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

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

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

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

Perfil de salud de los recién nacidos ingresados en una unidad de cuidados intermedios neonatales convencionales / Perfil de saúde de recém-nascidos admitidos em unidade de cuidados intermediários neonatais convencionais / Health profile of newborns admitted to a conventional neonatal intermediate care unit

Objetivo: Caracterizar el perfil de salud de los recién nacidos ingresados en una Unidad de Cuidados Intermedios Neonatales Convencionales de Maternidad de referencia en el Estado de Piauí. Método: Estudio descriptivo, exploratorio y analítico, con abordaje de datos cuantitativos, realizado en el período de julio a agosto de 2021 en una Unidad de Cuidados Intermedios Neonatales Convencionales de Maternidad de referencia en el Estado de Piauí. Se elaboró mediante la evaluación y el análisis de la propia lista de control de admisión de recién nacidos de la unidad. La recogida de datos se realizó mediante un formulario elaborado y probado. Se incluyeron 1.251 recién nacidos ingresados en la unidad en el periodo elegido, y se excluyeron los reingresos, los registros incompletos o no concluyentes, o los que estaban fuera de plazo. Los datos se analizaron mediante estadísticas descriptivas e inferenciales. Resultados: Los ingresos se produjeron en mayor porcentaje en 2020, con predominio de madres procedentes del interior del estado, recién nacidos varones, pretérmino, adecuados a la edad gestacional, con puntuación de Apgar de 8-10, nacidos de parto por cesárea y procedentes de la sala de partos. Conclusión: A partir de los datos obtenidos mediante la caracterización de los recién nacidos, se obtiene un manejo adecuado, la reducción de la morbimortalidad, la reducción del tiempo de internamiento y la adquisición de los recursos necesarios para la atención al recién nacido. (AU)

Objetivo: Caracterizar o perfil de saúde de recém-nascidos admitidos em uma Unidade de Cuidados Intermediários Neonatais Convencionais de Maternidade de referência do Estado do Piauí. Método: Estudo descritivo, exploratório e analítico, com abordagem quantitativa de dados, realizado no período de julho a agosto de 2021 em Unidade de Cuidados Intermediários Neonatais Convencionais de Maternidade de referência do Estado do Piauí. Ele foi desenvolvido por meio de avaliação e análise de checklist próprio de admissão de recém-nascidos da unidade. A coleta dos dados foi realizado por meio de formulário elaborado e testado. Foram incluidos 1.251 recém-nascidos internados na unidade no periodo elegido, e excluídos readmissões, registros incompletos, inconclusivos ou fora do recorte temporal. Os dados foram analisados utilizando estatística descritiva e inferencial. Resultados: As admissões ocorreram em maior porcentagem em 2020, com predominância de mães provenientes do interior do Estado, recém-nascidos do sexo masculino, pré-termos, adequado para a idade gestacional, com Apgar de 8-10, nascidos de parto cesáreos e provenientes da sala de parto. Conclusão: A partir dos dados obtidos por meio da caracterização dos recém-nascidos, obtém-se manejo adequado, redução da morbimortalidade, redução de tempo de internação e aquisição de recursos necessários para o atendimento ao neonato. (AU)

Objective: To characterize the health profile of newborns admitted a Conventional Neonatal Intermediate Care Unit of a reference Maternity in the State of Piauí. Method: Descriptive, exploratory and analytical study, with quantitative data approach, conducted from July to August 2021 in a Conventional Neonatal Intermediate Care Unit of a reference Maternity in the State of Piauí. It was developed through the evaluation and analysis of the unit's own newborn admission checklist. The data collection was performed using an elaborated and tested form. 1,251 newborns admitted to the unit during the selected period were included, and readmissions, incomplete or inconclusive records, or those outside the time frame were excluded. Data were analyzed using descriptive and inferential statistics. Results: The admissions occurred in a higher percentage in 2020, with a predominance of mothers from the interior of the state, male newborns, preterm, suitable for gestational age, with Apgar score of 8-10, born from cesarean delivery and coming from the delivery room. Conclusion: From the data obtained through the characterization of newborns, we obtain adequate management, reduced morbidity and mortality, reduced hospitalization time and acquisition of resources needed for the care of the newborn. (AU)

