Avaliação da implantação do serviço de atenção à saúde das pessoas estomizadas / Evaluation of implantation of ostomy patient health care program / Evaluación de la implementación del servicio de atención de la salud de las personas ostomizadas

Avaliar a implantação dos Serviços de Atenção à Saúde das Pessoas Ostomizadas em Minas Gerais.MÉTODO: estudo seccional realizado em 28 unidades de saúde do estado de Minas Gerais. Os dados foram coletados a partir de questionários que compõem a base do Sistema Integrado de Gerenciamento da Assistência Farmacêutica da Secretaria de Estado de Saúde. O grau de implantação foi definido por meio de uma matriz de análise e julgamento validada para o estudo com escores diferenciados para cada indicador avaliado.RESULTADOS: foram analisados dados sobre estrutura e processo dos serviços de saúde. Observou-se que 11% atingiram o grau de implantação plena; 42% apresentaram implantação satisfatória; 36% incipientes e 11% foram classificados como não implantados. Na organização do programa, a estrutura foi mais bem avaliada que o processo. Destaca-se ausência de orientação e capacitação de profissionais, atendimento em grupo, organização da demanda de atendimento e escassez de enfermeiro qualificado.CONCLUSÃO: os serviços estão focados no fornecimento de equipamentos coletores em detrimento de serviços norteados para uma assistência integral, ampliada e em rede.

To evaluate the implementation of Health Care Services of Ostomized in Minas Gerais. Methods: a Cross-sectional study conducted in28 health facilities in the state of Minas Gerais-Brazil. Data collected through questionnaires that form the basis of the Integrated Pharmaceutical Care Management System of State Health Department. The degree of implementation defined by an array of analysis and judgment validated inthe study with different scores for each evaluated indicator. Results: information on structure and process of health services were analyzed. It wasobserved that 11% reached the level of full deployment; 42% had satisfactory implementation; 36% incipient and 11% were classified as nondeployed.In the program's organization, the structure was better evaluated than process. It is noteworthy the absence of guidance and professional training, group care, the organization's demand for care and shortage of qualified nurses. Conclusion: Service is focused on providing collector equipment tothe detriment of guided services for comprehensive health care, expanded and networked.

Determinar la implementación de los servicios de atención de la Salud de las personas ostomizadas en Minas Gerais. Métodos: estudiotransversal realizado en 28 centros de salud del estado de Minas Gerais – Brasil. Los datos fueron recogidos a partir de encuestas que forman la basedel Sistema Integrado de Gestión de la Atención Farmacéutica de la Secretaría de Estado de Salud. El grado de implementación fue definido pormedio de una matriz de análisis y juicio de valor, validada para el estudio con diferentes puntuaciones para cada indicador evaluado. Resultados:se analizaron los datos de estructura y proceso de los servicios de salud. Se observó que el 11% alcanzó el grado de implementación completa; 42%implementación satisfactoria; 36% incipiente y 11% se clasificó como no implementado. En la organización del programa, la estructura fue mejor evaluada que el proceso. Cabe destacar la ausencia de orientación y formación profesional, atención en grupo, organización de la demanda deatención y la escasez de enfermeros cualificados. Conclusión: Los servicios están enfocados en suministrar equipos colectores en detrimento deservicios dirigidos a la atención integral de la salud, amplia y en red.

Validation of an instrument for evaluating health care services to ostomized people.

Objectives: to develop and validate an array of analysis and judgment for the evaluation of Health Care Services of people with stomas. Methods: cross-sectional study in 28 health facilities in the state of Minas Gerais. A descriptive analysis of the instrument and a study of its psychometric properties were performed. We used the Delphi technique for the validation of content and appearance. A psychometric analysis was carried out through the study of the reliability and validity of the measures obtained with the instrument. Results: it was possible to construct an array analysis and judgment with 16 components (with scores from zero to five) grouped according to size and structure and process considered essential to evaluate the service. The results achieved in the reliability for structure and process, through the Cronbach alpha coefficient (α = 0.771 and α = 0.809, respectively), and the validity of content and construct demonstrated good internal consistency and satisfactory validity. An exploratory factor analysis indicated the item "main activity performed in the unit" as a limitation of the scale. Conclusion: the study provides a new tool for the evaluation of structure and process of Health Care Services of a Person with a stoma.

Ressuscitação cardiopulmonar de adultos com parada cardíaca intra-hospitalar utilizando o estilo Utstein / Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style

