Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients.

BACKGROUND: Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. METHODS: This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). RESULTS: The median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918-0.939) and validation (temporal AUROC 0.927, 95% CI 0.911-0.941; geographic AUROC 0.819, 95% CI 0.792-0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). CONCLUSIONS: The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.

Potential and limitations of machine meta-learning (ensemble) methods for predicting COVID-19 mortality in a large inhospital Brazilian dataset.

The majority of early prediction scores and methods to predict COVID-19 mortality are bound by methodological flaws and technological limitations (e.g., the use of a single prediction model). Our aim is to provide a thorough comparative study that tackles those methodological issues, considering multiple techniques to build mortality prediction models, including modern machine learning (neural) algorithms and traditional statistical techniques, as well as meta-learning (ensemble) approaches. This study used a dataset from a multicenter cohort of 10,897 adult Brazilian COVID-19 patients, admitted from March/2020 to November/2021, including patients [median age 60 (interquartile range 48-71), 46% women]. We also proposed new original population-based meta-features that have not been devised in the literature. Stacking has shown to achieve the best results reported in the literature for the death prediction task, improving over previous state-of-the-art by more than 46% in Recall for predicting death, with AUROC 0.826 and MacroF1 of 65.4%. The newly proposed meta-features were highly discriminative of death, but fell short in producing large improvements in final prediction performance, demonstrating that we are possibly on the limits of the prediction capabilities that can be achieved with the current set of ML techniques and (meta-)features. Finally, we investigated how the trained models perform on different hospitals, showing that there are indeed large differences in classifier performance between different hospitals, further making the case that errors are produced by factors that cannot be modeled with the current predictors.

Predictors of venous thromboembolism in COVID-19 patients: results of the COVID-19 Brazilian Registry.

Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-19 patients have shown inconsistent results. Our aim was to investigate VTE predictors by both logistic regression (LR) and machine learning (ML) approaches, due to their potential complementarity. This cohort study of a large Brazilian COVID-19 Registry included 4120 COVID-19 adult patients from 16 hospitals. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting, and bagging were used to investigate the association of variables upon hospital presentation with VTE. Among 4,120 patients (55.5% men, 39.3% critical patients), VTE was confirmed in 6.7%. In multivariate LR analysis, obesity (OR 1.50, 95% CI 1.11-2.02); being an ex-smoker (OR 1.44, 95% CI 1.03-2.01); surgery ≤ 90 days (OR 2.20, 95% CI 1.14-4.23); axillary temperature (OR 1.41, 95% CI 1.22-1.63); D-dimer ≥ 4 times above the upper limit of reference value (OR 2.16, 95% CI 1.26-3.67), lactate (OR 1.10, 95% CI 1.02-1.19), C-reactive protein levels (CRP, OR 1.09, 95% CI 1.01-1.18); and neutrophil count (OR 1.04, 95% CI 1.005-1.075) were independent predictors of VTE. Atrial fibrillation, peripheral oxygen saturation/inspired oxygen fraction (SF) ratio and prophylactic use of anticoagulants were protective. Temperature at admission, SF ratio, neutrophil count, D-dimer, CRP and lactate levels were also identified as predictors by ML methods. By using ML and LR analyses, we showed that D-dimer, axillary temperature, neutrophil count, CRP and lactate levels are risk factors for VTE in COVID-19 patients.

Chagas disease and SARS-CoV-2 coinfection does not lead to worse in-hospital outcomes.

Chagas disease (CD) continues to be a major public health burden in Latina America. Information on the interplay between COVID-19 and CD is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Consecutive patients with confirmed COVID-19 were included from March to September 2020. Genetic matching for sex, age, hypertension, diabetes mellitus and hospital was performed in a 4:1 ratio. Of the 7018 patients who had confirmed COVID-19, 31 patients with CD and 124 matched controls were included (median age 72 (64-80) years-old, 44.5% were male). At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p < 0.05). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). In-hospital management, outcomes and complications were similar between the groups. In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation.

Coping strategies of people living with AIDS in face of the disease.

