Risk classification and door-to-antibiotic time in patients with suspected sepsis. / Clasificación de riesgo y tiempo puerta-antibiótico en pacientes con sospecha de sepsis.

OBJECTIVE: to evaluate the association between risk classification and door-to-antibiotic time in patients with suspected sepsis. METHOD: retrospective cohort study, with a sample of 232 patients with suspected sepsis treated at the emergency department. They were divided into 2 groups: with and without risk classification. Once the door-to-antibiotic time was identified, one-way analysis of variance was performed with Bonferroni post hoc test or independent Student's t-test for continuous quantitative variables; Pearson correlation tests, point-biserial correlation or biserial correlation for association analyses; and bootstrap procedure when there was no normal distribution of variables. For data analysis, the Statistical Package for the Social Sciences software was used. RESULTS: the door-to-antibiotic time did not differ between the group that received risk classification compared to the one that was not classified. Door-to-antibiotic time was significantly shorter in the group that received a high priority risk classification. CONCLUSION: there was no association between door-to-antibiotic time and whether or not the risk classification was performed, nor with hospitalization in infirmaries and intensive care units, or with the length of hospital stay. It was observed that the higher the priority, the shorter the door-to-antibiotic time.

Clasificación de riesgo y tiempo puerta-antibiótico en pacientes con sospecha de sepsis / Risk classification and door-to-antibiotic time in patients with suspected sepsis / Classificação de risco e tempo porta-antibiótico no paciente com suspeita de sepse

Objetivo: evaluar la asociación entre la clasificación de riesgo y el tiempo puerta-antibiótico en pacientes con sospecha de sepsis. Método: estudio de cohorte retrospectivo, con una muestra de 232 pacientes con sospecha de sepsis atendidos en el departamento de emergencias. Se dividieron en 2 grupos: con y sin clasificación de riesgo. Una vez identificado el tiempo puerta-antibiótico, se realizó un análisis de varianza de un factor con la prueba post hoc de Bonferroni o la prueba t de Student independiente para variables cuantitativas continuas; pruebas de correlación de Pearson, correlación biserial puntual o correlación biserial para análisis de asociación; y procedimiento de bootstrap cuando no había distribución normal de variables. Para el análisis de los datos se utilizó el software Statistical Package for the Social Sciences. Resultados: el tiempo puerta-antibiótico no difirió entre el grupo que recibió clasificación de riesgo en comparación con el que no fue clasificado. El tiempo puerta-antibiótico fue significativamente más corto en el grupo que recibió una clasificación de riesgo de alta prioridad. Conclusión: no hubo asociación entre el tiempo puerta-antibiótico y si se realizó o no la clasificación de riesgo, ni con la hospitalización en enfermería y en unidad de cuidados intensivos, ni con la duración de la estancia hospitalaria. Se observó que cuanto mayor era la prioridad, más corto era el tiempo puerta-antibiótico.

Objective: to evaluate the association between risk classification and door-to-antibiotic time in patients with suspected sepsis. Method: retrospective cohort study, with a sample of 232 patients with suspected sepsis treated at the emergency department. They were divided into 2 groups: with and without risk classification. Once the door-to-antibiotic time was identified, one-way analysis of variance was performed with Bonferroni post hoc test or independent Student's t-test for continuous quantitative variables; Pearson correlation tests, point-biserial correlation or biserial correlation for association analyses; and bootstrap procedure when there was no normal distribution of variables. For data analysis, the Statistical Package for the Social Sciences software was used. Results: the door-to-antibiotic time did not differ between the group that received risk classification compared to the one that was not classified. Door-to-antibiotic time was significantly shorter in the group that received a high priority risk classification. Conclusion: there was no association between door-to-antibiotic time and whether or not the risk classification was performed, nor with hospitalization in infirmaries and intensive care units, or with the length of hospital stay. It was observed that the higher the priority, the shorter the door-to-antibiotic time.

