Sizing of nursing staff associated with self-care promotion in a pediatric semi-intensive care unit. / Dimensionamento de pessoal de enfermagem referente à promoção do autocuidado em unidade de terapia semi-intensiva pediátrica.

OBJECTIVES: To calculate and compare the nursing staff size associated with self-care promotion at a pediatric semi-intensive care unit. METHODS: This was a prospective study in which 31 children and their caregivers participated. The nursing workload associated with each participant was evaluated at two different times (first and second hospital stays) using the Nursing Activities Score instrument. The first hospital stay corresponded to self-care promotion. Staff size was calculated according to the nursing hours recommended by the Nursing Activities Score instrument and by Conselho Federal de Enfermagem (COFEN) resolution no. 527/16, in the two hospital stays, and the results were compared. RESULTS: The nursing workload in the first hospital stay (14.6 hours) was higher than the nursing workload in the second stay (9.9 hours) (p < 0.001). The Nursing Activities Score revealed that according to the nursing hours, the nursing staff size corresponded to 26 and 18 professionals in the first and second hospital stays, respectively, and to 15 professionals according to COFEN resolution no. 527/16. CONCLUSION: The number of personnel responsible for promoting self-care in pediatric semi-intensive care units, according to the nursing hours suggested by the Nursing Activities Score, was higher than that recommended by the existing legislation. This demonstrates the necessity of reconsidering staff size for this healthcare profile.

OBJETIVOS: Calcular e comparar o dimensionamento de pessoal no que diz respeito à promoção do autocuidado em unidade de terapia semi-intensiva pediátrica. MÉTODOS: Estudo prospectivo, do qual participaram 31 crianças e seus respectivos cuidadores. Os participantes foram avaliados em dois momentos (primeira e segunda internação) quanto à carga de trabalho de enfermagem, por meio do Nursing Activities Score. A primeira internação correspondeu à promoção do autocuidado. O dimensionamento de pessoal foi calculado segundo as horas do Nursing Activities Score e a resolução do Conselho Federal de Enfermagem (COFEN) 527/16, nas duas internações, e estes dados foram posteriormente comparados. RESULTADOS: A carga de trabalho de enfermagem na primeira internação (14,6 horas) foi maior em comparação à segunda (9,9 horas) (p < 0,001). O dimensionamento de pessoal segundo as horas, de acordo com o Nursing Activities Score, foi de 26 e 18 profissionais, e de 15 profissionais, conforme a resolução do COFEN 527/16. CONCLUSÃO: O quantitativo de profissionais referente à promoção do autocuidado em unidade de terapia semi-intensiva pediátrica, segundo as horas do Nursing Activities Score, foi superior ao recomendado pela legislação existente, demonstrando a necessidade de se reconsiderar o dimensionamento de pessoal neste perfil assistencial.

Insulin analogues in the treatment of diabetes in pregnancy.

Pregnancy affects both maternal and fetal metabolism, and even in non-diabetic women, it exerts a diabetogenic effect. Among pregnant women, 2% to 14% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, which may predispose the fetus to many alterations in organogenesis, restrict growth, and the mother, to some diabetes-related complications, such as retinopathy and nephropathy, or to acceleration of the course of these complications, if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle changes; when these changes are not enough for optimal glycemic control, insulin therapy must then be considered. Women with type 2 diabetes using oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes should start intensive glycemic control. As basal insulin analogues have frequently been used off-label in pregnant women, there is a need to evaluate their safety and efficacy. The aim of this review is to report the use of both short- and long-acting insulin analogues during pregnancy and to enable clinicians, obstetricians, and endocrinologists to choose the best insulin treatment for their patients.

Dimensionamento de pessoal de enfermagem referente à promoção do autocuidado em unidade de terapia semi-intensiva pediátrica / Sizing of nursing staff associated with self-care promotion in a pediatric semi-intensive care unit

