Oximetry at admission as a predictor of tomographic and functional impairment after 3-6 months in hospitalized patients with COVID-19.

OBJECTIVE: To investigate characteristics that may be associated with radiologic and functional findings following discharge in patients with severe coronavirus disease 2019 (COVID-19). METHODS: This single-center, prospective, observational cohort study comprised patients aged >18 years who were hospitalized with COVID-19 pneumonia, between May and October 2020. After 3 to 6 months of discharge, patients were clinically evaluated and underwent spirometry, a 6-minute walk test (6MWT), and chest computed tomography (CT). Statistical analysis was performed using association and correlation tests. RESULTS: A total of 134 patients were included (25/114 [22%] were admitted with severe hypoxemia). On the follow-up chest CT, 29/92 (32%) had no abnormalities, regardless of the severity of the initial involvement, and the mean 6MWT distance was 447 m. Patients with desaturation on admission had an increased risk of remaining CT abnormalities: patients with SpO2 between 88 and 92% had a 4.0-fold risk, and those with SpO2 < 88% had a 6.2-fold risk. The group with SpO2 < 88% also walked shorter distances than patients with SpO2 between 88 and 92%. CONCLUSION: Initial hypoxemia was found to be a good predictor of persistent radiological abnormalities in follow-up and was associated with low performance in 6MWT.

COVID-19 and invasive fungal coinfections: A case series at a Brazilian referral hospital.

BACKGROUND: COVID-19 co-infections have been described with different pathogens, including filamentous and yeast fungi. METHODOLOGY: A retrospective case series study conducted from February to December 2020, at a Brazilian university hospital. Data were collected from two hospital surveillance systems: Invasive fungal infection (IFI) surveillance (Mycosis Resistance Program - MIRE) and COVID-19 surveillance. Data from both surveillance systems were cross-checked to identify individuals diagnosed with SARS-CoV-2 (by positive polymerase chain reaction (PCR)) and IFI during hospital stays within the study period. RESULTS: During the study period, 716 inpatients with COVID-19 and 55 cases of IFI were identified. Fungal co-infection with SARS-CoV-2 was observed in eight (1%) patients: three cases of aspergillosis; four candidemia and one cryptococcosis. The median age of patients was 66 years (IQR 58-71 years; range of 28-77 years) and 62.5% were men. Diagnosis of IFI occurred a median of 11.5 days (IQR 4.5-23 days) after admission and 11 days (IQR 6.5-16 days) after a positive PCR result for SARS-CoV-2. In 75% of cases, IFI was diagnosed in the intensive care unit (ICU). Cases of aspergillosis emerged earlier than those of candidemia: an average of 8.6 and 28.6 days after a positive PCR for SARS-CoV-2, respectively. All the patients with both infections ultimately died. CONCLUSION: A low rate of COVID-19 co-infection with IFI was observed, with high mortality. Most cases were diagnosed in ICU patients. Aspergillosis diagnosis is highly complex in this context and requires different criteria.

Hearing Loss in the Elderly: Is the Hearing Handicap Inventory for the Elderly - Screening Version Effective in Diagnosis When Compared to the Audiometric Test?

Introduction Hearing losses inherent to the natural process of aging represent today a major public health issue, despite the little attention that their adequate care still receives. Early recognition and proper management of these shortcomings can significantly improve hearing, as well as the patient's general quality of life, reducing the overall impact of this important and prevalent condition of the aging process. Objective The aim of this research was to evaluate the accuracy of the Hearing Handicap Inventory for the Elderly - Screening Version (HHIE-S) in the diagnosis of hearing loss in the elderly when compared with the audiometric test. Methods Through a cross-sectional study, our target population was composed of 138 individuals, aged over 60 and with any otorhinolaryngological complaints, recruited at the Clinic of Otorhinolaryngology and Speech Therapy of the Faculdade de Medicina de Marília (Famema), in the city of Marília, SP, Brazil. Patients already in the process of auditory rehabilitation were excluded, as well as those who did not demonstrate the minimum level of oral understanding necessary to allow the interview. Results The prevalence of hearing loss according to the questionnaire was of 76.1%, while audiometry showed 79.7%. We found the diagnostic accuracy of the instrument to be of 86.2%, with a sensitivity of 89.1% and a specificity of 75.0%, regardless of gender. Conclusion Thereby, we conclude that the standardized questionnaire under rating is suitable for the screening of hearing loss in the elderly, given its high accuracy and user-friendly quality.

