Proposta de um plano de gestão por processos para o alcance da meta calórica diária de pacientes em condições clínicas adversas / Process based management plan to enable patients in adverse clinical conditions reach the daily caloric target

Objetivos ­ Apresentar um modo de gestão por processos coordenados à assistência nutricional, por meio da equipe de terapia multiprofissional (EMTN), alinhando o plano terapêutico a fim de se atingir as metas energético-proteicas dos pacientes, e assim, manter o gerenciamento de dados para o indicador de qualidade. O controle de qualidade em terapia nutricional deve ser realizado por meio de instrumentos de monitorização periódica pré-estabelecidos, almejando alcançar os objetivos e as metas propostas, assim como identificar a problemática e criar estratégias e normativas de gerenciamento. Métodos ­ O processo de gestão foi implementado em dois hospitais privados de grande porte da cidade de São Paulo, os dados foram coletados pela equipe multiprofissional de terapia nutricional (EMTN) diariamente, compilados em planilhas e os resultados discutidos mensalmente durante reuniões administrativas da equipe, sendo proposto planos de ação para melhorias permanentes. Resultados ­ O plano de ação proposto no presente trabalho se mostrou sensível quanto à detecção e identificação de intercorrências durante a terapia nutricional e também se mostrou como uma ferramenta importante para o estabelecimento de um plano de ação tendo como reflexo uma equipe de EMTN continuamente treinada e atenta para corrigir possíveis falhas. Conclusões ­ A adequação da rotina a partir do plano de gestão como o proposto nesse estudo é uma ferramenta importante para o alcance das metas energéticos-protéicas dos pacientes e manutenção do gerenciamento de dados e indicadores de qualidade

Objetives ­ To present a process-based management method in which nutritional care is coordinated by a multidisciplinary nutrition therapy team (MNTT), whereby the therapeutic plan is tailored to meet patient energy and protein requirements and manage data, thus allowing for the monitoring of quality indicators. The management process was implemented in two large private hospitals in the city of São Paulo, SP, Brazil. Quality control of nutrition therapy should be performed using validated periodic monitoring instruments that allow health professionals to identify problems and devise appropriate solutions and management regulations in order to achieve proposed objectives and goals. Methods ­ Data was collected on a daily basis by the MNTT and compiled in spreadsheets. The results were discussed at monthly administrative team meetings, and action plans were drawn up to promote permanent improvements. Results ­ The action plan proposed by the present study was able to detect complications that arise during nutrition therapy and proved to be an important tool for tailoring nutrition therapy to meet patient protein and energy requirements, being supported by a continuously trained and attentive MNTT that is qualified to correct possible flaws. Conclusions ­ The adequacy of the routine from the management plan as proposed in this study is an important tool to reach the patient's protein-energy goals and maintenance of data management and quality indicators

Nutrition therapy: A new criterion for treatment of patients in diverse clinical and metabolic situations.

OBJECTIVE: This study developed an instrument in table format to help determine the energy requirements of patients in adverse situations. The instrument allows for the weekly adjustment of nutrition therapy and energy intake, advocating a new approach to treatment based on clinical observation performed by staff specialized in individualized nutrition therapy. METHODS: The table was elaborated by grouping patients according to the following criteria: criticality, chronicity, and stability of the clinical status. Energy supply was readjusted weekly to respect the cyclicity of the patient's metabolic response. RESULTS: The table should be used in the following order: Obese > Elderly > Specific Clinical Situations > Chronic Diseases > Stable Clinical Situations. The protein requirements of patients with pressure ulcers or with wounds healing by secondary intention should be increased by 30% to 50%. Current patient weight should always be used, except in patients with anasarca. In these cases, the patient's last known dry weight or the ideal weight should be used. For elderly patients whose weight is not known and who cannot be weighed because of the patient's clinical condition, a body mass index of 23 should be assumed. CONCLUSION: The proposed nutrition table allows for management of optimal energy and protein intake for patients in different clinical situations, while respecting the different phases of the posttraumatic metabolic response, thus leading to favorable clinical outcomes.

Analysis and chromosomal mapping of Leishmania (Leishmania) amazonensis amastigote expressed sequence tags.

The characterization of expressed sequence tags (ESTs) generated from a cDNA library of Leishmania (Leishmania) amazonensis amastigotes is described. The sequencing of 93 clones generated new L. (L.) amazonensis ESTs from which 32% are not related to any other sequences in database and 68% presented significant similarities to known genes. The chromosome localization of some L. (L.) amazonensis ESTs was also determined in L. (L.) amazonensis and L. (L.) major. The characterization of these ESTs is suitable for the genome physical mapping, as well as for the identification of genes encoding cysteine proteinases implicated with protective immune responses in leishmaniasis.

Analysis and chromosomal mapping of Leishmania (Leishmania) amazonensis amastigote expressed sequence tags

The characterization of expressed sequence tags (ESTs) generated from a cDNA library of Leishmania (Leishmania) amazonensis amastigotes is described. The sequencing of 93 clones generated new L. (L.) amazonensis ESTs from which 32 percent are not related to any other sequences in database and 68 percent presented significant similarities to known genes. The chromosome localization of some L. (L.) amazonensis ESTs was also determined in L. (L.) amazonensis and L. (L.) major. The characterization of these ESTs is suitable for the genome physical mapping, as well as for the identification of genes encoding cysteine proteinases implicated with protective immune responses in leishmaniasis.

Cloning and characterisation of a cysteine proteinase gene expressed in amastigotes of Leishmania (L.) amazonensis.

The present study describes the cloning and characterisation of a gene encoding a cysteine proteinase isoform, Llacys1, expressed in amastigote forms of Leishmania (L.) amazonensis. Recombinant clones containing the Llacys1 gene were isolated from genomic DNA by PCR amplification and screening of an amastigote cDNA library. Sequence analysis of the Llacys1 gene showed a high identity to sequence of Leishmania (L.) pifanoi Lpcys1, Leishmania (L.) major cpa, Leishmania (L.) mexicana LCPa, and Leishmania (L.) chagasi Ldccys2. The Llacys1 gene is present in a single copy per L. (L.) amazonensis haploid genome and was mapped on a chromosome of approximately 700 kb. Two transcripts of the Llacys1 gene were identified, one of 2.4 kb transcribed in both forms of L. (L.) amazonensis, and another of 1.6 kb weakly expressed in amastigotes. Related forms of Llacys1 gene exist in other species of Leishmania genus, including L. (L.) major, L. (L.) mexicana, L. (L.) chagasi and Leishmania (V.) braziliensis. The Llacys1 expression in Escherichia coli was obtained when the nucleotide sequence corresponding to the signal sequence was deleted, suggesting that this signal sequence was recognised by Escherichia coli and cleaved, generating a truncated protein.