RESUMO Objetivo: Analisar o perfil clínico de pacientes com parada cardiorrespiratória intra-hospitalar, seu atendimento e evolução, com registro baseado no estilo Utstein. Métodos: Estudo observacional, prospectivo e longitudinal em ambiente de terapia intensiva de pacientes com parada cardiorrespiratória incluídos durante 1 ano. Resultados: Foram 89 pacientes, com média de idade de 59,0 anos, 51,6% homens, submetidos às manobras de ressuscitação cardiopulmonar. Os episódios ocorreram no período diurno em 64,6% dos casos. A assistolia/bradiarritmia foi o ritmo inicial mais frequente (42,7%). A maior parte dos que apresentaram retorno à circulação espontânea evoluiu com parada cardiorrespiratória recorrente, principalmente nas primeiras 24 horas (61,4%). As médias dos tempos foram de 10,3 dias entre a internação e ocorrência de parada cardiorrespiratória; 0,68 minutos entre a parada cardiorrespiratória e ressuscitação cardiopulmonar; 7,1 minutos entre a parada cardiorrespiratória e a desfibrilação; 16,3 minutos de duração da ressuscitação cardiopulmonar. Houve associação entre sexo e duração da ressuscitação cardiopulmonar (19,2 minutos nas mulheres versus 13,5 minutos nos homens; p = 0,02), duração da ressuscitação cardiopulmonar e retorno à circulação espontânea (10,8 minutos versus 30,7 minutos; p < 0,001), entre cardiopatia e a idade (60,6 anos versus 53,6; p < 0,001). A sobrevida imediata após a parada cardiorrespiratória foi de 71% e, até a alta hospitalar e no sexto mês após a alta, de 9% e de 6%, respectivamente. Conclusão: O principal ritmo inicial detectado foi a assistolia/bradiarritmia com curto intervalo entre a parada cardiorrespiratória e a reanimação, porém com desfibrilação tardia. Mulheres apresentaram maior tempo de reanimação. Houve baixa taxa de sobrevida hospitalar.

ABSTRACT Objective: The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. Methods: This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. Results: The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. Conclusions: The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low.

Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style. / Ressuscitação cardiopulmonar de adultos com parada cardíaca intra-hospitalar utilizando o estilo Utstein.

OBJECTIVE:: The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. METHODS:: This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. RESULTS:: The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. CONCLUSIONS:: The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low.

Validation of an instrument for evaluating health care services to ostomized people / Validação de um instrumento para avaliação de serviços de atenção à saúde da pessoa estomizada / Validación de un instrumento para evaluación de servicios de atención a la salud de la persona ostomizada

ABSTRACT Objectives: to develop and validate an array of analysis and judgment for the evaluation of Health Care Services of people with stomas. Methods: cross-sectional study in 28 health facilities in the state of Minas Gerais. A descriptive analysis of the instrument and a study of its psychometric properties were performed. We used the Delphi technique for the validation of content and appearance. A psychometric analysis was carried out through the study of the reliability and validity of the measures obtained with the instrument. Results: it was possible to construct an array analysis and judgment with 16 components (with scores from zero to five) grouped according to size and structure and process considered essential to evaluate the service. The results achieved in the reliability for structure and process, through the Cronbach alpha coefficient (α = 0.771 and α = 0.809, respectively), and the validity of content and construct demonstrated good internal consistency and satisfactory validity. An exploratory factor analysis indicated the item "main activity performed in the unit" as a limitation of the scale. Conclusion: the study provides a new tool for the evaluation of structure and process of Health Care Services of a Person with a stoma.

RESUMO Objetivos: desenvolver e validar uma matriz de análise e julgamento para a avaliação de Serviços de Atenção à Saúde da Pessoa Estomizada. Método: estudo seccional em 28 unidades de saúde do estado de Minas Gerais. Foi realizada uma análise descritiva do instrumento e um estudo das suas propriedades psicométricas. Para a validação de conteúdo e de aparência foi utilizada a técnica Delphi. A análise psicométrica foi realizada por meio do estudo da confiabilidade e validade das medidas obtidas com o instrumento. Resultados: foi possível construir uma matriz de análise e julgamento com 16 componentes (pontuados com escores de zero a cinco) agrupados de acordo com as dimensões estrutura e processo considerados fundamentais para a avaliação do serviço. Os resultados alcançados para a confiabilidade para estrutura e processo, por meio do Coeficiente alfa de Cronbach (α = 0,771 e α = 0,809 respectivamente), e validades de conteúdo e de construto, demonstraram boa consistência interna e satisfatória validade. A análise fatorial exploratória apontou o item "principal atividade realizada na unidade" como limitação da escala. Conclusão: o estudo disponibiliza nova ferramenta para a avaliação de estrutura e processo do Serviço de Atenção à Saúde da Pessoa Ostomizada.

RESUMEN Objetivos: desarrollar y validar una matriz de análisis y juzgamiento para la evaluación de Servicios de Atención a la Salud de la Persona Ostomizada. Método: estudio seccional en 28 unidades de salud del estado de Minas Gerais. Fue realizado un análisis descriptivo del instrumento y un estudio de sus propiedades psicométricas. Para la validación de contenido y de apariencia fue utilizada la técnica Delphi. El análisis psicométrico fue realizada por medio del estudio de la confiabilidad y validez de las medidas obtenidas con el instrumento. Resultados: fue posible construir una matriz de análisis y juzgamiento con 16 componentes (evaluados con puntajes de cero a cinco) agrupados de acuerdo con las dimensiones estructura y proceso considerados fundamentales para la evaluación del servicio. Los resultados alcanzados para la confiabilidad para estructura y proceso, por medio del Coeficiente Alfa de Cronbach (α = 0,771 y α = 0,809 respectivamente), y validez de contenido y de constructo, demostraron buena consistencia interna y satisfactoria validez. El análisis factorial exploratória apuntó el ítem "principal actividad realizada en la unidad" como limitación de la escala. Conclusión: el estudio suministra una nueva herramienta para la evaluación de estructura y proceso del Servicio de Atención a la Salud de la Persona Ostomizada.

