Improved performance of an intensive care unit after changing the admission triage model.

The aim of this study is to analyze the effect of implementing a prioritization triage model for admission to an intensive care unit on the outcome of critically ill patients. Retrospective longitudinal study of adult patients admitted to the Intensive Care Unit (ICU) carried out from January 2013 to December 2017. The primary outcome considered was vital status at hospital discharge. Patients were divided into period 1 (chronological triage) during the years 2013 and 2014 and period 2 (prioritization triage) during the years 2015-2017. A total of 1227 patients in period 1 and 2056 in period 2 were analyzed. Patients admitted in period 2 were older (59.8 years) compared to period 1 (57.3 years; p < 0.001) with less chronic diseases (13.6% vs. 19.2%; p = 0.001), and higher median APACHE II score (21.0 vs. 18.0; p < 0.001)) and TISS 28 score (28.0 vs. 27.0; p < 0.001). In period 2, patients tended to stay in the ICU for a shorter time (8.5 ± 11.8 days) compared to period 1 (9.6 ± 16.0 days; p = 0.060) and had lower mortality at ICU (32.8% vs. 36.9%; p = 0.016) and hospital discharge (44.2% vs. 47.8%; p = 0.041). The change in the triage model from a chronological model to a prioritization model resulted in improvement in the performance of the ICU and reduction in the hospital mortality rate.

Evaluation of time to death after admission to an intensive care unit and factors associated with mortality: A retrospective longitudinal study.

Background: Among nonsurvivors admitted to the intensive care unit (ICU), some present early mortality while other patients, despite having a favorable evolution regarding the initial disease, die later due to complications related to hospitalization. This study aims to identify factors associated with the time until death after admission to an ICU of a university hospital. Methods: Retrospective longitudinal study that included adult patients admitted to the ICU between January 1, 2008, and December 31, 2017. Nonsurviving patients were divided into groups according to the length of time from admission to the ICU until death: Early (0-5 days), intermediate (6-28 days), and late (>28 days). Patients were considered septic if they had this diagnosis on admission to the ICU. Simple linear regression analysis was performed to evaluate the association between time to death over the years of the study. Multivariate cox regression was used to assess risk factors for the outcome in the ICU. Results: In total, 6596 patients were analyzed. Mortality rate was 32.9% in the ICU. Most deaths occurred in the early (42.8%) and intermediate periods (47.9%). Patients with three or more dysfunctions on admission were more likely to die early (P < 0.001). The diagnosis of sepsis was associated with a higher mortality rate. The multivariate analysis identified age >60 years (hazard ratio [HR] 1.009), male (HR 1.192), mechanical ventilation (HR 1.476), dialysis (HR 2.297), and sequential organ failure assessment >6 (HR 1.319) as risk factors for mortality. Conclusion: We found a higher proportion of early and intermediate deaths in the study period. The presence of three or more organ dysfunctions at ICU admission was associated with early death. The diagnosis of sepsis evident on ICU admission was associated with higher mortality.

Recusa de leitos e triagem de pacientes admitidos nas unidades de terapia intensiva do Brasil: estudo transversal do tipo survey nacional / Refusal of beds and triage of patients admitted to intensive care units in Brazil: a cross-sectional national survey

RESUMO Objetivo: Conhecer dados sobre recusa de leitos nas unidades intensivas no Brasil, assim como avaliar o uso de sistemas de triagem pelos profissionais atuantes. Métodos: Estudo transversal do tipo survey. Com a metodologia Delphi, foi criado um questionário contemplando os objetivos do trabalho. Foram convidados médicos e enfermeiros inscritos na rede de pesquisa da Associação de Medicina Intensiva Brasileira (AMIBnet). Uma plataforma da web (SurveyMonkey®) foi a forma de aplicação do questionário. As variáveis deste trabalho foram mensuradas em categorias e expressas como proporção. Foram usados o teste do qui-quadrado ou o teste exato de Fisher, para verificar associações. O nível de significância foi de 5%. Resultados: No total, 231 profissionais responderam o questionário, representando todas as regiões do país. As unidades intensivas nacionais tinham mais de 90% de taxa de ocupação sempre ou frequentemente para 90,8% dos participantes. Dentre os participantes, 84,4% já deixaram de admitir pacientes em leito intensivo devido à lotação da unidade. Metade das instituições brasileiras (49,7%) não possuía protocolos de triagem de leitos intensivos instituídos. Conclusão: A recusa de leito pela alta taxa de ocupação é frequente nas unidades de terapia intensiva do Brasil. Ainda assim, metade dos serviços do Brasil não adota protocolos para triagem de leitos.

