Impact of Care Interventions on the Survival of Patients with Cardiac Chest Pain.

BACKGROUND: Chest pain is considered the second most frequent complaint among patients seeking emergency services. However, there is limited information in the literature about how the care provided to patients with chest pain, when being attended to in the emergency room, influences their clinical outcomes. AIMS: To assess the relationship between care interventions performed on patients with cardiac chest pain and their immediate and late clinical outcomes and to identify which care interventions were essential to survival. METHODS: In this retrospective study. We analyzed 153 medical records of patients presenting with chest pain at an emergency service center, São Paulo, Brazil. Participants were divided into two groups: (G1) remained hospitalized for a maximum of 24 h and (G2) remained hospitalized for between 25 h and 30 days. RESULTS: Most of the participants were male 99 (64.7%), with a mean age of 63.2 years. The interventions central venous catheter, non-invasive blood pressure monitoring, pulse oximetry, and monitoring peripheral perfusion were commonly associated with survival at 24 h and 30 days. Advanced cardiovascular life support and basic support life (p = 0.0145; OR = 8053; 95% CI = 1385-46,833), blood transfusion (p < 0.0077; OR = 34,367; 95% CI = 6489-182,106), central venous catheter (p < 0.0001; OR = 7.69: 95% CI 1853-31,905), and monitoring peripheral perfusion (p < 0.0001; OR = 6835; 95% CI 1349-34,634) were independently associated with survival at 30 days by Cox Regression. CONCLUSIONS: Even though there have been many technological advances over the past decades, this study demonstrated that immediate and long-term survival depended on interventions received in an emergency room for many patients.

Scale of Adherence to Good Hospital Practices for COVID-19: Psychometric Properties.

To avoid hospital transmission, all COVID-19 prevention measures should be followed. This study aimed to evaluate the psychometric properties of a novel scale developed to assess adherence to good practices for COVID-19 in the hospital setting. A methodological cross-sectional study was conducted at a public hospital in the state of São Paulo, Brazil, with 307 healthcare providers. Data were collected using a questionnaire addressing sociodemographic/occupational data and the Adherence to Standard Precautions for COVID-19 scale. Cronbach's alpha coefficients and the intraclass correlation coefficients were used to measure internal consistency and temporal stability (test-retest analysis), respectively. Concurrent validity was evaluated using Spearman's correlation coefficients between the scores of the overall scale and its domains. Factorial structure was evaluated using exploratory factor analysis and goodness-of-fit of the model was tested using confirmatory factor analysis. Cronbach's alpha coefficients for the scale and its domains were higher than 0.7, except the psychosocial domain (0.61). All intraclass correlation coefficients were higher than 0.7. Strong correlations were found between the total score and the personal (0.84) and organizational (0.90) domains of the scale and a good correlation was found with the psychosocial domain (0.66). The fit of the multidimensional model was satisfactory for all parameters and the three-dimensional structure of the scale was confirmed by the fit of the factor loadings. The novel scale is a valid and reliable instrument for assessing adherence to good hospital practices for COVID-19.

TuCASA questionnaire for assessment of children with obstructive sleep apnea: validation.

OBJECTIVE: The aim of the present study was to validate The Tucson Children's Assessment of Sleep Apnea Study (TuCASA) questionnaire for use in the Brazilian population. METHODS: Of the total 62 children who participated in the present study (27 girls), aged 4 to 11 years, 45 (72.6%) had sleep-disordered breathing (SDB) diagnosed by polysomnography, while 17 (27.4%) had no sleep disorders. Translation, back-translation, and pretesting were previously performed. The final Portuguese-language version of TuCASA was administered to the participants from May 2012 to August 2013. The interviewer was blinded to presence or absence of SDB. Cronbach's alpha for the overall scale (with 95% CI) and the effect of excluding any items were evaluated. RESULTS: There was no difference among TuCASA items/score and the presence of SDB with either age or gender. The TuCASA had a Cronbach's alpha coefficient of 0.726 (95% CI 0.614 to 0.817), which denotes satisfactory internal consistency - a finding reinforced by evaluation of the effect of item exclusion on the questionnaire. Convergent validity was also satisfactory, in as much as most correlations were positive and significant. CONCLUSION: The translated version of the TuCASA questionnaire was validated for Brazilian populations and proved to be a reliable, validated instrument that can be used in clinical practice for evaluation of children with symptoms of SDB.

Symptoms of sleep disorders and objective academic performance.

OBJECTIVE: We aimed to compare the academic performance of children with and without symptoms of sleep disorders (SSD). METHODS: We distributed 5400 questionnaires (Sleep Disturbance Scale for Children [SDSC], Brazilian version) to 7- to 10-year-old children at public elementary schools in São Paulo, Brazil. We analyzed the academic grades of Portuguese (Port) and Mathematics (Math) in 2384 children (1224 girls; 51%). Grades were assigned on a scale of 0-10 and five was considered a passing grade. Children with symptoms of sleep disorders (SSD) and symptoms of sleep-breathing disorders (SSBD) were compared to children with no symptoms of SSD (no-SSD). RESULTS: Mean Port (6.6±2.2) and Math (6.3±2.2) grades were lower in children with SSD or sleep-breathing disorders (SBD) than those among children with no-SSD (Port, 7.1±2.1 and Math, 7.1±2.1; P<.05). Boys with SSD or SSBD had lower grades (Port, 6.4±2.2 and Math, 6.1±2.2) than girls (Port, 6.9±2.2 and Math, 6.5±2.2; P<.05). There were more children with failing Port grades with SSD or SSBD (13%) than those among children with no-SSD (9%; P<.05). Regarding Math, 25.4% of SSD or SSBD children had failing grades vs. 8.4% of children with no-SSD (P<.05). CONCLUSION: In our sample, children with SSD particularly SBD were at increased risk for poor academic performance in Math and Port.

Sleep disturbance scale for children: translation, cultural adaptation, and validation.

INTRODUCTION: The Sleep Disturbance Scale for Children (SDSC) is a 26-item instrument for evaluating sleep among children aged 3-18 years. It differentiates among conditions such as disorders of initiating and maintaining sleep, sleep breathing disorders, disorders of arousal, sleep-wake transition disorders, excessive somnolence, and sleep hyperhydrosis. The aim of this study was to translate, culturally adapt, and validate it for Brazilian Portuguese. METHOD: The study was carried out in two phases: (1) forward translation, back translation, pretesting, and calculation of sample size; (2) validation: reliability (Chronbach's alpha), convergent analysis (Pearson correlation), and discriminatory validity (comparing the scores of the test with the results of polysomnography). One hundred children, aged 3-18 years, accompanied by their parents and/or guardians participated in the phases. PSG studies have been done to calculate the sample size and validation. RESULTS: The scale instructions and items were adapted regarding semantic, experiential, conceptual, and cultural equivalence validation. The scale structure related to visual communication was also adapted to Brazilian population preference and habits, and this resulted in a chart with clear instructions and easy recognition of the statements and possible responses. Reliability analysis showed values greater than 0.55. There has been reasonable convergent validity. Discriminatory validity using the PSG study for positive sleep-disordered breathing (SDB) was 8.9, attesting discriminatory validity only for SDB. The three questions of the scale can screen SDB. CONCLUSION: The SDSC was translated, adapted and validated for Brazilian Portuguese, and it presented internal consistency and convergent and discriminatory validity. It can be used in population-based studies in order to screen for sleep-disordered breathing in children.