Hearing Loss in the Elderly: Is the Hearing Handicap Inventory for the Elderly - Screening Version Effective in Diagnosis When Compared to the Audiometric Test?

Abstract Introduction Hearing losses inherent to the natural process of aging represent today a major public health issue, despite the little attention that their adequate care still receives. Early recognition and proper management of these shortcomings can significantly improve hearing, as well as the patient's general quality of life, reducing the overall impact of this important and prevalent condition of the aging process. Objective The aim of this research was to evaluate the accuracy of the Hearing Handicap Inventory for the Elderly - Screening Version (HHIE-S) in the diagnosis of hearing loss in the elderly when compared with the audiometric test. Methods Through a cross-sectional study, our target population was composed of 138 individuals, aged over 60 and with any otorhinolaryngological complaints, recruited at the Clinic of Otorhinolaryngology and Speech Therapy of the Faculdade de Medicina de Marília (Famema), in the city ofMarília, SP, Brazil. Patients already in the process of auditory rehabilitation were excluded, as well as those who did not demonstrate the minimum level of oral understanding necessary to allow the interview. Results The prevalence of hearing loss according to the questionnaire was of 76.1%, while audiometry showed 79.7%. We found the diagnostic accuracy of the instrument to be of 86.2%, with a sensitivity of 89.1% and a specificity of 75.0%, regardless of gender. Conclusion Thereby, we conclude that the standardized questionnaire under rating is suitable for the screening of hearing loss in the elderly, given its high accuracy and userfriendly quality.

Prevalence of neurocognitive disorders and depression in a Brazilian HIV population.

INTRODUCTION: Combined antiretroviral therapy has enabled human immunodeficiency virus (HIV) carriers to live longer. This increased life expectancy is associated with the occurrence of degenerative diseases, including HIV-associated neurocognitive disorders (HAND), which are diagnosed via a complex neuropsychological assessment. The International HIV Dementia Scale (IHDS) is a screening instrument validated in Brazil for use in the absence of neuropsychological evaluation. HIV patients are frequently diagnosed with depression. We aimed to determine the prevalence of neurocognitive impairment using the IHDS and depressive disorders using the Hamilton Rating Scale for Depression (HAM-D17), compare the IHDS performance with the performances on the Timed Gait Test (TGT), the Digit Symbol Coding Test (DS) and the Brazilian version of the Scale of Instrumental Activities of Daily Living (IADL), and evaluate the association between the IHDS performance and clinical-demographic variables. METHODS: One hundred fourteen patients were evaluated in a cross-sectional study conducted in a public outpatient clinic for infectious diseases in Marília City, State of São Paulo, Brazil. Data were collected following consultation. Statistical analysis was performed in accordance with the nature and distribution of the data and hypotheses. RESULTS: According to the IHDS, 53.2% of the sampled patients were neuropsychologically impaired. According to the HAM-D17, 26.3% had depressive disorders. There were significant associations between the IHDS and the TGT and DS. Multiple regression analysis indicated that female gender, educational level, and cluster of differentiation 4 (CD4) levels were significantly and independently associated with neurocognitive impairment. CONCLUSIONS: The prevalence of neurocognitive impairment according to the IHDS is high and associated with female gender, education level, and low CD4 levels.

Prevalence of neurocognitive disorders and depression in a Brazilian HIV population

Combined antiretroviral therapy has enabled human immunodeficiency virus (HIV) carriers to live longer. This increased life expectancy is associated with the occurrence of degenerative diseases, including HIV-associated neurocognitive disorders (HAND), which are diagnosed via a complex neuropsychological assessment. The International HIV Dementia Scale (IHDS) is a screening instrument validated in Brazil for use in the absence of neuropsychological evaluation. HIV patients are frequently diagnosed with depression. We aimed to determine the prevalence of neurocognitive impairment using the IHDS and depressive disorders using the Hamilton Rating Scale for Depression (HAM-D17), compare the IHDS performance with the performances on the Timed Gait Test (TGT), the Digit Symbol Coding Test (DS) and the Brazilian version of the Scale of Instrumental Activities of Daily Living (IADL), and evaluate the association between the IHDS performance and clinical-demographic variables.