Avaliação da ingestão proteica por meio do registro alimentar em pacientes com doença renal crônica / Evaluation of protein intake by food record in patients with chronic kidney disease

Introdução: A principal manipulação dietética utilizada na tentativa de reduzir a progressão da doença renal crônica (DRC) é o controle da ingestão proteica. Objetivo: analisar a utilização do registro alimentar (RA) para avaliação da ingestão proteica de pacientes com DRC em tratamento conservador, considerando o Equivalente Proteico do Aparecimento de Nitrogênio Ureico (PNA) como método de referência. Metodologia: avaliaram-se os prontuários de pacientes adultos em acompanhamento nutricional no Serviço de Nefrologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, no período de janeiro de 2009 a dezembro de 2011. Foram coletados dados clínicos, epidemiológicos, bioquímicos e RA no prontuário e na ficha de anamnese do serviço. A ingestão proteica estimada por meio do RA foi comparada aos valores de PNA em dois momentos distintos, ambos referentes ao mesmo dia de avaliação. Resultados: foram incluídos no estudo 45 pacientes, sendo 23 (51,1%) do sexo masculino. A idade foi superior a 60 anos em 25 pacientes (55,6%) e a escolaridade média foi de 5,62 ± 3,73 anos de estudo. Não houve correlação entre a avaliação da ingestão proteica pelo RA e o PNA nos dois momentos de avaliação (teste de correlação de Pearson; r=0,06 e p=0,69 e r=0,15 e p=0,32, respectivamente). A ingestão calórica média nos dois momentos de avaliação por meio do RA foi abaixo da recomendação. Conclusão: na amostra estudada não houve correlação do RA com o método de referência PNA para avaliação da ingestão proteica em pacientes com DRC em tratamento conservador.

Predictive factors for the progression of chronic Chagas cardiomyopathy in patients without left ventricular dysfunction.

The identification of predictors for the progression of chronic Chagas cardiomyopathy (CCC) is essential to ensure adequate patient management. This study looked into a non-concurrent cohort of 165 CCC patients between 1985 and 2010 for independent predictors for CCC progression. The outcomes were worsening of the CCC scores and the onset of left ventricular dysfunction assessed by means of echo-Doppler cardiography. Patients were analyzed for social, demographic, epidemiologic, clinical and workup-related variables. A descriptive analysis was conducted, followed by survival curves based on univariate (Kaplan-Meier and Cox's univariate model) and multivariate (Cox regression model) analysis. Patients were followed from two to 20 years (mean: 8.2). Their mean age was 44.8 years (20-77). Comparing both iterations of the study, in the second there was a statistically significant increase in the PR interval and in the QRS duration, despite a reduction in heart rates (Wilcoxon < 0.01). The predictors for CCC progression in the final regression model were male gender (HR = 2.81), Holter monitoring showing pauses equal to or greater than two seconds (HR = 3.02) increased cardiothoracic ratio (HR = 7.87) and time of use of digitalis (HR = 1.41). Patients with multiple predictive factors require stricter follow-up and treatment.

Predictive factrrs for the progression of chronc chagas cardiomyopathy in patiients without left ventricular dysfunction / Preditores da evolução da cardiopatia chagásica crônica em pacientes sem disfunção ventricular esquerda

The identification of predictors for the progression of chronic Chagas cardiomyopathy (CCC) is essential to ensure adequate patient management. This study looked into a non-concurrent cohort of 165 CCC patients between 1985 and 2010 for independent predictors for CCC progression. The outcomes were worsening of the CCC scores and the onset of left ventricular dysfunction assessed by means of echo-Doppler cardiography. Patients were analyzed for social, demographic, epidemiologic, clinical and workup-related variables. A descriptive analysis was conducted, followed by survival curves based on univariate (Kaplan-Meier and Cox’s univariate model) and multivariate (Cox regression model) analysis. Patients were followed from two to 20 years (mean: 8.2). Their mean age was 44.8 years (20-77). Comparing both iterations of the study, in the second there was a statistically significant increase in the PR interval and in the QRS duration, despite a reduction in heart rates (Wilcoxon < 0.01). The predictors for CCC progression in the final regression model were male gender (HR = 2.81), Holter monitoring showing pauses equal to or greater than two seconds (HR = 3.02) increased cardiothoracic ratio (HR = 7.87) and time of use of digitalis (HR = 1.41). Patients with multiple predictive factors require stricter follow-up and treatment.