ABSTRACT Objective: To obtain data on bed refusal in intensive care units in Brazil and to evaluate the use of triage systems by professionals. Methods: A cross-sectional survey. Using the Delphi methodology, a questionnaire was created contemplating the objectives of the study. Physicians and nurses enrolled in the research network of the Associação de Medicina Intensiva Brasileira (AMIBnet) were invited to participate. A web platform (SurveyMonkey®) was used to distribute the questionnaire. The variables in this study were measured in categories and expressed as proportions. The chi-square test or Fisher's exact test was used to verify associations. The significance level was set at 5%. Results: In total, 231 professionals answered the questionnaire, representing all regions of the country. The national intensive care units had an occupancy rate of more than 90% always or frequently for 90.8% of the participants. Among the participants, 84.4% had already refused admitting patients to the intensive care unit due to the capacity of the unit. Half of the Brazilian institutions (49.7%) did not have triage protocols for admission to intensive beds. Conclusions: Bed refusal due to high occupancy rates is common in Brazilian intensive care units. Even so, half of the services in Brazil do not adopt protocols for triage of beds.

Refusal of beds and triage of patients admitted to intensive care units in Brazil: a cross-sectional national survey. / Recusa de leitos e triagem de pacientes admitidos nas unidades de terapia intensiva do Brasil: estudo transversal do tipo survey nacional.

OBJECTIVE: To obtain data on bed refusal in intensive care units in Brazil and to evaluate the use of triage systems by professionals. METHODS: A cross-sectional survey. Using the Delphi methodology, a questionnaire was created contemplating the objectives of the study. Physicians and nurses enrolled in the research network of the Associação de Medicina Intensiva Brasileira (AMIBnet) were invited to participate. A web platform (SurveyMonkey®) was used to distribute the questionnaire. The variables in this study were measured in categories and expressed as proportions. The chi-square test or Fisher's exact test was used to verify associations. The significance level was set at 5%. RESULTS: In total, 231 professionals answered the questionnaire, representing all regions of the country. The national intensive care units had an occupancy rate of more than 90% always or frequently for 90.8% of the participants. Among the participants, 84.4% had already refused admitting patients to the intensive care unit due to the capacity of the unit. Half of the Brazilian institutions (49.7%) did not have triage protocols for admission to intensive beds. CONCLUSIONS: Bed refusal due to high occupancy rates is common in Brazilian intensive care units. Even so, half of the services in Brazil do not adopt protocols for triage of beds.

OBJETIVO: Conhecer dados sobre recusa de leitos nas unidades intensivas no Brasil, assim como avaliar o uso de sistemas de triagem pelos profissionais atuantes. MÉTODOS: Estudo transversal do tipo survey. Com a metodologia Delphi, foi criado um questionário contemplando os objetivos do trabalho. Foram convidados médicos e enfermeiros inscritos na rede de pesquisa da Associação de Medicina Intensiva Brasileira (AMIBnet). Uma plataforma da web (SurveyMonkey®) foi a forma de aplicação do questionário. As variáveis deste trabalho foram mensuradas em categorias e expressas como proporção. Foram usados o teste do qui-quadrado ou o teste exato de Fisher, para verificar associações. O nível de significância foi de 5%. RESULTADOS: No total, 231 profissionais responderam o questionário, representando todas as regiões do país. As unidades intensivas nacionais tinham mais de 90% de taxa de ocupação sempre ou frequentemente para 90,8% dos participantes. Dentre os participantes, 84,4% já deixaram de admitir pacientes em leito intensivo devido à lotação da unidade. Metade das instituições brasileiras (49,7%) não possuía protocolos de triagem de leitos intensivos instituídos. CONCLUSÃO: A recusa de leito pela alta taxa de ocupação é frequente nas unidades de terapia intensiva do Brasil. Ainda assim, metade dos serviços do Brasil não adota protocolos para triagem de leitos.

Caring for critically ill patients outside intensive care units due to full units: a cohort study.

OBJECTIVES: This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. METHODS: A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. RESULTS: Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. CONCLUSIONS: Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.

Effects of topical and subconjunctival use of bevacizumab on corneal neovascularization in rabbits' eyes.