Tradução, Adaptação Cultural e Validação do Questionário “Reação Médica à Incerteza (PRU)” na Tomada de Decisões / Translation, Cultural Adaptation and Validation of the “Physicians’ Reactions to Uncertainty (PRU)” Questionnaire

Introdução A incerteza influencia diretamente a tomada de decisões pelos médicos, e a inabilidade em lidar com ela pode resultar em cuidados médicos com baixo padrão de qualidade eem desperdício de recursos em saúde. A incerteza também afeta a satisfação profissional e a qualidade de vida desses profissionais. O questionário Physicians’ Reactions to Uncertainty (PRU) objetiva quantificar as reações afetivas de médicos à incerteza e suas maneiras de lidar com ela. Os objetivos deste trabalho são a tradução para o português, a adaptação cultural e a validação do questionário PRU. Materiais e métodos Estudo transversal analítico, que compreende a tradução, retrotradução e adaptação cultural do questionário PRU. As etapas posteriores consistiram em validação na população-alvo, seguida de avaliação de reprodutibilidade intra e interobservador, e análise da consistência interna. Na avaliação da consistência interna do instrumento foi utilizado o coeficiente alfa de Cronbach; e na análise da reprodutibilidade intra e interobservador, o coeficiente de correlação de Pearson. Resultados Em todos os domínios do questionário, os resultados da correlação intraobservador (test-retest) e interobservador (concordância total) pelo testede correlação de Pearson foram estatisticamente significantes, com p<0,01. De forma geral, a consistência interna do instrumento foi moderada, com um alfa de Cronbach de 0,58. Entre as várias dimensões, atingiu-se consistência moderada, com valores que oscilaram ao redor de 0,6. Conclusões A versão brasileira do questionário PRU tem propriedades de medida adequadas e oferece um novo instrumento nesse campo de pesquisa, possibilitando melhor compreensão da incerteza gerada na tomada de decisão clínica. .

Introduction Uncertainty directly influences physicians’ decision-making, and their inability to deal with it can result in substandard medical care and wasted health care resources. Uncertainty also affects the job satisfaction and quality of life of such professionals. The Physicians’ Reactions to Uncertainty (PRU) questionnaire aims to quantify the emotive reactions of physicians to uncertainty and their ways of dealing with it. The objectives of this study are the Portuguese translation, cultural adaptation and validation of the PRU questionnaire. Materials and Methods Cross-sectional analytic study involving translation, back-translation and cultural adaptation of the PRU questionnaire. The subsequent steps consisted of validation in the target population, followed by assessment of intra- and inter-observer reproducibility and internal consistency analysis. Cronbach’s alpha was used to evaluate the internal consistency of the questionnaire, and Pearson’s Correlation Coefficient was applied for the test-retest. Results In all areas of the questionnaire the results of the intra-observer (test-retest) and inter-observer (total agreement) correlation through Pearson’s correlation test were statistically significant, with p < 0.01. Overall, the internal consistency of the questionnaire was moderate, with a Cronbach’s alpha score of 0.58. Among the various dimensions, a moderate consistency was achieved, with values oscillating around 0.06. Conclusions The Brazilian version of the PRU questionnaire has demonstrated adequate measurement properties and offers a new instrument in this field of research, enabling better understanding of the uncertainty generated in clinical decision-making. .

[The experience of a public institution in the training of health professionals to work in primary care]. / A experiência de uma instituição pública na formação do profissional de saúde para atuação em atenção primária.

This scope of this paper is to analyze the training of nurses and physicians to work in primary care at a public institution in the municipality of Marilia, duly identifying the concepts of professors, coordinators and graduates in relation to the formation of health professionals. It is a qualitative, exploratory study with interviews conducted with 21 individuals. The results revealed that according to the individuals interviewed, both courses prepare professionals to work in primary care, albeit with limitations in relation to actions in management collective and care. The interviewees believe that the use of active methodologies has been important in the teaching and learning process. Also, the fact that from the first year of undergraduate studies the students participate in primary health care broadens their knowledge of this reality. The study highlights the need to enhance the teaching-service partnership and strategies to improve the training physicians to work in primary health care.

