O efeito conjunto de gemelaridade e prematuridade no aleitamento materno exclusivo na alta hospitalar / The joint effect of twinning and prematurity on exclusive breastfeeding at hospital discharge / El efecto conjunto de la gemelaridad y la prematuridad en la lactancia materna exclusiva al momento del alta hospitalaria

Objetivo: estimar a prevalência de Aleitamento Materno Exclusivo (AME) entre gemelares pré-termos e investigar o efeito de nascer gemelar e pré-termo no AME na alta hospitalar. Método: coorte prospectiva de recém-nascidos em uma instituição localizada no Rio de Janeiro, no período de 13 de março de 2017 a 12 de outubro de 2018. Dados coletados em questionário e prontuário médico. Foi utilizado DAG para construção do modelo conceitual, análise exploratória dos dados e regressão logística múltipla. Resultados: a prevalência de AME na alta hospitalar de gemelares pré-termos foi de 47,8%. Pré-termos apresentaram maior chance de não estarem em AME na alta hospitalar. Não gemelares apresentaram maior chance de não estarem em AME na alta hospitalar. Conclusão: pouco mais da metade dos gemelares pré-termo não estavam em AME na alta hospitalar. Prematuros tiveram maior chance de não estarem em AME. Não gemelares pré-termo apresentaram maior chance de não estarem em AME.

Objective: to estimate the prevalence of Exclusive Breastfeeding (EBF) in preterm twins and to investigate the effect of twin and preterm birth on EBF at hospital discharge. Method: prospective cohort of newborns in an institution located in Rio de Janeiro, from March 13, 2017, to October 12, 2018. Data collected through a questionnaire and medical records. A DAG was used to build the conceptual model, exploratory data analysis and multiple logistic regression. Results: prevalence of EBF at hospital discharge of preterm twins of 47.8%. Preterm infants were more likely to not be on EBF at hospital discharge. Non-twins were more likely to not be on EBF at hospital discharge. Conclusion: just over half of preterm twins were not on EBF at hospital discharge. Preterm infants had a greater chance of not being on EBF. Preterm non-twins were more likely to not be on EBF.

Objetivo: estimar la prevalencia de Lactancia Materna Exclusiva (LME) entre gemelos prematuros y investigar el efecto de nacer gemelo y prematuro en la LME al momento del alta hospitalaria. Método: cohorte prospectiva de recién nacidos en una institución ubicada en Rio de Janeiro, entre 13//marzo/2017 y 12/octubre/2018. Los datos se recolectaron mediante cuestionario y expediente médico. Se utilizó DAG para la construcción del modelo conceptual, análisis exploratorio de los datos y regresión logística múltiple. Resultados: la prevalencia de LME en el alta hospitalaria de gemelos prematuros fue del 47,8%. Los prematuros tuvieron mayor probabilidad de no estar en LME en el alta hospitalaria. Los no gemelares tuvieron mayor probabilidad de no estar en LME en el alta hospitalaria. Conclusión: poco más de la mitad de los gemelos prematuros no estaban en LME en el alta hospitalaria. Los prematuros tuvieron mayor probabilidad de no estar en LME. Los no gemelos prematuros presentaron mayor probabilidad de no estar en LME.

Perfil demográfico, epidemiológico e clínico de pacientes com covid-19 segundo desfecho clínico: um estudo retrospectivo com pacientes admitidos em uma unidade hospitalar / Demographic, epidemiological, and clinic profile of COVID-19 patients by clinical outcome: a retrospective study with patients admitted to a medical unit / Perfil demográfico, epidemiológico y clínico de pacientes con covid-19 según resultado clínico: un estudio retrospectivo con pacientes ingresados en un hospital

O surgimento da covid-19 impactou o cenário de saúde mundial e a compreensão do perfil desses pacientes pode auxiliar no desenvolvimento de medidas e análise de como ocorreu o controle da doença. Assim, este artigo visa descrever o perfil demográfico, epidemiológico e clínico de pacientes com covid-19, internados em uma unidade hospitalar, durante 2020 e 2022. Realizou-se uma pesquisa observacional, de caráter retrospectivo e descritivo, baseada no levantamento e análise de dados de prontuários de pacientes com covid-19, assistidos por uma unidade hospitalar em Barreiras (BA). As informações coletadas foram relacionadas a aspectos demográficos, epidemiológicos e clínicos desses pacientes. Participaram do estudo 1355 indivíduos, sendo que houve predominância em pacientes do sexo masculino (61%), faixa etária entre 40 e 59 anos (44,6%), permanência inferior a cinco dias (51,8%) na instituição de saúde. Acerca do desfecho clínico, houve maior frequência em pacientes que tiveram a alta hospitalar (69,5%). Quanto à sintomatologia na admissão, observou-se predominância de pacientes com temperatura corpórea inferior a 38 °C (91,6%). Ademais, mais frequência em relatos de cefaléia (64,9%), desconforto respiratório (58,1%) e tosse (79,8%). Constatou-se que o perfil dos internados foi de alta hospitalar, idade entre 40 e 59 anos, permanência menor que cinco dias, sem comorbidades. No que se refere aos sintomas, observou-se prevalência de cefaléia, desconforto respiratório, sem disgeusia. Quanto à oxigenoterapia, houve uso expressivo de oxigenação extracorpórea.

COVID-19 onset impacted the global health scenario and understanding the profile of these patients can help us develop measures and analyze how the disease was controlled. Hence, this article described the demographic, epidemiological, and clinical profile of COVID-19 patients admitted to a hospital unit, during 2020 and 2022. An observational retrospective and descriptive research was conducted based on data survey and analysis of COVID-19 patient records from a hospital unit in Barreiras, Bahia, Brazil. Data on demographic, epidemiological, and clinical aspects of the patients were collected. A total of 1355 individuals participated in the study, mostly male patients (61%) aged 40 to 59 years (44.6%) and hospital stay of less than five days (51.8%). Patient discharge (69.5%) was the prevalent clinical outcome. Regarding symptoms at admission, we observed a predominance of patients with body temperature below 38 °C (91.6%). Additionally, there were frequent reports of headache (64.9%), respiratory distress (58.1%) and cough (79.8%). Results confirmed a profile of patient discharge, age between 40 and 59 years, hospital stay of less than five days, without comorbidities. Prevalent symptoms were headache and respiratory discomfort, without dysgeusia. Regarding oxygen therapy, there is expressive use of extracorporeal oxygenation.

