle; discuter les implications pour l'implantation de la pratique de soins infirmiers médico-légaux dans les salles d'urgence; concevoir une application pour appareils mobiles permettant aux infirmiers de documenter et d'enregistrer des traces médico-légales. Il s'agit d'une étude dialectique critique avec une approche qualitative. Les participants étaient des hommes âgés de 18 à 59 ans, victimes de violences interpersonnelles admis dans les urgences d'un hôpital de la région centre-sud de l'État de Rio de Janeiro, ainsi que 20 infirmières(ers) travaillant dans le contexte étudié. La collecte de données a été réalisée en quatre étapes, comme suit: Première étape - le chercheur a été présenté à l'équipe de soins infirmiers, suivi d'orientation aux professionnels concernant les objectifs de l'étude et le parcours méthodologique établi; Ensuite, on a réalisé l'ambiance/description du contexte d'étude; Deuxième étape: On a consulté les registres des événements du secteur et le bulletin de service médical contenant le cachet d'occurrence policière (OP), les formulaires du système d'information sur les maladies à notification (SINAN) et les données des soins médicaux présents dans le système TOTVS du 1er janvier 2015 au 31 décembre 2017; La troisième étape a consisté à observer les soins reçus par les hommes victimes de violences et à les interviewer. Dans la quatrième étape, on a réalisé un entretien avec l'équipe infirmière. Les données ont été analysées à travers le contenu des entretiens avec les infirmières(ers) et des entretiens avec des hommes victimes de violences interpersonnelles. Nous avons analysé la totalité de 413 dossiers d'enregistrements de soins d'hommes victimes de violence, dont 49% ont été identifiés dans un groupe âgé de 18 à 29 ans. En ce qui concerne la couleur de la peau, on a observé que 21,1% étaient des blancs et 19,6% étaient des noirs. L'occurrence de cas de violence a été prédominante pendant le week-end, le dimanche soir de 20h à 23h59 étant le jour et l'horaire de pointe. La voie publique en était l'endroit d'occurrence majeure. En ce qui concerne la typologie des violences, 95% étaient physiques. Dans 62,5% des cas, on a utilisé la force corporelle et les coups comme moyen de violence. Quant à la région du corps, la tête et le cou ont représenté 34,1% des cas. Parmi les agresseurs, 43% étaient des hommes et 22,5% étaient connus des victimes. On remarque que beaucoup d'hommes sont considérés comme des agresseurs et peu comme des victimes, ce qui les rend invisibles en tant que sujets nécessitant des soins. Par rapport à l'environnement, au corps et à la prise en charge de l'équipe de soins infirmiers légistes, on a constaté que les salles d'urgences n'étaient pas adéquates pour répondre aux besoins médico-légaux des hommes victimes de violences interpersonnelles, car il était possible d'y avoir de la contamination et, par conséquent, de la détérioration des traces biologiques, morphologiques, entomologiques, chimiques, physiques et des micro traces. Quant au corps de l'infirmière (er), on a identifié que c'était l'instrument de la prise en charge des soins infirmiers médico-légaux et qu'un habillage approprié était nécessaire pour éviter des contaminations; on a identifié un nombre réduit d'infirmières(ers) qui identifient les besoins médico-légaux des hommes et qui établissent la prise en charge des soins infirmiers médico-légaux. Ainsi, on a constaté la nécessité de formations pour que les infirmières(ers) fassent une collecte de qualité qui préserve les traces médico-légales. On a identifié que l'infirmière(er) assurait la prise en charge de soins infirmiers médico-légaux chez les hommes victimes de violences interpersonnelles à travers 14 méthodes de prise en charge de médecine légale, à savoir: admission médico-légale, enregistrement médico-légal, identification médico-légale, électronique médico-légale, connexion médico-légal, environnement médico-légal, accueil médico-légal, chaîne de traçabilité, dynamique médico-légale, marge sociale médico-légale, multifaces médico-légales, médecine légale circadienne, libération médico-légale et libération médico-légale avec le corps du décédé(e). On a identifié que l'infirmière(er) devait adopter un modèle intégré de soins infirmiers médico-légaux, sachant que les victimes masculines de violence interpersonnelle présentaient des besoins médico-légaux et qu'il était essentiel de prêter attention aux aspects micro- moléculaires et macromoléculaires. On a compris que les soins infirmiers médico- légaux sont dialectiques, car cela concerne l'établissement de l'acte de soigner et des soins à manières différenciées aux victimes et aux auteurs, basés sur un savoir-faire à profil médico-légal.

