Construction of hypermedia for prevention of bloodstream infection.

OBJECTIVE: To describe the process of construction and assessment of the content of a Virtual Learning Object on preventing bloodstream infections associated with infusion therapy. METHOD: Methodological study carried out in three stages: elaborating the technical, scientific content; assessing theoretical content; and constructing the Virtual Learning Object. RESULTS: We produced the theoretical content of the Virtual Learning Object. Such content obtained an 85% agreement in assessment, which was adequate. The final product comprised 39 content screens, which integrate the main recommendations and contain images, hypertexts, videos, case studies, and quiz, through an exclusive platform. FINAL CONSIDERATIONS: This study made it possible to portray the method for constructing and assessing the content of a Virtual Learning Object, enabling am easy application to health professionals, aiming at guiding them to quality care.

A desinfecção de endoscópios com ácido peracético por dez minutos é efetiva? / Is endoscope disinfection with peracetic acid during ten minutes effective?

Artigos médico-hospitalares permanentes necessitam ser processados de maneira segura. Os objetivos foram avaliar a efetividade do ácido peracético na desinfecção de eendoscópios; identificar a oxidação dos equipamentos e verificar o tempo de atividade da solução. Métodos: Coletamos 40 amostras antes e 40 após a desinfecção dos gastroscópios. os lavados foram envaidos para identificação de bactérias, fungos e micobactérias. A avaliação da integridade foi feita antes e após seis meses. A monitoração da atividade da solução foi diária. Resultados: Pré-desinfecção, 12,5% dos videogastroscópicos foram positivas e pós, todas negativas. Na pré-desinfecção dos videocolonoscópios, 34,1% positivas e na pós-desinfecção, negativas. Pesquisa para micobactérias foi negativa. Conclusões: a desinfecção por dez minutos de endoscópios com ácido peracético foi efetiva, os equipamentos não oxidaram, e a solução apresentou boa estabilidade.

Validation of the Portuguese version of the Minnesota Living with Heart Failure Questionnaire.

BACKGROUND: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is an important measurement instrument for assessing the quality of life of heart failure patients. Despite being largely used within our context, the questionnaire had not yet been translated and validated into the Portuguese language. OBJECTIVE: Of this study was to translate and validate the Portuguese version of the MLHFQ for use in heart failure patients. METHODS: Forty patients with heart failure (30 men, LVEF 30+/-6%, 55% ischemic etiology, classified as NYHA I to III), clinically stable and on optimized drug therapy underwent maximal cardiopulmonary stress testing to assess their physical capacity. Right after the test, the MLHFQ duly translated into Portuguese was administered by the same investigator. The NYHA functional classification was provided by the medical team. RESULTS: The Portuguese version of the MLHFQ had the same structure and metrics of the original version. There was no difficulty in the administration of the questionnaire or in the patient's understanding of the questions. The Portuguese version of the MLHFQ was consistent with peak VO2, duration of the cardiopulmonary test, and NYHA functional classification. There was no difference in the score mean for the questionnaire between the group of patients with ischemic etiology and the group with non-ischemic etiology. CONCLUSION: The Portuguese version of the MLHFQ proposed in this study proved to be valid for heart failure patients, and constitutes a new and important instrument for assessing quality of life.

Validação da versão em português do Minnesota Living with Heart Failure Questionnaire / Validación de la versión en portugués del Minnesota Living with Heart Failure Questionnaire / Validation of the Portuguese version of the Minnesota Living with Heart Failure Questionnaire

