Pulse oximetry test for screening congenital heart diseases: a systematic review.

OBJECTIVE: To determine the accuracy of the Pulse Oximetry Test (POT) in screening for Congenital Heart Diseases (CHD) in newborns in the first 48 hours of life. METHOD: Systematic review of diagnostic test accuracy with meta-analysis. The selection of studies was carried out in June 2021. Studies were selected with newborns, in a hospital or home environment, without a previous diagnosis of CHD, regardless of gestational age at birth, who underwent POT within the first 48 hours after birth. Registration on the PROSPERO platform - CRD42021256286. RESULTS: Twenty-nine studies were included, totaling a population of 388,491 newborns. POT demonstrated sensitivity of 47% (95% CI: 43% to 50%) and specificity of 98% (95% CI: 98% to 98%). Subgroup analyses were carried out according to the different testing period, inclusion of retests in protocols and population of premature newborns. CONCLUSION: POT is a test with moderate sensitivity and high specificity. It is more effective when carried out within 24h - 48h of birth; in protocols that present retests, within two hours after the first measurement. It does not show satisfactory effectiveness for premature newborns.

Effectiveness of auriculotherapy for anxiety, stress or burnout in health professionals: a network meta-analysis.

OBJECTIVE: to analyze the effectiveness of auriculotherapy, when compared to the control group, placebo or usual treatment for anxiety, stress or burnout in health professionals. METHOD: a systematic review conducted in nine information sources, being selected experimental or quasi-experimental studies with auriculotherapy intervention in health professionals, compared to control, placebo or usual treatment groups. Descriptive analysis and network meta-analysis by means of direct and indirect comparison. Quality of the outcomes was assessed with the Confidence in Network Meta-analysis. RESULTS: 15 articles were included: 66.6% with Nursing teams and 53.3% with interventions involving semi-permanent needles. The shen men, brainstem, kidney, sympathetic, lung and liver acupoints predominated. There was a reduction in anxiety with semi-permanent needles (CI -8.18, -6.10), magnetic palettes (CI -7.76, -5.54), placebo (CI -5.47, -3.36) and seeds (CI -6.35, -4.05); as well as in stress with semi-permanent needles (CI -37.21, -10.88) and seeds with (CI -28.14, -11.70) and without a closed protocol (CI -36.42, -10.76). Meta-analysis was unfeasible for burnout; however, significant reductions were verified when it was treated with auriculotherapy. CONCLUSION: Auriculotherapy is effective to reduce anxiety and stress in health professionals; however, this assertion cannot be made in the case of burnout. It was evidenced that workers' health is favored with the use of auriculotherapy.

Dedicated Education Unit is a cost-effective clinical education model for undergraduate nursing programs.

OBJECTIVE: To evaluate the cost-effectiveness of clinical education models for undergraduate nursing programs. METHODS: A model-based cost-effectiveness analysis. Settings were universities with undergraduate nursing courses. Participants consisted of the decision tree that guided the structure of the model, filled in with effectiveness results from a hypothetical cohort of undergraduate nursing students. Interventions were Clinical Preceptor or Clinical Facilitator or Clinical Education Unit. Main outcome measure was effectiveness, defined as improvement of clinical education. The projected economic outcomes included incremental costs, incremental effectiveness, and incremental cost-effectiveness ratio. Monte Carlo probabilistic sensitivity analysis was employed to assess uncertainty in the model and robustness of our results. RESULTS: The model based on Clinical Education Unit could be defined as the best, followed by Clinical Facilitator and Clinical Preceptor. The incremental cost of telephone-support intervention was US$ 59,604.40 higher than the second-best performing intervention (Clinical Facilitator), and US$ 32,661.86 higher than the last best performing intervention (Clinical Preceptor). In addition, Clinical Education Unit model showed 7% and 19% more effectiveness than Clinical Facilitator and Clinical Preceptor, respectively. CONCLUSION: Clinical Education Unit represents the best choice to promote better development of skills, knowledge and socialization in undergraduate nursing programs considering its effectiveness and costs.

Economic and epidemiological evaluation of text message-based interventions in patients with the Human Immunodeficiency Virus.

OBJECTIVE: to evaluate the cost-effectiveness ratio and the budget impact of sending text messages associated with medical consultations in order to reduce the viral load of patients infected with the Human Immunodeficiency Virus. METHOD: a randomized clinical trial, basis for the development of a dynamic cohort model with Markov states in order to compare medical appointments for adults infected with the Human Immunodeficiency Virus versus the alternative strategy that associated medical consultations to sending text messages through telephone. RESULTS: 156 adults participated in the study. As for the viral load, it was verified that in the control group there was an increase, in the intervention group A (weekly messages) there was a reduction (p = 0.002) and in group B (biweekly messages) there was no statistically significant difference. Sending text messages would prevent 286,538 new infections by the Human Immunodeficiency Virus and 282 deaths in the 20-year period, compared to the standard treatment. The alternative strategy would result in saving R$ 14 billion in treatment costs. CONCLUSION: weekly sending messages in association with the standard treatment can reduce the circulating viral load due to its effect in decreasing new infections, in addition to reducing health costs.

Association between social support and adherence to anti-retroviral treatment in people living with HIV.

OBJECTIVE: To investigate the association between social support, adherence to HIV anti-retroviral therapy, and clinical and sociodemographic factors. METHOD: A cross-sectional study conducted from July 2016 to August 2018 in a specialized outpatient clinic in southern Brazil. Individual interviews were conducted for the application of the following instruments: Questionnaire for the Evaluation of Adherence to Anti-retroviral Treatment (CEAT-HIV) and Social Support Scale for People Living with HIV/AIDS. The Spearman bivariate correlation test was used for analysis purposes. RESULTS: Among the 168 participants, the mean social support score was 3.53 points (SD = 0.66), and 64.9% (n = 109) of the respondents had insufficient adherence. There was a significant association (p < 0.05) between emotional social support and the following adherence domains: antecedents of non-adherence behaviors and doctor-patient communication. CONCLUSIONS: Social support is associated with antecedents of non-adherence behaviors and doctor-patient communication.