El surgimiento de la covid-19 generó impactos en el ámbito de salud mundial, y comprender el perfil de los pacientes puede auxiliar en el desarrollo de medidas y analizar cómo se controló la enfermedad. Este estudio tuvo por objetivo describir el perfil demográfico, epidemiológico y clínico de los pacientes con covid-19 ingresados en un hospital en el período entre 2020 y 2022. Se realizó un estudio observacional, retrospectivo y descriptivo a partir de una búsqueda y de análisis de datos de historias clínicas de pacientes con covid-19 ingresados en un hospital de Barreiras, en Bahía (Brasil). Se recolectaron datos sobre aspectos demográficos, epidemiológicos y clínicos de estos pacientes. En este estudio participaron 1.355 personas, de las cuales hubo un mayor predominio de pacientes del sexo masculino (61%), de grupo de edad de entre 40 y 59 años (44,6%), con estancia inferior a cinco días (51,8%) en el centro de salud. Respecto al resultado clínico, hubo una mayor frecuencia en pacientes que recibieron el alta hospitalaria (69,5%). En cuanto a la sintomatología de ingreso, predominó temperatura corporal inferior a 38 °C (91,6%). Además, hubo frecuentes relatos de cefalea (64,9%), malestar respiratorio (58,1%) y tos (79,8%). Se constató que el perfil de los hospitalizados fue el alta hospitalaria, edad de entre 40 y 59 años, estancia inferior a cinco días, sin comorbilidades. En cuanto a los síntomas, hubo mayor prevalencia de cefalea, malestar respiratorio, sin disgeusia. Respecto a la oxigenoterapia, hubo un uso significativo de la oxigenación extracorpórea.

Experiencia en el manejo de fístulas enterocutáneas postoperatorias en el Hospital Nacional del 2017 al 2022

Introducción: la mayoría de las fistulas enterocutáneas se producen como complicación de una o varias cirugías previas. La mortalidad sigue siendo muy elevada. Su tratamiento supone un reto para el cirujano y gran uso de recursos humanos, económicos y prolongada estancia hospitalaria. Objetivo: determinar la experiencia del manejo de las fístulas enterocutáneas postoperatorias en el servicio de cirugía general del Hospital Nacional de Itauguá durante el periodo 2017-2022. Metodología: estudio observacional descriptivo retrospectivo de corte transversal, con muestreo no probabilístico. Solo hubo 30 casos con fichas completas, las cuales sometimos a procesamiento y análisis de las variables de interés. Resultados: de la muestra final 70 % fueron hombres, el promedio de edad fue de 49,6 años y de días de internación 28,6. Solo 5 pacientes consultaron por secreción fecaloide, los demás refirieron secreción seropurulenta por herida o cicatriz operatoria. Del total, 9 fueron de alto débito. El 100 % recibió antibioticoterapia; obitaron 4 de los 14 pacientes intervenidos quirúrgicamente con fin terapéutico. La técnica quirúrgica mayormente utilizada fue: laparotomía + liberación de adherencias e identificación de la fístula + resección intestinal + anastomosis. De los antecedentes la mayoría fueron postoperados de oclusión intestinal mecánica alta o peritonitis aguda de origen apendicular. Conclusión: debido a su alto impacto en la capacidad laboral y social las fístulas enterocutáneas representan patologías quirúrgicas muy complejas y relevantes con bajas tasas de curación definitiva. La mayoría se presentan como complicación de cirugías de urgencia; requiere intervención multidisciplinaria adaptada para cada caso en particular.

Introduction: the occur enterocutaneous fistula as a complication of one or several previous surgeries. Mortality is still very high. Its treatment represents a challenge for the surgeon and great use of human and economic resources and a long hospital stay. Objective: to determine the experience in the management of postoperative enterocutaneous fistulae in the general surgery service of the Itauguá National Hospital during the period 2017-2022. Methodology: retrospective, cross-sectional, descriptive, observational study with non-probabilistic sampling. There were only 30 cases with complete records, which we subjected to processing and analysis of the variables of interest. Results: of the final sample, 70 % were men, the average age was 49,6 years and 28,6 days of hospitalization. Only 5 patients consulted due to fecaloid discharge, the rest reported seropurulent discharge from wound or surgical scar. Of the total, 9 were high debit. 100 % received antibiotic therapy, 4 of the 14 patients who underwent surgery as therapeutics, died. The most commonly used surgical technique was: laparotomy + release of adhesions and identification of the fistula + intestinal resection + anastomosis. Most of the antecedents were post-operated for high mechanical intestinal occlusion or acute peritonitis of appendiceal origin. Conclusion: due to their high impact on work and social capacity, enterocutaneous fistulas represent very complex and relevant surgical pathologies with low definitive cure rates. Most present as a complication in emergency surgeries; requires multidisciplinary intervention adapted to each particular case.

Post-discharge all-cause mortality in COVID-19 recovered patients hospitalized in 2020: the impact of chronic kidney disease

ABSTRACT In Brazil, the COVID-19 burden was substantial, and risk factors associated with higher in-hospital mortality rates have been extensively studied. However, information on short-term all-cause mortality and the factors associated with death in patients who survived the hospitalization period of acute SARS-CoV-2 infection is limited. We analyzed the six-month post-hospitalization mortality rate and possible risk factors of COVID-19 patients in a single center in Brazil. This is a retrospective cohort study focused on a six-month follow-up. The exclusion criteria were death during hospitalization, transference to another hospital, and age under 18. We collected data from the charts of all hospitalized patients from March 2020 to December 2020 with a positive RT-PCR test for SARS-CoV-2, resulting in a sample size of 106 patients. The main outcome was death after hospitalization, whereas comorbidities and demographics were evaluated as risk factors. The crude post-hospitalization death rate was 16%. The first 30 days of follow-up had the highest mortality rate. In a Cox regression model for post-hospitalization mortality, previous chronic kidney disease (HR, 4.06, 95%CI 1.46 - 11.30) and longer hospital stay (HR 1.01, 95%CI 1.00 - 1.02) were the only factors statistically associated with death. In conclusion, a high six-month all-cause mortality was observed. Within the six-month follow-up, a higher risk of death was observed for patients who had prior CKD and longer hospital stay. These findings highlight the importance of more intensive medical surveillance during this period.

