Adherence to antiretroviral therapy and factors associated with non-adherence: a cohort study at two referral services in Brazil.

This cohort study evaluated non-adherence to antiretrovirals at referral services in Pernambuco, Brazil, 2016/2017, through self-report. A generalized mixed-effects model for binary outcomewas used. We assessed 542 participants with an adherence rate of 85.50%. A greater chance of non-adherence was associated with:a low/moderate level of nicotine dependence (OR = 2.79, p = 0.00, IC = 1.44-5.41); ≥7 tablets/day (OR = 6.14, p = 0.00, IC = 3.42-11.02); LPV/r (OR = 1.49, p = 0.6, IC = 0.98-2.26), ddI (OR = 3.34, p = 0.03, IC = 1.12-9.97), ABC (OR = 4.02, p = 0.05, IC = 1.01-16.03), RAL (OR = 2.49, p = 0.01, IC = 1.32-4.70) and DTG (OR = 4.65, p = 0.01, IC = 1.42-15.16); 6-10 year seropositive diagnosis (OR = 2.17, p = 0.01, IC = 1.20-3.92) and symptoms of depression (OR = 1.55, p = 0.03, IC = 1.03-2.33). Protective factors for non-adherence weres: ≥50 years (OR = 0.67, p = 0.06, IC = 0.45-1.01), secondary/higher education (OR = 0.48, p = 0.00, IC = 0.34-0.70), embarrassment at health service (OR = 0.49, p = 0.04, IC = 0.24-0.97), good understanding of antiretrovirals (OR = 0.62, p = 0.03, IC = 0.40-0.96), adverse event (OR = 0.74, p = 0,06, IC = 0.54-1.01), use of TDF (OR = 0.62, p = 0.01, IC = 0.43-0.90), NVP (OR = 0.41, p = 0.05, IC = 0.71-1.00) and EFZ (OR = 0.48, p = 0.01, IC = 0.29-0.80) and good knowledge of HIV/AIDS/ART. (OR = 0.67, p = 0.07, IC = 0.43-1.04). Variables with stronger association were those linked to ART. Systematic use of self-report adherence is recommended for priority groups.

Cuidado pré-operatório para pacientes em estágio terminal de doença na perspectiva dos enfermeiros / Preoperative care for patients in terminal stage of disease from the perspective of nurses

RESUMO Objetivo compreender os significados atribuídos pelos enfermeiros à assistência pré-operatória prestada a pacientes em estágio terminal de doenças. Métodos pesquisa qualitativa que utilizou como referencial metodológico a Teoria Fundamentada nos Dados e foi realizada nas enfermarias cirúrgicas de um hospital universitário. Resultados participaram da pesquisa onze enfermeiros. Elaborou-se uma teoria para o fenômeno central: Os enfermeiros cuidando de pacientes em estágio terminal de doença no período pré-operatório no contexto de uma enfermaria cirúrgica. Conclusão os enfermeiros atribuem significados a este cuidado que tem particularidades próprias, que requer preparo do profissional e que demanda, ainda, mais de uma comunicação efetiva dentro da equipe multidisciplinar e na relação com paciente e família. Contribuições para a prática: a teoria apresentada permite a reflexão do profissional sobre sua práxis, a compreensão das condições intervenientes para os dilemas éticos e conflitos envolvidos e consequências, além de estratégias para melhorar a assistência neste cenário.

ABSTRACT Objective to understand the meanings attributed by nurses to preoperative care provided to terminal disease patients. Methods qualitative research that used the Grounded Theory as methodological reference and was conducted in the surgical wards of a university hospital. Results eleven nurses participated in the research. A theory was elaborated for the central phenomenon: Nurses caring for terminal disease patients in the preoperative period in the context of a surgical ward. Conclusion nurses attribute meanings to this care that has its own particularities, that requires professional preparation and that demands, even more, an effective communication within the multidisciplinary team and in the relationship with the patient and family. Contributions to practice: the theory presented allows professionals to reflect on their praxis, understand the intervening conditions for ethical dilemmas and conflicts involved and consequences, as well as strategies to improve care in this scenario.

Effectiveness of four antiretroviral regimens for treating people living with HIV.