A experiência de uma instituição pública na formação do profissional de saúde para atuação em atenção primária / The experience of a public institution in the training of health professionals to work in primary care

Este estudo analisa a formação de enfermeiros e médicos de uma instituição pública do município de Marília para a atuação em Atenção Primária, identificando as concepções dos docentes, coordenadores e egressos em relação à formação profissional. Trata-se de um estudo qualitativo, exploratório, realizado por meio de entrevistas com 21 sujeitos. Os resultados revelaram que segundo os entrevistados ambos os cursos preparam os profissionais para atuar em Atenção Primária, entretanto, com limitações em relação às ações de gestão e cuidado coletivo. Os entrevistados acreditam que o uso das metodologias ativas tem sido importante para o processo de ensino e aprendizagem e que o fato dos estudantes participarem desde o primeiro ano da graduação junto a Atenção Primária amplia o conhecimento sobre esta realidade. O estudo aponta para a necessidade do fortalecimento da parceria ensino serviço e de estratégias que melhorem a formação do médico para atuação na Atenção Primária.

This scope of this paper is to analyze the training of nurses and physicians to work in primary care at a public institution in the municipality of Marilia, duly identifying the concepts of professors, coordinators and graduates in relation to the formation of health professionals. It is a qualitative, exploratory study with interviews conducted with 21 individuals. The results revealed that according to the individuals interviewed, both courses prepare professionals to work in primary care, albeit with limitations in relation to actions in management collective and care. The interviewees believe that the use of active methodologies has been important in the teaching and learning process. Also, the fact that from the first year of undergraduate studies the students participate in primary health care broadens their knowledge of this reality. The study highlights the need to enhance the teaching-service partnership and strategies to improve the training physicians to work in primary health care.

[School-service integration in the training of nurses and doctors: the experience of FAMEMA]. / A integração ensino-serviço na formação de enfermeiros e médicos: a experiência da FAMEMA.

The scope of this study is to identify contributions and limits of teaching-service integration between the School of Medicine of Marília and the Municipal Health Department of Marília for academia, for the health teams and for the community. The study involved cross-sectional research using a quantitative approach. A questionnaire with 20 affirmations structured around a Likert scale was applied to students, professors and collaborating professors with a total of 183 participants. A trend for a positive evaluation of teaching-service integration for professional education was revealed. As regards contributions of teaching-service integration to the community, the positive evaluation was close to 50%. The items referring to contributions to the health teams were the ones that had the highest number of negative responses. Data indicate that it is necessary to move forward such that teaching and service are considered interdependent processes with possibilities of joint reflections.

A integração ensino-serviço na formação de enfermeiros e médicos: a experiência da FAMEMA / School-service integration in the training of nurses and doctors: the experience of FAMEMA

O estudo tem como objetivo identificar contribuições e limites da integração ensino-serviço entre a Faculdade de Medicina de Marília e a Secretaria Municipal de Saúde de Marília, para a academia, para as equipes de saúde e para a comunidade. Trata-se de uma pesquisa transversal, de abordagem quantitativa. Um questionário com 20 assertivas, organizado sob a forma de escala Likert, foi aplicado a estudantes, docentes e professores colaboradores, num total de 183 participantes. Constatou-se tendência à avaliação positiva da integração ensino-serviço para a formação profissional. Quanto às contribuições da integração ensino-serviço para a comunidade, a avaliação positiva aproximou-se de 50%. Os itens referentes às contribuições para as equipes de saúde foram os que tiveram maior quantidade de respostas negativas. Os dados indicam que é preciso avançar de forma que ensino e serviço sejam considerados processos interdependentes e com possibilidades de reflexões conjuntas.