Admisiones en la Unidad de Intervención en Crisis del Hospital Psiquiátrico Provincial Luis Ramírez López, Guantánamo 2015-2017 / Internações hospitalares na Unidade de Intervenção de Crise do Hospital Psiquiátrico Provincial Luis Ramírez López, Guantánamo 2015-2017 / Hospital admissions in the Crisis Intervention Unit of the Luis Ramírez López Provincial Psychiatric Hospital, Guantánamo 2015-2017

Introducción: en el Hospital Psiquiátrico Provincial Luis Ramírez López de la provincia Guantánamo no se han caracterizado los pacientes ingresados en la Unidad de Intervención en Crisis (UIC). Objetivo: caracterizar las admisiones hospitalarias en la citada unidad en el periodo comprendido 2015-2017. Método: se realizó un estudio descriptivo y retrospectivo de los pacientes que ingresaron en esta unidad (n=538). Se estudiaron las variables: edad, sexo, procedencia, diagnóstico y estadía. Resultados: la mayor proporción de los pacientes admitidos tenía entre 18 y 23 años (21,9 por ciento), eran del sexo femenino (53,9 por ciento), procedieron del municipio Guantánamo (42,0 por ciento), el diagnóstico más frecuente fue el trastorno de adaptación depresivo (27,9 por ciento) y el 66,4 por ciento tuvo una estadía hospitalaria menor de 7 días. Conclusiones: en la Unidad de Intervención en Crisis se admitieron pacientes en la etapa productiva de la vida, sobre todo mujeres con trastornos depresivos, lo que muestra la pertinencia social de su estudio(AU)

Introduction: the patients admitted to the Crisis Intervention Unit (UIC) have not been characterized in the "Luis Ramírez López" Provincial Psychiatric Hospital of the Guantánamo province. Objective: to characterize hospital admissions in said unit in the period 2015-2017. Method: a descriptive and retrospective study of the patients admitted to this unit was carried out (n=538). The variables were studied: age, sex, origin, diagnosis and stay. Results: the highest proportion of admitted patients was between 18 and 23 years old (21.9 percent), they were female (53.9 percent), they came from the Guantanamo municipality (42.0 percent), the most frequent diagnosis was Depressive adjustment disorder (27.9 percent) and 66.4 percent had a hospital stay of less than 7 days. Conclusions: Patients in the productive stage of life were admitted to the Crisis Intervention Unit, especially women with depressive disorders, which shows the social relevance of their study(AU)

Introdução: os pacientes admitidos na Unidade de Intervenção de Crise (UIC) não foram caracterizados no Hospital Psiquiátrico Provincial "Luis Ramírez López" da Província de Guantánamo. Objetivo: caracterizar internações hospitalares na referida unidade no período 2015-2017. Método: estudo descritivo e retrospectivo dos pacientes admitidos nesta unidade (n=538). As variáveis foram estudadas: idade, sexo, origem, diagnóstico e permanência. Resultados: a maior proporção de pacientes internados foi entre 18 e 23 anos (21,9 por cento), eran do sexo feminino (53,9 por cento), procedentes do município de Guantánamo (42,0 por cento), o diagnóstico mais frequente foi Transtorno de ajuste depressivo (27,9 por cento) e 66,4 por cento tiveram internação hospitalar inferior a 7 dias. Conclusões: pacientes em estágio produtivo de vida foram admitidos na Unidade de Intervenção à Crise, especialmente mulheres com transtornos depressivos, o que mostra a relevância social de seu estudo(AU)

Medicina de alto valor: análisis de su práctica / High Value Care: Analysis of this Medical Practice

Analizar la relación entre los planteamientos diagnósticos de ingreso y egreso, así como la utilidad de los exámenes paraclínicos solicitados para su eficacia diagnóstica. También se determinaron los tiempos de estancia en los servicios de emergencia y hospitalización como parte del sistema de control de calidad. Métodos: Estudio de casos, prospectivo y longitudinal. La muestra estuvo constituida por pacientes que consultaron al Servicio de Emergencia del Hospital General del Oeste y fueron hospitalizados en el servicio de Medicina Interna. Se trató de un muestreo no probabilístico, de selección intencional, de pacientes de cualquier género mayores de 18 años, que ingresaron en el período de Enero a Julio de 2018 con un total de 135. Los datos recolectados de los exámenes complementarios se clasificaron en útiles o no, según cada diagnóstico. Otra importante variable medida fue la identificación de estancia intrahospitalaria prolongada y su causa. Tratamiento estadístico: Se aplicó estadística descriptica a través de medidas de tendencia central y proporción según la naturaleza de las variables, con el fin de priorizar las principales fallas de calidad seguida de la estimación de los costos. Resultados: En el 45% de los casos la causante de estancia prolongada en la Emergencia fue la limitación en la infraestructura. En cuanto a la estancia hospitalaria y su costo, las seis principales fallas correspondieron a un total estimado de US$ 289.695 e incluyó al personal y al Sistema de Salud. Los exámenes diagnósticos de laboratorio e imágenes más solicitados representaron un porcentaje de no utilidad con un costo total estimado de US$ 7.224. Conclusión: En este primer trabajo venezolano sobre Atención Médica de Alto Valor se observaron múltiples causas por las cuales su práctica no fue completa(AU)