The aim of this study was to compare 4 different ARV regimens in a clinical cohort in Brazil, with regard to the virologic and immunologic responses, clinical failure and reasons for changing. To compare the virologic response and clinical failure between groups we used the Cox and Kaplan Meier proportional hazard models. To analyze the immunologic outcome, we used multilevel GLLAMM and mixed effect linear regression models. To compare regimen change outcomes we used the Pearson's chi-square test. We included 840 participants distributed across the groups according to the initial ART regimen. The mean follow-up period was 27.8 months. Almost half the sample initiated ART with AIDS-related signs/symptoms. Virologic response was effective in 79.6% of participants within 12 months. The tenofovir/lamivudine/efavirenz group presented a higher proportion of virologic response (VL<50 at 6 months) when compared to the zidovudine/lamivudine/efavirenz group. There was no difference between the regimens regarding the immunologic response. A total of 17.3% of individuals changed regimen because of failure and 46.5% due to adverse events. Changes due to adverse events were more frequent in the group using zidovudine/lamivudine/efavirenz. The proportion of hospitalizations at 1 year was higher in the zidovudine/lamivudine/efavirenz group when compared to the tenofovir/lamivudine/efavirenz group. The effectiveness outcomes between the regimens were similar. Some differences may be due to the individual characteristics of patients, toxicity and acceptability of drugs. Studies are needed that compare similarly effective regimens and their respective treatment costs and financial impacts on SUS (Integrated Healthcare System).

Fatores associados a lesões de pele decorrentes do período intraoperatório / Factors associated with skin lesions resulting during the intraoperative period / Factores asociados a lesiones de piel resultantes del período intraoperatorio

Objetivo: Avaliar a ocorrência de lesões de pele no período intraoperatório decorrentes de procedimentos cirúrgicos realizados em um hospital universitário de grande porte. Método: Estudo transversal, descritivo, com abordagem quantitativa, realizado em um hospital universitário do Recife, Pernambuco, Brasil. A amostra foi constituída de 154 pacientes submetidos a cirurgias eletivas entre os meses de janeiro e abril de 2018, avaliados nos períodos pré e pós-operatório, por meio da aplicação da Escala de Avaliação de Risco para o Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico (ELPO), no intraoperatório. A coleta de dados ocorreu na visita pré-operatória e no primeiro dia de pós-operatório. Resultados: Dos 154 pacientes avaliados, sete apresentaram 11 lesões de pele, como lesões por pressão estágio I, estágio II e abrasão, predominantemente no glúteo e no tórax. As variáveis tempo do procedimento cirúrgico, tipo de anestesia e comorbidades foram os principais fatores de associados à ocorrência das lesões. Conclusão: Entre os pacientes que apresentaram lesões de pele devido ao posicionamento cirúrgico, a maioria foi classificada pela ELPO como alto risco, o que leva a crer que se trata de uma escala adequada para avaliação de risco de lesões de pele em pacientes cirúrgicos

Objective: To evaluate the occurrence of skin lesions in the intraoperative period due to surgical procedures performed at a large university hospital. Method: A cross-sectional, descriptive study with a quantitative approach, performed at a university hospital in Recife, Pernambuco, Brazil. The sample consisted of 154 patients undergoing elective surgeries between January and April 2018. They were evaluated in the pre and postoperative periods, through the application of the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning (ELPO), during the intraoperative period. Data were collected at the preoperative visit and on the first postoperative day. Results: Of the 154 patients evaluated, seven presented 11 skin lesions, such as stage I, stage II and abrasion lesions, predominantly in the gluteus and thorax. The variables length of the surgical procedure, type of anesthesia and comorbidities were the main factors associated with the occurrence of lesions. Conclusion: Among patients who presented skin lesions due to surgical positioning, most were classified by the ELPO as high risk, which suggests that this is a suitable scale for assessing the risk of skin lesions in surgical patients.