Economic burden of inpatients infected with Klebsiella pneumoniae carbapenemase.

OBJECTIVE: To estimate the direct medical costs of drug therapy of Klebsiella pneumoniae carbapenemase (KPC) infection patients in hospital-based context. METHODS: A cost-of-illness study conducted with a prospective cohort design with hospitalized adults infected by KPC. Data collection was performed using an instrument composed of sociodemographic data, clinical and prescription medication. Estimates of the direct costs associated to each treatment were derived from the payer's perspective, in the case of federal public hospitals from Brazil, and included only drug costs. These costs were based on the average price available at the Brazilian Price Database Health. No discount rate was used for the cost of drugs. The costs are calculate in American Dollar (US$). RESULTS: A total of 120 inpatients participated of this study. The total drug cost of these inpatients was US$ 367,680.85. The systemic antimicrobial group was responsible for 59.5% of total costs. The direct drug cost per patients infected by KPC was conservatively estimated at nearly US$ 4,100.00, and about of 60% of costs occurred during the period of infection. CONCLUSION: The findings of our study indicate a thoughtful economic hazard posed by KPC that all healthcare sectors have to face. The increasing worldwide incidence of these bacteria represents a growing burden that most health systems are unable to deal with. There is an imperative need to develop protocols and new antimicrobials to treatment of KPC, aiming to rearrange resources to increase the effectiveness of healthcare services.

Cost-effectiveness of two dressings in preventing pressure injuries in intensive care patients / Rentabilidad de dos apósitos en la prevención de lesiones por presión en pacientes de cuidados intensivos / Custo-efetividade de duas coberturas na prevenção de lesão por pressão em pacientes de terapia intensiva

ABSTRACT Objective: to analyze the cost-effectiveness of using silicone adhesive multilayer foam and transparent polyurethane film in preventing pressure injuries in patients admitted to an Intensive Care Unit. Method: this is an economic cost-effectiveness study, developed with public domain data and a rapid literature review, which included three studies developed in Canada, the United Kingdom, Italy and the United States. The searches were carried out in the PubMed, Cochrane and Scopus databases. The population was patients admitted to the Intensive Care Unit. The perspective was from the Brazilian Health System, with a time horizon of less than one year. Data was collected and analyzed between March and June 2022. A decision tree model was developed using TreeAge Pro® 2017 software to project economic outcomes of incremental cost and effectiveness, incremental cost per effectiveness, and cost per percentage increase in preventing the development of pressure injuries. Sensitivity analysis was also performed. The Consolidated Health Economic Evaluation Reporting Standards and the Methodological Guideline for Economic Evaluation of the Brazilian Ministry of Health recommendations were adopted. Results: multilayer foam reduces the occurrence of pressure injuries at a lower cost when compared to film, promoting an average saving of R$ 278.78 (US$ 1,393.90) for each patient. Conclusion: multilayer foam was the most cost-effective technology in preventing pressure injuries in Intensive Care Unit patients in the Brazilian Health System.

RESUMEN Objetivo: analizar la costo-efectividad del uso de espuma de poliuretano multicapa con silicona y película de poliuretano transparente en la prevención de lesiones por presión en pacientes ingresados en una Unidad de Cuidados Intensivos. Método: estudio de costo-efectividad económica, desarrollado con datos de dominio público y una revisión rápida de la literatura, que incluyó tres producciones desarrolladas en Canadá, Reino Unido, Italia y Estados Unidos. Las búsquedas se realizaron en las bases de datos PubMed, Cochrane y Scopus. La población fueron pacientes ingresados ​​en la Unidad de Cuidados Intensivos. La perspectiva fue desde el Sistema Único de Salud, con un horizonte temporal inferior a un año. Los datos se recopilaron y analizaron entre marzo y junio de 2022. Se desarrolló un modelo de árbol de decisiones utilizando el software TreeAge Pro® 2017 para proyectar resultados económicos de costo y efectividad incrementales, costo incremental por efectividad y costo por aumento porcentual en la prevención del desarrollo de lesiones por presión. También se realizó un análisis de sensibilidad. Se adoptaron las recomendaciones de los Consolidated Health Economic Evaluation Reporting Standarts y la Guía Metodológica para la Evaluación Económica del Ministerio de Salud de Brasil. Resultados: la espuma multicapa reduce la aparición de lesiones por presión a un costo menor en comparación con la película, promoviendo un ahorro promedio de R$ 278,78 (US$ 1.393,90) por cada paciente. Conclusión: la espuma multicapa fue la tecnología más costo-efectiva en la prevención de lesiones por presión en pacientes de la Unidad de Cuidados Intensivos del Sistema Único de Salud.

RESUMO Objetivo: analisar o custo-efetividade do uso da espuma multicamadas de poliuretano com silicone e do filme transparente de poliuretano na prevenção de lesões por pressão, em pacientes internados em Unidade de Terapia Intensiva. Método: estudo econômico de custo-efetividade, desenvolvido com dados de domínio público e de uma revisão rápida da literatura, que incluiu três produções desenvolvidas no Canadá, Reino Unido, Itália e Estados Unidos. As buscas foram realizadas nas bases PubMed, Cochrane e Scopus. A população foi de pacientes internados em Unidade de Terapia Intensiva. A perspectiva foi do Sistema Único de Saúde, com horizonte temporal inferior a um ano. Os dados foram coletados e analisados entre março e junho de 2022. Um modelo de árvore de decisão foi desenvolvido por meio do Software TreeAge Pro ® 2017 para projetar resultados econômicos de custos e eficácia incremental, custo incremental por eficácia, e custo por aumento percentual na prevenção do desenvolvimento de lesões por pressão; também foi feita análise de sensibilidade. Adotou-se as recomendações do Consolidated Health Economic Evaluation Reporting Standarts e da Diretriz Metodológica de Avaliação Econômica do Ministério da Saúde do Brasil. Resultados: a espuma multicamadas reduz a ocorrência de lesão por pressão a um custo inferior quando comparado ao filme, promovendo em média, uma economia de R$ 278,78 (US$ 1.393,90) para cada paciente. Conclusão: a espuma multicamadas apresentou-se como a tecnologia mais custo-efetiva na prevenção de lesão por pressão em pacientes de Unidade de Terapia Intensiva, no contexto do Sistema Único de Saúde.