OBJECTIVE: to identify the coping strategies of people living with aids to face the disease and analyze them according to sociodemographic, clinical and lifestyle variables. METHOD: this is a cross-sectional quantitative study. The sample consisted of 331 people living with aids treated at an outpatient clinic at a referral hospital for treatment of aids. The Coping Strategies Inventory was used to collect the data. RESULTS: emotion-focused coping modes were more frequently mentioned. The mean scores of women, workers, religious people, and people who never withdrew from the treatment were higher for all factors. Patients who had a partner, who lived with family members and who received treatment support, had higher mean scores in coping, withdrawal and social support factors. As for leisure and the practice of physical exercises, the emotion-focused modes also predominated. A correlation was identified between treatment time, schooling, family income and the factors of the Coping Strategies Inventory of. CONCLUSION: the study showed that the most frequent coping modes were those focused on emotion.

Coping strategies of people living with AIDS in face of the disease / Estratégias de enfrentamento utilizadas por pessoas vivendo com aids frente à situação da doença / Estrategias de enfrentamiento utilizadas por personas viviendo con SIDA frente a la situación de la enfermedad

To identify the coping strategies of people living with aids to face the disease and analyze them according to sociodemographic, clinical and lifestyle variables. This is a cross-sectional quantitative study. The sample consisted of 331 people living with aids treated at an outpatient clinic at a referral hospital for treatment of aids. The Coping Strategies Inventory was used to collect the data. Emotion-focused coping modes were more frequently mentioned. The mean scores of women, workers, religious people, and people who never withdrew from the treatment were higher for all factors. Patients who had a partner, who lived with family members and who received treatment support, had higher mean scores in coping, withdrawal and social support factors. As for leisure and the practice of physical exercises, the emotion-focused modes also predominated. A correlation was identified between treatment time, schooling, family income and the factors of the Coping Strategies Inventory of. The study showed that the most frequent coping modes were those focused on emotion.

Identificar as estratégias de enfrentamento de pessoas vivendo com aids frente à situação da doença e analisá-las segundo variáveis socidemográficas, clínicas e hábitos de vida. Trata-se de um estudo transversal de cunho quantitativo. A amostra foi composta por 331 pessoas vivendo com aids atendidos em um ambulatório de um hospital de referência no tratamento da aids. Para coletar os dados, foi utilizado o Inventário de Estratégias de Enfrentamento. Houve maior referência nos modos de enfrentamento focados na emoção. Os escores médios das mulheres, dos trabalhadores, dos religiosos e dos que nunca abandonaram o tratamento foram mais elevados para todos os fatores. Os usuários que possuíam companheiro, moravam com familiares e receberam apoio no tratamento apresentaram maiores escores médios para os fatores confronto, afastamento e suporte social. Quanto ao lazer e a prática de exercícios físicos também predominou os modos focados na emoção. Identificou-se correlação entre o tempo de tratamento, escolaridade e renda familiar e os fatores do Inventário de Estratégias de Enfrentamento. O estudo permitiu evidenciar que os modos de enfrentamento mais frequentes foram os focados na emoção.

Identificar las estrategias de enfrentamiento de personas viviendo con SIDA frente a la situación de la enfermedad y analizarlas según variables sociodemográficas, clínicas y hábitos de vida. Se trata de un estudio transversal de cuño cuantitativo. La muestra fue compuesta por 331 personas viviendo con sida atendidos en ambulatorio de un hospital de referencia en el tratamiento de sida. Para recolectar los datos, fue utilizado el Inventario de Estrategias de Enfrentamiento. Hubo mayor referencia en los modos de enfrentamiento centrados en la emoción. Los escores medios de las mujeres, de los trabajadores, de los religiosos y de los que nunca abandonaron el tratamiento fueron más elevados para todos los factores. Los usuarios que poseían compañero, vivían con familiares y recibieron apoyo en el tratamiento presentaron mayores escores medios para los factores confronto, alejamiento y soporte social. En cuanto al entretenimiento y la práctica de ejercicios físicos también predominaron los modos centrados en la emoción. Se identificó correlación entre el tiempo de tratamiento, escolaridad y renta familiar y los factores del Inventario de Estrategias de Enfrentamiento. El estudio permitió evidenciar que los modos de enfrentamiento más frecuentes fueron los centrados en la emoción.