Objetivo: Evaluar la ocurrencia de lesiones de piel en el período intraoperatorio resultantes de procedimientos quirúrgicos realizados en un hospital universitario de gran porte. Método: Estudio transversal, descriptivo, con abordaje cuantitativo, realizado en un hospital universitario de Recife, Pernambuco, Brasil. La muestra fue constituida de 154 pacientes sometidos a cirugías electivas entre los meses de enero y abril de 2018, valuados en los períodos pre y postoperatorio, por medio de la aplicación de la Escala de Evaluación de Riesgo para el Desarrollo de Lesiones Debidas al Posicionamiento Quirúrgico (ELPO), en el intraoperatorio. La recolección de datos ocurrió en la visita preoperatoria y en el primer día de postoperatorio. Resultados: De los 154 pacientes evaluados, siete presentaron 11 lesiones de piel, como lesiones por presión estadio I, II y abrasión, predominantemente en el glúteo y en el tórax. Las variables tiempo del procedimiento quirúrgico, tipo de anestesia y comorbilidades fueron los principales factores de asociados a la ocurrencia de las lesiones. Conclusión: Entre los pacientes que representaron lesiones de piel debido al posicionamiento quirúrgico, la mayoría fue clasificada por ELPO como alto riesgo, lo que lleva a creer que se trata de una escala adecuada para la evaluación del riesgo de lesiones de piel en pacientes quirúrgicos

Cost of Tuberculosis Diagnosis and Treatment in Patients with HIV: A Systematic Literature Review.

OBJECTIVES: To summarize the costs of tuberculosis (TB) diagnosis and treatment in human immunodeficiency virus (HIV)-infected patients and to assess the methodological quality of these studies. METHODS: We included cost, cost-effectiveness, and cost-utility studies that reported primary costing data, conducted worldwide and published between 1990 and August 2016. We retrieved articles in PubMed, Embase, EconLit, CINAHL plus, and LILACS databases. The quality assessment was performed using two guidelines-the Consolidated Health Economic Evaluation Reporting Standards and the Tool to Estimate Patient's Costs. TB diagnosis was reported as cost per positive result or per suspect case. TB treatment was reported as cost of TB drugs, TB/HIV hospitalization, and treatment. We analyzed the data per level of TB/HIV endemicity and perspective of analysis. RESULTS: We included 34 articles, with 24 addressing TB/HIV treatment and 10 addressing TB diagnosis. Most of the studies were carried out in high TB/HIV burden countries (82%). The cost of TB diagnosis per suspect case varied from $0.5 for sputum smear microscopy to $175 for intensified case finding. The cost of TB/HIV hospitalization was higher in low/medium TB/HIV burden countries than in high TB/HIV burden countries ($75,406 vs. $2,474). TB/HIV co-infection presented higher costs than TB from the provider perspective ($814 vs. $604 vs. $454). Items such as "choice of discount rate," "patient interview procedures," and "methods used for valuing indirect costs" did not achieve a good score in the quality assessment. CONCLUSIONS: Our findings point to the need of generation of more standardized methods for cost data collection to generate more robust estimates and thus, support decision-making process.

Pacientes submetidos a cirurgias bariátricas: fatores associados a complicações pós-operatórias de sítio cirúrgico / Patients undergoing bariatric surgeries: factors associated with post-operative complications from the surgical site / Pacientes sometidos a cirugías bariátricas: factores asociados con complicaciones postoperatorias del sitio quirúrgico

Objetivo: Verificar a prevalência e os fatores associados às complicações pós-operatórias de sítio cirúrgico em pacientes submetidos a cirurgias bariátricas. Método: Estudo transversal, retrospectivo, analítico, com abordagem quantitativa. Foram analisados 197 casos de pacientes obesos submetidos à cirurgia bariátrica entre janeiro de 2013 e janeiro de 2016 em Pernambuco, Brasil. As variáveis relacionadas dicotomizadas foram analisadas por teste do χ2. O risco de complicações foi estimado pela odds ratio (OR). Assumiu-se significância de p<0,05. Resultados: Entre os 30 pacientes que compuseram a amostra, foram observadas 45 complicações pós-operatórias de sítio cirúrgico. Houve maior incidência nos indivíduos acima de 45 anos (70,0%). Dos fatores que poderiam estar associados aos desfechos, destacaram-se abordagem cirúrgica aberta (OR=5,35), inserção de drenos (OR=4,48) e período de tempo de pós-operatório superior a 3 dias de internação (OR=5,03). Conclusão: Comprovou-se maior prevalência de seroma como complicação de sítio cirúrgico, além da técnica cirúrgica (bypass em Y de Roux), faixa etária maior de 45 anos, tipo de abordagem cirúrgica convencional/aberta, presença de inserção de dreno cavitário e tempo de internação superior a 3 dias como predisponentes a um maior desenvolvimento de complicações.