Alta hospitalar de pacientes adultos e idosos: elaboração e validação de checklist / Alta hospitalaria de pacientes adultos y mayores: elaboración y validación de checklist / Hospital discharge of adults and older adults: checklist elaboration and validity

Resumo Objetivo Descrever a elaboração e a validação do conteúdo de um checklist para o preparo da alta hospitalar de pacientes adultos e idosos. Métodos Estudo metodológico desenvolvido de maio de 2020 a setembro de 2022 (em duas etapas) para elaboração e validação do checklist. Foi usada a técnica Delphi, com avaliação por um comitê de especialistas para validação de conteúdo. Para o cálculo do grau de concordância, utilizou-se a taxa de concordância e o Índice de Validade de Conteúdo (IVC). Resultados Foi elaborado e validado um checklist com 17 itens que ajudam a organizar a alta hospitalar. O checklist foi elaborado partindo da compilação dos resultados obtidos em entrevistas realizadas com os profissionais de uma equipe multidisciplinar, os quais atuavam em unidades de internação, revisão integrativa sobre a transição do cuidado na alta hospitalar de pacientes adultos e leitura de artigos sobre o uso de checklist para a alta. Na primeira etapa de validação, foi obtida uma média para a taxa de concordância, para abrangência (94%) e pertinência (91%) do instrumento. Ao final da segunda rodada, foi obtida a média do cálculo do IVC (clareza: 0,95; pertinência: 0,96). Conclusão O checklist foi validado quanto ao seu conteúdo por consenso pelo comitê de especialistas, podendo ser utilizado por equipes assistenciais ou de gestão de altas hospitalares.

Resumen Objetivo Describir la elaboración y la validación del contenido de una checklist para la preparación del alta hospitalaria de pacientes adultos y mayores. Métodos Estudio metodológico llevado a cabo de mayo de 2020 a septiembre de 2022 (en dos etapas) para la elaboración y validación de la checklist. Se utilizó el método Delphi, con evaluación realizada por un comité de especialistas para la validación de contenido. Para calcular el nivel de concordancia, se utilizó el índice de concordancia y el Índice de Validez de Contenido (IVC). Resultados Se elaboró y validó una checklist con 17 ítems que ayudan a organizar el alta hospitalaria. La checklist fue elaborada a partir de la compilación de los resultados obtenidos en entrevistas realizadas a profesionales de un equipo multidisciplinario que trabajaban en unidades de internación, de revisiones integradoras sobre la transición del cuidado en el alta hospitalaria de pacientes adultos y de la lectura de artículos sobre el uso de checklists para el alta. En la primera etapa de validación, se obtuvo un promedio del índice de concordancia, respecto al alcance (94 %) y pertinencia (91 %) del instrumento. Al final de la segunda ronda, se obtuvo el promedio del cálculo del IVC (claridad: 0,95; pertinencia: 0,96). Conclusión La checklist fue validada en cuanto a su contenido por consenso del comité de especialistas y puede ser utilizada por equipos asistenciales o de gestión de altas hospitalarias.

Abstract Objective To describe content elaboration and validity of a checklist for preparing adults and older adults for hospital discharge. Methods This is a methodological study, developed from May 2020 to September 2022 (in two stages), for checklist elaboration and validity. The Delphi technique was used, with assessment by an expert committee for content validity. To calculate the degree of agreement, the agreement rate and the Content Validity Index (CVI) were used. Results A checklist with 17 items that help organize hospital discharge was prepared and validated. The checklist was prepared based on the compilation of results obtained from interviews with multidisciplinary team professionals, who worked in inpatient units, an integrative review on transition of care at hospital discharge of adult patients and reading of articles on the use of discharge checklist. In the first stage of validity, a mean was obtained for the instrument's agreement rate, scope (94%) and relevance (91%). At the end of the second round, the mean CVI calculation was obtained (clarity: 0.95; relevance: 0.96). Conclusion The checklist was validated as to its content by consensus by an expert committee, and can be used by care teams or hospital discharge management.

Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation

ABSTRACT Introduction: Findings of inadequate tissue perfusion might be used to predict the risk of mortality. In this study, we evaluated the effects of lactate and lactate clearance on mortality of patients who had undergone extracorporeal membrane oxygenation (ECMO). Methods: Patients younger than 18 years old and who needed venoarterial ECMO support after surgery for congenital heart defects, from July 2010 to January 2019, were retrospectively analyzed. Patients successfully weaned from ECMO constituted Group 1, and patients who could not be weaned from ECMO were in Group 2. Postoperative clinics and follow-ups of the groups including mortality and discharge rates were evaluated. Results: There were 1,844 congenital heart surgeries during the study period, and 55 patients that required ECMO support were included in the study. There was no statistically significant difference between the groups regarding demographics and operative variables. The sixth-, 12th-, and 24th-hour lactate levels in Group 1 were statistically significantly lower than those in Group 2 (P=0.046, P=0.024, and P<0.001, respectively). There were statistically significant differences regarding lactate clearance between the groups at the 24th hour (P=0.009). The cutoff point for lactate level was found as ≥ 2.9, with 74.07% sensitivity and 78.57% specificity (P<0.001). The cutoff point for lactate clearance was determined as 69.44%, with 59.26% sensitivity and 78.57% specificity (P=0.003). Conclusion: Prognostic predictive factors are important to initiate advanced treatment modalities in patients with ECMO support. In this condition, lactate and lactate clearance might be used as a predictive marker.