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

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

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

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

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

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

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

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

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

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

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

Triaje, predicción de ingreso y constantes vitales / Triage, predicting hospital admission, and vital constants

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Novel Coronavirus (2019-nCov) do you have enough Intensive Care Units? / Nuevo coronavirus (2019-nCov): ¿tiene suficientes unidades de cuidados intensivos?

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

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

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

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

Trascendencia de la detección precoz del riesgo nutricional en nuestros pacientes. Experiencia en un hospital de media-larga estancia / Transcendence of the early detection of nutritional risk in our patients. Experience at a half-long stay hospital

FUNDAMENTO: El cribado de riesgo nutricional permite detectar el riesgo de desnutrición desde su inicio y antes de su manifestación clínica. OBJETIVO: Evidenciar la utilidad del CONUT en el cribado nutricional al ingreso en un hospital de media-larga estancia. MÉTODOS: Se realizaron dos estudios longitudinales (2014n=121-2018n=155), utilizando CONUT para detectar precozmente el riesgo de desnutrición y evaluar la eficacia de la intervención nutricional. Las variables respuesta fueron el tipo y grado de desnutrición al ingreso y al alta. RESULTADOS: La prevalencia de desnutrición/riesgo nutricional detectada con CONUT al ingreso fue de 85,9%. Con la Valoración Nutricional Completa (VNC), la prevalencia de desnutrición al ingreso fue del 81,0% (5% desnutrición calórica, 17,4% mixta y 58,7% proteica). Un 5% de los pacientes en riesgo detectados mediante CONUT, todavía no podían ser diagnosticados mediante la VNC. Los valores al alta fueron 5% desnutrición calórica, 7,7% mixta y 36,4% proteica. CONUT permitió identificar y seguir la evolución del paciente desnutrido con mayor sensibilidad que los parámetros antropométricos. La intervención nutricional redujo la prevalencia y severidad de la desnutrición, mejorando fundamentalmente a expensas de corregir la desnutrición proteica. Los pacientes desnutridos presentaron mayor número de categorías diagnósticas. Se observaron diferencias significativas entre los perfiles nutricionales de las patologías más prevalentes. CONCLUSIONES: CONUT permitió automatizar eficientemente el cribado nutricional. La aplicación de un protocolo estructurado para la detección, monitorización y tratamiento de la desnutrición permitió identificar pacientes subsidiarios de beneficiarse del soporte nutricional, lo que se reflejó en una mejora del estado nutricional al alta

BACKGROUND: Nutritional risk screening enables the risk of malnutrition to be detected from its beginning and before its clinical expression. OBJECTIVE: To demonstrate the usefulness of CONUT in nutritional screening at admission to a medium-to-long stay hospital. METHODS: Two longitudinal studies (2014n=121-2018n=155) were conducted using CONUT for the early detection of the risk of malnutrition and to evaluate the efficacy of the nutritional intervention. The response variables were the type and degree of malnutrition at admission and discharge. RESULTS: The prevalence of malnutrition/nutritional risk detected with CONUT at admission was 85.9%. With the Comprehensive Nutritional Assessment (CNA), the prevalence of malnutrition at admission was 81.0% (caloric malnutrition 5%, mixed malnutrition 17.4%, and protein malnutrition 58.7%). 5% of the patients at risk detected by CONUT still could not be diagnosed by the CNA. The values at discharge were caloric malnutrition 5%, mixed malnutrition 7.7%, and protein malnutrition 36.4%. CONUT enabled the evolution of the malnourished patient to be identified and followed up with greater sensitivity when compared to the anthropometric parameters. Nutritional intervention reduced the prevalence and severity of malnutrition, essentially improving it upon protein malnutrition correction. Malnourished patients showed a greater number of diagnostic categories. Significant differences were observed among the nutritional profiles of the most prevalent diseases. CONCLUSIONS: CONUT enabled nutritional screening to be efficiently automated. The application of a structured protocol for the detection, monitoring and treatment of malnutrition made it possible to identify subsidiary patients to benefit from nutritional support, which was reflected in an improvement in nutritional status at discharge