Objective: To verify the prevalence and the factors associated with postoperative surgical site complications in patients undergoing bariatric surgeries. Method: A cross-sectional, retrospective, analytical study with a quantitative approach. 197 cases of obese patients undergoing bariatric surgery were analyzed between January 2013 and January 2016 in Pernambuco, Brazil. Dichotomized variables were analyzed using the χ2 test. The risk of complications was estimated by the odds ratio (OR). A significance of p <0.05 was assumed. Results: Among the 30 patients that made up the sample, 45 postoperative surgical site complications were observed. There was a higher incidence in individuals over 45 years of age (70.0%). The factors that stood out as possibly being associated with the outcomes were: an open surgical approach (OR = 5.35), the insertion of drains (OR = 4.48), and a postoperative period longer than 3 days of hospitalization (OR = 5.03). Conclusion: The following showed a high disposition for the development of complications from the surgical site: a high prevalence of seroma, the Roux-en-Y bypass surgical technique, the patient's age over 45 years old, a conventional/ open surgical approach, the insertion of cavitary drainage, and a hospitalization stay longer than 3 days.

Objetivo: Verificar la prevalencia y los factores asociados con las complicaciones del sitio quirúrgico postoperatorio em pacientes sometidos a cirugías bariátricas. Método: Estudio transversal, retrospectivo y analítico con enfoque cuantitativo. Se analizaron 197 casos de pacientes obesos sometidos a cirugía bariátrica entre enero de 2013 y enero de 2016, em Pernambuco, Brasil. Las variables dicotomizadas se analizaron usando la prueba χ2. Le riesgo de complicaciones es estimó mediante la odds ratio (OR). Se asumió una significancia de p<0,05. Resultados: entre los 30 pacientes em la muestra, 45 complicaciones postoperatorias fueran observadas en el sitio quirúrgico. Hubo una mayor incidencia em individuos mayores de 45 años (70,0%). Los factores que se destacaron como posiblemente asociados con los resultados fueron: un abordaje quirúrgico abierto (OR = 5,35), la inserción de drenajes (OR = 4,48), y un periodo postoperatorio mayor a 3 días de hospitalización (OR = 5,03). Conclusión: Los siguientes mostraron una alta disposición para el desarrollo de complicaciones del sitio quirúrgico: alta prevalencia de seroma, técnica quirúrgica de derivación Roux-em-Y, edad del paciente mayor de 45 años, abordaje quirúrgico convencional/abierto, inserción de denaje cavitario y hospitalización por más de 3 días.

Impaired religiosity and spiritual distress in people living with HIV/AIDS. / Religiosidade prejudicada e sofrimento espiritual em pessoas vivendo com HIV/aids.

OBJECTIVE: To verify the inference of Nursing Diagnoses, Impaired religiosity and Spiritual distress in people living with HIV/AIDS. METHODS: This is a cross-sectional study with a quantitative approach, performed in a specialized Service CenteR of Recife, Pernambuco, from June to November 2015. The results related to 52 people living with HIV/AIDS and that were interviewed were analyzed by three nurse judges. RESULTS: Spiritual distress was estimated at 73.1% (38), Impaired religiosity at 36.5% (19), with an average number of defining characteristics of 3.88 ± 2.05 and 2.55±0.69. The main defining characteristic for Impaired religiosity was: "reports a need to reconnect with previous beliefs" (92.3%); and for Spiritual distress, it was: "Expresses a lack of purpose in life/expresses lack of meaning in life" (86.5%). CONCLUSIONS: The results point to the need to consider the religious-spiritual dimension in care protocols and research in nursing.

Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study.