To analyze the relationship between the diagnostic approaches at admission and discharge of our hospital, as well as the utility of the tests requested in terms of their diagnostic efficacy and the determination of the length of stay in the emergency services and hospitalization as part of the evaluation of the health system´s quality. Methods: Case study, prospective and longitudinal. The sample were patients who consulted to the Emergency Service of the Hospital General del Oeste, Caracas, Venezuela, and were hospitalized in the Internal Medicine wards. It was a non-probabilistic sampling, of intentional selection, of patients of any gender over 18 years old, from January to July 2018, with a total sample of 135 subjects. The data collected of the tests and images ordered, were clasified as useful or not according to their iagnostic power; another important variable was to evaluate the prolonged hospital stay length and the causes for it. Statistics: Measures of central tendency and proportion, according to the nature of the variables, in order to prioritize the main quality faults, followed by the estimation of costs. Results: In 45% the cause of prolonged stay in the Emergency was the limitation of the infrastructure. In the context of the hospital stay and the six main failures corresponded to an estimated total cost of US$ 289.695 and ncluded health personnel and the Health System. The most frequently ordered laboratory tests and images showed a percentage of non-utility with an estimated total cost of US$ 7.224. Conclusion: In this first Venezuelan study on High-Value Medical Care, multiple causes were observed and explain why its practice is not complete(AU)

Protótipo de um Ambiente Virtual de Aprendizagem para utilização da metodologia Lean Healthcare em unidades de internação hospitalar / Prototype of a Virtual Learning Environment for use of the Lean Healthcare methodology in hospital admission units

A gestão dos hospitais tem sido cada vez mais difícil. Os problemas são causados, principalmente, em função da escassez de recursos financeiros, aumento da demanda, que resulta em longas filas de espera para iniciar tratamentos, falta de vagas em leitos de internação, aumento dos custos operacionais e limitações do espaço físico. No cenário hospitalar, o custo com internação é um dos maiores, sendo apontado como um dos principais responsáveis pelo aumento dos gastos médico-hospitalares que crescem acima da inflação geral. Partindo dessa dificuldade, faz-se necessário adotar um novo método capaz de eliminar os desperdícios e gerar valor para o paciente. O lean healthcare demonstrou ser um método capaz de solucionar os principais problemas nas instituições hospitalares, tratando-se de metodologia com foco na geração de valor para o cliente e, com isso, reduzindo os desperdícios nas atividades das instituições. Contudo, os gestores encontram dificuldades para implementá-la, haja vista que se trata de uma metodologia muito complexa, que demanda profissionais que contemplem o completo domínio da temática, a fim de obter êxito nos resultados. Nesse contexto, as tecnologias de informação e comunicação se apresentam como um recurso estratégico no processo de ensino-aprendizagem, sendo o ambiente virtual de aprendizagem (AVA) uma das mais importantes. Este estudo tem como objetivo desenvolver um protótipo de um AVA que contemple os passos para a implementação de melhores ferramentas e práticas da metodologia lean healthcare para setor de internação em instituições hospitalares. Para o desenvolvimento do AVA, este trabalho baseou-se no Modelo do Design Institucional. Como primeira etapa, foi realizada a revisão integrativa da literatura visando identificar na literatura problemas nos processos de trabalho do setor de internação de instituições hospitalares, bem como as ferramentas utilizadas nas implementações da metodologia lean healthcare. Dentre os problemas identificados, destaca-se o tempo de permanência do paciente, levando a uma sobrecarga dos leitos de internação, o atraso nas altas hospitalares, e os erros durante a prestação do cuidado. A partir desse resultado, o protótipo do AVA foi desenvolvido e está disponível no endereço eletrônico: < https://diangelessilva.wixsite.com/website>. Como proposta futura, o ambiente virtual será avaliado por especialistas na metodologia lean, por especialistas em informática e novas demandas para setor de internação relacionadas ao lean healthcare serão identificadas e acrescentadas