Análise de custo-efetividade em saúde: estudo documental de teses e dissertações / Análisis de costo-efectividad en salud: estudio documental de tesis de doctorado y de maestría / Cost-effectiveness analysis in healthcare: documentary study of theses and dissertations

Resumo Objetivo Caracterizar as teses e dissertações brasileiras que usaram métodos de análise de custo-efetividade em tecnologias de saúde e os respectivos modelos de decisão. Métodos Este estudo documental e quantitativo foi realizado em fevereiro de 2023 com busca no Catálogo de Teses e Dissertações (Coordenação de Aperfeiçoamento de Pessoas de Nível Superior) no período 2011-2022 usando o termo "custo-efetividade". Após a aplicação dos critérios de inclusão e exclusão, 81 produções foram incluídas no estudo e então foi realizada a análise quantitativa das teses e dissertações. Resultados A maioria das produções era de teses de doutorado (54,3%) defendidas em 2018 (22,2%) na região sudeste do Brasil (60,5%) e conduzidas em ambiente hospitalar (42,0%). Foi adotado o modelo de Árvore de Decisão (37,0%) de Markov (28,4%), seguido de outros modelos. Além disso, a maioria das teses seguiu as recomendações de boas práticas na análise econômica de custo-efetividade: elas atenderam grande parte (55,6%), minimamente (25,9%) e parcialmente (18,5%) os itens necessários e recomendações. Conclusão Os estudos de custo-efetividade realizados nas teses analisadas usaram o modelo de Árvore de Decisão e seguiram as recomendações de boas práticas em seu desenvolvimento.

Resumen Objetivo Caracterizar las tesis de doctorado y de maestría brasileñas que utilizaron métodos de análisis de costo-efectividad en tecnologías de salud y los respectivos modelos de decisión. Métodos Este estudio documental y cuantitativo fue realizado en febrero de 2023 con búsqueda en el Catálogo de Tesis de Doctorado y de Maestría (Coordinación de Perfeccionamiento de Personas de Nivel Superior) durante el período 2011-2022 usando el término "costo-efectividad". Después de aplicar los criterios de inclusión y exclusión, se incluyeron 81 producciones en el estudio y luego se realizó el análisis cuantitativo de las tesis de doctorado y de maestría. Resultados La mayoría de las producciones fue de tesis de doctorado (54,3 %) defendidas en 2018 (22,2 %) en la región Sudeste de Brasil (60,5 %) y llevadas a cabo en ambiente hospitalario (42,0 %). Se adoptó el modelo de Árbol de Decisión (37,0 %) de Markov (28,4 %), seguido por otros modelos. Además, la mayoría de las tesis siguió las recomendaciones de buenas prácticas en el análisis económico de costo-efectividad: cumplieron gran parte (55,6 %), mínimamente (25,9 %) y parcialmente (18,5 %) los ítems necesarios y recomendaciones. Conclusión Los estudios de costo-efectividad realizados en las tesis analizadas utilizaron el modelo de Árbol de Decisión y siguieron las recomendaciones de buenas prácticas en su desarrollo.

Abstract Objective To characterize Brazilian theses and dissertations that used cost-effectiveness analysis methods in health technologies and the respective decision models. Method This documentary and quantitative study was carried out in February 2023 with a search in the Catalog of Theses and Dissertations (Coordination for the Improvement of Higher Education Persons) in the period 2011-2022 using the term "cost-effectiveness". After applying the inclusion and exclusion criteria, 81 studies were included in the study and then a quantitative analysis of theses and dissertations was carried out. Results The majority of studies were doctoral theses (54.3%), defended in 2018 (22.2%) in southeastern Brazil (60.5%) and conducted in a hospital setting (42.0%). The Markov Decision Tree model (37.0%) (28.4%) was adopted, followed by other models. Furthermore, most theses followed the recommendations of good practices in economic cost-effectiveness analysis: they met a largely (55.6%), minimally (25.9%) and partially (18.5%) of the necessary items and recommendations. Conclusion The cost-effectiveness studies carried out in the theses analyzed used the Decision Tree model and followed best practice recommendations in their development.

Pulse oximetry test for screening congenital heart diseases: a systematic review / Prueba de oximetría de pulso para el screening de cardiopatías congénitas: revisión sistemática / Teste de oximetria de pulso para triagem de cardiopatias congênitas: revisão sistemática

ABSTRACT Objective: To determine the accuracy of the Pulse Oximetry Test (POT) in screening for Congenital Heart Diseases (CHD) in newborns in the first 48 hours of life. Method: Systematic review of diagnostic test accuracy with meta-analysis. The selection of studies was carried out in June 2021. Studies were selected with newborns, in a hospital or home environment, without a previous diagnosis of CHD, regardless of gestational age at birth, who underwent POT within the first 48 hours after birth. Registration on the PROSPERO platform - CRD42021256286. Results: Twenty-nine studies were included, totaling a population of 388,491 newborns. POT demonstrated sensitivity of 47% (95% CI: 43% to 50%) and specificity of 98% (95% CI: 98% to 98%). Subgroup analyses were carried out according to the different testing period, inclusion of retests in protocols and population of premature newborns. Conclusion: POT is a test with moderate sensitivity and high specificity. It is more effective when carried out within 24h - 48h of birth; in protocols that present retests, within two hours after the first measurement. It does not show satisfactory effectiveness for premature newborns.