A identificação de preditores da progressão da cardiopatia chagásica crônica (CCC) é essencial ao manejo adequado do paciente. Estudo coorte não concorrente de 165 pacientes portadores de CCC entre 1985-2010 quanto a preditores independentes da evolução da CCC. Os desfechos foram piora da classificação da CCC e surgimento de disfunção ventricular esquerda ao ecoDopplercardiograma. Variáveis sócio-demográficas, epidemiológicas, clínicas e propedêuticas foram estudadas e realizadas análise descritiva, análise de sobrevida com análise univariada (Kaplan-Meier e modelo univariado de Cox) e multivariada (modelo de regressão de Cox). O seguimento foi de dois a 20 anos, com média de 8,2 anos. A média de idade dos pacientes foi de 44,8 anos (20- 77 anos). Comparando ambos os tempos do estudo, no tempo 2 houve significância estatística do aumento do intervalo PR e da duração do QRS, além da redução da frequência cardíaca (Wilcoxon < 0,01). Os preditores da evolução da CCC no modelo final de regressão foram sexo masculino (HR = 2,81), pausas iguais ou maiores que dois segundos ao Holter (HR = 3,02), aumento do índice cardiotorácico (HR = 7,87) e tempo de uso de digital (HR = 1,41), destacando-se necessidade de seguimento e tratamento mais rigoroso para os chagásicos que cumulam estes fatores.

Reasons for discharge delays in teaching hospitals.

OBJECTIVE: To analyze the causes of delay in hospital discharge of patients admitted to internal medicine wards. METHODS: We reviewed 395 medical records of consecutive patients admitted to internal medicine wards of two public teaching hospitals: Hospital das Clínicas of the Universidade Federal de Minas Gerais and Hospital Odilon Behrens. The Appropriateness Evaluation Protocol was used to define the moment at which notes in the medical records indicated hospital stay was no longer appropriate and patients could be discharged. The interval between this estimated time and actual discharge was defined as the total number of days of delay in hospital discharge. An instrument was used to systematically categorize reasons for delay in hospital discharge and frequencies were analyzed. RESULTS: Delays in discharge occurred in 60.0% of 207 hospital admissions in the Hospital das Clínicas and in 58.0% of 188 hospital admissions in the Hospital Odilon Behrens. Mean delay per patient was 4.5 days in the former and 4.1 days in the latter, corresponding to 23.0% and 28.0% of occupancy rates in each hospital, respectively. The main reasons for delay in the two hospitals were, respectively, waiting for complementary tests (30.6% versus 34.7%) or for results of performed tests to be released (22.4% versus 11.9%) and medical-related accountability (36.2% versus 26.1%) which comprised delays in discussing the clinical case and in clinical decision making and difficulties in providing specialized consultation (20.4% versus 9.1%). CONCLUSIONS: Both hospitals showed a high percentage of delay in hospital discharge. The delays were mainly related to processes that could be improved by interventions by care teams and managers. The impact on mean length of stay and hospital occupancy rates was significant and troubling in a scenario of relative shortage of beds and long waiting lists for hospital admission.

Fatores de atraso na alta hospitalar em hospitais de ensino / Reasons for discharge delays in teaching hospitals

OBJETIVO Analisar os motivos de atraso na alta hospitalar de pacientes internados em enfermarias de clínica médica. MÉTODOS Foram analisados 395 prontuários de pacientes consecutivos das enfermarias de clínica médica de dois hospitais públicos de ensino: Hospital das Clínicas da Universidade Federal de Minas Gerais e Hospital Odilon Behrens. Foi utilizado o Appropriateness Evaluation Protocol para definir o momento a partir do qual as anotações do prontuário permitiam concluir que a permanência no hospital não mais era adequada. O intervalo entre esse momento e a data da alta hospitalar efetivada definiu o total de dias de atraso na alta hospitalar. Foi utilizado, sistematicamente, instrumento para categorizar os motivos de atraso da alta hospitalar, tendo sido realizada análise de frequências. RESULTADOS O atraso na alta hospitalar ocorreu em 60,0% das 207 internações do Hospital das Clínicas e em 58,0% das 188 internações do Hospital Odilon Behrens. O atraso por paciente foi em média de 4,5 dias no primeiro e 4,1 dias no segundo, o que corresponde à taxa de ocupação de 23,0% e 28,0% em cada hospital, respectivamente. Os principais motivos de atraso nos dois hospitais foram, respectivamente: espera para realização de exames complementares (30,6% e 34,7%) ou para liberação dos laudos dos exames (22,4% e 11,9%) e os relacionados à responsabilidade médica (36,2% e 26,1%), compreendendo a demora na discussão do caso clínico e na tomada de decisão clínica e dificuldades nas interconsultas, respectivamente (20,4% e 9,1%). CONCLUSÕES Foi constatado percentual elevado de atraso na alta hospitalar nos dois hospitais. O atraso foi devido principalmente a fatores relacionados a processos, que podem ser melhorados por intervenções da equipe assistencial e dos ...