FUNDAMENTO: O Minnesota Living with Heart Failure Questionnaire (MLHFQ) é uma importante ferramenta de avaliação da qualidade de vida em pacientes com insuficiência cardíaca. Apesar de amplamente usado em nosso meio, não contávamos com a sua tradução e validação em língua portuguesa. OBJETIVO: Este estudo pretendeu traduzir e validar a versão em português do MLHFQ em pacientes com insuficiência cardíaca. MÉTODOS: Quarenta pacientes com insuficiência cardíaca (30 homens, FEVE 30±6 por cento, 55 por cento de etiologia isquêmica, NYHA I a III) com estabilidade clínica e terapia medicamentosa otimizada realizaram teste cardiopulmonar máximo para avaliação da capacidade física. Logo após, o MLHFQ, devidamente traduzido, foi aplicado por um mesmo pesquisador. A classe funcional NYHA foi encaminhada pela equipe medica. RESULTADOS: A versão em português do MLHFQ apresentou-se com a mesma estrutura e métrica da versão original. Não houve dificuldade na aplicação e compreensão do questionário por parte dos pacientes. A versão em português do MLHFQ mostrou-se concordante com o pico de VO2, o tempo de exercício do teste cardiopulmonar e com a classificação funcional da NYHA. Não houve diferença da média do escore do questionário entre os grupos de etiologia isquêmica e não-isquêmica. CONCLUSÃO: A versão em língua portuguesa da MLHFQ, proposta no presente estudo, demonstrou ser válida em pacientes com insuficiência cardíaca, constituindo uma nova e importante ferramenta para avaliar a qualidade de vida.

BACKGROUND: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is an important measurement instrument for assessing the quality of life of heart failure patients. Despite being largely used within our context, the questionnaire had not yet been translated and validated into the Portuguese language. OBJECTIVE: Of this study was to translate and validate the Portuguese version of the MLHFQ for use in heart failure patients. METHODS: Forty patients with heart failure (30 men, LVEF 30±6 percent, 55 percent ischemic etiology, classified as NYHA I to III), clinically stable and on optimized drug therapy underwent maximal cardiopulmonary stress testing to assess their physical capacity. Right after the test, the MLHFQ duly translated into Portuguese was administered by the same investigator. The NYHA functional classification was provided by the medical team. RESULTS: The Portuguese version of the MLHFQ had the same structure and metrics of the original version. There was no difficulty in the administration of the questionnaire or in the patient's understanding of the questions. The Portuguese version of the MLHFQ was consistent with peak VO2, duration of the cardiopulmonary test, and NYHA functional classification. There was no difference in the score mean for the questionnaire between the group of patients with ischemic etiology and the group with non-ischemic etiology. CONCLUSION: The Portuguese version of the MLHFQ proposed in this study proved to be valid for heart failure patients, and constitutes a new and important instrument for assessing quality of life.

FUNDAMENTO: El Minnesota Living with Heart Failure Questionnaire (MLHFQ) es un importante instrumento de evaluación de la calidad de vida en pacientes con insuficiencia cardiaca. A pesar de su amplio empleo en nuestro medio, no contábamos con su traducción y validación en lengua portuguesa. OBJETIVO: Este estudio tuvo por objeto traducir y validar la versión en portugués del MLHFQ en pacientes con insuficiencia cardiaca. MÉTODOS: Se realizó la prueba de ejercicio cardiopulmonar máximo en 40 pacientes con insuficiencia cardiaca (30 varones, FEVE 30±6 por ciento, el 55 por ciento de etiología isquémica, NYHA I a III) con estabilidad clínica y terapia medicamentosa optimizada, para evaluarse la capacidad física. Acto seguido, un investigador aplicó el MLHFQ debidamente traducido. La clase funcional NYHA fue referida por el equipo médico. RESULTADOS: La versión en portugués del MLHFQ se presentó con la misma estructura y estándares de medición de la versión original. No hubo dificultad en la aplicación y compensación del cuestionario por parte de los pacientes. La versión en portugués del MLHFQ resultó concordante con el pico de VO2, el tiempo de ejercicio de la prueba de ejercicio cardiopulmonar y con la clasificación funcional de la NYHA. No hubo diferencia del promedio del score del cuestionario entre los grupos de etiología isquémica y no isquémica. CONCLUSIÓN: La versión en lengua portuguesa de la MLHFQ, propuesta en el presente estudio, resultó válida en pacientes con insuficiencia cardiaca, constituyendo un nuevo e importante instrumento para evaluar la calidad de vida.

