Profile of patients using nasoenteric probe at the adult emergency service in a public hospital

Introduction: Part of the prognosis of hospitalized patient depends on nutritional status and the safety and efficacy of the feeding administration route. Therefore, the aim of this study was to identify data on the indication of nasoenteric tube (NET) prescription to analyze the profile of these patients. Methods: A retrospective cross-sectional study was carried out with data collection in medical records of patients over 18 years of age, of both sexes, treated at the Emergency Adult Service (EAS), using NET. Results: there was a predominance of females (51.9%); neurological disease was the most prevalent underlying disease, and 57.8% had more than one diagnosed disease. Malnutrition, bronchopneumonia, and dysphagia were present in 23.6%, 27% and 40% of the cases, respectively. There was a request for speech-language evaluation in only 8.7% of the patients. And 80.7% did not use NET prior to emergency care. Regarding the indications for the use of NET by group of underlying disease, low food intake was the most prevalent clinical reason described in the medical records, followed by dysphagia, with a higher prevalence of patients taking NET for nutritional reasons. There was no justification for prescription in 15.2% of the sample. There was an association between the variables bronchopneumonia and dysphagia (p = 0.01). Conclusion: It was verified that in the studied population there are risk factors for dysphagia. The analysis of the population profile in the present study contributed to increased knowledge and information about this population regarding the criteria for indication of the use of the alternative route. (AU)

Prevalência de dor osteomuscular em profissionais de enfermagem de equipes de cirurgia em um hospital universitário / Prevalence of musculoskeletal pain among surgical nursing teams

Dentre as profissões da área da saúde, a enfermagem, em particular, tem sido afetada pelos distúrbios musculoesqueléticos produzindo alterações na vida desses trabalhadores, impossibilitando-os de realizarem atividades cotidianas e laborais. Objetivo: Investigar a prevalência de dor osteomuscular e a associação com a qualidade de vida em profissionais de enfermagem que atuam em equipes de cirurgia no Hospital de Clínicas de Porto Alegre. Método: Estudo transversal realizado entre março de 2011 ejaneiro de 2012, em um hospital universitário terciário do sul do Brasil. Foram avaliados 110 trabalhadores de enfermagem das equipes de cirurgia. Foram excluídos os trabalhadores em licença saúde, fériasou outro tipo de afastamento durante o período de coleta dos dados. A dor osteomuscular foi avaliada através do questionário Nórdico de Sintomas Osteomusculares e a qualidade de vida foi avaliada atravésdo questionário Medical Outcomes Study 36 - Item Short-Form Survey (SF-36). As relações entre dor osteomuscular e qualidade de vida foram analisadas através do Teste U de Mann-Whitney, utilizandonível de significância de 95%. Resultados: A prevalência de dor osteomuscular encontrada neste estudo foi de 91,81%. Com relação às regiões anatômicas, considerou-se as queixas de dor osteomuscular retroativo há doze meses, onde o predomínio foi de dor no pescoço (56%) e ombros (56%). Quando consideramos afastamento por dor osteomuscular encontramos a prevalência de dor lombar (34%). O grupo que não relatou dor osteomuscular apresentou melhores índices de qualidade de vida nos domínios de capacidade funcional, aspectos físicos, dor, vitalidade, aspectos sociais e saúde mental. Conclusão: A dor osteomuscular apresenta maior prevalência nas regiões do pescoço e ombros. Além disso, o maior número de afastamentos ocorre por prevalência de dor lombar entre os trabalhadores de enfermagem das equipes de cirurgia. A dor influenciou na qualidade de vida afetando seis dos domínios avaliados