PURPOSE:: To evaluate and compare the effects of topical application and subconjunctival injection of bevacizumab on corneal neovascularization (CNV) in rabbits' eyes after chemical burning of the cornea. METHODS:: The animals were randomly distributed into four groups of five animals. In one group, the drug was instilled, while in another, it was administered by subconjunctival injection. The two procedures using bevacizumab were compared with instillation and subconjunctival injection of saline solution (S). Neovascularization was evaluated according to the size of the invasion area of new blood vessels and through computerized analysis of this area. The data were analyzed using the Kruskal-Wallis test followed by Dunn's test for two-by-two comparison of the groups, to assess the external examination of CNV. Analysis of variance was used to assess the area of CNV. P<0.05 was considered statistically significant. RESULTS:: Assessing both the external examination and the invasion area of neovessels on the 5th and 10th days, there was a clear difference between the groups. The group to which saline solution had been applied showed higher scores for CNV, as well as increases in the invasion area of neovessels. Two-by-two comparison of groups revealed no significant differences. However, an analysis of the factors involved (injection vs. instillation and bevacizumab vs. saline solution) showed that injection did not differ from instillation, but that bevacizumab differed from saline solution. CONCLUSION:: Bevacizumab showed an inhibitory effect on CNV in rabbits' eyes after chemical burning of the cornea. There was no difference between the topical or subconjunctival administration of bevacizumab in the inhibition of CNV.

Caring for critically ill patients outside intensive care units due to full units: a cohort study

OBJECTIVES: This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. METHODS: A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. RESULTS: Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. CONCLUSIONS: Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.

Effects of topical and subconjunctival use of bevacizumab on corneal neovascularization in rabbits' eyes / Efeitos do uso tópico e subconjuntival do bevacizumabe na neovascularização corneana de olhos de coelhos

ABSTRACT Purpose: To evaluate and compare the effects of topical application and subconjunctival injection of bevacizumab on corneal neovascularization (CNV) in rabbits' eyes after chemical burning of the cornea. Methods: The animals were randomly distributed into four groups of five animals. In one group, the drug was instilled, while in another, it was administered by subconjunctival injection. The two procedures using bevacizumab were compared with instillation and subconjunctival injection of saline solution (S). Neovascularization was evaluated according to the size of the invasion area of new blood vessels and through computerized analysis of this area. The data were analyzed using the Kruskal-Wallis test followed by Dunn's test for two-by-two comparison of the groups, to assess the external examination of CNV. Analysis of variance was used to assess the area of CNV. P<0.05 was considered statistically significant. Results: Assessing both the external examination and the invasion area of neovessels on the 5th and 10th days, there was a clear difference between the groups. The group to which saline solution had been applied showed higher scores for CNV, as well as increases in the invasion area of neovessels. Two-by-two comparison of groups revealed no significant differences. However, an analysis of the factors involved (injection vs. instillation and bevacizumab vs. saline solution) showed that injection did not differ from instillation, but that bevacizumab differed from saline solution. Conclusion: Bevacizumab showed an inhibitory effect on CNV in rabbits' eyes after chemical burning of the cornea. There was no difference between the topical or subconjunctival administration of bevacizumab in the inhibition of CNV.

RESUMO Objetivos: Avaliar e comparar o efeito do uso tópico e da injeção subconjuntival do bevacizumabe na neovascularização corneana de olhos de coelhos após queimadura química. Métodos: Os animais foram distribuídos de forma aleatória em quatro grupos de cinco animais. Em um grupo de coelhos a droga foi instilada, enquanto em outro foi aplicada injeção subconjuntival, sendo os dois procedimentos comparados com a instilação e injeção subconjuntival de soro fisiológico 0,9% (SF) e entre si. A neovascularização foi avaliada conforme o tamanho da área de invasão dos neovasos e com análise computadorizada da mesma. Na análise de dados aplicou-se o teste de Kruskal-Wallis seguido do teste de Dunn com p<0,05 para comparação dos grupos dois a dois na análise do exame externo da neovascularização corneana. Na análise da área de neovascularização corneana, aplicou-se o teste F de análise de variância. A significância estatística foi definida como valor de p<0.05. Resultados: A avaliação do exame externo e da área de invasão de neovasos, no 5º e 10º dia, mostrou nítida diferença entre os grupos. Com o uso de soro fisiológico houve maior graduação na escala de neovascularização corneana e também na área de invasão dos nevasos, o que demonstrou o efeito inibitório do bevacizumabe. Nas comparações dos grupos dois a dois não foram detectadas diferenças significativas, porém, ao analisar os fatores envolvidos (procedimentos: injeção ou instilação, e as drogas: bevacizumabe ou soro fisiológico), verificou-se que a injeção não diferiu da instilação, mas o bevacizumabe diferiu do soro fisiológico. Conclusão: O bevacizumabe apresentou efeito inibitório na neovascularização corneana de olhos de coelhos após queimadura química, tanto por via tópica como por via subconjuntival e não houve diferença entre a via tópica e a via subconjuntival de administração do bevacizumabe na inibição da neovascularização corneana.