Construção e validação de um objeto de aprendizagem para enfermeiros / Construction and validation of a learning object for nurses

In today's societies, health care is increasingly culturally diverse due to the increasing migratory processes of the population and nurses. Therefore, it is necessary to train nurses to provide culturally competent care. Learning objects are didactic, multimedia, interactive and challenging materials that constitute relevant resources for the teaching-learning processes that go beyond the classroom. In many countries, in nursing education, they are still an innovative way of learning. The study was developed as part of the international project Developing Multimedia Learning for Cross-Cultural Collaboration and Competence in Nursing - TransCoCon, (ERASMUS + Program, contract: 2017-1-UK01-KA203-36612) and aimed to build and validate a learning object that supports the learning of transcultural competences, necessary in nursing care. The learning object developed is subordinated to the theme of admission of a client in a hospital. For its development, the following steps were followed: choice of content; analyze; conceptual map; navigational architecture; storyboard; Implementation; documentation of use; use, evaluation and maintenance. As a result of the work developed, we obtained the learning object "Admission to hospital" and its Portuguese version "Acolhimento do Cliente num Hospital". Both versions include a set of written supportive material for cross-cultural nursing care in hospital and illustrative videos of cross-cultural communication skills. The adopted methodology proved to be effective for the construction of an attractive, interactive and meaningful learning object for nursing students, nurses and nursing teachers

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

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

High HIV prevalence in an early cohort of hospital admissions with COVID-19 in Cape Town, South Africa

Background. South Africa (SA) has a high prevalence of HIV and tuberculosis. Cape Town was the SA metropole most affected in the early stages of the COVID-19 pandemic. Early observational data from Africa may provide valuable insight into what can be expected as the pandemic expands across the continent.Objectives. To describe the prevalence, clinical features, comorbidities and outcome of an early cohort of HIV-positive and HIV-negative patients admitted with COVID-19.Methods. This was a descriptive observational study of an early cohort of adults with COVID-19 pneumonia admitted from 25 March to 11 May 2020.Results. Of 116 patients (mean age 48 years, 61% female) admitted, 24 were HIV-positive (21%). The most common symptoms reported were cough (n=88; 73%), shortness of breath (n=78; 69%), fever (n=67; 59%), myalgia (n=29; 25%) and chest pain (n=22; 20%). The most common comorbidities were hypertension (n=46; 41%), diabetes mellitus (n=43; 38%), obesity (n=32; 28%) and HIV (n=24; 21%). Mortality was associated with older age (mean (standard deviation) 55 (12) years v. 46 (14) years; p<0.01); the presence of hypertension or hypertension along with diabetes and/or obesity; lower partial pressure of arterial oxygen to fraction of inspired oxygen ratio; and higher urea level, white cell count, neutrophil count, and C-reactive protein, lactate dehydrogenase and ferritin levels, and high neutrophil to lymphocyte ratio. The overall survival rate for all hospital admissions was 86/116 (73%). In this early cohort, survival was similar in patients with HIV (n=18; 75%) compared with those without HIV (n=67; 75%) (p=1). Of the 74 patients admitted to the wards, 63 (85%) survived, whereas 22 of 42 (52%) admitted to the intensive care unit survived.Conclusions. Patients with HIV infection represented a large proportion of all COVID-19 admissions. The presentation and outcome of patients with HIV did not differ significantly from those of patients without HIV

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

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

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

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

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

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