Among the health professions, nursing, in particular, has been affected by musculoskeletal disorders. The WMSD produce changes in the lives of these workers, impossible of them held daily activities andlabour. Objective: Investigating the prevalence of musculoskeletal pain and associated with the quality of life in nursing professionals who work in surgery teams. Method: Cross-sectional study conductedbetween March 2011 and January 2012 in a tertiary university hospital in southern Brazil. We evaluated 110 workers nursing teams. It was excluded workers on sick leave, vacation or other absence duringthe period of data collection. The musculoskeletal pain was assessed using the Nordic Musculoskeletal symptoms questionnaire the quality of life was assessed by the Medical Outcomes Study 36 - Item Short-Form Survey (SF-36). The relationship between musculoskeletal pain and quality of life were analyzed by the U of Mann-Whitney test, using a significance level of 95%. Results: The prevalence of musculoskeletal pain found in this study was 91.81%. With respect to anatomic regions, it was consideredthe complaints of musculoskeletal pain retroactive twelve months ago, where there was the predominance of neck pain (56%) and shoulders (56%). When we consider sick leaving for musculoskeletal painwe found the prevalence of low back pain (34%). The group who reported no musculoskeletal pain showed better indices of quality of life in the areas of physical functioning, physical aspect, bodily pain,vitality, social and mental health aspect. Conclusion: the higher prevalence of musculoskeletal pain in the neck and shoulder regions. Moreover, the largest number of sick leaves occurs because of the prevalenceof low back pain among nursing staff of the surgical teams. The pain influenced the quality of life affecting six of the areas assessed.

Comparison of two risk stratification models in elective coronary artery bypass patients.

OBJECTIVE: To compare the Cleveland Clinical Score and EuroSCORE when evaluating patients submitted to elective CABGS in Rio Grande do Sul, RS, Brazil. METHODS; This was a cohort study of 202 patients given CABGS between January 2006 and March 2007. Surgical risk was categorized according to the Cleveland Clinic Score and the EuroSCORE as low, medium or high. The incidence of deaths was measured over a 60-day period. RESULTS: The mean age of patients was 62 ± 10 years and 134 (66%) of them were men. A correlation was observed between the scores for classifying patients into different levels of risk. According to the Cleveland Clinic score and the EuroSCORE, respectively, patients were categorized as follows: 142(70.3%) and 155(76.7%) low risk patients, 56(27.7%) and 43(21.3) intermediate risk patients and 4(2%) and 4(2%) high risk patients; with a Kaplan correlation coefficient of 0.432; p0.001. Thirteen (13, 6.4%) patients died during the first 60 days after surgery. There was a correlation between greater incidence of death and higher risk categories for both the Cleveland Clinic score and the EuroSCORE. Deaths occurred in the Cleveland and EuroSCORE risk groups, respectively, as follows: 6 (4.4%) and 7 (4.5%) in the low risk group; 5 (8.9%) and 5 (11.6%) in the intermediate risk group and 2 (50%) 3 1(25%) in the high risk group. Observed sensitivity for surgical mortality prediction was 72.5% and 66.5% for the Cleveland score and EuroSCORE respectively. CONCLUSION: The Cleveland Clinic and EuroSCORE surgical risk prediction instruments are both moderately effective for predicting mortality among elective CABGS patients.

Changes in functional capacity of patients two years after coronary artery bypass grafting surgery.

OBJECTIVE: To check changes in the functional capacity of patients undergoing coronary artery bypass grafting (CABG) by testing six-minute walk test (6MWT) following two years. METHODS: A prospective cohort study where 215 patients were enrolled who underwent CABG, 13 did not meet the criteria for inclusion. 202 patients were evaluated preoperatively, 13 died during hospitalization and 6 in the follow up of two years. Four patients were considered lost follow up. This study followed 179 patients for two years classified into active and sedentary, according to physical activity in leisure time and to the 6MWT preoperatively and 2 years later. RESULTS: One hundred and twenty patients were evaluated in the day before CABGS, being 67% male with an average age of 63 (+/- 9.75) years. Before surgery and 2 years later, 52 were active and the 6MWT distances performed had been 359m (+/- 164.47) and 439m (+/- 171.34), respectively; P= 0.016. Forty five patients were classified as sedentary before and 2 years after surgery. The 6MWT distances walked before and after surgery had been 255m (+/- 172.15) and 376m (+/- 210.92), respectively; P < 0.001. Eighty two patients transited between these two groups, 71 passed from sedentary to active and had walked before and after surgery 289m (+/- 157.15) and 380m (+/- 125.44), respectively; P= 0.001. The 11 patients who were active and passed to the sedentary group walked 221m (+/- 191.91) and 384m (+/- 63.73), respectively; P= 0.007. CONCLUSION: The functional capacity of the patients submitted to CABGS had a significant improvement in a medium period of follow-up.