OBJECTIVE To analyze the causes of delay in hospital discharge of patients admitted to internal medicine wards. METHODS We reviewed 395 medical records of consecutive patients admitted to internal medicine wards of two public teaching hospitals: Hospital das Clínicas of the Universidade Federal de Minas Gerais and Hospital Odilon Behrens. The Appropriateness Evaluation Protocol was used to define the moment at which notes in the medical records indicated hospital stay was no longer appropriate and patients could be discharged. The interval between this estimated time and actual discharge was defined as the total number of days of delay in hospital discharge. An instrument was used to systematically categorize reasons for delay in hospital discharge and frequencies were analyzed. RESULTS Delays in discharge occurred in 60.0% of 207 hospital admissions in the Hospital das Clínicas and in 58.0% of 188 hospital admissions in the Hospital Odilon Behrens. Mean delay per patient was 4.5 days in the former and 4.1 days in the latter, corresponding to 23.0% and 28.0% of occupancy rates in each hospital, respectively. The main reasons for delay in the two hospitals were, respectively, waiting for complementary tests (30.6% versus 34.7%) or for results of performed tests to be released (22.4% versus 11.9%) and medical-related accountability (36.2% versus 26.1%) which comprised delays in discussing the clinical case and in clinical decision making and difficulties in providing specialized consultation (20.4% versus 9.1%). CONCLUSIONS Both hospitals showed a high percentage of delay in hospital discharge. The delays were mainly related to processes that could be improved by interventions by care teams and managers. The impact on mean length of stay and hospital occupancy rates was significant and troubling in a scenario of relative shortage of beds and long waiting lists for hospital admission. .

Serviços de atenção ao estomizado: análise diagnóstica no Estado de Minas Gerais, Brasil / Ostomy patients health care services: diagnostic analysis in the State of Minas Gerais, Brazil

Este estudo teve como objetivo descrever as características das dimensões de estrutura e de processos dos Serviços de Atenção à Saúde da Pessoa Ostomizada (SASPO) no Estado de Minas Gerais, Brasil. Foi uma pesquisa transversal e descritiva realizada na Rede Estadual de Atenção à Saúde das Pessoas Ostomizadas no Estado de Minas Gerais, em 2011. Foram analisados critérios relacionados à estrutura e aos processos de 28 unidades de SASPO distribuídas em 13 macrorregiões de saúde. Os dados foram obtidos por meio de questionários estruturados com base nas normas governamentais para o serviço de referência ambulatorial para os estomizados. Foi realizada a distribuição de frequências para a análise descritiva dos dados. Os resultados mostraram que 72% dos SASPO têm estrutura para o cadastro dos pacientes e a dispensação de dispositivos e que 40% das unidades correspondem a serviços do tipo II. Quanto aos processos, 96% das unidades contavam com a assistência de enfermeiros, porém 52% deles sem capacitação. Percebeu-se ainda que esses profissionais estão mais envolvidos com as ações relacionadas à operacionalização do programa do que à assistência clínica. Conclui-se que os SASPO de Minas Gerais contam com estrutura e processos relacionados ao cadastro, controle e dispensação de equipamentos coletores e dispositivos.

This study aimed to describe the characteristics of the structure and processes dimensions of ostomized patients' Health Care Services (SASPO) in the State of Minas Gerais, Brazil. It's a cross-sectional and descriptive survey carried out in 28 SASPO of Minas Gerais in 2011. Criteria related to structure and processes were analyzed in these 28 health care units distributed in 13 health macro-regions. The data were obtained from structured questionnaires based on governmental regulations for reference service to ambulatory of the ostomized patients. Frequency distribution was used for the descriptive analysis. The results showed that 72% of the units have a structure able to register the patients and dispense devices, and that 40% of them correspond to the service classified as type II. Regard to the processes, 96% of the units relied on nurses, but 52% of them had no qualification. It was also observed that these professionals are more involved in actions related to the program implementation than in health care. It was concluded that the SASPO of Minas Gerais have structure and processes related to registration, control and dispensing of collector bags and devices.

[Fatality and hospitalization in hemodialysis patients in a health plan]. / Letalidade e internacoes de pacientes em hemodialise em plano de saude.

OBJECTIVE: To analyze clinical outcomes of patients on hemodialysis linked to health care plan provider. METHODS: Cohort study of hemodialysis events in Belo Horizonte, MG, Southeastern Brazil, between 2004 and 2008, based on records from health care plan provider databases. The independent variables were: sex, age, time between first appointment with nephrologist and starting hemodialysis, type of first vascular access, diabetes mellitus, length of time spent in hospital/year of treatment and death. DEPENDENT VARIABLES: time between starting hemodialysis and death and length of time spent in hospital/year of treatment > 7.5 days. Statistical analysis was carried out using Pearson's Chi-squared test in the univariate analysis for the outcomes 'death' and 'length of time spent in hospital/year of treatment'; the Kaplan-Meier method was used to analyze survival; the Cox model and Poisson regression were used for risk of death and chance of length of time spent in hospital/year of treatment > 7.5 days. The Business Intelligence tool and Stata(r) 10.0 software were used to extract data. RESULTS: There were 311 patients on hemodialysis included in the study, with a mean age of 62 (sd 16.6 years), of whom 55.5% were male. Prevalence increased 160% during the period in question. Survival analysis showed a higher mortality among older patients, patients that did not consult a nephrologists, those whose first vascular access was using a temporary catheter, those with diabetes mellitus, those admitted to hospital within a month of beginning hemodialysis. The Cox model showed that a higher risk of death was associated with age, diabetes mellitus, not consulting a nephrologists and those that were hospitalized within a month of beginning hemodialysis. Greater length of time spent in hospital/year of treatment was not associated with sex or diabetes. According to Poisson regression, the variables were not significant. CONCLUSIONS: Assessment by a specialist before starting hemodialysis decreases the risk of death in cases of chronic kidney disease, whereas the presence of diabetes and being hospitalized within a month of beginning hemodialysis are markers of risk of death.