BACKGROUND: Nosocomial pneumonia has correlated to dental plaque and to oropharynx colonization in patients receiving mechanical ventilation. The interruption of this process, by preventing colonization of pathogenic bacteria, represents a potential procedure for the prevention of ventilator-associated pneumonia (VAP). METHODS: The study design was a prospective, randomized trial to verify if oral hygiene through toothbrushing plus chlorhexidine in gel at 0.12% reduces the incidence of ventilatior-associated pneumonia, the duration of mechanical ventilation, the length of hospital stay and the mortality rate in ICUs, when compared to oral hygiene only with chlorhexidine, solution of 0.12%, without toothbrushing, in adult individuals under mechanical ventilation, hospitalized in Clinical/Surgical and Cardiology Intensive Care Units (ICU). The study protocol was approved by the Ethical Committee of Research of the Health Sciences Center of the Federal University of Pernambuco - Certificate of Ethical Committee Approval (CAAE) 04300012500005208. Because it was a randomized trial, the research used CONSORT 2010 checklist criteria. RESULTS: Seven hundred sixteen patients were admitted into the ICU; 219 fulfilled the criteria for inclusion and 213 patients were included; 108 were randomized to control group and 105 to intervention group. Toothbrushing plus 0.12% chlorhexidine gel demonstrated a lower incidence of VAP throughout the follow up period, although the difference was not statistically significant (p = 0.084). There was a significant reduction of the mean time of mechanical ventilation in the toothbrushing group (p = 0.018). Regarding the length of hospital stay in the ICU and mortality rates, the difference was not statistically significant (p = 0.064). CONCLUSIONS: The results obtained showed that, among patients undergoing toothbrushing there was a significant reduction in duration of mechanical ventilation, and a tendency to reduce the incidence of VAP and length of ICU stay, although without statistical significance. TRIAL REGISTRATION: Retrospectively registered in the Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos) - RBR-4TWH4M (4 September 2016).

Religiosidade prejudicada e sofrimento espiritual em pessoas vivendo com HIV/aids / Religiosidad deteriorado y espiritual sufrimiento en personas con VIH/sida / Impaired religiosity and spiritual distress in people living with HIV/AIDS

RESUMO Objetivo Verificar a inferência dos Diagnósticos de Enfermagem, Religiosidade prejudicada e Sofrimento espiritual em pessoas vivendo com HIV/AIDS. Métodos Trata-se de um estudo transversal, com abordagem quantitativa, realizado em um Serviço de Assistência Especializada de Recife, Pernambuco, de junho a novembro de 2015. Os resultados relacionados às 52 pessoas vivendo com HIV/AIDS entrevistadas foram analisados por três juízes enfermeiros. Resultados Estimou-se em 73,1% (38) a incidência de Sofrimento espiritual, 36,5% (19) de Religiosidade prejudicada, com número médio de características definidoras de 3,88±2,05 e 2,55±0,69. A principal característica definidora para a Religiosidade prejudicada foi: "relata necessidade de reconectar-se com crenças anteriores" (92,3%); e para Sofrimento espiritual: "expressa falta de finalidade na vida/expressa falta de significado na vida" (86,5%). Conclusões Os resultados apontam para a necessidade de considerar a dimensão religiosa-espiritual nos protocolos assistenciais e de pesquisa em enfermagem.

RESUMEN Objetivo Comprobar la inferencia de diagnósticos de enfermería, deterioro religiosidad y sufrimiento espiritual de personas con VIH/SIDA. Métodos Se trata de un estudio transversal, cuantitativo, realizado en un servicio de atención especializada de Recife, Pernanbuco, de junio a noviembre de 2015. Los resultados de 52 encuestados fueron analizados por tres jueces enfermeras. Resultados Se estimó en un 73,1% (38) la incidencia de sufrimiento espiritual, el 36,5% (19) de la Religiosidad con deficiencias, con un promedio características definitorias de 3,88 ± 2,05 y 2,55 ± 0,69. La principal características definitorias de Religiosidad alterada: los informes tienen que volver a conectar con creencias anteriores (92,3%); y Sufrimiento espiritual: expresión de la falta de propósito en la vida/falta de sentido de la vida (86,5%). Conclusiones Los resultados apuntan a la necesidad de considerar la dimensión religiosa-espiritual en los protocolos de atención y la investigación en enfermería.