Objetivo: avaliar a associação entre a realização de classificação de risco e o tempo porta-antibiótico no paciente com suspeita de sepse. Método: estudo de coorte retrospectivo, com amostra de 232 pacientes com suspeita de sepse atendidos no pronto atendimento. Foram distribuídos em 2 grupos: com e sem classificação de risco. Identificado o tempo porta-antibiótico, realizou-se análise de variância de um fator com post hoc de Bonferroni ou teste T-Student independente para variáveis quantitativas contínuas; testes de correlação de Pearson, correlação bisserial por pontos ou correlação bisserial para análises de associação; e procedimento de bootstrap quando não havia distribuição normal de variáveis. Para a análise dos dados foi utilizado o software Statistical Package for the Social Sciences. Resultados: o tempo porta-antibiótico não diferiu entre o grupo que recebeu classificação de risco comparado ao que não foi classificado. O tempo porta-antibiótico foi significativamente menor no grupo que recebeu classificação de risco de alta prioridade. Conclusão: não houve associação entre o tempo porta-antibiótico e a realização ou não da classificação de risco, tampouco com internação em enfermaria e em unidade de terapia intensiva, ou com o tempo de internação hospitalar. Observou-se que quanto maior a prioridade, menor o tempo porta-antibiótico.

Assessment of nursing care using indicators generated by software.

OBJECTIVE: to analyze the efficacy of the Nursing Process in an Intensive Care Unit using indicators generated by software. METHOD: cross-sectional study using data collected for four months. RNs and students daily registered patients, took history (at admission), performed physical assessments, and established nursing diagnoses, nursing plans/prescriptions, and assessed care delivered to 17 patients using software. Indicators concerning the incidence and prevalence of nursing diagnoses, rate of effectiveness, risk diagnoses, and rate of effective prevention of complications were computed. RESULTS: the Risk for imbalanced body temperature was the most frequent diagnosis (23.53%), while the least frequent was Risk for constipation (0%). The Risk for Impaired skin integrity was prevalent in 100% of the patients, while Risk for acute confusion was the least prevalent (11.76%). Risk for constipation and Risk for impaired skin integrity obtained a rate of risk diagnostic effectiveness of 100%. The rate of effective prevention of acute confusion and falls was 100%. CONCLUSION: the efficacy of the Nursing Process using indicators was analyzed because these indicators reveal how nurses have identified patients' risks and conditions, and planned care in a systematized manner.

Assessment of nursing care using indicators generated by software / Avaliação da assistência de enfermagem utilizando indicadores gerados por um software / Evaluación de la asistencia de enfermería utilizando indicadores generados por un software

OBJECTIVE: to analyze the efficacy of the Nursing Process in an Intensive Care Unit using indicators generated by software. METHOD: cross-sectional study using data collected for four months. RNs and students daily registered patients, took history (at admission), performed physical assessments, and established nursing diagnoses, nursing plans/prescriptions, and assessed care delivered to 17 patients using software. Indicators concerning the incidence and prevalence of nursing diagnoses, rate of effectiveness, risk diagnoses, and rate of effective prevention of complications were computed. RESULTS: the Risk for imbalanced body temperature was the most frequent diagnosis (23.53%), while the least frequent was Risk for constipation (0%). The Risk for Impaired skin integrity was prevalent in 100% of the patients, while Risk for acute confusion was the least prevalent (11.76%). Risk for constipation and Risk for impaired skin integrity obtained a rate of risk diagnostic effectiveness of 100%. The rate of effective prevention of acute confusion and falls was 100%. CONCLUSION: the efficacy of the Nursing Process using indicators was analyzed because these indicators reveal how nurses have identified patients' risks and conditions, and planned care in a systematized manner. .