The scope of this study is to identify contributions and limits of teaching-service integration between the School of Medicine of Marília and the Municipal Health Department of Marília for academia, for the health teams and for the community. The study involved cross-sectional research using a quantitative approach. A questionnaire with 20 affirmations structured around a Likert scale was applied to students, professors and collaborating professors with a total of 183 participants. A trend for a positive evaluation of teaching-service integration for professional education was revealed. As regards contributions of teaching-service integration to the community, the positive evaluation was close to 50%. The items referring to contributions to the health teams were the ones that had the highest number of negative responses. Data indicate that it is necessary to move forward such that teaching and service are considered interdependent processes with possibilities of joint reflections.

Aspectos da integração ensino-serviço na formação de enfermeiros e médicos / Aspects of teaching-service integration in nursing and medical education

Pesquisa qualitativa com o objetivo de identificar as contribuições, limites e sugestões indicados para o aperfeiçoamento da integração ensino-serviço entre a Faculdade de Medicina de Marília e a Secretaria Municipal de Saúde de Marília, para a formação de enfermeiros e médicos. Realizada com base nas narrativas de docentes, estudantes e profissionais dos serviços, a análise pautou-se no método hermenêutico-dialético. Verificou-se que a integração ensino-serviço possibilita a inserção precoce do estudante no mundo do trabalho, a construção do conhecimento pautado na prática, a troca de informação com os profissionais dos serviços e a ampliação das ações junto à coletividade. Como limite, foi identificada a falta de reconhecimento do papel do estudante, falta de suporte da gestão e indefinição de papéis da academia e do serviço. Sugerem-se ampliação da inserção do professor colaborador nas atividades acadêmicas, melhorias na gestão da Atenção Básica e revisão do contrato de parceria, como parte da necessidade de corresponsabilização nos processos de ensino-serviço.

This qualitative research aims to identify advances and challenges of teaching-service integration in nursing and medical education between the Marilia Medical School and Marilia Municipal Health Secretary. Data were collected from accounts given by teachers, students and health professionals. The analysis was based on the hermeneutic-dialectic method. The results showed that teaching-service integration allows early integration of the student in the workplace, guides the construction of knowledge in professional practice, supports the exchange of information and increases the quantity and quality of health actions aimed at the community. The identified challenges were a lack of recognition of the student's role by health team members, a lack of management support for the development of Family Health Strategy principles and a lack of definition of academia and service roles in partnership contracts. Suggestions for the improvement of the integration included expanding the insertion of the collaborating teacher in academic activities, improving the management of Primary Health Care and reviewing the partnership agreement. These advances are needed to enhance co-responsibility in the process of in-service learning.

Tromboprofilaxia venosa em pacientes clínicos: análise de sua aplicação / Venous thromboprophylaxis in medical patients: an application review

OBJETIVO: A tromboprofilaxia de rotina, a despeito de sua efetividade estar bem estabelecida e o tromboembolismo venoso ser uma condição potencialmente evitável, não se apresenta completamente consolidada na prática clínica. Os objetivos do presente estudo são: 1. Determinar a frequência da utilização da tromboprofilaxia e presença dos fatores de risco para tromboembolismo; 2. Verificar a adequação de sua utilização em pacientes clínicos internados, assumindo como parâmetro uma diretriz nacional estabelecida. MÉTODOS: Estudo retrospectivo transversal envolvendo pacientes internados por doenças clínicas em uma enfermaria geral de adultos de um hospital universitário. A análise foi baseada em diretriz definida. RESULTADOS: Foram incluídos 146 pacientes para análise. Destes, 94,5% possuíam pelo menos um fator de risco para tromboembolismo venoso. Em 130 (89%) pacientes havia indicação para uso de heparina profilática, sendo que em 73,3% dos casos estava prescrito algum tipo de heparina. Quanto à adequação da profilaxia, 53,4% das prescrições estavam corretas em relação à indicação e à dose da profilaxia; 24% apresentavam dose ou frequência incorretas; 19,2% não tinham prescrição de profilaxia, apesar de ela ser indicada; e em cinco casos (3,4%) o fármaco foi prescrito, apesar de não haver indicação. CONCLUSÃO: Existe subutilização da tromboprofilaxia nesta população, com inadequada dose prescrita em 50% dos casos. Portanto, estudos e intervenções futuros devem incluir um programa educacional que se inicie desde o atendimento em pronto-socorro, sendo essencial para aproximar a evidência à prática clínica.