ABSTRACT Objective To verify the inference of Nursing Diagnoses, Impaired religiosity and Spiritual distress in people living with HIV/AIDS. Methods This is a cross-sectional study with a quantitative approach, performed in a specialized Service CenteR of Recife, Pernambuco, from June to November 2015. The results related to 52 people living with HIV/AIDS and that were interviewed were analyzed by three nurse judges. Results Spiritual distress was estimated at 73.1% (38), Impaired religiosity at 36.5% (19), with an average number of defining characteristics of 3.88 ± 2.05 and 2.55±0.69. The main defining characteristic for Impaired religiosity was: "reports a need to reconnect with previous beliefs" (92.3%); and for Spiritual distress, it was: "Expresses a lack of purpose in life/expresses lack of meaning in life" (86.5%). Conclusions The results point to the need to consider the religious-spiritual dimension in care protocols and research in nursing.

Avaliação do risco para desenvolvimento de úlceras por pressão em pacientes críticos / Risk assessment for development of pressure ulcers in critical patients / Evaluación del riesgo para el desarrollo de úlceras por presión en pacientes críticos

Objetivo: avaliar o risco para desenvolvimento ou evolução de úlceras por pressão em pacientes críticos através da escala de Braden. Método: estudo descritivo, com abordagem quantitativa, realizada na Unidade de Terapia Intensiva de um hospital universitário. Foram coletados dados nos prontuários de 51 pacientes no período de fevereiro a abril de 2013. A análise estatística foi avaliada pelo teste de Mann-Whitney. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, CAAE nº 26122213.4.0000.5208. Resultados: foi encontrado nos pacientes um risco moderado ao desenvolvimento de úlceras por pressão; verificou-se a associação de risco elevado na escala de Braden e utilização de noradrenalina, ventilação mecânica invasiva e pontuações baixas na escala de Glasgow. Conclusão: verificou-se o risco moderado ao desenvolvimento de úlceras por pressão e uma associação de risco elevado nos pacientes em uso terapêutico de noradrenalina, ventilação mecânica invasiva, monitorizações invasivas e baixos escores na escala de Glasgow.(AU)

Objective: to evaluate the risk for development or progression of pressure ulcers in critically ill patients through the Braden Scale. Method: a descriptive study with a quantitative approach, performed in the Intensive Care Unit of a university hospital. Data were collected from 51 patients´ medical records in February to April 2013. The statistical analysis was assessed by the Mann-Whitney test. The research project was approved by the Ethics Committee in Research, CAAE number 26122213.4.0000.5208. Results: a moderate risk to the development of pressure ulcers was found in patients; there was a high-risk association in Braden Scale and use of noradrenaline, invasive mechanical ventilation and low scores in Glasgow Scale. Conclusion: there was a moderate risk to the development of pressure ulcers and a high-risk association in patients with therapeutic use of norepinephrine, invasive mechanical ventilation, invasive monitoring and low scores on the Glasgow Scale.(AU)

Objetivo: evaluar el riesgo para desarrollo o evolución de úlceras por presión en pacientes críticos a través de la Escala de Braden. Método: estudio descriptivo, con enfoque cuantitativo, realizado en la Unidad de Terapia Intensiva de un hospital universitario. Fueron recogidos datos en los registros de 51 pacientes en el período de febrero a abril de 2013. El análisis estadístico fue evaluado por el test de Mann-Whitney. El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, CAAE n. 26122213.4.0000.5208. Resultados: fue encontrado en los pacientes un riesgo moderado al desarrollo de úlceras por presión; se verificó asociación riesgo elevado en la Escala de Braden y uso de Noradrenalina, ventilación mecánica invasiva y puntuaciones bajas en la Escala de Glasgow. Conclusión: se verificó riesgo moderado al desarrollo de úlceras por presión y una asociación de riesgo elevado en los pacientes en uso terapéutico de noradrenalina, ventilación mecánica invasiva, monitorizaciones invasivas y baja puntuación en la Escala de Glasgow.(AU)

Adesão às medidas de prevenção para pneumonia associada à ventilação mecânica / Adhesión a las medidas de prevención de la neumonía asociada a laventilación mecánica / Accession to the prevention measures for pneumonia associated with mechanical ventilation