Alterações na capacidade funcional de pacientes após dois anos da cirurgia de revascularização do miocárdio / Changes in functional capacity of patients two years after coronary artery bypass grafting surgery

OBJETIVO: Verificar alterações na capacidade funcional dos pacientes que se submetem à cirurgia de revascularização do miocárdio (CRM) por meio do teste de caminhada de seis minutos (TC6) no seguimento de dois anos. MÉTODOS: Estudo de coorte prospectivo, no qual foram arrolados 215 pacientes submetidos a CRM, 13 não preencheram os critérios de inclusão. Foram 202 pacientes avaliados no pré-operatório, 13 morreram no período da internação e seis no seguimento de dois anos. Quatro pacientes foram considerados perdas de seguimento. Foram acompanhados 179 pacientes no período de 2 anos, classificados em ativos e sedentários, conforme a prática de atividade física no tempo livre e submetidos ao TC6 no préoperatório e 2 anos depois. RESULTADOS: Dos 202 pacientes avaliados no pré-operatório da CRM, 67 por cento eram do sexo masculino, com idade média de 63 (± 9,75) anos. Pré e após 2 anos da CRM, 52 pacientes se mantiveram ativos e as distâncias caminhadas foram 359m (± 164,47) e 439m (± 171,34), respectivamente, P= 0,016. A distância caminhada no pré e pós-operatório, dos 45 pacientes que permaneceram sedentários, foi, respectivamente, 255m (± 172,15) e 376m (± 210,92) P<0,001. Oitenta e dois pacientes transitaram entre estes dois grupos, 71 passaram de sedentários para ativos e caminharam 289m (± 157,15) no pré e 380m (± 125,44) no pós-operatório, P= 0,001; os 11 pacientes que eram ativos e passaram a sedentários caminharam no pré 221m (± 191,91) e, no pós-operatório, 384m (± 63,73) P= 0,007. CONCLUSÃO: A capacidade funcional dos pacientes submetidos à CRM melhorou de forma importante no seguimento de médio prazo.

OBJECTIVE: To check changes in the functional capacity of patients undergoing coronary artery bypass grafting (CABG) by testing six-minute walk test (6MWT) following two years. METHODS: A prospective cohort study where 215 patients were enrolled who underwent CABG, 13 did not meet the criteria for inclusion. 202 patients were evaluated preoperatively, 13 died during hospitalization and 6 in the follow up of two years. Four patients were considered lost follow up. This study followed 179 patients for two years classified into active and sedentary, according to physical activity in leisure time and to the 6MWT preoperatively and 2 years later. RESULTS: One hundred and twenty patients were evaluated in the day before CABGS, being 67 percent male with an average age of 63 (± 9.75) years. Before surgery and 2 years later, 52 were active and the 6MWT distances performed had been 359m (± 164.47) and 439m (± 171.34), respectively; P= 0.016. Forty five patients were classified as sedentary before and 2 years after surgery. The 6MWT distances walked before and after surgery had been 255m (± 172.15) and 376m (± 210.92), respectively; P < 0.001. Eighty two patients transited between these two groups, 71 passed from sedentary to active and had walked before and after surgery 289m (± 157.15) and 380m (± 125.44), respectively; P= 0.001. The 11 patients who were active and passed to the sedentary group walked 221m (± 191.91) and 384m (± 63.73), respectively; P= 0.007. CONCLUSION: The functional capacity of the patients submitted to CABGS had a significant improvement in a medium period of follow-up.

Comparação de dois modelos de estratificação de risco em pacientes eletivamente submetidos à cirurgia de revascularização miocárdica / Comparison of two models of risk stratification in patients submitted to elective coronary artery bypass surgery