Transição de cuidado de pacientes internados por COVID-19 e sua relação com as características clínicas / Transición de cuidado de pacientes internados por COVID-19 y su relación con las características clínicas / Care transition for patients admitted to hospital due to COVID-19 and its relationship with clinical characteristics

Resumo Objetivo Analisar a transição do cuidado (TC), e sua relação com as características clínicas de pacientes internados por COVID-19. Métodos Estudo transversal, realizado em um hospital geral, com 165 pacientes hospitalizados em decorrência da COVID-19 e que receberam alta para o domicílio. Participaram aqueles que estiveram internados por pelo menos 24hs, maiores de 18 anos, com acesso telefônico após a alta. Excluídos aqueles que receberam alta por transferência, que evoluíram a óbito ou aqueles sem condições cognitivas. Dados coletados entre março a julho de 2021, por meio de questionário sociodemográfico e clínico, bem como o Care Transitions Measure-15. Aplicou-se análise estatística descritiva e inferencial. Resultados A média geral do Care Transitions Measure-15 foi considerada satisfatória (71,8±7,45). O fator Preferências Asseguradas obteve maior média (80,5± 9,84) e o fator Plano de Cuidados a menor (57,5± 11,4). Foram encontradas diferenças estatísticas significativas quando se associou os fatores do CTM-15 com as variáveis clínicas tempo de doença crônica (p<0,03), presença de artefato clínico (p<0,040), uso de medicação contínua (p<0,029) e a reinternação teve diferença significativa nos fatores Preparação para o Autogerenciamento (p<0,045), Preferências Asseguradas (p<0,027) e Plano de Cuidados (p<0,032). Conclusão Os pacientes hospitalizados por COVID-19 avaliaram a TC geral como satisfatória e as variáveis clínicas tempo de doença crônica, artefato clínico, medicação contínua e reinternação interferiram na TC desses pacientes.

Resumen Objetivo Analizar la transición del cuidado (TC) y su relación con las características clínicas de pacientes internados por COVID-19. Métodos Estudio transversal, realizado en un hospital general, con 165 pacientes hospitalizados como consecuencia de COVID-19, que fueron dados de alta para volver a su domicilio. Participaron aquellas personas que estuvieron internadas por lo menos 24 horas, mayores de 18 años, con acceso telefónico después del alta. Se excluyeron aquellas que fueron dadas de alta por transferencia, que fallecieron o que no tenían condiciones cognitivas. Los datos fueron recopilados entre marzo y julio de 2021, mediante cuestionario sociodemográfico y clínico, así como también el Care Transitions Measure-15. Se aplicó análisis estadístico descriptivo e inferencial. Resultados El promedio general del Care Transitions Measure-15 fue considerado satisfactorio (71,8±7,45). El factor Preferencias Aseguradas obtuvo el mayor promedio (80,5± 9,84) y el factor Plan de Cuidados, el menor (57,5± 11,4). Se encontraron diferencias estadísticas significativas cuando se asociaron los factores del CTM-15 con las variables clínicas tiempo de enfermedad crónica (p<0,03), presencia de artefacto clínico (p<0,040), uso de medicación continua (p<0,029). La reinternación tuvo una diferencia significativa en los factores Preparación para la Autogestión (p<0,045), Preferencias Aseguradas (p<0,027) y Plan de Cuidados (p<0,032). Conclusión Los pacientes hospitalizados por COVID-19 evaluaron la TC general como satisfactoria. Las variables clínicas tiempo de enfermedad crónica, artefacto clínico, medicación continua y reinternación interfirieron en la TC de estos pacientes.

Abstract Objective To analyze care transition (CT) and its relationship with the clinical characteristics of patients admitted to hospital due to COVID-19. Methods This is a cross-sectional study, carried out in a general hospital, with 165 patients admitted to hospital due to COVID-19 and who were discharged home. Participants were those who had been admitted to hospital for at least 24 hours, over 18 years of age, with telephone access after discharge. Those who were discharged by transfer, who died or those without cognitive conditions were excluded. Data collected between March and July 2021, using a sociodemographic and clinical questionnaire as well as Care Transitions Measure-15. Descriptive and inferential statistical analysis was applied. Results The overall mean of Care Transitions Measure-15 was considered satisfactory (71.8±7.45). The Important preferences factor obtained the highest mean (80.5± 9.84) and the Care Plan factor the lowest (57.5± 11.4). Significant statistical differences were found when the CTM-15 factors were associated with the clinical variables: duration of chronic disease (p<0.03); presence of clinical artifact (p<0.040); use of continuous medication (p<0.029). Readmission had a significant difference in the factors Health management preparation (p<0.045), Important preferences (p<0.027) and Care plan (p<0.032). Conclusion Patients admitted to hospital due to COVID-19 assessed the general CT as satisfactory and the clinical variables, length of chronic illness, clinical artifact, continuous medication and readmission interfered in the CT of these patients.

Construção e validação de um formulário para a transição de cuidados para o recém-nascido prematuro / Construcción y validación de un formulario para la transición de la atención al recién nacido prematuro / Construction and validity of a form for transition of care for premature newborns

Objetivo: construir e validar um formulário para a transição de cuidados com o neonato prematuro. Método: estudo metodológico realizado em três etapas: levantamento do referencial teórico-metodológico, análise semântica e validação de conteúdo, baseado no Modelo de Construção de Instrumentos e utilizando o método de Delphi, sendo considerado aprovado quando o índice de validação de conteúdo foi maior que 80%.Resultados: o formulário composto por seis domínios foi aprovado após três rodadas, com 64itens e alcançou uma aprovação média de 89%.Conclusão: o formulário de transição de cuidados foi validado quanto a face e conteúdo, disponibilizando uma nova tecnologia a ser utilizada para a transição de informações de forma padronizada e segura.

Objective:to construct and validate a form for transition of care for premature newborns. Method:a methodological study carried out in three steps: theoretical-methodological framework survey, semantic analysis and content validity, based on the instrument construction model and using the Delphi method, being considered approved when the Content Validity Index was greater than 80%. Results:the form consisting of six domains was approved after three rounds, with 64 items, and achieved a mean approval of 89%. Conclusion:the transition of care form was validated in terms of face and content, providing a new technology to be used for standardized and safe transition of information.