Treatment costs of burn victims in a university hospital.

OBJECTIVES: To analyze the direct costs of treating critically ill patients in the intensive care unit of a center specializing in treating burns. METHODS: This is a prospective cohort study of 180 patients from May 2011 to May 2013. Clinical and demographic data were collected in addition to data for the calculation of severity scores. The costs related to daily clinical and surgical treatment were evaluated until hospital outcome. The costs were grouped into five blocks: Clinical support, Drugs and blood products, Medical procedures, Specific burn procedures and Hospital fees. The level of significance was set at 5%. RESULTS: There was a predominance of males, 131 (72.8%). The mean age of the patients was 42.0±15.3years and the mean burned body surface area was 27.9±17%. The median length of stay in intensive care beds was 15.0 (interquartile range IQR: 7.0-24.8) days and the median hospital stay was 23.0 (IQR: 14.0-34.0) days. The mean daily cost was US$ 1330.48 (standard error of the mean SE=38.36) and the mean total cost of hospitalization was US$ 39,594.90 (SE: 2813.11). The drugs and blood products block accounted for the largest fraction of the total costs (US$ 18,086.09; SE 1444.55). There was a difference in the daily costs of survivors and non survivors (US$ 1012.89; SE: 29.38 and US$ 1866.11, SE: 36.43, respectively, P<0.001). CONCLUSION: The direct costs of the treatment of burn patients at the study center were high. The drugs and blood products block presented the highest mean total and daily costs. Non surviving patients presented higher costs.

Functional disability for mobility in adults: a population-based study / Incapacidade funcional para mobilidade em adultos: estudo de base populacional

Abstract Introduction: Functional disability is an important health indicator associated with worse quality of life. Objective: To estimate the prevalence of functional disability for mobility and to identify factors associated with difficulty going up and down stairs in adults aged 40 years or over. Methods: Cross-sectional, population-based study, with residents of the Municipality of Cambé, PR, interviewed in 2011. The dependent variable was the difficulty of going up and down stairs. Analysis of associated factors was performed using Poisson regression for each subgroup (40 - 59 years and 60 years or older). Results: In total, 24% of the subjects presented some kind of difficulty going up stairs (p < .01). In both subgroups, a significantly higher prevalence in women, among those inactive during leisure time and those with a history of cerebrovascular disease was observed. In the subgroup aged 40 to 59 years, age 50 - 59 years, hypertension, diabetes and falls in the previous 12 months were also associated with the outcome. Conclusion: The results suggest the need to expand the actions of health promotion, prevention and control of chronic conditions, especially among middle-aged people.

Resumo Introdução: A incapacidade funcional é importante indicador de saúde, associada a pior qualidade de vida. Objetivo: Estimar a prevalência de incapacidade funcional para mobilidade e identificar os fatores associados à dificuldade de subir e descer escadas em adultos de 40 anos ou mais. Metódos: Estudo transversal, de base populacional, com residentes no Município de Cambé-PR, entrevistados em 2011. A variável dependente foi a dificuldade de subir e descer escadas. A análise de fatores associados foi realizada por meio da regressão de Poisson, para cada subgrupo etário (40 a 59 anos e 60 anos ou mais). Resultados: No total, 24% referiram alguma dificuldade para subir e descer escadas (p < 0,01). Em ambos os subgrupos, observaram-se prevalências significativamente mais elevadas em mulheres, entre os inativos no lazer e naqueles com histórico de doença cerebrovascular. No subgrupo com idade entre 40 e 59 anos, associaram-se também ao desfecho a faixa etária de 50 a 59 anos, a hipertensão arterial, o diabetes e queda nos últimos 12 meses. Conclusão: Os resultados apontam a necessidade de ampliar as ações de promoção da saúde e de prevenção e controle das condições crônicas, principalmente entre não idosos.

Predictors of acute kidney injury and mortality in an Intensive Care Unit.