OBJETIVO: analisar a eficácia do Processo de Enfermagem em uma Unidade de Terapia Intensiva, utilizando indicadores gerados por um software. MÉTODO: estudo transversal, cujos dados foram coletados durante quatro meses. Enfermeiros e acadêmicos realizaram, diariamente, cadastro e anamnese (na admissão), exame físico, diagnósticos de enfermagem, planejamento/prescrição de enfermagem e avaliação da assistência de 17 pacientes, utilizando um software. Calculou-se os indicadores incidência e prevalência de diagnósticos de enfermagem, taxa de efetividade diagnóstica de risco e taxa de efetividade na prevenção de complicações. RESULTADOS: o Risco de desequilíbrio na temperatura corporal foi o diagnóstico mais incidente (23,53%) e o menos incidente foi o Risco de constipação (0%). O Risco de integridade da pele prejudicada foi prevalente em 100% dos pacientes, enquanto o Risco de confusão aguda foi o menos prevalente (11,76%). Risco de constipação e Risco de integridade da pele prejudicada obtiveram taxa de efetividade diagnóstica de risco de 100%. A taxa de efetividade na prevenção de confusão aguda e de queda foi de 100%. CONCLUSÃO: analisou-se a eficácia do Processo de Enfermagem utilizando indicadores, pois retratam como o enfermeiro tem identificado os problemas e riscos do paciente, e planejado a assistência de forma sistematizada. .

OBJETIVO: analizar la eficacia del Proceso de Enfermería en una Unidad de Terapia Intensiva, utilizando indicadores generados por un software. MÉTODO: estudio transversal, cuyos datos fueron recolectados durante cuatro meses. Enfermeros y académicos realizaron, diariamente, registro y anamnesis (en la admisión), examen físico, diagnósticos de enfermería, planificación/prescripción de enfermería y evaluación de la asistencia en 17 pacientes, utilizando un software. Se calculó los indicadores incidencia y prevalencia de diagnósticos de enfermería, la tasa de efectividad diagnóstica de riesgo y la tasa de efectividad en la prevención de complicaciones. RESULTADOS: el Riesgo de desequilibrio en la temperatura corporal fue el diagnóstico más prevalente (23,53%) y el menos prevalente fue el Riesgo de constipación (0%). El Riesgo de integridad de la piel perjudicada fue prevalente en 100% de los pacientes, en cuanto el Riesgo de confusión aguda fue el menos prevalente (11,76%). El Riesgo de constipación y el Riesgo de integridad de la piel perjudicada obtuvieron una tasa de efectividad diagnóstica de riesgo de 100%. La tasa de efectividad en la prevención de confusión aguda y de caída fue de 100%. CONCLUSIÓN: se analizó la eficacia del Proceso de Enfermería utilizando indicadores, ya que retratan cómo el enfermero ha identificado los problemas y riesgos del paciente, y planificado la asistencia de forma sistematizada. .

Avaliação da assistência de enfermagem através de indicadores gerados por um software / Evaluation of nursing assistance through indicators generated by a software

Na prática assistencial, percebe-se a necessidade de se instrumentalizar o enfermeiro a fim de que ele possa avaliar a qualidade da assistência de enfermagem por meio de indicadores obtidos a partir da implementação do processo de enfermagem. É necessário que os enfermeiros tenham dados essenciais de enfermagem padronizados e informatizados para avaliar a efetividade do atendimento e demonstrar o quanto os cuidados de enfermagem contribuem para os resultados alcançados pelo paciente. Este estudo teve por objetivo analisar a eficácia do processo de enfermagem através de indicadores gerados por um software em uma Unidade de Terapia Intensiva. Para cálculo dos indicadores incidência, prevalência, taxa de efetividade diagnóstica de risco e taxa de efetividade na prevenção de complicações, utilizou-se os diagnósticos risco de confusão aguda, risco de constipação, risco de desequilíbrio na temperatura corporal, risco de integridade da pele prejudicada e risco de quedas. Trata-se de um estudo de coorte prospectivo, com amostra de 17 pacientes internados no período de 28 de junho a 26 de outubro de 2013. Foram identificados 93 títulos diagnósticos e 175 diferentes prescrições de enfermagem. Diariamente, foram formulados, em média, 21 diagnósticos e 87 ações de enfermagem por paciente. Entre os diagnósticos, cinco foram formulados para 100% dos pacientes, e 24 para mais de 50%. Os 93 títulos diagnósticos encontram-se em 12 (dos 13) domínios da NANDA-I. Das 87 prescrições de enfermagem, cinco foram prescritas para 100% dos pacientes. Os diagnósticos de risco de desequilíbrio na temperatura corporal e risco de integridade da pele prejudicada foram os mais incidentes. O diagnóstico risco de integridade da pele prejudicada foi prevalente em 100% dos pacientes. Os diagnósticos risco de constipação e risco de integridade da pele prejudicada obtiveram te diagnóstica de risco de 100%. Por sua vez, tal taxa foi de 0% para o diagnóstico risco de confusão aguda. A taxa...