Objetivo:construir y validar un formulario para la transición de la atención al recién nacido prematuro. Método:estudio metodológico realizado en tres etapas: levantamiento del marco teórico-metodológico, análisis semántico y validación de contenido, con base en el modelo de construcción de instrumentos y mediante el método Delphi, considerándose aprobado cuando el índice de validación de contenido fue superior al 80%. Resultados:el formulario compuesto por seis dominios fue aprobado después de tres rondas, con 64 ítems, y alcanzó una tasa de aprobación promedio del 89%. Conclusión:el formulario de transición de atención fue validado en términos de apariencia y contenido, proporcionando una nueva tecnología para ser utilizada para la transición de información de forma estandarizada y segura.

Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up / Desmascarando as consequências ocultas: sequelas pós-unidade de terapia intensiva, planejamento da alta e acompanhamento a longo prazo

ABSTRACT A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.

RESUMO Parcela significativa de indivíduos que enfrentaram doença crítica sofre de síndrome pós-cuidados intensivos, caracterizada por comprometimento novo ou exacerbado da função física, cognitiva ou de saúde mental. Além disso, os sobreviventes geralmente apresentam maior risco de consequências adversas, como infecção, eventos cardiovasculares maiores, reinternação e taxas de mortalidade elevadas, durante os meses após a hospitalização. Esses achados reforçam a necessidade urgente de prevenção e manejo eficazes da deterioração da saúde a longo prazo no ambiente de cuidados intensivos. Embora haja poucas evidências conclusivas de ensaios clínicos randomizados bem desenhados, potenciais intervenções incluem estratégias como limitação da sedação, mobilização precoce, presença da família durante a internação na unidade de terapia intensiva, implementação de programas de transição multidisciplinares (da unidade de terapia intensiva para a enfermaria e do hospital para o domicílio) e acompanhamento especializado após a alta hospitalar. Esta revisão objetiva fornecer um resumo conciso da literatura médica recente sobre os desfechos a longo prazo após doenças críticas e destacar potenciais abordagens para prevenir e abordar a deterioração da saúde de sobreviventes de cuidados intensivos.

Percepções de pessoas idosas internadas acerca da transição do cuidado do hospital para casa / Perceptions of hospitalized older adults regarding the transition of care from hospital to home

Resumo Objetivo analisar as percepções de pessoas idosas internadas acerca da transição do cuidado do hospital para casa. Método pesquisa com abordagem qualitativa, descritivo-exploratória, realizada em unidade de internação clínica de hospital público, médio porte, no interior do estado de São Paulo, Brasil. Participaram 22 pessoas idosas, por meio de entrevistas semiestruturadas, conduzidas por questões fundamentadas nos pilares do Care Transition Intervention. Posteriormente, foi realizada observação participante no local do estudo, com registro em diário de campo e transcrição das falas. Seguiram-se análise temática e sistematização dos dados por meio de software específico para análise de dados qualitativos. Resultados a média de idade dos participantes foi de 68 anos (DP±5,4); 16 (77%) possuíam uma ou mais doenças crônicas; 14 (64%) faziam uso de um ou mais medicamentos de uso contínuo. O Código Internacional de Doenças principal de internação foi covid-19. A média de permanência de internação foi de 9 dias (DP±5,7), com máximo de 31 dias e mínimo de dois dias, sendo que quatro (18%) tiveram a forma grave da doença. A partir da percepção das pessoas idosas, emergiram quatro temas de análise: problemas relacionados a medicamentos; preparo para alta hospitalar; continuidade do cuidado; e rede familiar. Conclusão na perspectiva das pessoas idosas, faz-se necessário a organização do plano de cuidados durante a internação por meio de reconciliação medicamentosa, preparo para os cuidados domiciliares, presença da família durante a internação e reconhecimento da Atenção Primária à Saúde na continuidade do cuidado durante a transição do cuidado do hospital para casa.

Abstract Objective To analyze the perceptions of older adults hospitalized regarding the transition of care from hospital to home. Method A qualitative, descriptive-exploratory research was conducted in a clinical inpatient unit of a medium-sized public hospital in the interior of São Paulo state, Brazil. Twenty-two older adults participated in the study through semistructured interviews, guided by questions based on the pillars of the Care Transitions Intervention (CTI). Subsequently, participant observation was conducted at the study site, with recording in a field diary and transcription of speeches. Thematic analysis and data systematization followed through specific software for qualitative data analysis Results The mean age of the participants was 68 years (SD±5.4); 16 (77%) had one or more chronic diseases; 14 (64%) were using one or more continuous medications. The primary International Classification of Diseases code for hospitalization was Covid-19. The average length of hospital stay was 9 days (SD±5.7), with a maximum of 31 days and a minimum of two days, with four (18%) experiencing severe disease. From the perception of older adults, four themes of analysis emerged: medication-related problems; preparation for hospital discharge; continuity of care; and family network. Conclusion From the perspective of older adults, it is necessary to organize the care plan during hospitalization through medication reconciliation, preparation for home care, family presence during hospitalization, and recognition of Primary Health Care in continuity of care during the transition from hospital to home care.

Qualidade de vida, funcionalidade e autoestima de pessoas no pós-alta por cura de hanseníase / Quality of life, functionality, and self-concept of people post-discharge from leprosy / Calidad de vida, funcionalidad y autoestima de las personas tras el alta del tratamiento contra la lepra

RESUMO: Objetivo: avaliar a qualidade de vida, funcionalidade e autoestima de pessoas no pós-alta por cura de hanseníase. Métodos: estudo epidemiológico transversal, desenvolvido numa instituição de referência para hanseníase na Paraíba-Brasil, de maio a agosto de 2021. Utilizaram-se quatro instrumentos para caracterização sociodemográfica e clínica, avaliação da qualidade de vida, da funcionalidade e da autoestima. Os dados foram analisados pelos testes qui-quadrado de Pearson, exato de Fisher, Mann-Whitney e Kruskal-Wallis. Resultados: participaram 131 pessoas, dos quais 86 (65,6%) eram do sexo masculino e 72 (55%) com 41 a 60 anos. Houve impacto negativo da qualidade de vida relacionada à saúde em não escolarizados e com baixa renda familiar. Limitação da funcionalidade em quem não pratica atividade física, afetado por neurite e com algum grau de incapacidade física. Contudo, elevada autoestima. Conclusão: torna-se imprescindível capacitar profissionais e organizar medidas assistenciais frente ao cuidado longitudinal e interdisciplinar nessa fase terapêutica.