RESUMEN Objetivo: Determinar la precisión de la Prueba de Oximetría de Pulso (POT) en el screening de Cardiopatías Congénitas (CC) en recién nacidos en las primeras 48 horas de vida. Método: Revisión sistemática de la precisión de las pruebas diagnósticas con metanálisis. La selección de estudios se realizó en junio de 2021. Se seleccionaron estudios con recién nacidos, en ambiente hospitalario o domiciliario, sin diagnóstico previo de CC, independientemente de la edad gestacional al nacer, a quienes se les realizó POT dentro de las primeras 48 horas después del nacimiento. Registro en la plataforma PROSPERO - CRD42021256286. Resultados: Se incluyeron 29 estudios, totalizando una población de 388.491 recién nacidos. POT demostró una sensibilidad del 47% (IC del 95%: 43% al 50%) y una especificidad del 98% (IC del 95%: 98% al 98%). Se realizaron análisis de subgrupos según los diferentes períodos de prueba, la inclusión de repruebas en los protocolos y la población de recién nacidos prematuros. Conclusión: POT es una prueba con sensibilidad moderada y especificidad alta. Es más eficaz cuando se realiza entre las 24 y 48 horas siguientes al nacimiento; en protocolos que presenten repruebas, dentro de las dos horas posteriores a la primera medición. No muestra una eficacia satisfactoria para los recién nacidos prematuros

RESUMO Objetivo: Determinar a acurácia do Teste de Oximetria de Pulso (TOP) na triagem de Cardiopatias Congênitas (CC) em recém-nascidos nas primeiras 48 horas de vida. Método: Revisão sistemática de acurácia de teste diagnóstico com metanálise. A seleção dos estudos foi realizada em junho de 2021. Foram selecionados estudos com recém-nascidos, em ambiente hospitalar ou domiciliar, sem o diagnóstico prévio de CC, independentemente da idade gestacional ao nascimento, que realizaram o TOP entre as primeiras 48h após o nascimento. Registro na plataforma PROSPERO - CRD42021256286. Resultados: Foram incluídos 29 estudos, somando uma população total de 388.491 recém-nascidos. O TOP demonstrou sensibilidade de 47% (IC 95%: 43% a 50%) e especificidade de 98% (IC 95%: 98% a 98%). Foram realizadas análises dos subgrupos conforme período de realização do teste diferente, inclusão de retestes nos protocolos e população de recém-nascidos prematuros. Conclusão: O TOP é um teste de moderada sensibilidade e alta especificidade. Apresenta maior efetividade quando realizado no intervalo entre 24h - 48h do nascimento; em protocolos que apresentem retestes, em até duas horas após a primeira medida. Não apresenta efetividade satisfatória para recém-nascidos prematuros.

Acurácia da oximetria de pulso para triagem das cardiopatias congênitas: protocolo de revisão sistemática / Accuracy of pulse oximetry for screening congenital heart disease: systematic review protocol

OBJETIVO: determinar a acurácia da oximetria de pulso para triagem de cardiopatias congênitas em recém-nascidos. MÉTODO: trata-se de uma Revisão Sistemática de acurácia diagnóstica que considerará recém-nascidos prematuros, termo e pós-termo, sem diagnóstico prévio de cardiopatia congênita, nascidos em ambiente hospitalar ou domiciliar. A busca será realizada nas bases de dados MEDLINE Complete (PubMed), CINAHL Complete, Embase, Scopus, Google Scholar, ProQuest Central e Trove. Sem delimitação de idioma ou período de publicação. As referências identificadas serão gerenciadas por meio do EndNote e, as duplicações excluídas. A seleção ocorrerá por dois revisores independentes. Os estudos serão avaliados criticamente por meio de uma lista de verificação para estudos de acurácia de testes diagnósticos. Detalhes sobre os testes de índice, populações, métodos de estudo e resultados significativos para a revisão, serão extraídos. Sempre que possível, a sensibilidade e a especificidade serão agrupadas em meta-análise estatística bivariada. Número de registro na plataforma PROSPERO: CRD42021256286

OBJECTIVE: to determine the accuracy of pulse oximetry for screening congenital heart defects in newborns. METHOD: this is a Systematic Review of diagnostic accuracy that will consider premature, term and post-term newborns, without previous diagnosis of congenital heart disease, born in a hospital or home environment. The search will be performed in MEDLINE Complete (PubMed), CINAHL Complete, Embase, Scopus, Google Scholar, ProQuest Central and Trove databases. No delimitation of language or period of publication. Identified references will be managed through EndNote, and duplicates will be excluded. The selection will take place by two independent reviewers. Studies will be critically evaluated using a checklist for diagnostic test accuracy studies. Details on index tests, populations, study methods, and significant results for the review will be extracted. Whenever possible, sensitivity and specificity will be pooled in bivariate statistical meta-analysis. Registration number on the PROSPERO platform: CRD42021256286

Effectiveness of auriculotherapy for anxiety, stress or burnout in health professionals: a network meta-analysis / Efetividade da auriculoterapia para ansiedade, estresse ou burnout em profissionais da saúde: metanálise em rede / Efectividad de la auriculoterapia para la ansiedad, el estrés o el burnout en profesionales de la salud: metaanálisis en red

Abstract Objective: to analyze the effectiveness of auriculotherapy, when compared to the control group, placebo or usual treatment for anxiety, stress or burnout in health professionals. Method: a systematic review conducted in nine information sources, being selected experimental or quasi-experimental studies with auriculotherapy intervention in health professionals, compared to control, placebo or usual treatment groups. Descriptive analysis and network meta-analysis by means of direct and indirect comparison. Quality of the outcomes was assessed with the Confidence in Network Meta-analysis. Results: 15 articles were included: 66.6% with Nursing teams and 53.3% with interventions involving semi-permanent needles. The shen men, brainstem, kidney, sympathetic, lung and liver acupoints predominated. There was a reduction in anxiety with semi-permanent needles (CI -8.18, -6.10), magnetic palettes (CI -7.76, -5.54), placebo (CI -5.47, -3.36) and seeds (CI -6.35, -4.05); as well as in stress with semi-permanent needles (CI -37.21, -10.88) and seeds with (CI -28.14, -11.70) and without a closed protocol (CI -36.42, -10.76). Meta-analysis was unfeasible for burnout; however, significant reductions were verified when it was treated with auriculotherapy. Conclusion: Auriculotherapy is effective to reduce anxiety and stress in health professionals; however, this assertion cannot be made in the case of burnout. It was evidenced that workers' health is favored with the use of auriculotherapy.