Erros de enfermagem e segurança do paciente: o conhecimento de graduandos de enfermagem / Nursing errors and security of the patient: the nursing undergraduates' knowledge

Pesquisa exploratória com abordagem qualitativa cujo objetivo foi compreender o conhecimento dos graduandos de enfermagem sobre os Erros da Enfermagem e a Segurança do Paciente. Para isso realizou-se entrevista semiestruturada com 36 graduandos de enfermagem de uma Instituição de Ensino Superior pública, cujo campus universitário localiza-se na cidade de Pau dos Ferros/RN. Evidenciou-se que os graduandos possuem uma visão ampliada acerca dos "Erros de Enfermagem", no sentido de valorizar a importância de se conhecer e discutir os fatores desencadeantes e condicionantes, além da não valorização a culpabilização apenas do profi ssional. Quanto a "Segurança do Paciente" se constitui como uma discussão relativamente nova no campo dos cuidados de enfermagem, onde se percebe que o tema não é sufi cientemente estudado na formação. Deste modo, há necessidade de incluir na grade curricular disciplinas que abordem com maior ênfase e mais diretamente as temáticas, inclusive é imperativo que o aluno se disponha a ser coparticipativo nesse processo

Exploratory research with a qualitative approach whose objective was to understand the perception of nursing undergraduates about Nursing Errors and Patient Safety. For this, a semi-structured interview was conducted with 36 nursing undergraduates from a public higher education institution, whose university campus is located in the city of Pau dos Ferros / RN. It was evident that the graduates have a broader view about the "Nursing Errors" in order to appreciate the importance of understanding and discuss the triggering and conditioning factors, in addition to no appreciation to blame only the professional. As for "Patient Safety" is constituted as a relatively new discussion in the fi eld of nursing care, where it is realized that the subject is not suffi ciently studied in training. Thus, there is need to include in the curriculum subjects that address with greater emphasis and more directly the issues, including it is imperative that the student is willing to be co-participative in this process

Privacidade e confidencialidade de usuários em um hospital geral / Privacy and confidentiality of users in a general hospital / Privacidad y confidencialidad de los usuarios en un hospital general

Resumo No ambiente hospitalar, privacidade e confidencialidade dos usuários são frequentemente desrespeitadas. Esta pesquisa, exploratória e qualitativa, realizada em hospital geral localizado em Pau dos Ferros, Rio Grande do Norte, Brasil, objetivou analisar a percepção de usuários sobre aspectos relacionados a sua privacidade e confidencialidade durante a internação. Utilizou-se para a coleta de dados a técnica da entrevista semiestruturada com análise de conteúdo. Após análise dos dados, foram criadas duas categorias: privacidade dos usuários hospitalizados e confidencialidade dos dados dos usuários hospitalizados. Os resultados demonstraram que os entrevistados têm entendimento ambíguo e limitado sobre privacidade e confidencialidade. Por não saberem que têm esses direitos não associaram situações invasivas durante a internação ao desrespeito. Além disso, os participantes manifestaram em suas falas passividade e aceitação diante dos cuidados recebidos. Logo, espera-se que os resultados deste estudo possam estimular discussões sobre os aspectos éticos estudados e aperfeiçoar os cuidados em saúde.

Abstract The privacy and confidentiality of users are often disrespected within the hospital setting. The present study, consisting of an exploratory and qualitative survey, was performed in a general hospital located in Pau dos Ferros, in the state of Rio Grande do Norte, Brazil and aimed to analyze the perception of users regarding aspects related to their privacy and confidentiality during hospitalization The semi-structured interview technique with content analysis was used for data collection. After data analysis, two categories were created: the privacy of hospitalized users and the confidentiality of their data. The results showed that interviewees had an ambiguous understanding of privacy and confidentiality and a limited comprehension of these issues. As they were not aware they had such rights, they did not associate invasive situations experienced during hospitalization with disrespect. In addition, the speeches of the participants showed passivity and acceptance towards the care received. It is therefore hoped that the results of this study can contribute to the expansion of discussions about the ethical aspects studied and possible improvements in health care.

Resumen En el ambiente hospitalario, la privacidad y la confidencialidad de los usuarios son a menudo irrespetadas. Esta investigación, exploratoria y cualitativa, realizada en un hospital general ubicado en Pau dos Ferros, Rio Grande do Norte, Brasil, tuvo como objetivo analizar la percepción de los usuarios respecto de los aspectos relacionados con su privacidad y confidencialidad durante la internación. Para la recolección de datos se utilizó la técnica de entrevista semiestructurada, con análisis de contenido. Luego del análisis de los datos, se generaron dos categorías: privacidad de los usuarios hospitalizados y confidencialidad de los datos de los usuarios hospitalizados. Los resultados demostraron que los entrevistados tienen un entendimiento ambiguo y limitado sobre privacidad y confidencialidad. Por no comprender que poseen estos derechos, no asociaron situaciones invasivas vivenciadas durante la internación con falta de respeto. Además, los participantes manifestaron en sus discursos pasividad y aceptación ante los cuidados recibidos. Así, se espera que los resultados de este estudio puedan estimular discusiones sobre los aspectos éticos estudiados y perfeccionar los cuidados en salud.