ABSTRACT Objective: to evaluate the quality of life, functionality, and self-concept of people after discharge from leprosy. Methods: This was a cross-sectional epidemiological study carried out in a reference institution for leprosy in Paraíba, Brazil, from May to August 2021. Four instruments were used for sociodemographic and clinical characterization, assessment of quality of life, functionality, and self-concept. The data was analyzed using Pearson's chi-square, Fisher's exact, Mann-Whitney, and Kruskal-Wallis tests. Results: 131 people took part, of whom 86 (65.6%) were male and 72 (55%) were aged between 41 and 60. There was a negative impact on health-related quality of life among those with no schooling and low family income. Limitation of functionality in those who do not practice physical activity, are affected by neuritis, and have some degree of physical disability. However, high self-concept. Conclusion: It is essential to train professionals and organize assistance measures in the face of longitudinal and interdisciplinary care in this therapeutic phase.

RESUMEN: Objetivo: evaluar la calidad de vida, la funcionalidad y la autoestima de las personas después del alta de la lepra. Métodos: Se trató de un estudio epidemiológico transversal realizado en una institución de referencia para lepra en Paraíba, Brasil, de mayo a agosto de 2021. Se utilizaron cuatro instrumentos para caracterización sociodemográfica y clínica, evaluación de la calidad de vida, funcionalidad y autoestima. Los datos se analizaron mediante las pruebas chi-cuadrado de Pearson, exacta de Fisher, Mann-Whitney y Kruskal-Wallis. Resultados: Participaron 131 personas, de las cuales 86 (65,6%) eran hombres y 72 (55%) tenían entre 41 y 60 años. Se observó un impacto negativo en la calidad de vida relacionada con la salud entre las personas sin estudios y con bajos ingresos familiares. Limitación de la funcionalidad en los que no practican actividad física, afectados por neuritis y con algún grado de discapacidad física. Sin embargo, alta autoestima. Conclusión: Es fundamental formar a los profesionales y organizar medidas asistenciales de cara a la atención longitudinal e interdisciplinar en esta fase terapéutica.

Multidrug stewardship and adherence to guidelines in >200,000 direct-to-consumer Telemedicine encounters

ABSTRACT Objective: The quality of care and safety for Telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications. This retrospective study aimed to assess adherence to the current COVID-19 guidelines in direct-to-consumer telemedicine encounters at a large center using multidrug stewardship protocols. Methods: A quarterly electronic survey utilizing medical records of individual physician care assessed various quality indicators. Physicians received ongoing adaptive feedback based on personal metrics, with Telemedicine Center recommendations derived from the 2020 Infectious Diseases Society of America guidelines. The study included all consecutive adults with new respiratory symptoms in the last 14 days who sought spontaneous Telemedicine consultations between March 2020 and August 2021. This study analyzed patients with suspected or confirmed COVID-19 and other airway infections. Results: Of the 221,128 evaluated patients, 42,042 (19%) had confirmed COVID-19; 104,021 (47%) were suspected to have COVID-19; and, 75,065 (33%) had other diagnoses. Patients with suspected or confirmed COVID-19 had a mean (+DP) age of 35±12 years. A total of 125,107 (85.65%) patients were managed at home, 2,552 (1.74%) were referred for non-urgent in-office reassessment, and 17,185 (11.7%) were referred to the emergency department for whom there was no further treatment recommendation. The antibiotic rate in confirmed or suspected COVID-19 cases was 0.46%/0.65% and that for non-evidence-based prescriptions was 0.01%/0.005%. Conclusion: Guideline training and Telemedicine consultation feedback may lead to lower antibiotic and antimicrobial prescriptions in suspected and confirmed COVID-19 cases. Multidrug stewardship protocols may improve guideline adherence and reinforce the quality of care and safety in Telemedicine encounters.

Expectativas e Planejamento da Alta em Saúde Mental: Perspectiva dos Pacientes / Expectations and Planning for Mental Health Discharge: Patients' Perspective

Resumo: Este estudo tem o objetivo de conhecer e compreender a experiência da internação psiquiátrica parcial em Hospital-Dia sob a perspectiva de pacientes em momento que antecedeu a alta, com foco nas expectativas e no planejamento sobre esse evento. Participaram do estudo oito pessoas internadas em um Hospital-Dia que tinham a alta programada. Cada participante respondeu individualmente a uma entrevista aberta. Os dados foram analisados pelo método de Análise de Conteúdo Temática. Os participantes expressaram sentimentos ambíguos despertados pela proximidade da alta, como a insegurança de perder o apoio do serviço e a satisfação pelo fim do tratamento hospitalar. Observou-se a valorização de práticas e posturas que consideraram o paciente enquanto pessoa situada em uma história, abarcando relações afetivas, expectativas, frustrações e planos futuros. Conhecer como os pacientes vivenciam a alta contribui para que tal evento seja considerado um processo imbricado em uma experiência histórica e social, sinalizando a relevância do cuidado ampliado, longitudinal e integral.

Abstract: This study aimed to know and understand patients' perspectives of their experiences of partial psychiatric hospitalization in a daycare hospital preceding discharge and focused on expectations and on planning about this event. In total, eight people hospitalized in a daycare hospital who were scheduled to be discharged participated in this study. Each participant answered an open interview. The data were analyzed by thematic content analysis. Participants expressed ambiguous feelings by the proximity of their discharge, such as insecurity of losing service support and satisfaction with the end of the hospital treatment. Patients appreciated the practices and postures that considered them a person situated in a story, encompassing affective relationships, expectations, frustrations, and future plans. Understanding how patients experience discharge contributes to considering this event as a process intertwined in a historical and social experience, signaling the relevance of extended, longitudinal, and comprehensive care.

