Avaliação do impacto da qualidade da água em parâmetros laboratoriais indicativos de bem estar clínico de pacientes submetidos à hemodiálise no Estado do Rio de Janeiro / Impact assessment of water quality in laboratory parameters indicative of clinical well-being of pacients undergoing hemodialysis in Rio de Janeiro

Este estudo buscou analisar o impacto da qualidade da água em alguns parâmetros laboratoriais indicativos de bem estar clínico de pacientes submetidos à hemodiálise no estado, através dos exames de albumina, hemoglobina, ferritina e uréia pré e pós sessão de diálise e analisar os possíveis impactos entre a qualidade da água no período estudado e os parâmetros laboratoriais.

Diseño e implementación de un sistema de gestión ambiental en un departamento de Hemodiálisis / Design and implementation of an environmental management system in a department of hemodialysis

La ocurrencia de infecciones con hepatitis B, C y VIH/SIDA, entre otras enfermedades contagiosas, en el Departamento de Hemodiálisis de los servicios de Nefrología, es un problema grave de salud en el país. El Hospital de Morón no era la excepción a esta problemática debido a diferentes causas que iban desde su ineficiente y antiguo diseño constructivo, hasta violaciones en la disciplina de trabajo, el desconocimiento por el personal de las buenas prácticas en bioseguridad e higiene ambiental y el manejo incorrecto de los desechos hospitalarios. Con el fin de superar estas deficiencias se planteó como objetivo diseñar e implementar un sistema de gestión ambiental, a partir de una revisión ambiental inicial, como solución a la ocurrencia de enfermedades infecciosas. El diseño e implementación de dicho sistema permitió realizar una serie de inversiones y medidas que dieron como resultado final la mejoría de la calidad de vida de los pacientes y trabajadores. Desde la implementación del sistema no se reportan casos incidentes de hepatitis B y C.

The occurrence of infections with hepatitis B, C and HIV / AIDS, among other infectious diseases in the Hemodialysis Department of Nephrology services is a serious health problem in the country. Morón Hospital was no exception to this problem due to various reasons ranging from their inefficient and old construction design, to violations of work discipline, lack of knowledge by staff of best practices in biosafety and environmental hygiene and mishandling of medical waste.To overcome these deficiencies the aim raised was to design and implement an environmental management system, from an initial environmental review as a solution to the occurrence of infectious diseases. The design and implementation of this system allowed a series of investments and actions that finally resulted the improved quality of patients life and workers. Since the system implementation are not reported incident cases of hepatitis B and C.

Survival of hemodialysis patients: modeling differences in risk of dialysis centers.

OBJECTIVE: Dialysis is the most common renal replacement therapy for patients with end stage renal disease. This paper considers survival of dialysis patients, aiming to assess quality of renal replacement therapy at dialysis centers in Rio de Janeiro, Brazil, and to investigate differences in survival between health facilities. METHODS: A Cox proportional hazards model, allowing for time-varying covariates and prevalent data, was the basic method used to analyze the survival of 11,579 patients on hemodialysis in 67 health facilities in Rio de Janeiro State from January 1998 until August 2001, using data obtained from routine information systems. A frailty random effects model was applied to investigate differences in mortality between health centers not explained by measured characteristics. RESULTS: The individual variables associated with the outcome were age and underlying disease, with diabetes being the main isolated risk factor. Considering covariates of the health unit, two factors were associated with performance: bigger units had on average better survival times than smaller ones and units which offered cyclic peritoneal dialysis performed less well than those that did not. There were significant frailty effects among centers, with relative risks varying between 0.24 and 3.15, and an estimated variance of 0.43. CONCLUSIONS: Routine assessment based on health registries of the outcome of any high technology medical treatment is extremely important in maintaining quality of care and in estimating the impact of changes in therapies, units, and patient profiles. The frailty model allowed estimation of variation in risk between centers not attributable to any measured covariates. This can be used to guide more specific investigation and changes in health policies related to renal transplant therapies.