Objetivo: avaliar a adesão dos profissionais de saúde das unidades de terapia intensiva às medidas preventivas de pneumonia associada à ventilação mecânica implantadas no hospital. Método: estudo descritivo, quantitativo e observacional, desenvolvido com 130 pacientes em ventilação mecânica invasiva por mais de 48 horas, totalizando 481 observações, realizadas em um hospital universitário da cidade do Recife de fevereiro a abril de 2014. Resultados: os resultados revelaram fragilidade no cuidado e exposição dos pacientes a situações de risco, visto que, apenas 35,38% dos pacientes acompanhados, aderiram completamente ao protocolo de prevenção de pneumonia associada à ventilação mecânica, sendo a interrupção da sedação e a higiene oral as intervenções que apresentaram o menor índice de conformidade, 70,06% e 48,86% respectivamente. Considerações finais: a qualidade do cuidado reflete na redução dos casos de pneumonia associada à ventilação mecânica e na segurança do paciente, demandando ações educativas multidisciplinares e auditorias periódicas.

Aim: to assess adherence of health professionals from intensive care units concerning the preventive measures of ventilation associatedto pneumonia implemented in the hospital. Method: descriptive, quantitative and observational study, developed with 130 patients on mechanical ventilation for more than 48 hours, resulting in 481 observations, conducted at a university hospitalin Recife city fromfebruary to april 2014. Results:results revealed substandard care and patient exposure to hazards, since only 35.38% of the patients, completely joined the ventilation associatedto pneumonia prevention protocol. Sedation interruptionand oral hygiene are the interventions that showed the lowest line index, 70.06% and 48.86% respectively. Final Remarks:quality care reflects in the reduction of pneumonia cases associated to mechanical ventilation and patient safety, therefore it requiresmultidisciplinary education and periodic lectures.

Objetivo: evaluar la adherencia de profesionales de la salud en unidades de cuidados intensivos a las medidas preventivas de la neumonía asociada a la ventilación mecánica implementada en el hospital. Método: estudio descriptivo, cuantitativo y observacional, desarrollado con 130 pacientes con ventilación mecánica invasiva durante más de 48 horas, con total de 481 observaciones, realizadas en un hospital universitario de la ciudad de Recife, de febrero-abril de 2014. Resultados: revelaron debilidad en el cuidado y exposición del paciente a riesgos, pues sólo 35,38% de los pacientes adherirán al protocolo de prevención de la neumonía asociada a ventilación, con interrupción de las intervenciones de sedación y de higiene oral que presentaron lo más bajo índice, 70.06% y 48.86% respectivamente. Consideraciones finales: la calidad de la atención refleja en la reducción de neumonía asociada a la ventilación y en la seguridad del paciente, requiriendo prácticas educativas multidisciplinares y auditorías periódicas.

Diagnosing visceral leishmaniasis and HIV/AIDS co-infection: a case series study in Pernambuco, Brazil.

HIV/AIDS-associated visceral leishmaniasis may display the characteristics of an aggressive disease or without specific symptoms at all, thus making diagnosis difficult. The present study describes the results of diagnostic tests applied to a series of suspected VL cases in HIV-infected/AIDS patients admitted in referral hospitals in Pernambuco, Brazil. From a total of 14 eligible patients with cytopenias and/or fever of an unknown etiology, and indication of bone marrow aspirate, 10 patients were selected for inclusion in the study. Diagnosis was confirmed by the following examinations: Leishmania detection in bone marrow aspirate, direct agglutination test, indirect immunofluorescence, rK39 dipstick test, polymerase chain reaction and latex agglutination test. Five out of the ten patients were diagnosed with co-infection. A positive direct agglutination test was recorded for all five co-infected patients, the Leishmania detection and latex agglutination tests were positive in four patients, the rK39 dipstick test in three, the indirect immunofluorescence in two and a positive polymerase chain reaction was recorded for one patient. This series of cases was the first to be conducted in Brazil using this set of tests in order to detect co-infection. However, no consensus has thus far been reached regarding the most appropriate examination for the screening and monitoring of this group of patients.