OBJETIVO: Comparar o Cleveland Clinical Score eo EuroSCORE na avaliação de pacientes submetidos eletivamente à CRM no Rio Grande do Sul (RS). MÉTODOS: Coorte com 202 pacientes submetidos à CRM entre janeiro de 2006 e março de 2007. O risco cirúrgico foi determinado por meio dos escores da Cleveland Clinic e do EuroSCORE como de baixo, médio e alto risco. A incidência de óbito foi aferida no intervalo de 60 dias. RESULTADOS: A idade média dos pacientes foi 62 (± 10) anos, 134 (66 por cento) eram homens. Houve correlação entre os escores da Cleveland Clinic e EuroSCORE em categorizar, respectivamente os pacientes em baixo: 142 (70,3 por cento) e 155 (76,7 por cento); médio 56 (27,7 por cento) e 43 (21,3); e alto risco 4 (2 por cento) e 4 (2 por cento) conforme o coeficiente de concordância de Kappa 0,432; P 0,001. No pós-operatório de 60 dias, 13 (6,4 por cento) pacientes morreram. Observou-se uma correlação com percentual crescente da incidência de óbitos com o aumento da categoria de risco em ambos os escores, 6 (4.4 por cento) e 7 (4,5 por cento) no baixo; 5 (8,9 por cento) e 5 (11,6 por cento) no médio; 2 (50 por cento) e 1 (25 por cento) no alto risco nos escore de Cleveland e EuroSCORE respectivamente. Observou-se sensibilidade na previsão de mortalidade cirúrgica de 72,5 por cento e 66,5 por cento para o Cleveland e EuroSCORE respectivamente. CONCLUSÃO: Ambos os escores de risco, da Cleveland Clinic e EuroSCORE, mostraram-se eficazes em prever mortalidade de pacientes submetidos eletivamente à CRM de forma moderada.

OBJECTIVE: To compare the Cleveland Clinical Score and EuroSCORE when evaluating patients submitted to CABGS electively in Rio Grande do Sul. METHODS: Cohort study with 202 patients submitted to CABGS between January 2006 and March 2007. Surgical risks were categorized by the Cleveland Clinic and EuroSCORE as low, medium and high risks. The incidence of deaths was measured in a 60 days interval. RESULTS: The average age of patients was 62±10 years and 134(66 percent) were men. A correlation was observed between both scores to classify patients at different levels of risk. Patients were categorized using the Cleveland Clinic and EuroSCORE respectively: 142(70.3 percent) and 155(76.7 percent) as low, 56(27.7 percent) and 43(21,3) as medium and 4(2 percent) and 4(2 percent) as high risks, with a Kaplan correlation coefficient of 0.432; p0.001. In the first sixty days after surgery, 13(6.4 percent) patients had died. A correlation between the higher incidences of death with increased category of risk was observed in the Cleveland Clinic and EuroSCORE. Deaths occurred respectively in the Cleveland and EuroSCORE: 6(4.4 percent) and 7(4.5 percent) in the low; 5(8.9 percent) and 5(11.6 percent) in the medium and 2(50 percent) 3 1(25 percent) in the high risks. Noted sensitivity in surgical mortality forecast was of 72.5 percent and 66.5 percent Cleveland and EuroSCORE respectively. CONCLUSION: The Cleveland Clinic and EuroSCORE risk scores have proven effective to evaluate risk of death in patients electively submitted to CABGS.

Estimulação elétrica neuromuscular em crianças com paralisia cerebral do tipo diplegia espástica / Neuromuscular electric stimulation in children with spastic diplegia

Nos últimos anos, vários estudos propuseram a utilização da estimulação elétrica como forma de tratamento da paralisia cerebral(PC). Objetivo: Utilizando um delineamento do tipo antes e depois(within-subjects design) buscou-se avaliar os efeitos da estimulação elétrica neuromuscular (EENM) nas habilidades motoras de criançascom PC do tipo diplegia espástica. Material e método: Doze pacientes(8 do sexo masculino, média de idade 6 anos) foram avaliados antese depois de 12 semanas de terapia utilizando EENM. As habilidades motoras foram avaliadas através da escala de função motora grossa(GMFM), parâmetros lineares da marcha e amplitude de movimento(ADM) de fl exão dorsal dos tornozelos. Resultados: A diferença entre as médias dos escores da GMFM foram estatisticamente signifi cativos (P = 0,032) quando comparados antes (73,1 ± 17,2)e depois (76,5 ± 16,3) da intervenção com EENM. Quando ospacientes foram classificados quanto à independência para marcha,o escore da GMFM permaneceu signifi cativo apenas nas crianças dependentes de auxílio para marcha (P = 0,045). O parâmetro decadência da marcha diferiu antes e depois da EENM no grupo decrianças independentes para marcha (P = 0,030). Conclusões: Este estudo demonstrou que a EENM pode ser uma ferramenta complementarno manejo de crianças PC do tipo diplégica espástica.Os mecanismos pelos quais a EENM melhora a função motora nãoestão totalmente esclarecidos.