OBJECTIVE: Routine thromboprophylaxis, despite its well-known effectiveness and the fact that venous thromboembolism is a potentially avoidable condition, is not fully established in clinical practice. The objectives of the present study were to determine how often thromboprophylaxis is used and the presence of thromboembolism risk factors, and to verify the appropriateness of its use in medical inpatients, assuming a long-standing national guideline as a parameter. METHODS: This was a retrospective cross-sectional study, involving inpatients with medical conditions in the adult general ward of a university hospital. The review was based on a defined guideline. RESULTS: 146 patients were included in the review. At least one risk factor for venous thromboembolism was found in 94.5%. In 130 (89%) patients, prophylactic heparin was indicated, and some kind of heparin was prescribed in 73.3%. Regarding the adequacy of prophylaxis, 53.4% of prescriptions were correct regarding prophylaxis indication and dose; 24% had incorrect dose or frequency of use; 19.2% had no prophylaxis prescription, although it was indicated; and in five cases (3.4%), the drugwas prescribed, even though itwas not indicated. CONCLUSION: Thromboprophylaxis is underused in this population, and an inappropriate dose was prescribed in 50% of cases. Therefore, future studies and interventions should include an educational program started from the emergency department care, an essential step to bring evidence closer to clinical practice.

[Venous thromboprophylaxis in medical patients: an application review]. / Tromboprofilaxia venosa em pacientes clínicos: análise de sua aplicação.

OBJECTIVE: Routine thromboprophylaxis, despite its well-known effectiveness and the fact that venous thromboembolism is a potentially avoidable condition, is not fully established in clinical practice. The objectives of the present study were to determine how often thromboprophylaxis is used and the presence of thromboembolism risk factors, and to verify the appropriateness of its use in medical inpatients, assuming a long-standing national guideline as a parameter. METHODS: This was a retrospective cross-sectional study, involving inpatients with medical conditions in the adult general ward of a university hospital. The review was based on a defined guideline. RESULTS: 146 patients were included in the review. At least one risk factor for venous thromboembolism was found in 94.5%. In 130 (89%) patients, prophylactic heparin was indicated, and some kind of heparin was prescribed in 73.3%. Regarding the adequacy of prophylaxis, 53.4% of prescriptions were correct regarding prophylaxis indication and dose; 24% had incorrect dose or frequency of use; 19.2% had no prophylaxis prescription, although it was indicated; and in five cases (3.4%), the drug was prescribed, even though it was not indicated. CONCLUSION: Thromboprophylaxis is underused in this population, and an inappropriate dose was prescribed in 50% of cases. Therefore, future studies and interventions should include an educational program started from the emergency department care, an essential step to bring evidence closer to clinical practice.

[The excessive use of urinary catheters in patients hospitalized in university hospital wards]. / Uso excessivo do cateter vesical em pacientes internados em enfermarias de hospital universitário.

This cohort study included 254 adult patients who used a urinary catheter (UC) during their hospitalization in a university hospital ward. The following were evaluated: catheter use, indication, time of permanence, urinary infection density, mortality, and hospital stay. Throughout the studied period, 14% of the hospitalized patients received UC, totaling 1735 UC-day. In 23% of cases, the procedure had not been prescribed, and neither was its indication documented. The average time of UC use was 6.8 days. Among clinical patients, the indication for UC was inadequate in 29%; time of permanence was considered inadequate in 49% of clinical patients and in 66.9% of surgical patients. Patients with inadequate UC use had more urinary tract infections (RR 1.86 IC95% 1.4 to 3.04) and longer hospital stay (11.9 and 8.9 days, p=0.002). This study permitted to identify flaws in the care process that are potentially changeable and important to avoid urinary tract infection by urinary catheter use.