Letalidade e internacoes de pacientes em hemodialise em plano de saude / Mortalidad e internaciones de pacientes en hemodialisis con seguro de salud / Fatality and hospitalization in hemodialysis patients in a health plan

OBJETIVO: Analisar desfechos clínicos de pacientes incidentes em hemodiálise vinculados a operadora de plano de saúde. MÉTODOS: Estudo de coorte de incidentes em hemodiálise em Belo Horizonte, MG, de 2004 a 2008, a partir de registros no banco de dados de operadora de planos de saúde. Variáveis independentes: sexo, idade, tempo entre primeira consulta com nefrologista e início da hemodiálise, tipo do primeiro acesso vascular, diabetes mellitus, tempo de permanência hospitalar/ano de tratamento e óbito. Variáveis dependentes: tempo entre início da hemodiálise e óbito e tempo de permanência hospitalar/ano de tratamento > 7,5 dias. Análise estatística: teste Qui-quadrado de Pearson na análise univariada para os desfechos óbito e tempo de permanência hospitalar/ano de tratamento; método de Kaplan-Meier para análise de sobrevida; modelo de Cox e regressão Poisson para risco de óbito e chance de tempo de permanência hospitalar/ano de tratamento > 7,5 dias. Foi utilizada ferramenta de Business Intelligence para extração dos dados e software Stata(r) 10.0. RESULTADOS: Estudados 311 indivíduos em hemodiálise, 55,5% homens, média de 62 anos (dp: 16,6 anos). A prevalência aumentou 160% no período estudado. Na análise de sobrevivência a mortalidade foi maior entre os mais idosos, nos que não realizaram consulta com nefrologista, fizeram uso de cateter vascular temporário como primeiro acesso, com diabetes mellitus, nos que foram internados no mesmo mês do início da hemodiálise. No modelo de Cox associaram-se a maior risco para óbito a idade avançada, diabetes mellitus, não realizar consulta prévia com nefrologista e internar-se no primeiro mês de hemodiálise. Maior tempo de permanência hospitalar/ano ...

OBJETIVO: Analizar los resultados clínicos de pacientes incidentes en hemodiálisis vinculados a operadora de seguro de salud MÉTODOS: Estudio de cohorte de incidentes en hemodiálisis en Belo Horizonte, MG, Brasil, de 2004 a 2008, a partir de registros en el banco de datos de operadora seguros de salud. Variables independientes: sexo, edad, tiempo entre primera consulta con nefrólogo e inicio de hemodiálisis, tipo del primer acceso vascular, diabetes mellitus, tiempo de permanencia en el hospital /año de tratamiento y óbito. Variables dependientes: tiempo entre inicio de hemodiálisis y óbito y tiempo de permanencia en hospital/año de tratamiento > 7,5 días. Análisis estadístico: prueba Chi-cuadrado de Pearson en el análisis univariado para los resultados óbito y tiempo de permanencia en el hospital/año de tratamiento; método de Kaplan-Meier para análisis de sobrevida; modelo de Cox y regresión Poisson para riesgo de óbito y chance de tiempo de permanencia en hospital/año de tratamiento > 7,5 días. Se utilizó herramienta de Business Intelligence para extracción de los datos y software Stata(r) 10.0. RESULTADOS: Se evaluaron 311 individuos en hemodiálisis, 55,5% hombres, promedio de edad de 62 años (ds: 16,6 años). La prevalencia aumentó 160% en el período estudiado. En el análisis de sobrevivencia la mortalidad fue mayor entre los adultos de mayor edad, en los que no realizaron consulta con el nefrólogo, uso de catéter vascular temporario como primer acceso, con diabetes mellitus, en los que fueron internados en el mismo mes de inicio de la hemodiálisis. En el modelo de Cox se asociaron a mayor riesgo de óbito la edad avanzada, diabetes mellitus, no realizar consulta previa con nefrólogo e internarse en el primer mes de hemodiálisis. El mayor ...