Resumen: Este estudio tiene como objetivo conocer y comprender la experiencia de la internación psiquiátrica parcial en Hospital de Día desde la perspectiva de los pacientes al momento en que antecedió el alta, con enfoque en las expectativas y en la planificación sobre este evento. Participaron en el estudio ocho personas internadas en un Hospital de Día que iban a recibir el alta. Cada participante respondió individualmente a una entrevista abierta. Se utilizó el método de análisis de contenido temático. Los participantes expresaron sentimientos ambiguos despertados por la proximidad del alta, como la inseguridad de perder el apoyo del servicio y la satisfacción por el fin del tratamiento hospitalario. Se observó la valorización de prácticas y posturas que comprenden al paciente como persona con una historia, que abarca relaciones afectivas, expectativas, frustraciones y planes futuros. Conocer cómo los pacientes perciben el alta permite ubicar el evento en un proceso que involucra una experiencia histórica y social, señalando la relevancia del cuidado ampliado, longitudinal e integral.

Quality of Care Transition for COVID-19 Patients in a University Hospital in Southern Brazil / Calidad de la transición del cuidado de pacientes con COVID-19 en un hospital universitario del sur de Brasil / Qualidade da transição do cuidado de pacientes com covid-19 em um hospital universitário ao sul do Brasil

ABSTRACT Objective: To assess the quality of care transition from hospital to home for COVID-19 patients. Method: A cross-sectional study conducted at a University Hospital in Southern Brazil, involving 78 patients discharged after COVID-19 hospitalization. Data collection was performed via telephone using the Brazilian version of the Care Transitions Measure (CTM-15). Data were analyzed using descriptive and analytical statistics. Results: The mean quality of care transition was 70.8 on a scale ranging from zero to 100, indicating moderate quality of care transition. The highest score was attributed to factor 1, "Preparation for self-management," and the lowest to factor 4, "Care Plan." Conclusions: It is important to enhance communication and support provided to patients during the transition process, especially regarding understanding prescribed medications and the development of clear care plans.

RESUMEN Objetivo: Evaluar la calidad de la transición del cuidado desde el hospital hasta el hogar para pacientes con COVID-19. Método: Estudio transversal realizado en un Hospital Universitario del sur de Brasil, que involucró a 78 pacientes dados de alta después de la hospitalización por COVID-19. La recolección de datos se realizó por teléfono utilizando la versión brasileña de la Medida de Transiciones del Cuidado (CTM-15). Los datos se analizaron utilizando estadísticas descriptivas y analíticas. Resultados: La calidad media de la transición del cuidado fue de 70.8 en una escala que va de cero a 100, lo que indica una calidad moderada de la transición del cuidado. La puntuación más alta se atribuyó al factor 1, "Preparación para el autogestionamiento", y la más baja al factor 4, "Plan de cuidado". Conclusiones: Es importante mejorar la comunicación y el apoyo proporcionado a los pacientes durante el proceso de transición, especialmente en lo que respecta a la comprensión de los medicamentos recetados y el desarrollo de planes de cuidado claros.

RESUMO Objetivo: Avaliar a qualidade da transição do cuidado do hospital para o domicílio de pacientes com covid-19. Método: Estudo transversal, realizado em um Hospital Universitário no Sul do Brasil, com 78 pacientes que tiveram alta hospitalar após internação por covid-19. A coleta de dados foi realizada por telefone e utilizou a versão brasileira do Care Transitions Measure (CTM-15). Os dados foram analisados por meio de estatística descritiva e analítica. Resultados: A média da qualidade da transição do cuidado foi de 70,8, em uma escala que varia de zero a 100, indicando uma qualidade moderada da transição do cuidado. O maior escore foi atribuído ao fator 1, "Preparação para autogerenciamento", e o menor ao fator 4, "Plano de cuidado". Conclusões: É importante aprimorar a comunicação e o suporte oferecidos aos pacientes durante o processo de transição, especialmente no que diz respeito à compreensão dos medicamentos prescritos e ao desenvolvimento de planos de cuidados claros.

The demand for discharge preparation services for patients readmitted to hospital with chronic heart failure-a qualitative research / 中国实用护理杂志

Objective:The aim was to explore the needs of patients readmitted with chronic heart failure (CHF) for pre-discharge preparation services and to provide reliable evidence to support the development of a discharge preparation service plan.Methods:The research was based on the phenomenology research method. Using a purposive sampling method, 12 readmitted patients with CHF from the First Hospital of Heilongjiang University of Traditional Chinese Medicine were selected and interviewed in a semi-structured manner between February and April 2023, and the data were analyzed using the Colaizzi seven-step analysis.Results:Among 12 patients, 6 males, 6 females, aged 53 to 85 years old. The discharge preparation service needs of readmitted patients with CHF can be categorised into 3 major themes of physiological-psychological-social, containing 6 sub-themes: the need to improve self-management skills, the need for rehabilitation and exercise, the need for improvement of negative emotions, the need for improvement of health education, the need for improvement of home care, and the need for health resource services.Conclusions:Patients readmitted with CHF have greater needs for self-management knowledge and skills, family care needs, professional guidance needs, and information on referral services from primary health resources, and nursing staff should focus on assessing such needs of patients in order to develop individualized plans for discharge preparation services for patients with CHF.