Metodologia de assistência de enfermagem na unidade de tratamento dialítico / Methodology of assistence of nursing in the units of dialytic treatment

O trabalho descreve a implantação da metodologia de assistência de enfermagem em uma unidade de tratamento dialítico de um hospital universitário e apresenta os impressos desenvolvidos para esse processo de trabalho. Utilizou-se como referencial metodológico as teorias de enfermagem de Dorothea Orem e Wanda de Aguiar Horta, adaptando-as às necessidades do paciente renal crônico. A utilização dos impressos na prática do processo de enfermagem favoreceu a uma assistência individual e humanizada, proporcionou a geração de dados para pesquisa, informações e controles efetivos do tratamento dialítico facilitando as discussões entre o profissional da enfermagem e os demais membros da equipe multidisciplinar(40)

Estudio microbiológico del agua para hemodiálisis / Microbiological study of water used for hemodialysis

Se llevó a cabo un monitoreo para estudiar la contaminación bacteriológica del agua en una unidad de hemodiálisis, por el riesgo que representa para la salud de los enfermos. Se investigó la presencia de bacterias heterotróficas de acuerdo con los lineamientos de la Asociación Americana para el Progreso de los Instrumentos Médicos, y la de Pseudomonas aeruginosa según métodos normalizados. Se informan las densidades de bacterias obtenidas, cuyos valores no transgreden las normas establecidas en el agua para diálisis y en los fluidos de diálisis. Se reportan las características piocinogénicas de las cepas de Pseudomonas aeruginosa aisladas, los piocinotipos 10 y 6 fueron los más frecuentes

Historia de la hemodialisis en Cochabamba / Hemodialysis history in Cochabamba

La historia de la hemodialisis en Cochabamba, es una descripcion de los acontecimientos relacionados con el desarrollo de la hemodialisis en nuestro departamento, sus dificultades, personajes involucrados, manejo de los primeros pacientes, centros en los que se hizo por primera vez este tipo de tratamiento. Relata asi mismo los motivos por los que dichos servicios fueron discontinuados con la llegada de los primeros nefrologos.

Challenges and barriers to managing quality in an end-stage renal disease facility.

The End-Stage Renal Disease Program is underfunded and overregulated. Objective parameters of end points of care do not correlate to specific clinical practice patterns. We do not have consensus between payers, providers, and patients as to what the objectives of the End-Stage Renal Disease Program are or should be. This report will address the need for an integrated health care delivery system that would benefit the end-stage renal disease patient and the barriers to designing such a system. The quality improvement program of a five-unit dialysis system will be described. The deficiencies of the quality improvement program and the limitation of the facilities to improve outcome will be discussed, and constructive alternatives to achieve an integrated health care delivery system that promotes improvement in patient outcomes will be suggested.

Aluminum determination in whole blood, dialysis solution, and tap water samples from Maracaibo dialysis units (Venezuela) by graphite furnace atomic absorption spectrometry.

Patients with chronic renal failure (CRF) on periodical hemodialysis may accumulate aluminum in tissues and show typical disorders such as dialysis encephalopathy, osteodystrophy, and microcytic anemia. Aluminum contamination of the water used to prepare the dialysis solution (dialysate) is one of the metal sources that may affect people under hemodialysis, especially in units in which untreated water is used. Graphite furnace atomic absorption spectrometric methods for aluminum determination in whole blood, dialysis solution, and tap water samples from CRF patients were developed, based upon the use of the same furnace temperature program. Samples were diluted 4-fold with 0.6% triton X-100 (whole blood) or with 0.01 mol/L nitric acid (dialysis solution and tap water) and analyzed by aqueous standard (blood and tap water) or matrix-matching standard (dialysis solution) calibration curves. The characteristic masses were 33.8, 11.3, and 19.5 pg Al/0.0044 A.s for whole blood, dialysate, and tap water, respectively. In the diluted solutions, the detection limits (2 sigma) for the described methods were 0.5 microgram/L Al (whole blood), 0.4 microgram/L Al (dialysate), and 0.4 microgram/L Al (tap water). The methods were applied to samples from several CRF patients under hemodialysis at Maracaibo University hospital. The data revealed extremely high aluminum levels, which corresponded to the symptoms of dialysis encephalopathy and/or osteodystrophy showed by some of them. The proposed methods are reliable and reproducible.