Introduction: For the last years, several studies have proposed theuse of electric stimulation as a valid therapy for cerebral palsy (CP).Aims: Using a within-subjects design, we set out to determine the effect of neuromuscular electrical stimulation (NMES) on the motorskills of children with spastic diplegic CP. Materials and methods:Twelve patients (8 male, mean age 6 years), were evaluated beforeand after 12 weeks of therapy with NMES. Motor abilities were accomplished by using the gross motor function measure (GMFM),linear parameters of gait, and ankle dorsifl exion range of movement. Results: The mean scores of GMFM were significantly different (P =0.032) before (73.1 ± 17.2) and after (76.5 ± 16.3) the intervention with NMES. When patients were classified for gait dependence, the GMFM scores remained significant only for children dependent ofaid (P = 0.045). The cadence parameter of gait significantly differ before and after NMES in the group of CP children independent forgait (P = 0.030). Conclusions: Th is study demonstrated that NMESmight be a complementary tool for the handling of children with spastic diplegic CP. The mechanisms by which NMES improves themotor function are yet not established.

Influence of the practice physical activity in the coronary artery bypass graft surgery results.

OBJECTIVE: To evaluate the frequency changes of physical activity practice in pre- and postoperative of the patients submitted to coronary artery bypass graft surgery (CABG) and the frequency influence on the physical activity practice in the patients' preoperative prognosis. METHODS: Cases studies of 55 patients submitted to CABG divided into active and sedentary regarding physical activity practices. RESULTS: After CAGB, 14 (47%) patients classified as sedentary before surgery were practicing exercises (p = 0.03). Seventeen (59%) sedentary patients in the preoperative period presented complications after the surgery compared to 8 (31%) active patients (p = 0.04). The hospital length of stay among sedentary patients versus active patients before surgery was 15 (SD=8) and 12 (SD=5) days; p=0.03, respectively. CONCLUSION: The present study showed the importance of physical activity practice in the preoperative stage on the outcomes of coronary artery bypass surgery. The patients physically active had a shorter hospital length of stay and a lower number of both trans- and postoperative complications within 1 year. The cardiac surgery promoted the patients' change of habits, increasing the number of physically active patients during the 1-year follow-up.

Influência da prática da atividade física no resultado da cirurgia de revascularização miocárdica / Influence of the practice physical activity in the coronary artery bypass graft surgery results

Objetivo: Avaliar a modificação da freqüência da prática da atividade física no pré e pós-operatório dos pacientes submetidos à cirurgia de revascularização miocárdica (CRM) e influência da freqüência da prática da atividade física no prognóstico dos mesmos...

Estimulação elétrica neuromuscular em crianças com paralisia cerebral do tipo diplegia espástica / Neuromuscular eletric stimulation in children with spastic diplegi cerebral palsy

Nos últimos anos, vários estudos propuseram a utilização da estimulação elétrica como forma de tratamento da paralisia cerebral (PC). Objetivo: Utilizando um delineamentodo tipo antes e depois (a within-subjects design) buscou-se avaliar os efeitos da estimulação elétrica neuromuscular (EENM) nas habilidades motoras de crianças com PC do tipo diplegia espástica. Material e método: Doze pacientes (08 do sexo masculino, média de 06 anos) foram avaliados antes e depois de 12 semanas de terapia utilizando EENM. As habilidades motoras forma avaliadas através da escala de função motora grossa(GMFM), parâmetros lineares da marcha e amplitude de movimento (ADM) de flexão dorsal dos tornozelos. Resultados: A diferença entre as médias dos escores da GMFM foram estatisticamente significativos (P= 0,032) quando comparados antes (73,1 +- 17,2) e depois (76,5 +- 16,3) da intervenção com EENM. Quando os pacientes forma classificados quanto à independência para marcha, o escore da GNMF permaneceu significativo apenas nas crinaças dependentes do auxílio para marcha (P=0,045). O parâmetro de cadência da marcha diferiu antes e depois da EENM no grupo de crianças independentes para marcha (P= 0,030). Conclusões: Este estudo demonstrou que a EENM pode ser uma ferramenta complementar no manejo de crianças PC do tipo diplégica espástica. Os mecanismos pelos quais a EENM melhora a função motora não estão totalmente esclarecidos.