Perfil clínico-epidemiológico de adultos HIV-positivo atendidos emum hospital de Natal/RN / Perfil clínico-epidemiológico de adultos VIH-positivos tratados en un hospital de Natal/RN / Clinical-epidemiological profile of HIV-positive adults attended in a hospital from Natal/RN

To characterize the clinical-epidemiological profile and habits of life of HIV-positive adults. Methods: this is a descriptive, cross-sectional and quantitative study with a sample of 331 HIV-positive people with outpatient scheduling between February and August 2014 in a reference hospital from Natal/RN. Data collection was conducted through a semi-structured interview. Results: the results showed a predominance of men (52%), young people (42%) natural from the capital (58%), brown color (53%), single (56%), heterosexual (79%), poor (68 %). Most of them held the first anti-HIV test for less than five years (60%), had signs and symptoms of AIDS before the test (90%), were hospitalized (90%), started HAART for less than five years (60%), suppose they have good knowledge of the disease (75%), and believe that their health has improved (92%). Most of them do not consume alcohol (71%), are non-smokers (88%), do not use illicit drugs (92%) and had never used preservatives before diagnosis (62%). Conclusion: the identified profile follow the national trends...

Caracterizar o perfil epidemiológico-clínico e de hábitos devida de adultos HIV-positivo. Métodos: estudo descritivo, transversal e quantitativo, com uma amostra de 331 pessoas soropositivas com agendamento ambulatorial entre fevereiro e agosto de 2014 em um hospital de referência de Natal/RN. A coleta de dados foi realizada através de entrevista semiestruturada. Resultados: os resultados mostraram predominância de homens (52%), jovens (42%), procedentes da capital(58%), cor parda (53%), solteiros (56%), heterossexuais (79%), pobres (68%). A maioria realizou o primeiro exame anti-HIV há menos de cinco anos (60%), teve sinais e sintomas da AIDS antes do exame (90%), foi internada (90%), iniciou o TARV há menos de cinco anos (60%), julga ter bom conhecimento sobre a doença (75%) e acredita que sua saúde melhorou (92%). Os pacientes não consumem álcool (71%), não fumam (88%) e não usam drogas ilícitas (92%), nunca usaram preservativos antes do diagnóstico (62%). Conclusão: o perfil identificado segue as tendências nacionais...

Caracterizar el perfil epidemiológico-clínico y de hábitos de vida de los adultos VIH-positivos. Métodos: estudio descriptivo, transversal y cuantitativo con una muestra de 331 personas VIH-positivas con programación ambulatoria entre febrero y agosto de 2014 de un hospital de referencia en Natal/RN. La recolección de datos se realizó a través de entrevistas semi-estructuradas. Resultados: los resultados mostraron un predominio de hombres (52%), jóvenes (42%), procedentes de la capital (58%), mulatos (53%), solteros (56%), heterosexuales (79%), pobres (68%). La mayoría había realizado el primer examen contra el VIH hacía menos de cinco años (60%), tenían señales y síntomas del SIDA antes del examen (90%), fueron internados (90%), habían iniciado el TAR hacía menos de cinco años (60 %), juzgan tener un buen conocimiento acerca de la enfermedad (75%) y creen que su salud ha mejorado (92%). No consumen alcohol (71%), no fuman (88%), no usan drogas ilícitas (92%) y nunca usaron preservativos antes del diagnóstico (62%). Conclusión: el perfil identificado sigue las tendencias nacionales...

Estratégia de inovação no ensino de enfermagem na atenção domiciliar a idosas / Estrategia para la innovación en la enseñanza de enfermería en la atención domiciliaria de la persona anciana / Strategy for innovation in the teaching of nursing in the home care for the elderly