RESUMO Objetivos: Calcular e comparar o dimensionamento de pessoal no que diz respeito à promoção do autocuidado em unidade de terapia semi-intensiva pediátrica. Métodos: Estudo prospectivo, do qual participaram 31 crianças e seus respectivos cuidadores. Os participantes foram avaliados em dois momentos (primeira e segunda internação) quanto à carga de trabalho de enfermagem, por meio do Nursing Activities Score. A primeira internação correspondeu à promoção do autocuidado. O dimensionamento de pessoal foi calculado segundo as horas do Nursing Activities Score e a resolução do Conselho Federal de Enfermagem (COFEN) 527/16, nas duas internações, e estes dados foram posteriormente comparados. Resultados: A carga de trabalho de enfermagem na primeira internação (14,6 horas) foi maior em comparação à segunda (9,9 horas) (p < 0,001). O dimensionamento de pessoal segundo as horas, de acordo com o Nursing Activities Score, foi de 26 e 18 profissionais, e de 15 profissionais, conforme a resolução do COFEN 527/16. Conclusão: O quantitativo de profissionais referente à promoção do autocuidado em unidade de terapia semi-intensiva pediátrica, segundo as horas do Nursing Activities Score, foi superior ao recomendado pela legislação existente, demonstrando a necessidade de se reconsiderar o dimensionamento de pessoal neste perfil assistencial.

ABSTRACT Objectives: To calculate and compare the nursing staff size associated with self-care promotion at a pediatric semi-intensive care unit. Methods: This was a prospective study in which 31 children and their caregivers participated. The nursing workload associated with each participant was evaluated at two different times (first and second hospital stays) using the Nursing Activities Score instrument. The first hospital stay corresponded to self-care promotion. Staff size was calculated according to the nursing hours recommended by the Nursing Activities Score instrument and by Conselho Federal de Enfermagem (COFEN) resolution no. 527/16, in the two hospital stays, and the results were compared. Results: The nursing workload in the first hospital stay (14.6 hours) was higher than the nursing workload in the second stay (9.9 hours) (p < 0.001). The Nursing Activities Score revealed that according to the nursing hours, the nursing staff size corresponded to 26 and 18 professionals in the first and second hospital stays, respectively, and to 15 professionals according to COFEN resolution no. 527/16. Conclusion: The number of personnel responsible for promoting self-care in pediatric semi-intensive care units, according to the nursing hours suggested by the Nursing Activities Score, was higher than that recommended by the existing legislation. This demonstrates the necessity of reconsidering staff size for this healthcare profile.

Insulin analogues in the treatment of diabetes in pregnancy / Análogos de insulina no tratamento do diabetes gestacional

Pregnancy affects both maternal and fetal metabolism, and even in non-diabetic women, it exerts a diabetogenic effect. Among pregnant women, 2% to 14% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, which may predispose the fetus to many alterations in organogenesis, restrict growth, and the mother, to some diabetes-related complications, such as retinopathy and nephropathy, or to acceleration of the course of these complications, if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle changes; when these changes are not enough for optimal glycemic control, insulin therapy must then be considered. Women with type 2 diabetes using oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes should start intensive glycemic control. As basal insulin analogues have frequently been used off-label in pregnant women, there is a need to evaluate their safety and efficacy. The aim of this review is to report the use of both short- and long-acting insulin analogues during pregnancy and to enable clinicians, obstetricians, and endocrinologists to choose the best insulin treatment for their patients.

A gravidez afeta tanto o metabolismo materno quanto o fetal e, mesmo em mulheres não diabéticas, apresenta um efeito diabetogênico. Entre as mulheres grávidas, 2% a 14% desenvolvem o diabetes gestacional. A gravidez pode ocorrer também em mulheres já diabéticas, o que pode predispor o feto a muitas alterações na organogênese, restrição de crescimento e a mãe a algumas complicações relacionadas ao diabetes, tais como retinopatia e nefropatia, ou acelerar o curso dessas complicações se já estiverem presentes. Pacientes com diabetes gestacional geralmente iniciam seu tratamento com dieta e mudanças no estilo de vida; porém, quando essas medidas falham em atingir um controle glicêmico adequado, a insulinoterapia deve ser considerada. Pacientes com diabetes tipo 2 em uso de hipoglicemiantes orais são aconselhadas a iniciar o uso de insulina. Pacientes com diabetes tipo 1 preexistente devem iniciar um controle glicêmico estrito. Em função do fato de os análogos basais de insulina estarem sendo utilizados muito frequentemente off-label em pacientes grávidas, faz-se necessário avaliar sua segurança e eficácia nessa condição. O objetivo desta revisão é avaliar o uso de tais análogos, tanto de ação curta como prolongada, durante a gravidez, para possibilitar médicos clínicos, obstetras e endocrinologistas escolher o melhor regime terapêutico para suas pacientes.