In practice assistance, there is a need to equip nurses to check the quality of nursing care through indicators obtained from the implementation of the nursing process. It´s necessary that nurses have essential nursing data standardized and computerized to assess the effectiveness of care and to demonstrate how much the nursing care contributes to the results achieved by the patient. This study aimed to analyze the effectiveness of the nursing process through indicators generated by software in an intensive care unit. To calculate the indicators incidence, prevalence, rate of risk diagnostic effectiveness and rate of effectiveness in preventing complications, we used the nursing diagnoses risk for acute confusion, risk for constipation, risk for imbalanced body temperature, risk for impaired skin integrity and risk for falls. This is a prospective cohort study with a sample of 17 patients hospitalized in the period 28 June to 26 October 2013. There were formulated 93 nursing diagnoses and 175 nursing actions. Daily, there was formulated a mean of 21 diagnoses and 87 nursing actions per patient. Between the diagnoses, five were formulated to 100% of patients, and 24 to more than 50%. The 93 different title diagnoses are in 12 (of 13) NANDA-I domains. Between 87 nursing actions, five were prescribed to 100% of patients. The diagnoses risk for imbalanced body temperature and risk for impaired skin integrity were the most incidents. The diagnosis risk for impaired skin integrity was prevalent in 100% of patients. The diagnoses risk for constipation and risk for impaired skin integrity had a rate of risk diagnostic effectiveness of 100%. This indicator was 0% to the risk for acute confusion. The rate of effectiveness in preventing complications to the risk for acute confusion and risk for falls was 100%, while to the risk for constipation, risk for imbalanced body temperature and and risk for impaired skin integrity, this indicator was 76,9%...

[Nursing diagnoses identified in inpatients of an adult intensive care unit]. / Diagnósticos de enfermagem identificados em pacientes internados em Unidade de Terapia Intensiva Adulto.

This descriptive study was performed to identify the nursing diagnoses in the records of the inpatients of an adult intensive care unit, and map the most frequent diagnosis according to the Fundamental Human Needs. The sample consisted of 44 patient records. A total of 1,087 nursing diagnoses were identified. After excluding the repetitions, 28 different diagnoses were identified. Twenty-five diagnoses were related to psychobiological needs, and three to psychosocial needs. Further studies should identify, among the formulated nursing diagnoses and the affected human needs, which problems were solved and for what needs the care is predominantly developed. The present study results are important for the organization of teaching content for students and nurses, preparing them to consider human beings as a whole when providing care, considering their biological, emotional, and spiritual aspects.

Diagnósticos de enfermagem identificados em pacientes internados em Unidade de Terapia Intensiva Adulto / Diagnósticos de enfermería identificados en pacientes internados en unidad de terapia intensiva de adultos / Nursing diagnoses identified in inpatients of an adult intensive care unit