Objetivo: Proporcionar aos estudantes a ampliação do escopo da Atenção Básica para além das atividades de assistência domiciliar, introduzindo atividades de internação domiciliar, para a compreensão das interfaces do Sistema Único de Saúde. Métodos: Relato de experiência no ensino de graduação em enfermagem com estudo de caso, aplicação da NANDA e do Modelo Calgary. Resultados: A assistência domiciliar é importante ferramenta de tecnologia de acesso à família e de sistematização da assistência de enfermagem no contexto das políticas públicas de atenção à saúde do idoso. Conclusão: na assistência domiciliar os cuidados primários co-existiram com cuidados complexos e é imperiosa a expansão da Estratégia Saúde da Família com a constituição de equipes para atividades de internação domiciliar, diferentes das equipes de saúde da família, mas no âmbito da Atenção Básica, dadas as demandas sociais emergentes

Objective: To provide undergraduate students with the experience of the expanding of the scope of primary health care in activities of home care, introducing complex care activities of home care, for the understanding of the interfaces of the Health Care System. Methods: A report of experience in nursing education with case study, application of NANDA and Calgary Model. Results: The home care is an important tool of technology for access to families and nursing care system in the context of the public policies of health care to the elderly. Conclusion: The primary home care co-existed with complex nursing care and is imperious the expansion of the Family Health Strategy with the constitution of teams for activities of home care, different from family health teams, but in the context of primary care, according to the social demands emerging

Objetivo: Proporcionar a los estudiantes la ampliación del alcance de la atención primaria de salud, com actividades de atención domiciliaria com cuidados de enfermeria complejos para la comprensión de las interrelaciones en el Sistema Único de Salud. Métodos: Informe de experiencia en la enseñanza de enfermería con estudio de casos, la aplicación de la NANDA y del modelo Calgary. Resultados: La atención domiciliaria es una herramienta importante de tecnología para el acceso a la familia y a la atención de enfermería en el contexto de las políticas públicas de atención sanitaria a los ancianos. Conclusión: en la atención domiciliaria la atención primaria co-existiero con cuidados complejos y es imperioso la expansión de la Estrategia de la Salud de la Familia con la constitución de equipos de salud para actividades de cuidados domiciliarios, diferente de los equipos de salud familiar, pero en el contexto de la atención primaria, habida cuenta de las demandas sociales emergentes

Ações educativas para terceira idade / Acciones educativas para la tercera edad / Educational actions for the elderly

No processo de envelhecimento, os idosos se deparam com o surgimento de doenças crônicas que muitas vezes repercutem em dificuldades para manutenção da saúde. Nesse sentido, é importante o trabalho com a terceira idade para promover a melhoria no estilo de vida. Este trabalho trata-se de um relato de experiência da execução de um projeto de pesquisa da Universidade Federal do Rio Grande do Norte, que realiza ações educativas na Associação Inaraí (Natal/RN), com o objetivo de divulgar atividades, estimulando assim, a formação de grupos que visem à promoção à saúde do idoso. Para desenvolver as ações, conforme informações coletadas no perfil epidemiológico previamente realizado na Associação, através de reuniões semanais com idosas, buscou-se estimular bons hábitos de vida, a fim de viabilizar a melhoria do estilo de vida e, portanto, promover saúde daquele grupo.

En el proceso del envejecimiento, anciano se enfrentan a la aparición de enfermedades crónicas que muchas veces reflejan en dificultades para el mantenimiento de la salud. En este contexto, es importante el trabajo con la tercera edad para promover la mejora del consiguiente estilo de vida. Este trabajo es un relato de experiencia de la ejecución de un proyecto de investigación de la Universidad Federal de Rio Grande do Norte, que lleva acciones educativas a la Asociación Inaraí (Natal/RN), con objetivo de divulgar actividades, así estimulando la formación de los grupos a que tienen como objetivo la promoción a salud de ancianos. Para desarrollar las acciones, según la informaciones recogidas en el perfil epidemiológico llevado previamente en la Asociación, por medio de reuniones semanales con ancianos, se buscó estimular buenos hábitos de vida, para llevar a cabo posible la mejora de lo estilo de vida y por lo tanto, promover salud de ese grupo.

In the aging process, the older adults are faced with the emergence of chronic diseases that often reflect in difficulties for health maintenance. Therefore, it is important to work with seniors to promote the improvement in lifestyle. This article is a report from a research project at the Federal University of Rio Grande do Norte, which carries out educational actions in the Inaraí Association (Natal, RN, Brazil), with the objective of divulging activities and thereby stimulate the formation of groups that aim at promoting the health of the elderly. To develop the actions, we rely on the information in the epidemiological profile previously developed in the Association, from then on, through weekly meetings collected with elderly women. We intend to stimulate good habits of life, in order to make possible the improvement of lifestyle and, therefore, to promote health for the group.