Resumo Objetivo: analisar a efetividade da auriculoterapia comparada ao grupo controle, placebo ou tratamento habitual para ansiedade, estresse ou burnout de profissionais da saúde. Método: revisão sistemática em nove fontes de informação, sendo selecionados estudos experimentais ou quase-experimentais com intervenção de auriculoterapia em profissionais da saúde, comparados com grupos controle, placebo ou tratamento habitual. Utilizou-se análise descritiva e metanálise em rede por comparação direta e indireta. A qualidade dos desfechos foi avaliada por meio do Confidence in Network Meta-analysis. Resultados: foram incluídos 15 artigos, sendo 66,6% com equipes de enfermagem, 53,3% com intervenção de agulhas semipermanentes. Predominaram os acupontos shen men, tronco cerebral, rim, simpático, pulmão e fígado. Houve redução de ansiedade com agulhas semipermanentes (IC -8,18, -6,10), paletas magnéticas (IC -7,76, -5,54), placebo (IC -5,47, -3,36) e sementes (IC -6,35, -4,05); de estresse com agulhas semipermanentes (IC -37.21, -10.88) e sementes com (IC -28.14, -11,70) e sem protocolo fechado (IC -36.42, -10.76). A metanálise foi inviável para burnout, mas foram constatadas reduções significativas quando tratado com auriculoterapia. Conclusão: a auriculoterapia é efetiva para reduzir ansiedade e estresse de profissionais da saúde, não sendo possível realizar esta afirmação para burnout. Evidenciou-se que a saúde do trabalhador é favorecida com uso da auriculoterapia.

Resumen Objetivo: analizar la efectividad de la auriculoterapia, comparándola con el grupo control, el placebo o el tratamiento habitual para la ansiedad, el estrés o el burnout de los profesionales de la salud. Método: revisión sistemática en nueve fuentes de información, siendo seleccionados estudios experimentales o cuasiexperimentales con intervención de auriculoterapia en profesionales de la salud, comparada con grupos control, placebo o atención habitual. Análisis descriptivo y metaanálisis en red por comparación directa e indirecta. La calidad de los resultados se evaluó con Confidence in Network Meta-analysis. Resultados: Se incluyeron 15 artículos, 66,6% con equipos de enfermería, 53,3% con intervención de aguja semipermanente. Predominaron los puntos de acupuntura shen men, tronco encefálico, riñón, simpático, pulmón e hígado. Se observó una reducción de la ansiedad con agujas semipermanentes (IC -8,18, -6,10), paletas magnéticas (IC -7,76, -5,54), placebo (IC -5,47, -3,36) y semillas (IC -6,35, -4,05); del estrés con agujas semipermanentes (CI -37,21, -10,88) y semillas con (CI -28,14, -11,70) y sin protocolo cerrado (CI -36,42, -10,76). No fue posible realizar el metaanálisis para el burnout, pero se constató que hubo reducciones significativas cuando se trató con auriculoterapia. Conclusión: la auriculoterapia es eficaz para reducir la ansiedad y el estrés en los profesionales de la salud, pero no se puede afirmar que lo sea para el burnout. Se observó que la salud del trabajador mejora con el uso de la auriculoterapia.

Potential drug interactions in patients given antiretroviral therapy.

Objective: to investigate potential drug-drug interactions (PDDI) in patients with HIV infection on antiretroviral therapy. Methods: a cross-sectional study was conducted on 161 adults with HIV infection. Clinical, socio demographic, and antiretroviral treatment data were collected. To analyze the potential drug interactions, we used the software Micromedex(r). Statistical analysis was performed by binary logistic regression, with a p-value of ≤0.05 considered statistically significant. Results: of the participants, 52.2% were exposed to potential drug-drug interactions. In total, there were 218 potential drug-drug interactions, of which 79.8% occurred between drugs used for antiretroviral therapy. There was an association between the use of five or more medications and potential drug-drug interactions (p = 0.000) and between the time period of antiretroviral therapy being over six years and potential drug-drug interactions (p < 0.00). The clinical impact was prevalent sedation and cardiotoxicity. Conclusions: the PDDI identified in this study of moderate and higher severity are events that not only affect the therapeutic response leading to toxicity in the central nervous and cardiovascular systems, but also can interfere in tests used for detection of HIV resistance to antiretroviral drugs.

A five-year review of vertical HIV transmission in a specialized service: cross-sectional study.

CONTEXT AND OBJECTIVE:: Healthcare professionals need to instill the process of prevention, control and treatment of people infected with HIV into care practice. Through maintaining preventive treatment among HIV-infected pregnant women, it has been demonstrated that prophylactic antiretroviral therapy, scheduled cesarean section and the prohibition of breastfeeding significantly reduce vertical HIV transmission. This study aimed to assess the rates of vertical HIV transmission in a specialized service and identify the factors associated with it. DESIGN AND SETTING:: Cross-sectional study developed at the University Hospital of Santa Maria (RS), Brazil. METHODS:: A cross-sectional study was conducted on a sample of 198 notification forms and medical records of HIV-positive pregnant women and exposed children. RESULTS:: The vertical transmission rate was 2.4%, and three children had been infected by vertical HIV transmission. The statistically significant risk factor was the use of injectable drugs. Delayed reporting of pregnancy, absence of antiretroviral therapy during pregnancy, lack of proper prenatal care, incapacity to perform viral load detection tests and CD4+ T cell counts and obstetric and maternal clinical complications were reported. CONCLUSIONS:: The vertical transmission rate was high and the recommended intervention measures were not adopted in full. Adequate prophylactic measures need to be implemented in HIV-positive pregnant women prenatally and during the antenatal, delivery and postpartum periods.

Effect of maternal exercises on biophysical fetal and maternal parameters: a transversal study.