The management of hospitals has been increasingly difficult. The problems are caused, mainly, by the role of financial resources, resulting in long lines to start treatments, lack of places in hospital beds, some increase in operating costs and restriction in physical space. In the hospital set, the cost of hospitalization is one of the largest, being appointed as one of the main responsible for the increment in medical and hospital that grow above the general inflation. Beginning form this difficulty, it is necessary to adopt a new method capable to eliminate waste and to generate value for the patient. The lean healthcare proved to be a capable method of solving problems in hospital institutions, being a methodology focused on generating of value for the client and, therefore, reducing the waste in the activities of the institutions. However, the managers find difficulties to implement it, because it is a very complex methodology that demands professionals who can complete the mastery of the subject in order to achieve the results. In this context, the technologies of information and communication are presented as a strategic resource in the teaching-learning process, being the virtual learning environment (VLE) one of the most important. This study has as aim to develop a prototype of a VLE that look on the steps for the implementation of the better tools and practices of the methodology of lean healthcare for the hospitalization sector in hospital institute. For the development of VLE, this research was based on the Institutional Design Model. As the first step, an integrative review of literature was fulfilled objecting to identify in the literature problems in the processes of the work of the hospitalization sector of hospital institutions, as well the tools used in the implementations of the lean healthcare methodology. Among the problems identified, stands out the length of stay of the patient, leading to an overload of hospital beds, delays in hospital discharge, and the errors during the care installment. From this result, the VLE prototype was developed and it is available at the electronic address: < https://diangelessilva.wixsite.com/website>. As a future proposal, experts in lean methodology, by computer experts, will evaluate the virtual environment and new demands for hospitalization related to lean healthcare will be identified and added

Costs of outpatient and inpatient MRSA screening and treatment strategies for patients at elective hospital admission - a decision tree analysis.

Background: Nosocomial infections are among the most common complications in hospitals. A major part is caused by multidrug-resistant organisms (MDRO). MRSA is still the most prominent and frequent MDRO. The early detection of carriers of multidrug-resistant bacteria is an effective measure to reduce nosocomial infections caused by MDRO. For patients who are planning to go to the hospital, an outpatient screening for MDRO and pre-hospital decolonization is recommended. However, the effectiveness of such pre-admission MDRO management in preparation for a planned hospital stay has not yet been sufficiently scientifically examined from an economic perspective. Methods: A decision tree will be used to develop scenarios for MDRO screening and treatment in the context of the outpatient and inpatient sectors using MRSA-positive patients as an example. Subsequently, the expected costs for the respective strategy are presented. Results: The decision tree analysis shows that the expected costs of outpatient MRSA management are €8.24 and that of inpatient MRSA management are €672.51. Conclusion: The forward displacement of the MRSA screening to the ambulatory sector and any subsequent outpatient decolonization for patients with a planned hospitalization is the most cost-effective strategy and should become a standard benefit. Excluding opportunity costs, the expected costs of inpatient MRSA management are €54.94.

Hemodilution is not the only reason of difference: Comparison of fasting and non-fasting lipoproteins in paired samples.

INTRODUCTION: Low-density lipoprotein cholesterol (LDL) is an important risk factor for cardiovascular disease (CVD) and generally measured after 8-12 h fasting. However, some recent studies have pointed that non-fasting lipoproteins, especially LDL concentrations, are better indicators for demonstrating CVD risk and atherosclerosis. They asserted that nutrition is a negligible factor on changes in lipoprotein concentrations and claimed this difference as a result of hemodilution effect, caused from fluid intake and can be eliminated by applying some adjustments. We aimed to compare the fasting and non-fasting LDL values of the same individuals and discuss whether non-fasting and fasting LDL results can be used in place of each other, directly or after applying hemodilution correction models. MATERIAL AND METHODS: Fasting and non-fasting blood samples of 248 apparently healthy participants were collected. Lipid panel tests, albumin and hemoglobin levels were studied in each sample. Results were evaluated in seven different models which were recommended to correct the hemodilution effect on fasting and non-fasting lipid concentrations of the same individual. Concordance of fasting and non-fasting risk group of the individual were calculated according to the National Cholesterol Education Program classification. RESULTS: Fasting and non-fasting LDL and non-high density lipoprotein cholesterol (non-HDL) concentrations were significantly different in every model (p < 0.001). Concordance results of fasting and non-fasting LDL and non-HDL risk groups were 63.8% and 77.9% respectively. CONCLUSIONS: Our results demonstrated that fasting and non-fasting LDL and non-HDL concentrations could not be used in place of each other even when the results were adjusted for elimination of the hemodilution effect.