Nursing practice of discharge planning service for primipara separated from their infants during hospitalization: a field research / 中国实用护理杂志

Objective:To understand the current status of discharge planning nursing for primipara who separated from their infants during hospitalization and provide a reference basis for constructing a clinical nursing plan.Methods:From February to June 2023, a field research about situation of nursing practice in discharge planning service among primiparas who separated from their infants was conducted in the Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Tongji University. Data was collected by field observation and informal interviews with 12 nurses and analyzed by three-level coding method of qualitative research.Results:All 12 nurses were female with 24-46 (33.33 ± 1.83) years old. The work content of the observation subjects could be divided into 4 items including providing infants′ health information, breastfeeding, postpartum rehabilitation, psychological care and social support. All the 4 items needed to be improved in providing infants′ health information, evaluating psychological status and social support, and quality of discharge teaching.Conclusions:It still needs further development in discharge planning nursing for primipara separated from their infants during hospitalization. It is urgent to improve the quality of discharge planning nursing for primiparas who have separated from their infants by developing scientific and standardized discharge planning nursing process, conducting standardized training for nurses, improving nurses′ psychosocial assessment ability, homogenizing health education, and improving humanistic care, so as to promote the rehabilitation of primiparas and get used to being a mother.

Hospital discharge readiness and its influencing factors and nursing strategies in patients with chronic diseases with multiple diseases / 中国实用护理杂志

Objective:To explore the discharge readiness and influencing factors of patients with multimorbidity, and to formulate corresponding strategies to guide clinical work.Methods:In a cross-sectional study, 183 patients were surveyed by convenience sample method for Department of General Practice, the Third Hospital of Peking University February in to December 2022. Multiple linear regression was used to analyze the factors affecting discharge readiness.Results:All 183 coexisting patients, 95 males, 88 females, mean age (67.34 ± 10.36) years old. Mean discharge readiness was (109.83 ± 18.40). 54.9% of the factors for patients with multiple chronic diseases came from the perception of self-care disorder, hospitalization, stay, and preparation for discharge ( R2=0.549, P<0.05). Conclusions:The discharge readiness of patients with multiple chronic diseases in general medicine is at a high level, and clinical nursing staff should give early intervention to the patients who perceive self-care barriers, need to stay with them, have multiple hospitalization, and are not ready for discharge, so as to ensure that the patients are in a good state of discharge readiness.

Analysis on the current situation and influencing factors of discharge readiness of patients with arteriosclerosis obliterans / 中国实用护理杂志

Objective:To explore the latent profile of discharge readiness of patients with lower extremity arteriosclerosis obliterans and analyze its influencing factors, so as to provide theoretical basis for individualized management of discharge readiness in patients with lower limb arteriosclerosis obliterans.Methods:From February 2022 to December 2022, 194 patients with arteriosclerosis obliterans of lower limbs who received surgical treatment in the vascular surgery department of Shandong Provincial Hospital Affiliated to Shandong First Medical University were investigated by using general information questionnaire, Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale and Family APGAR Index for a cross-sectional survey. Latent profile analysis was used to identify different categories, and Logistic regression analysis was used to explore its influencing factors.Results:Totally 182 valid questionnaires were collected, of which 127 males and 55 females, and patients over 60 years old were the majority, accounting for 81.9%. Three latent profile models were identified in this study, namely, low discharge readiness group (27.47%), medium discharge readiness-high expected support group (41.21%) and high discharge readiness group (31.31%). Logistic regression analysis showed that first hospitalization ( OR=19.218, 95% CI 2.949-125.237), the quality of discharge guidance ( OR=0.896, 95% CI 0.857-0.937) were the predictive factors of medium discharge readiness-high expected support group ( P<0.05); family function ( OR=0.185, 95% CI 0.097-0.353) and the quality of discharge guidance ( OR=0.823, 95% CI 0.764-0.888) were the predictive factors of the low discharge readiness group of patients with arteriosclerosis obliterans (all P<0.05). Conclusions:There are different types of discharge readiness of patients with arteriosclerosis obliterans, and patients with poor quality of discharge guidance and poor family function are more likely to have a trend of low discharge readiness. Patients with low quality discharge guidance and first hospitalization are more likely to have a trend of moderate discharge readiness-high expected support. For this kind of patients, medical staff should take corresponding measures to improve their readiness for discharge.

Safety analysis of video-assisted thoracic surgery in Day Care Unit and the risk factors for delayed discharge / 中国胸心血管外科临床杂志

@#Objective To explore the perioperative safety of video-assisted thoracic surgery (VATS) in Day Care Unit and the risk factors for delayed discharge under centralized management model. Methods The patients with VATS managed by the Day Care Unit of the Drum Tower Hospital Affiliated to Nanjing University Medical School in 2021 were retrospectively collected. The patients’ postoperative data and risk factors for delayed discharge were analyzed. Results A total of 383 patients were enrolled, including 179 males and 204 females with an average age of 46.09±14.82 years. Eleven (2.87%) patients developed grade 3-4 postoperative complications during the hospitalization. Eighteen (4.70%) patients visited unscheduled outpatient clinic within 7 days, and 6 (1.57%) patients were re-hospitalized within 30 days after discharge. The remaining patients had no significant adverse events during the 30-day follow-up. The average length of hospital stay was 2.27±0.35 d. The length of hospital stay was over 48 h in 48 (12.53%) patients. The independent risk factor for delayed discharge was lobectomy or combined resection (OR=3.015, 95%CI 1.174-7.745, P=0.022). Conclusion VATS can be safely conducted under the centralized management in Day Care Unit. The risk factor for delayed discharge is the extent of surgical resection.

Experience in Treating Diarrhea-predominant Irritable Bowel Syndrome Based on the Theory of Spleen Deficiency Generating Turbidity / 中医杂志

Based on the view of "spleen deficiency generating turbidity"， it is believed that the main pathology of irritable bowel syndrome diarrhea-predominant （IBS-D） is spleen deficiency and turbidity excess， with spleen deficiency as the root and turbidity stagnating intestines as the branch， and the treatment principle of draining turbidity and transporting the center was proposed. In the acute stage， turbidity excess is the main cause， the treatment should unblock the bowels and discharge turbidity， commonly with modified Zhishi Daozhi Decoction （枳实导滞汤）； in the remission stage， spleen deficiency is the main cause， the treatment should boost qi and fortify the spleen， commonly with modified Qiwei Baizhu Powder （七味白术散）. Treating the branch in acute conditions， and treating the root in moderate conditions， so as to help restore the conduction function of the intestines and bowels， the transportation and transformation function of the spleen and stomach， then the water and grains have their own way， clear and turbid each in its own way.