OBJECTIVE: To evaluate the acute effects of maternal and fetal hemodynamic responses in pregnant women submitted to fetal Doppler and an aerobic physical exercise test according to the degree of effort during the activity and the impact on the well-being. METHODS: Transversal study with low risk pregnant women, obtained by convenience sample with gestational age between 26 to 34 weeks. The participants carry out a progressive exercise test. RESULTS: After the exercise session, reduced resistance (p=0.02) and pulsatility indices (p=0.01) were identified in the umbilical artery; however, other Doppler parameters analyzed, in addition to cardiotocography and fetal biophysical profile did not achieve significant change. Maternal parameters obtained linear growth with activity, but it was not possible to establish a standard with the Borg scale, and oxygen saturation remained stable. CONCLUSION: A short submaximal exercise had little effect on placental blood flow after exercise in pregnancies without complications, corroborating that healthy fetus maintains homeostasis even in situations that alter maternal hemodynamics. OBJETIVO: Avaliar os efeitos agudos de respostas hemodinâmicas maternas e fetais em gestantes submetidas a Doppler fetal e a um teste de exercício físico aeróbio, de acordo com o grau de esforço durante a atividade e o impacto sobre o bem-estar. MÉTODOS: Estudo transversal desenvolvido com gestantes de baixo risco, por amostra de conveniência com idade gestacional entre 26 e 34 semanas. As participantes realizam um teste de esforço progressivo. RESULTADOS: Na artéria umbilical, após sessão de exercício físico, identificou-se a redução do índice de resistência (p=0,02) e do índice de pulsatilidade (p=0,01), mas os demais parâmetros Doppler analisados, além da cardiotocografia e do perfil biofísico fetal, não obtiveram alteração significativa. Os parâmetros maternos obtiveram crescimento linear com a atividade, mas não foi possível estabelecer padrão com a escala de Borg, e a saturação de oxigênio se manteve estável. CONCLUSÃO: O esforço submáximo curto teve pouco efeito sobre o fluxo de sangue da placenta após o exercício em gestações sem complicações, corroborando que o feto hígido mantém a homeostase mesmo em situações que alterem a hemodinâmica materna.

Dedicated Education Unit is a cost-effective clinical education model for undergraduate nursing programs / A Unidade de Educação Dedicada é um modelo de educação clínica custo-efetivo para programas de graduação em enfermagem

ABSTRACT Objective To evaluate the cost-effectiveness of clinical education models for undergraduate nursing programs. Methods A model-based cost-effectiveness analysis. Settings were universities with undergraduate nursing courses. Participants consisted of the decision tree that guided the structure of the model, filled in with effectiveness results from a hypothetical cohort of undergraduate nursing students. Interventions were Clinical Preceptor or Clinical Facilitator or Clinical Education Unit. Main outcome measure was effectiveness, defined as improvement of clinical education. The projected economic outcomes included incremental costs, incremental effectiveness, and incremental cost-effectiveness ratio. Monte Carlo probabilistic sensitivity analysis was employed to assess uncertainty in the model and robustness of our results. Results The model based on Clinical Education Unit could be defined as the best, followed by Clinical Facilitator and Clinical Preceptor. The incremental cost of telephone-support intervention was US$ 59,604.40 higher than the second-best performing intervention (Clinical Facilitator), and US$ 32,661.86 higher than the last best performing intervention (Clinical Preceptor). In addition, Clinical Education Unit model showed 7% and 19% more effectiveness than Clinical Facilitator and Clinical Preceptor, respectively. Conclusion Clinical Education Unit represents the best choice to promote better development of skills, knowledge and socialization in undergraduate nursing programs considering its effectiveness and costs.

RESUMO Objetivo Avaliar a relação de custo-efetividade dos modelos de educação clínica para cursos de graduação em enfermagem. Métodos Análise de custo-efetividade baseada em modelo. Os ambientes foram universidades com cursos de graduação em enfermagem. Os participantes consistiram na árvore de decisão, que norteou a estrutura do modelo, preenchida com resultados de efetividade de uma coorte hipotética de estudantes de graduação em enfermagem. As intervenções foram o Preceptor Clínico ou o Facilitador Clínico ou a Unidade de Educação Clínica. A principal medida de resultado foi a efetividade, definida como a melhoria da educação clínica. Os resultados econômicos projetados incluíram custos incrementais, efetividade incremental e custo incremental por efetividade. A análise probabilística de sensibilidade de Monte Carlo foi utilizada para avaliar a incerteza no modelo e a robustez de nossos resultados. Resultados O modelo baseado na Unidade de Educação Clínica foi o melhor, seguido pelo Facilitador Clínico e pelo Preceptor Clínico. O custo incremental da intervenção com suporte por telefone foi US$ 59,604.40 a mais do que o da segunda intervenção de melhor desempenho (Facilitador Clínico) e US$ 32,661.86 a mais do que a última intervenção de melhor desempenho (clínico preceptor). Além disso, o modelo da Unidade de Educação Clínica mostrou 7% e 19% mais efetividade do que Facilitador Clínico e Preceptor Clínico, respectivamente. Conclusão A Unidade de Educação Clínica representa a melhor escolha para promover um desenvolvimento de habilidades otimizado, conhecimentos e socialização nos cursos de graduação em enfermagem, considerando efetividade e custos.

Qualidade de vida, adesão e indicadores clínicos em pessoas vivendo com HIV / Calidad de vida, adherencia e indicadores clínicos en personas que viven con el VIH / Quality of life, adherence and clinical indicators among people living with HIV

Resumo Objetivo Avaliar a associação entre a qualidade de vida e a adesão ao tratamento antirretroviral. Métodos Estudo transversal, desenvolvido em serviço ambulatorial de doenças infecciosas em hospital universitário, localizado no interior do Rio Grande do Sul, Brasil. A amostra constitui-se de 156 participantes com HIV que responderam a questões de caracterização social, demográfica, clínica, de avaliação da adesão ao tratamento antirretroviral (CEAT-VIH), e de qualidade de vida (HAT-QoL). Foram realizadas análises estatísticas, entre elas a regressão logística para verificar associações. Resultados Os domínios da qualidade de vida que interferem positivamente na adesão foram os relacionados à função geral, preocupações com a medicação e confiança no profissional de saúde. O domínio que interferiu de forma negativa na adesão foi relacionado com as preocupações com o sigilo. Observou-se que as médias mais elevadas dos domínios de qualidade de vida estão relacionadas com a adesão estrita (adequada). A adesão estrita promove a supressão viral e o aumento das células de defesa no organismo. No entanto, resultados negativos nesses indicadores clínicos prejudicam os domínios de qualidade de vida, principalmente os relacionados à preocupação com a saúde, preocupações com a medicação e função sexual. Conclusão A qualidade de vida, associada à adesão e aos indicadores clínicos geram um ciclo, em que os diferentes resultados de cada um admitem a interferência entre si.