Clustering of Enterococcus faecalis infections in a cardiology hospital neonatal intensive care unit.

Early identification of an outbreak is one of the main advantages of routine epidemiological surveillance. Enterococcus spp. used to be regarded as microorganisms of low pathogenicity, because they are part of the normal microbial flora of the gastrointestinal and genitourinary tract. Recently, they have emerged as important pathogenic agents, sometimes causing infections with high mortality rates. We studied a clustering of primary bloodstream infections caused by Enterococcus faecalis in a cardiology hospital neonatal intensive care unit (NICU). Four cases of primary bloodstream infection by E. faecalis were detected from April 15 to May 13, 2004, during active infection surveillance. The isolates were sensitive to glycopeptides. Some aspects of the management of these patients, including the date of insertion and placement of a central venous catheter, prescription of a specific medication, contiguity of beds, personnel attending the patients, and occurrence of diarrhea were analyzed to look for factors that might affect the spread of the microorganisms. Measures taken to hamper the spread included contact precautions throughout the unit, cleansing and disinfection of equipment and surfaces, bathing children with 2% chlorhexidine-gluconate-containing soap, professional reeducation, and reinforcement of all measures to prevent infections. We suggest that there is a need to re-evaluate preventive infection measures and to review the strategies aimed at decreasing the nosocomial infection rate in the NICU.

Clustering of Enterococcus faecalis infections in a cardiology hospital neonatal intensive care unit

Early identification of an outbreak is one of the main advantages of routine epidemiological surveillance. Enterococcus spp. used to be regarded as microorganisms of low pathogenicity, because they are part of the normal microbial flora of the gastrointestinal and genitourinary tract. Recently, they have emerged as important pathogenic agents, sometimes causing infections with high mortality rates. We studied a clustering of primary bloodstream infections caused by Enterococcus faecalis in a cardiology hospital neonatal intensive care unit (NICU). Four cases of primary bloodstream infection by E. faecalis were detected from April 15 to May 13, 2004, during active infection surveillance. The isolates were sensitive to glycopeptides. Some aspects of the management of these patients, including the date of insertion and placement of a central venous catheter, prescription of a specific medication, contiguity of beds, personnel attending the patients, and occurrence of diarrhea were analyzed to look for factors that might affect the spread of the microorganisms. Measures taken to hamper the spread included contact precautions throughout the unit, cleansing and disinfection of equipment and surfaces, bathing children with 2 percent chlorhexidine-gluconate-containing soap, professional reeducation, and reinforcement of all measures to prevent infections. We suggest that there is a need to re-evaluate preventive infection measures and to review the strategies aimed at decreasing the nosocomial infection rate in the NICU.

Influência do sistema fechado de infusão venosa sem agulha na incidência das infecções de corrente sangüínea em crianças operadas no InCor – HC- FMUSP / Influence of the needleless closed system device (Interlink) of venous infusion in the incidence of the bloodstream infection (BSI) in children operated in the Heart Institute