Introduction: For the last years, several studies have proposed the use of eletric stimulation as a valid therapy for cerebral palsy (CP). Aims: Using a within-subjects design , we set out to determine the effect of neuromeuscular eletric stimulation (NMES) on tje motor skills of children with spastic diplegic CP. Materials and methods: Twelve patients (08 male, men age 06 years), were evaluated before accomplished by using the gross motor function measure (GNMF), linear parameters of gait, and ankle dorsiflexion range of moviment. Results: The mean scores of GMFM were significantly different (P= 0,032) before (73,1 =-17,2) and after (76,5 =- 16,3) the intervention with NMES. When patients were classified for gait dependence, the GMFM scores remained significant only for children dependent of aid (p = 0,045). The cadence parameter of gait significantly differ before and after NMES in the group of CP children independent for gait (P = 0,030). Conclusions: This study demonstrated that NMES might be a complementary tool for the handling of children with spadtic diplegic CP. The mechanisms by wich NMES improves the motor function are yet not established.

[Relationship between adverse neural tension and nerve conduction studies in patients with symptoms of the carpal tunnel syndrome]. / Relação entre tensão neural adversa e estudos de condução nervosa em pacientes com sintomas da sídrome do túnel do carpo.

The purpose of this study was to evaluate, through a series of cases, the relationship between the adverse neural tension of median nerve (ANTm) and the electrophysiological involvement in 38 patients with symptoms of the carpal tunnel syndrome (CTS), submitted to nerve conduction studies (NCS). The main measures had been ANTm (in degrees) obtained through the test of neural tension provocation (TNTP) and parameters of the NCS, divided into three groups: normal, without severe electrophysiological alteration and with severe electrophysiological alteration. Significant correlations were found between ANTm and parameters of the NCS (p<0.05), as well as between ANTm and the three groups defined by the electrophysiologic alteration (rs=+0.437, p=0.002). The TNAm values were significantly higher in the arms with electrophysiologic diagnoses (p=0.007). It is suggested that the ANTm does have a participation in the physiopathology of the CTS, and the use of therapeutical procedures that diminish the development of neural tension.

Relação entre tensão neural adversa e estudos de condução nervosa em pacientes com sintomas da sídrome do túnel do carpo / Relationship between adverse neural tension and nerve conduction studies in patients with symptoms of the carpal tunnel syndrome

O propósito deste estudo foi avaliar, através de uma série de casos, a relação entre tensão neural adversa do nervo mediano (TNAm) e o parâmetro eletrofisiológico em 38 pacientes com sintomas da síndrome do túnel do carpo (STC), submetidos a estudos de condução nervosa (ECN). As principais medidas foram a TNAm obtida no teste de provocação de tensão neural (TPTN) e parâmetros dos ECN, dividindo-se os braços avaliados em três grupos: normal, com alteração eletrofisiológica sem gravidade e com alteração eletrofisiológica grave. Correlação significante entre TNAm e parâmetros dos ECN foram encontrados (p<0,05), bem como entre a TNAm e os três grupos definidos pela alteração eletrofisiológica (r s=+0.437, p=0,002). Valores de TNAm foram significantemente maiores nos braços com diagnóstico eletrofisiológico (p=0,007). Sugere-se que a TNAm tem participação na fisiopatologia da STC, indicando o uso de procedimentos terapêuticos que diminuam ou previnam a tensão neural.

Estimulaçäo elétrica transcutânea: estudo de seu efeito sobre o músculo esquelético sadio, através da análise eletromiográfica / Transcutaneous electrical stimulation: study of your effects on the healthy skeletal muscle, through the analyse of the electromyography

Pesquisa apresentada como conteúdo de monografia, para conclusäo do Curso de graduaçäo em Fisioterapia da Universidade Federal de Santa Maria, onde através da análise do sinal eletromiográfico bruto, procurou-se determinar os efeitos da estimulaçäo elétrica sobre o músculo esquelético humano sadio. Pesquisa financiada pelo CNPq e FAPERGS