OBJECTIVE: To analyze clinical outcomes of patients on hemodialysis linked to health care plan provider. METHODS: Cohort study of hemodialysis events in Belo Horizonte, MG, Southeastern Brazil, between 2004 and 2008, based on records from health care plan provider databases. The independent variables were: sex, age, time between first appointment with nephrologist and starting hemodialysis, type of first vascular access, diabetes mellitus, length of time spent in hospital/year of treatment and death. Dependent variables: time between starting hemodialysis and death and length of time spent in hospital/year of treatment > 7.5 days. Statistical analysis was carried out using Pearson's Chi-squared test in the univariate analysis for the outcomes 'death' and 'length of time spent in hospital/year of treatment'; the Kaplan-Meier method was used to analyze survival; the Cox model and Poisson regression were used for risk of death and chance of length of time spent in hospital/year of treatment > 7.5 days. The Business Intelligence tool and Stata(r) 10.0 software were used to extract data. RESULTS: There were 311 patients on hemodialysis included in the study, with a mean age of 62 (sd 16.6 years), of whom 55.5% were male. Prevalence increased 160% during the period in question. Survival analysis showed a higher mortality among older patients, patients that did not consult a nephrologists, those whose first vascular access was using a temporary catheter, those with diabetes mellitus, those admitted to hospital within a month of beginning hemodialysis. The Cox model showed that a higher risk of death was associated with age, diabetes mellitus, not consulting a nephrologists and those that were hospitalized within a month of beginning hemodialysis. Greater length of time spent in hospital/year of treatment was not associated with sex or diabetes. According to Poisson regression, the variables were not significant. CONCLUSIONS: ...

Does intravascular ultrasound provide clinical benefits for percutaneous coronary intervention with bare-metal stent implantation? A meta-analysis of randomized controlled trials.

BACKGROUND: The role of intravascular ultrasound (IVUS) in percutaneous coronary interventions (PCI) is still controversial despite several previously published meta-analyses. A meta-analysis to evaluate the controversial role of IVUS-guided PCI with bare-metal stenting was performed and a previous published meta-analysis was re-evaluated in order to clarify the discrepancy between results of these studies. METHODS: A systematic review was performed by an electronic search of the PubMed, Embase and Web of Knowledge databases and by a manual search of reference lists for randomized controlled trials published until April 2011, with clinical outcomes and, at least, six months of clinical follow-up. A meta-analysis based on the intention to treat was performed with the selected studies. RESULTS: Five studies and 1,754 patients were included. There were no differences in death (OR = 1.86; 95% CI = 0.88-3.95; p = 0.10), non-fatal myocardial infarction (OR = 0.65; 95% CI = 0.27-1.58; p = 0.35) and major adverse cardiac events (OR = 0.74; 95% CI = 0.49-1.13; p = 0.16). An analysis of the previous published meta-analysis strongly suggested the presence of publication bias. CONCLUSIONS: There is no evidence to recommend routine IVUS-guided PCI with bare-metal stent implantation. This may be explained by the paucity and heterogeneity of the studies published so far.

Diagnóstico eletrocardiográfico da hipertrofia ventricular esquerda em gestantes hipertensas / Electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive pregnant women

Fundamento: gestações em fases mais adiantadas da vida podem associar-se a hipertensão arterial sistêmica crônica e hipertrofia ventricular esquerda, ocasionando aumentos nas taxas de morbimortalidade cardiovascular. Objetivos: avaliar a eficácia do eletrocardiograma na identificação de gestantes hipertensas crônicas portadoras de hipertrofia ventricular esquerda. Métodos: foram estudadas 80 gestantes no 3º trimestre de gestação. Utilizou-se a quantificação ecocardiográfica da massa ventricular esquerda como padrão-ouro para o diagnóstico de hipertrofia miocárdica, sendo considerado o ponto de corte de 122 g/m² como limite superior normal para massa ventricular esquerda no 3º trimestre de gestação. Foram utilizados os critérios de Sokolow-Lyon, Lewis, Sokolow-Lyon-Rappaport, Gubner, Cornell, escore de pontos de Romhilt e Estes, Grant, onda ?R? de aVL > 11 mm, razão RV6 / RV5 > 1. Resultados: todos os critérios eletrocardiográficos analisados apresentaram baixa eficácia para o reconhecimento da hipertrofia ventricular esquerda em gestantes hipertensas crônicas. Conclusões: apesar da ampla difusão do eletrocardiograma como recurso propedêutico, ao utilizá-lo para a pesquisa de hipertrofia ventricular esquerda em gestantes hipertensas crônicas, deve-se considerar suas importantes limitações para essa finalidade.

Background: Pregnancy at late stages of life may be associated with chronic systemic arterial hypertension and left ventricular hypertrophy, causing increased cardiovascular morbimortality rates. Objectives: To assess electrocardiograph efficiency to identify chronic hypertensive pregnant women with left ventricular hypertrophy. Methods: Eighty women in the third trimester of pregnancy were investigated. Echocardiographic quantification of left ventricular mass was used as gold standard to diagnose myocardial hypertrophy, the 122g/m2 cut-off being assumed as the maximal limit for normal left ventricular mass in the third trimester of pregnancy. The following criteria were used:Sokolow-Lyon, Lewis, Sokolow-Lyon-Rappaport, Gubner, Cornell, Grant, Romhilt and Estes point scores, ?R? wave of aVL > 11 mm, ratio RV5 / RV5 > 1. Results: All the electrocardiograph criteria analyzed showed low efficacy to recognize left ventricular hypertrophy in chronic hypertensive pregnant women. Conclusions: Despite wide use of electrocardiograph as a propaedeutic resource, studies on left ventricular hypertrophy in chronic hypertensive pregnant women should consider the limitation of this resource

Atitude do estudante de medicina a respeito da relação médico-paciente x modelo pedagógico / Medical students' attitudes towards patient-centered care according to curricular models