Resumen Objetivo Evaluar la relación entre la calidad de vida y la adherencia al tratamiento antirretroviral. Métodos Estudio transversal, desarrollado en servicio ambulatorio de enfermedad infecciosas en hospital universitario, ubicado en el interior del estado de Rio Grande do Sul, Brasil. La muestra consistió en 156 participantes con VIH que respondieron preguntas de caracterización social, demográfica, clínica, de evaluación de adherencia al tratamiento antirretroviral (CEAT-VIH) y de calidad de vida (HAT-QoL). Se realizaron análisis estadísticos, entre ellos regresión logística para verificar relaciones. Resultados Los dominios de calidad de vida que interfieren positivamente en la adherencia fueron los relacionados con la función general, preocupaciones con la medicación y confianza en el profesional de la salud. El dominio que interfirió de forma negativa en la adherencia estuvo relacionado con la preocupación por el secreto profesional. Se observó que los promedios más elevados de los dominios de calidad de vida están relacionados con la adherencia estricta (adecuada). La adherencia estricta promueve la supresión viral y el aumento de las células de defensa en el organismo. Sin embargo, resultados negativos de estos indicadores clínicos perjudican los dominios de calidad de vida, principalmente los relacionados con la preocupación por la salud, preocupación por la medicación y función sexual. Conclusión La calidad de vida, relacionada con la adherencia e indicadores clínicos, generan un ciclo, en el cual los diferentes resultados de cada uno permiten la interferencia entre sí.

Abstract Objective To evaluate the association between quality of life and adherence to antiretroviral treatment. Methods Cross-sectional study conducted in an outpatient clinic for infectious disease in a university hospital located in the state of Rio Grande do Sul, Brazil. The sample consisted of 156 participants with HIV who answered questions related to social, demographic and clinical characterization, evaluation of adherence to antiretroviral treatment (CEAT-HIV), and quality of life (HAT-QoL). Statistical analyzes were performed, including logistic regression to verify associations. Results The quality of life domains that affect adherence positively were those related to general function, medication concerns and confidence in the health professional. The domain that affected adherence negatively was related to concerns about confidentiality. It was observed that the highest means of quality of life were associated with strict adherence (adequate). Strict adherence promotes viral suppression and increases the defense cells in the body. However, negative results in these clinical indicators impair quality of life domains, especially those related to health concerns, medication concerns, and sexual function. Conclusion Quality of life, associated with adherence and clinical indicators generate a cycle, in which the different results of each one suffers the interference of the others.

Economic and epidemiological evaluation of text message-based interventions in patients with the Human Immunodeficiency Virus / Avaliação econômica e epidemiológica de intervenções baseadas em mensagens de texto em pacientes com o Vírus da Imunodeficiência Humana / Evaluación económica y epidemiológica de intervenciones basadas en mensajes de texto en pacientes con el Virus de la Inmunodeficiencia Humana

Objective: to evaluate the cost-effectiveness ratio and the budget impact of sending text messages associated with medical consultations in order to reduce the viral load of patients infected with the Human Immunodeficiency Virus. Method: a randomized clinical trial, basis for the development of a dynamic cohort model with Markov states in order to compare medical appointments for adults infected with the Human Immunodeficiency Virus versus the alternative strategy that associated medical consultations to sending text messages through telephone. Results: 156 adults participated in the study. As for the viral load, it was verified that in the control group there was an increase, in the intervention group A (weekly messages) there was a reduction (p = 0.002) and in group B (biweekly messages) there was no statistically significant difference. Sending text messages would prevent 286,538 new infections by the Human Immunodeficiency Virus and 282 deaths in the 20-year period, compared to the standard treatment. The alternative strategy would result in saving R$ 14 billion in treatment costs. Conclusion: weekly sending messages in association with the standard treatment can reduce the circulating viral load due to its effect in decreasing new infections, in addition to reducing health costs.

Objetivo: avaliar a razão custo-efetividade e o impacto orçamentário do envio de mensagens de texto, associadas às consultas médicas, para redução da carga viral de pacientes infectados com o Vírus da Imunodeficiência Humana. Método: ensaio clínico randomizado, base para o desenvolvimento de um modelo de coorte dinâmica com estados de Markov a fim de comparar consultas médicas para adultos infectados pelo Vírus da Imunodeficiência Humana versus a estratégia alternativa que associou consultas médicas, ao envio de mensagens de texto pelo telefone. Resultados: participaram do estudo 156 adultos. Quanto à carga viral, foi verificado que no grupo controle houve aumento, no grupo intervenção A (mensagens semanais) houve redução (p=0,002) e no grupo B (mensagens quinzenais) não houve diferença estatisticamente significante. O envio de mensagens de texto evitaria 286.538 novas infecções pelo Vírus da Imunodeficiência Humana e 282 mortes no período de 20 anos, ao comparar com o tratamento padrão. A estratégia alternativa resultaria em uma economia de R$ 14 bilhões nos custos de tratamento. Conclusão: o envio semanal de mensagens em associação ao tratamento padrão pode reduzir a carga viral circulante por seu efeito na diminuição de novas infeções, além da redução de custos em saúde.