A incidência das ICS depende do tipo e tempo de uso do catéter, das características clínicas e aptidão dos profissionais na sua utilização. O objetivo foi verificar a influência do sistema fechado de infusão venosa na incidência das infecções da corrente sangüínea (ICS) em crianças operadas no InCor-HC.FMUSP. Avaliamos 422 crianças que receberem sistema de infusão venoso aberto ou fechado. Swab do hub positivo: 1.43 por cento sistema fechado e 3.30 por cento no aberto(p=0.33); ICS primária: 0.47 por cento no fechado e 1.41 por cento no aberto; ICS clínica: 0 por cento no fechado e 3.3 por cento no aberto; ponta de catéter positiva: 8.57 por cento no fechado e 7.55 por cento no aberto e hemocultura positiva: 5.24 por cento no fechado e 4.25 por cento no aberto. Os resultados sugerem que o sistema de infusão venosa fechado apresenta-se como fator de proteção contra colonização do hub / The incidence of the BSI depends of the type and time of catheter use, of the clinical characteristics and aptitude of the professionals in its use. The objective was to verify the influence of needleless closed system of venous infusion in the incidence of the BSI in children operated in the InCor-HC.FMUSP. Was performed 422 children, had been randomized. Swab of hub positive: 1.43 per cent in the closed system and 3,30 per cent in open(p=0.33); Primary BSI: 0.47 per cent in closed and the 1,41 per cent in the opened one; Clinical BSI: 0 per cent in closed and the 3,3 per cent in the opened one; tip of catheter positive: 8.57 per cent in closed and the 7,55 per cent in open and the positive blood culture: 5.24 per cent in closed and the 4,25 percent in the opened one. The results suggest that the closed system of venous infusion showed itself to be a factor in the protection against hub colonization...

Hormônio do crescimento na otimizaçäo do tratamento da insuficiência cardíaca refratária / Growth hormone for optimization of refractory heart failure treatment

It has been reported that growth hormone may benefit selected patients with congestive heart failure. A 63-year-old man with refractory congestive heart failure waiting for heart transplantation, depending on intravenous drugs (dobutamine) and presenting with progressive worsening of the clinical status and cachexia, despite standard treatment, received growth hormone replacement (8 units per day) for optimization of congestive heart failure management. Increase in both serum growth hormone levels (from 0.3 to 0.8 mg/l) and serum IGF-1 levels (from 130 to 300ng/ml) was noted, in association with clinical status improvement, better optimization of heart failure treatment and discontinuation of dobutamine infusion. Left ventricular ejection fraction (by MUGA) increased from 13 percent to 18 percent and to 28 percent later, in association with reduction of pulmonary pressures and increase in exercise capacity (rise in peak VO2to 13.4 and to 16.2ml/kg/min later). The patient was"de-listed" for heart transplantation. Growth hormone may benefit selected patients with refractory heart failure

Efeitos do carvedilol (Bloqueador beta 1, Beta 2, alfa), na insuficiência cardíaca refratária / Effects of carvedilol (beta 1, beta 2, alpha 1 bloker) on refractory congestive heart failure

Objetivo - Os efeitos dos Beta-bloqueadores n insuficiência cardiaca (IC) refratária näo tem sido adequadamente estudados. Investigamos os efeitos do caverdilol (Bloqueador Beta1, Beta2, Alfa) nos sintomas e na funçäo ventricular de portadores de IC refratária. Métodos - Foram estudados 21 pacientes, idade média de 56/10 anos, 9 em classe funcional (CF) IV, e 12 em CF III intermitente com IV. A dose inicial de carvedilol foi de 6,25mg e, se tolerada, aumentada progressivamente. A dose média final foi 42/11mg. Os pacientes foram submetidos a avaliaçöes clínicas e eletrocardiográficas seriadas. realizaram-se, antes e com 196/60 dias de evoluçäo, ecocardiograma e ventriculografia radioisotópica. Resultados - O medicamento foi tolerado em (76 por cento ) pacientes. Um paciente está em fase de titulaçäo em CF II. Com 196/60dias de evoluçäo observaram-se 8 pacientes em CF I e 7 em II; reduçäo da frequencia cardiaca de 96/15 para 67/10bpm (p<0,001); reduçäo do diametro diastólicofinal do ventrículo esquerdo (VE) de 73/13 para 66/12mm (ecocardiograma) (p<0,009); e aumento da fraçäo de ejeçäo de VE de 0,21/0,06 para 0,34/0,12 (p<0,003). Conclusäo - O carvedilol aos seus efeitos beneficos na funçäo ventricular ; remodelamento do CF é, se tolerado, uma potencial alternativa terapêutica no tratamento medicamentoso da IC refratária. Entretanto, estudos adicionais säo necessários para definiçäo do efeito a longo prazo neste específico subgrupo de pacientes.