Este estudo comparou a atitude do estudante de Medicina a respeito da relação médico-paciente de uma escola de currículo tradicional (CT) com outra de Aprendizado Baseado em Problemas (ABP) de uma mesma universidade privada. Para a avaliação da atitude, foi utilizada a escala PPOS (Patient-Practitioner Orientation Scale). A coleta de dados abrangeu 132 estudantes da escola de ABP e 142 da escola de CT. O valor do escore total da PPOS (ETPPOS) para toda a amostra na escola de ABP foi de 4,62 e na escola de CT foi de 4,45 (p = 0,002), significando atitudes mais centradas no paciente na primeira. O ETPPOS entre os homens, no décimo período, apresentou aumento significante na escola de ABP. Em ambas as escolas, as mulheres apresentaram atitudes de maior compartilhamento de decisões com os pacientes em relação aos homens. A análise de regressão multivariada demonstrou que os valores dos escores da PPOS foram explicados apenas pela variável escola. Este estudo encontrou atitudes mais centradas no paciente na escola de ABP, que poderiam ser atribuídas ao modelo curricular, uma vez que as escolas estudadas diferem basicamente em relação a esse aspecto.

This study focused on medical students' attitudes towards the physician-patient relationship, comparing two private Brazilian medical schools, one with a traditional curriculum (TC) and the other with a problem-based learning (PBL) curriculum. Attitudes were measured with the Patient-Practitioner Orientation Scale (PPOS). 132 students from the PBL school and 142 from the TC school completed data collection. Total PPOS scores were 4.62 and 4.45 for the PBL and TC medical schools, respectively (p=0.002), meaning more patient-centered attitudes among the PBL medical students. Among male students enrolled in the 10th semester, the total PPOS score was significantly higher in the PBL school. In both schools, as compared to men, women showed more decision-sharing attitudes with patients. Multivariate regression analysis showed that PPOS results were only explained by the school variable. This study found more patient-centered attitudes in the PBL school, which could be attributed to the curriculum model, since this was the only basic difference between the two schools.

Adenosine for vasoreactivity testing in pulmonary hypertension: a head-to-head comparison with inhaled nitric oxide.

BACKGROUND: APVT is an invasive method recommended for symptomatic patients with PAH that permits the identification of the minority of patients (<20%) that may benefit from long-term calcium channel blockers. Adenosine has been indicated in guidelines as a vasodilator agent of choice for APVT, although it has not been directly compared with iNO, the gold standard for this test. The objective of the study was to compare adenosine with inhaled nitric oxide (iNO) for acute pulmonary vasoreactivity testing (APVT) in pulmonary arterial hypertension (PAH), in order to determine the efficacy and safety of the first in the clinical setting. METHODS: The measurements of cardiac output, pulmonary and systemic resistance were done in the basal state and with a stepwise increase of the dose of each drug until either maximum dosage (adenosine: 500 microg/kg/min or iNO: 80 ppm) or side effects observed or a positive response were reached, according to current guidelines. The order of drugs used in each test was consecutively alternated during the study. RESULTS: Six of the 39 studied patients (15%) presented a positive response to iNO; none to adenosine (p = 0.047, McNemar's test). Twenty-three patients (59%) did not reach the maximum dose of adenosine due to side effects, including bronchospasm, thoracic pain and bradycardia. CONCLUSIONS: APVT testing with adenosine was not able to detect PAH patients responsive to iNo and provoked frequent adverse effects. Adenosine should not be used as a vasodilator drug in APVT.

Percepção bioética sobre a dignidade no processo de morrer / Bioethical perception about the dignity in the death process

Artigo elaborado a partir de pesquisa de natureza qualitativa e fenomenológica realizada por meio de entrevistas em profundidade, utiliza dois procedimentos metodológicos: técnicas de história oral e observação participante. O tema matriz refere-se ao processo da terminalidade da vida humana. Relaciona-se à bioética e à atenção ao paciente sem perspectiva terapêutica convencional. O cerne da reflexão foi o morrer com dignidade. Consideraram-se três atitudes: o controle da dor, a morte domiciliar e o processo de silêncio que por horas ou dias antecede a morte. A atenção aos sujeitos pode representar respeito às diferenças, abertura de espaço para se criar e reforçar atitudes de autonomia, de dignidade e incentivar o uso de técnicas de cuidados paliativos.

Testing pulmonary vasoreactivity.

Pulmonary arterial hypertension is classified as idiopathic or secondary (associated with collagenoses, heart disease, portal hypertension, pulmonary thromboembolism, and pulmonary vascular diseases). Pulmonary vasoreactivity should be tested in order to define the best treatment option. Of the many drugs that have been used to test pulmonary vasoreactivity, inhaled nitric oxide is the best choice, due its specific pulmonary effect and very short half-life (5-10 s). The results of this test identify candidates for heart surgery among patients with congenital heart disease and candidates for the use of calcium antagonists among patients with other forms of pulmonary hypertension. Performing and interpreting the results of such tests are a great responsibility, since mistakes can lead to incorrect treatment decisions, resulting in the death of patients.