Objetivo: evaluar la relación costo-efectividad y el impacto presupuestario del envío de mensajes de texto, asociados con consultas médicas, para reducir la carga viral de pacientes infectados con el Virus de Inmunodeficiencia Humana. Método: ensayo clínico aleatorizado, que sirve de base para el desarrollo de un modelo de cohorte dinámico con estados de Markov para comparar consultas médicas para adultos infectados con el Virus de Inmunodeficiencia Humana versus la estrategia alternativa que consistió en asociar las consultas médicas al envío de mensajes de texto por teléfono móvil. Resultados: 156 adultos participaron en el estudio. En cuanto a la carga viral, se encontró que en el grupo control hubo aumento, en el grupo de intervención A (mensajes semanales) hubo una reducción (p = 0,002) y en el grupo B (mensajes quincenales) no hubo diferencias estadísticamente significativas. El envío de mensajes de texto podría evitar 286.538 nuevas infecciones por el Virus de Inmunodeficiencia Humana y 282 muertes en el período de 20 años, en comparación con el tratamiento estándar. La estrategia alternativa resultaría en un ahorro de R$ 14 mil millones en costos de tratamiento Conclusión: el envío semanal de mensajes de forma complementaria al tratamiento estándar puede reducir la carga viral circulante debido a su efecto en la disminución de nuevas infecciones, además de reducir los costos en materia de salud.

Economic burden of inpatients infected with Klebsiella pneumoniae carbapenemase / Impacto econômico do tratamento de pacientes infectados com Klebsiella pneumoniae carbapenemase

ABSTRACT Objective: To estimate the direct medical costs of drug therapy of Klebsiella pneumoniae carbapenemase (KPC) infection patients in hospital-based context. Methods: A cost-of-illness study conducted with a prospective cohort design with hospitalized adults infected by KPC. Data collection was performed using an instrument composed of sociodemographic data, clinical and prescription medication. Estimates of the direct costs associated to each treatment were derived from the payer's perspective, in the case of federal public hospitals from Brazil, and included only drug costs. These costs were based on the average price available at the Brazilian Price Database Health. No discount rate was used for the cost of drugs. The costs are calculate in American Dollar (US$). Results: A total of 120 inpatients participated of this study. The total drug cost of these inpatients was US$ 367,680.85. The systemic antimicrobial group was responsible for 59.5% of total costs. The direct drug cost per patients infected by KPC was conservatively estimated at nearly US$ 4,100.00, and about of 60% of costs occurred during the period of infection. Conclusion: The findings of our study indicate a thoughtful economic hazard posed by KPC that all healthcare sectors have to face. The increasing worldwide incidence of these bacteria represents a growing burden that most health systems are unable to deal with. There is an imperative need to develop protocols and new antimicrobials to treatment of KPC, aiming to rearrange resources to increase the effectiveness of healthcare services.

RESUMO Objetivo: Estimar os custos médicos diretos da terapia medicamentosa de pacientes com infecção por carbapenemase por Klebsiella pneumoniae carbapenemase (KPC) em contexto hospitalar. Métodos: Estudo de custo de doença realizado com desenho de coorte prospectiva, com adultos hospitalizados infectados por KPC. A coleta de dados foi realizada usando instrumento composto por dados sociodemográficos, medicamentos clínicos e prescritos. As estimativas dos custos diretos associados a cada tratamento foram derivadas da perspectiva dos pagadores, no caso dos hospitais públicos federais do Brasil, e incluíram apenas custos de medicamentos, os quais basearam-se no preço médio disponível na Price Database Health do Brasil. Nenhuma taxa de desconto foi utilizada para o custo dos medicamentos. Os custos foram calculados em dólares norte-americanos (US$). Resultados: Um total de 120 pacientes hospitalizados participou do estudo. O custo total da droga desses pacientes internados foi de US$ 367,680.85. O grupo antimicrobianos de uso sistêmico foi responsável por 59,5% dos custos totais. O custo direto estimado de forma conservadora, por paciente, foi de aproximadamente US$ 4,100.00, e cerca de 60% destes se deram durante o período de infecção. Conclusão: Os achados deste estudo apontam um risco econômico importante relacionado a KPC, o qual todos os setores de saúde terão que enfrentar. A incidência mundial em elevação destas bactérias representa carga crescente, e a maioria dos sistemas de saúde é incapaz de resolvê-la. Há necessidade imperativa de se desenvolverem protocolos e novos antimicrobianos para o tratamento de KPC, com o objetivo de reorganizar os recursos para aumentar a efetividade dos serviços de saúde.

[Effects of physical exercise on the fetal hemodynamic parameters]. / Efeito do exercício físico sobre os parâmetros hemodinâmicos fetais.

PURPOSE: To assess the effects of aerobic physical exercise on the Doppler velocimetry of fetal vessels in pregnant women with no clinical or obstetrical complications. METHODS: A cross-sectional study was conducted on 10 healthy low-risk pregnant women at 2 different gestational times: between the 26th and 29th week and 6 days, and at the end of pregnancy, between the 30th and 35th week. The patients were submitted to aerobic physical exercise on a treadmill until reaching fatigue. Ultrasonographic data were obtained at rest and after physical exercise (Doppler velocimetry indices for the umbilical artery, middle cerebral artery, ductus venosus, and uterine arteries). Data were analyzed statistically by the paired and independent Student's t-test using the Statistical Package for the Social Sciences (SPSS) package, version 21.0. RESULTS: A change in the pulsatility index was observed, with an indication of vasodilatation, with a median value of 1.1±0.1 before exercise and of 1.0±0.1 after exercise; the median value of the resistance index was 0.7±0.04 before exercise and 0.6±0.07 after exercise. The median systole/diastole ratio of the umbilical artery was 3.1±0.4 before exercise and 2.9±0.2 (p=0.03) after exercise at the beginning of pregnancy. No changes in the Doppler velocimetry parameters were observed for the uterine arteries, the middle cerebral artery or the ductus venosus after physical activity at either testing time. Paired analysis of pre- and post-activity data showed a reduction of resistance from the first to the second period (p<0.04). CONCLUSIONS: Physical exercise does not lead to changes in systemic blood flow or fetal-placental flow in healthy pregnant women, confirming that exercises of mild to moderate intensity can be prescribed.