Estudo descritivo para identificar nos registros de prontuários de pacientes internados em uma Unidade de Terapia Intensiva de Adultos os diagnósticos de enfermagem e mapear os diagnósticos mais frequentes às Necessidades Humanas Básicas. Obteve-se uma amostra de 44 prontuários. Identificaram-se 1.087 diagnósticos de enfermagem. Após exclusão de repetições, encontraram-se 28 diferentes títulos de diagnósticos. Vinte e cinco diagnósticos estavam relacionados às necessidades psicobiológicas, e três, às necessidades psicossociais. Sugere-se a realização de estudos que identifiquem, entre os diagnósticos de enfermagem formulados e as necessidades humanas afetadas, quais foram solucionados e para quais necessidades são predominantemente elaborados os cuidados. Os resultados deste estudo são importantes para a organização de conteúdos de ensino para alunos e enfermeiros, preparando-os para que, ao prestar o cuidado, considerem o ser humano, tanto nos aspectos biológicos, como emocionais e espirituais.

This descriptive study was performed to identify the nursing diagnoses in the records of the inpatients of an adult intensive care unit, and map the most frequent diagnosis according to the Fundamental Human Needs. The sample consisted of 44 patient records. A total of 1,087 nursing diagnoses were identified. After excluding the repetitions, 28 different diagnoses were identified. Twenty-five diagnoses were related to psychobiological needs, and three to psychosocial needs. Further studies should identify, among the formulated nursing diagnoses and the affected human needs, which problems were solved and for what needs the care is predominantly developed. The present study results are important for the organization of teaching content for students and nurses, preparing them to consider human beings as a whole when providing care, considering their biological, emotional, and spiritual aspects.

Estudio descriptivo apuntando identificar en historias clínicas de pacientes internados en una Unidad de Terapia Intensiva de Adultos los diagnósticos de enfermería y mapear los diagnósticos más frecuentes relativos a las Necesidades Humanas Básicas. Se obtuvo una muestra de 44 historias clínicas. Se identificaron 1087 diagnósticos de enfermería. Luego de exclusión de repeticiones, se encontraron 28 diferentes títulos de diagnósticos. Veinticinco diagnósticos se relacionaban con necesidades psicobiológicas y tres a necesidades psicosociales. Se sugiere realizar estudios que identifiquen, entre los diagnósticos de enfermería formulados y las necesidades humanas afectadas, cuáles de ellos fueron solucionados y para cuáles necesidades son elaborados mayoritariamente los cuidados. Los resultados de este estudio son importantes para la organización de contenidos de enseñanza para alumnos y enfermeros, preparándolos para que al prestar el cuidado consideren al ser humano, tanto en aspectos biológicos como emocionales y espirituales.

Mercury and selenium concentrations in fish samples from Cachoeira do PiriáMunicipality, ParáState, Brazil.

Mercury is a major public health concern because of its widespread occurrence in the environment and its toxic effects on humans, mainly through fish ingestion. On the other hand, selenium is known by its antioxidant effect. For this reason, the knowledge of the correlation between mercury and selenium concentrations in fish samples can bring important information allowing a better understanding of mercury equilibrium in the inhabitants of the Amazon region. In this paper, total mercury and selenium levels were measured in carnivorous (47), omnivorous (44), and herbivorous (4) fish species caught in rivers and in an artificial lake in Cachoeira do PiriáMunicipality, situated in ParáState, Amazon region. The mercury concentration ranged from 1.15 to 13.44 nmol g(-1) and selenium from 2.44 to 14.56 nmol g(-1) for carnivorous species. For noncarnivorous species, mercury concentration ranged from 0.08 to 2.03 nmol g(-1) and selenium from 1.27 to 15.32 nmol g(-1). The molar ratios between mercury and selenium contents obtained for carnivorous and noncarnivorous species were 0.65 and 0.14, respectively. Mercury and selenium levels were positively correlated with fish body mass (weight) only for Hoplias malabaricus (n=35, R2=0.565, P<0.005 and R2=0.608, P<0.005, respectively). Selenium and mercury concentrations were statistically positively correlated only for H. malabaricus (n=35, R2=0.787, P=0.005) and Leporinus sp. (n=38, R2=0.485, P<0.005) known locally as Traíra (carnivorous) and Aracu (omnivorous), respectively.