Diagnosing visceral leishmaniasis and HIV/AIDS co-infection: a case series study in Pernambuco, Brazil / Diagnosticando co-infecção leishmaniose visceral e HIV/AIDS: uma série de casos em Pernambuco, Brasil

HIV/AIDS-associated visceral leishmaniasis may display the characteristics of an aggressive disease or without specific symptoms at all, thus making diagnosis difficult. The present study describes the results of diagnostic tests applied to a series of suspected VL cases in HIV-infected/AIDS patients admitted in referral hospitals in Pernambuco, Brazil. From a total of 14 eligible patients with cytopenias and/or fever of an unknown etiology, and indication of bone marrow aspirate, 10 patients were selected for inclusion in the study. Diagnosis was confirmed by the following examinations: Leishmania detection in bone marrow aspirate, direct agglutination test, indirect immunofluorescence, rK39 dipstick test, polymerase chain reaction and latex agglutination test. Five out of the ten patients were diagnosed with co-infection. A positive direct agglutination test was recorded for all five co-infected patients, the Leishmania detection and latex agglutination tests were positive in four patients, the rK39 dipstick test in three, the indirect immunofluorescence in two and a positive polymerase chain reaction was recorded for one patient. This series of cases was the first to be conducted in Brazil using this set of tests in order to detect co-infection. However, no consensus has thus far been reached regarding the most appropriate examination for the screening and monitoring of this group of patients.

A associação da leishmaniose visceral com o HIV/AIDS pode se manifestar com características de doença agressiva ou sem sintomas específicos, dificultando o diagnóstico. Este artigo descreve o resultado de testes diagnósticos aplicados a uma série de casos suspeitos de leishmaniose visceral em pacientes com HIV/AIDS internados em hospitais de referência de Pernambuco, Brasil. De 14 pacientes elegíveis com citopenias e/ou febre de etiologia indefinida, com indicações de mielograma, foram incluídos dez. Para o diagnóstico, foram empregados os seguintes exames: pesquisa de Leishmania em aspirado de medula óssea, DAT, IFI, rK39, PCR e a KAtex. Cinco dos dez pacientes foram diagnosticados com co-infecção. Entre os cinco co-infectados, o DAT foi positivo em todos, a pesquisa de Leishmania foi positiva em quatro, assim como o KAtex, o rK39 em três, a IFI em dois e a PCR positiva em apenas um. Esta série de casos foi a primeira realizada no Brasil utilizando esse conjunto de exames para detecção de co-infecção, no entanto, ainda não há consenso quanto aos exames mais adequados a serem aplicados para screening e acompanhamento desse grupo de pacientes.

Como será o amanhã? responda quem puder!: perspectivas de enfermeirandos quanto ao seu futuro profissional / What will our future look like? answer me, if you can!: perspectives from nursing students for their future professional lives

Estudo qualitativo que teve como objetivos: Identificar os fatores significativos na formação do enfermeiro; descortinar o perfil do enfermeiro na percepção do graduando; conhecer as perspectivas dos enfermeirandos quanto ao seu amanhã profissional. Teve como sujeitos 12 alunos concluintes do Curso de Graduação em Enfermagem de três Universidades de Pernambuco. Foram realizadas entrevistas gravadas e observação assistemática, nos meses de março e abril de 2003. Como resultados foram construídas as seguintes categorias: Escolha pela profissão de enfermagem; envolvimento com a formação profissional; reflexões quanto à formação acadêmica e perspectivas em relação ao futuro profissional.

[What will our future look like? Answer, if you can! Perspectives from nursing students about their professional future]. / Como será o amanhã? Responda quem puder! Perspectivas de enfermeirandos quanto ao seu futuro profissional.

This is a qualitative study aimed at: identifying significant factors in nurse education; presenting a nurse profile as perceived by an undergraduate student; getting to know the perspectives nursing students have for their future professional lives. The interviewees were twelve students in nursing undergraduate programs from three universities located in the state of Pernambuco, Brazil. Recorded interviews and non-systematic observation were carried out between March and April, 2003. The following categories were identified: choice of the nurse profession; involvement in professional education; reflections on academic education and perspectives for future professional lives.

Dermatologia comparativa / Comparative dermatology

No presente estudo, através de um ensaio fotográfico em preto e branco, evidencia-se a semelhança entre lesões dermatológicas e imagens registradas da natureza