Uso excessivo do cateter vesical em pacientes internados em enfermarias de hospital universitário / The excessive use of urinary catheters in patients hospitalized in university hospital wards / Uso excesivo del catéter vesical en pacientes internados en enfermerías de Hospital Universitario

Este estudo de corte incluiu 254 pacientes adultos que usaram cateter vesical (CV) durante a hospitalização em enfermarias de um hospital universitário. Foram avaliados: utilização do cateter, indicação, tempo de permanência, densidade de infecção urinária, mortalidade e permanência hospitalar. Durante o período de estudo, 14 por cento dos pacientes internados usaram CV, totalizando 1.735 CV-dia. Em 23 por cento dos casos, o procedimento não foi prescrito, nem sua indicação foi documentada. O tempo médio de uso do CV foi de 6,8 dias. Entre os pacientes clínicos, a indicação do CV foi inadequada em 29 por cento; o tempo de permanência foi considerado inadequado em 49 por cento dos pacientes clínicos e em 66,9 por cento dos pacientes cirúrgicos. Pacientes com uso inadequado do CV tiveram mais infecção do trato urinário (RR 1,86 IC95 por cento 1,4 a 3,04) e maior tempo de permanência hospitalar (11,9 e 8,9 dias, p=0,002). O estudo permitiu identificar no processo assistencial falhas potencialmente modificáveis e importantes para a prevenção da infecção do trato urinário por cateter vesical.

This cohort study included 254 adult patients who used a urinary catheter (UC) during their hospitalization in a university hospital ward. The following were evaluated: catheter use, indication, time of permanence, urinary infection density, mortality, and hospital stay. Throughout the studied period, 14 percent of the hospitalized patients received UC, totaling 1735 UC-day. In 23 percent of cases, the procedure had not been prescribed, and neither was its indication documented. The average time of UC use was 6.8 days. Among clinical patients, the indication for UC was inadequate in 29 percent; time of permanence was considered inadequate in 49 percent of clinical patients and in 66.9 percent of surgical patients. Patients with inadequate UC use had more urinary tract infections (RR 1.86 IC95 percent 1.4 to 3.04) and longer hospital stay (11.9 and 8.9 days, p=0.002). This study permitted to identify flaws in the care process that are potentially changeable and important to avoid urinary tract infection by urinary catheter use.

Estudio de coorte incluyendo 254 pacientes adultos que recibieron catéter vesical (CV) durante hospitalización en enfermerías de hospital universitario. Se evaluó: utilización del catéter, indicación, tiempo de permanencia, densidad de infección urinaria, mortalidad y permanencia hospitalaria. Durante el período de estudio, 14 por ciento de los internados usaron CV, totalizando 1753 CV-día. En 23 por ciento de los casos no fue prescripto, ni documentada su indicación. El tiempo medio de uso del CV fue 6,8 días. Entre pacientes clínicos, la indicación del CV fue inadecuada en 29 por ciento; el tiempo de permanencia se consideró inadecuado en 49 por ciento de pacientes clínicos y en 66,9 por ciento de pacientes quirúrgicos. Los pacientes con uso inadecuado del CV sufrieron más infecciones del tracto urinario (RR 1,86 IC95 por ciento 1,4 a 3,044) y mayor permanencia hospitalaria (11,9 y 8,9 días, p=0,002). El estudio identificó fallas del proceso asistencial, potencialmente modificables, importantes para prevención de infección del tracto urinario por catéter vesical.

A influência das estratégias promocionais das indústrias farmacêuticas sobre o receituário médico na Faculdade de Medicina de Marília: uma visão ética / The influence of pharmaceutical companies advertising strategies on medical prescription at the School of Medicine in Marília, São paulo, Brazil: an ethical perspective

Os laboratórios farmacêuticos e a indústria de medicamentos estão inseridos numa economia de mercado capitalista, onde a disputa comercial e a busca por novos medicamentos (mais eficazesz e com menos efeitos colaterais) tornam-se objetivos a alcançar na corrida pelo domínio mercadológico. O investimento dessas empresas privadas em novas descobertas se reflete num aumento significativo em seu custo. Sem esse incentivo financeiro, essas pesquisas científicas seriam consideravelmente reduzidas. Para que o novo medicamento seja apresentado categoria médica e inserido no mercado, as indústrias utilizam técnicas e estratégias de venda que variam desde a participação em congressos até o contato individual sob a forma de benefícios pessoais. Este trabalho analisa os fatores envolvidos no que diz respeito à ética na prescrição de medicamentos e à conduta médica, tendo em vista que são constantemente influenciados pela propaganda comercial, por vantagens concedidas e pela distorção de interesses das partes envolvidas.

Climacteric symptoms and quality of life: validity of women's health questionnaire.

OBJECTIVE: To evaluate the reliability and validity of the Portuguese version of the Women's Health Questionnaire. METHODS: In order to evaluate the Women's Health Questionnaire (WHQ), an analytical cross-sectional study was carried out at the women's menopause outpatient clinic of a university hospital in São Paulo, Brazil. There were studied 87 women in perimenopause or menopause, defined as experiencing at least one year's absence of menstrual flow. The following variables were collected: demographic data, clinical variables (Kupperman index and correlate numeric scale) and quality of life indexes (SF-36 and utility). RESULTS: The WHQ proved to be a questionnaire easily translated into Portuguese and well-adjusted to Brazilian women. The internal consistency of the overall WHQ was excellent (Cronbach alpha =0.83; 95% CI: 0.71-0.91). Test-retest reliability was also excellent (intraclass correlation coefficient [ICC]=0.92; 95% IC: 0.86-0.96) and had good absolute agreement (0.84; 95% CI: 0.71-0.92). A satisfactory clinical validity was observed. The construct validity was corroborated by clear associations with others scales. A good index of responsiveness after the intervention was reached. CONCLUSIONS: The Portuguese version of the WHQ is of easy and fast administration and understanding. Its measuring properties were related, allowing its use in the evaluation of Brazilian climacteric women's quality of life for various purposes.

Climacteric symptoms and quality of life: validity of women's health questionnaire

OBJETIVO: Validar para o português o instrumento de avaliação de qualidade de vida no climatério, Women's Health Questionnaire. MÉTODOS: Para avaliação do Women's Health Questionnaire, foi realizado estudo transversal analítico no ambulatório de assistência ao climatério de um hospital universitário do Município de São Paulo. Foram estudadas 87 mulheres na peri-menopausa ou menopausa, definida como ao menos um ano sem apresentar fluxo menstrual, e analisadas as seguintes variáveis: demográficas, índices clínicos (índice menopausal de Kuppermann, e escala numérica correlata) índices de qualidade de vida (SF-36, e utility). RESULTADOS: A consistência interna do WHQ traduzido foi muito boa (Coeficiente Alfa de Cronbach =0,83 IC 95%: 0,71-0,91), assim como a correlação intra-classe (teste-reteste =0,92; IC 95%: 0.86-0,96), e boa concordância absoluta (0,84; IC 95%: 0,71-0,92). Sua validade de construto foi corroborada pela boa associação com outras escalas. A validade clínica foi considerada satisfatória e um bom índice de sensibilidade após intervenção foi alcançado. CONCLUSÕES: A versão para o português do Women's Health Questionnaire é de fácil e rápida aplicação e compreensão. Suas propriedades de medida foram avaliadas e provadas podendo ser utilizada para a avaliação da qualidade de vida das mulheres brasileiras no climatério, para vários objetivos.

[Acquisition of skills in medical ethics in learning-teaching small groups. Comparing problem-based learning with the traditional model]. / Apreensão de tópicos em ética médica no ensino-aprendizagem de pequenos grupos. Comparando a aprendizagem baseada em problemas com o modelo tradicional.

BACKGROUND: Aiming to evaluate the acquisition of skills on Medical Ethics among medical students from Marilia Medical School, some of them from the small group learning-teaching method, others from traditional teaching method. METHODS: A prospective analytical study was done based on the application of questionnaires about general themes on Ethics, at two different times. RESULTS: There weren't significant differences on the skills' acquisition between the two methods. Students from late graduation years showed a significantly better performance than those from early years. The themes that presented worse results were medical secret, legal responsible consent, patient autonomy, medical prescription, medical handbook and corporative feeling in the presence of medical mistake. CONCLUSION: The most important difference between the groups was not the pedagogical pattern but the exposition time to the theme. PBL gives the chance to distribute the theme in different situations accelerating the acquisition of knowledge in Medical Ethics. It was realized that a revitalization on Medical Ethics teaching is necessary at our institution, aiming a better integration with the socio-economical situation in our country.