INTRODUCTION AND OBJECTIVES: To compare clinical characteristics and outcomes of patients with and without acute kidney injury (AKI), to evaluate the incidence and mortality of AKI and predictors of AKI and death in patients hospitalized in an Intensive Care Unit (ICU). METHODS: A retrospective study analyzed 152 patients admitted to a single ICU. We assessed age, gender, reason for hospitalization, risk factors for ARF, laboratory data, the need for renal therapy substitutive and mortality. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA) and RIFLE were recorded on the day of ICU admission. We determined the incidence of AKI, mortality and the independent predictors of AKI and death using logistic regression model. RESULTS: Mean age was 57.1 ± 20 years, ranging between 19 to 88 years, and 60.1% were male. Non-dialysis dependent AKI occurred in 81 patients (53.2%) while the ARF requiring dialysis occurred in 19 patients (12.4%). The overall mortality rate in the ICU was 35.9%, whereas the mortality rate in patients with non-dialysis dependent AKI was 43.2% and the IRA with dialysis of 84.2%. In multivariate analysis, invasive mechanical ventilation, elevated creatinine and urea at admission were independent risk factors for AKI, whereas clinical diagnosis, invasive mechanical ventilation, increased lactate and urea and hypernatremia were independent risk factors for ICU mortality. CONCLUSION: The incidence and mortality of AKI in ICU were high in this study, despite the advances that have been emerging in their management.

Mortality and risks related to healthcare-associated infection / Mortalidad y riesgos asociados a la infección relacionada con la asistencia a la salud / Mortalidade e riscos associados a infecção relacionada à assistência à saúde

Healthcare-associated infections are a major cause of morbidity-mortality among hospitalized patients. The aim of this epidemiological study was to determine mortality and risks related to death in adult patients with healthcare-associated infections admitted to a teaching hospital in one year. Patient data were collected from infection medical reports. The mortality rate associated with infections was 38.4%, and it was classified as a contributing factor to deaths in 87.1% of death cases. The correlation between healthcare-associated infection and death was statistically significant among clinical patients (41.3%) presenting comorbidities related to the diagnosis (55.8%), cardiovascular infection (62.2%), pneumonia (48.9%), developing sepsis (69.0%), as well as patients who had been colonized (45.2%) and infected (44.7%) by multidrug resistance microorganisms.

La infección relacionada con la atención sanitaria es una de las principales causas de morbimortalidad entre los pacientes hospitalizados. El objetivo de este estudio epidemiológico fue determinar la mortalidad y los riesgos asociados con el fallecimiento de pacientes adultos con la infección relacionada con la atención sanitaria ingresados en un hospital universitario en el periodo de un año. Los datos de los pacientes se obtuvieron de registros de notificación de infecciones. La tasa de mortalidad asociada con las infecciones fue del 38,4%, y fueron clasificados como un factor que contribuye en el 87,1% de las muertes. La asociación de la infección relacionada con la atención sanitaria con el fallecimiento fue estadísticamente significativa entre pacientes clínicos (41,3%), que presentaron comorbilidad asociadas a el diagnóstico (55,8%), con infección cardiovascular (62,2%), neumonía (48,9%), que desarrollaron sepsis (69,0%), colonizados (45,2%) o infectados (44,7%) por microorganismos multirresistentes. Se concluyó que las infecciones contribuyeron a la muerte de la mayoría de los pacientes.

A infecção relacionada à assistência à saúde é uma das principais causas de morbimortalidade entre pacientes hospitalizados. O objetivo deste estudo epidemiológico foi determinar a mortalidade e os riscos associados ao óbito de pacientes adultos com infecção relacionada à assistência à saúde, internados em um hospital-escola no período de um ano. Dados dos pacientes foram coletados das fichas de notificação de infecções. A taxa de mortalidade associada a essas infecções foi de 38,4%, classificadas como fator contribuinte em 87,1% dos óbitos. A associação das infecções relacionadas à assistência à saúde com o óbito foi estatisticamente significativa entre pacientes clínicos (41,3%), que apresentavam comorbirdades associadas ao diagnóstico (55,8%), com infecção cardiovascular (62,2%), pneumonia (48,9%), que evoluíram com sepse (69,0%), colonizados (45,2%) ou infectados (44,7%) por microrganismos multirresistentes. Concluiu-se que as infecções contribuíram para o óbito da maioria dos pacientes.

Preditores de injúria renal aguda e de mortalidade em uma Unidade de Terapia Intensiva / Predictors of acute kidney injury and mortality in an Intensive Care Unit

Introdução e Objetivos: Comparar características clínicas e evolução dos pacientes com e sem injúria renal aguda (IRA), avaliar a incidência, mortalidade da IRA e fatores de risco de IRA e de óbito em pacientes em uma Unidade de Terapia Intensiva (UTI). Métodos: Estudo retrospectivo que analisou 152 pacientes em uma única UTI. Avaliamos a idade, o sexo, o motivo do internamento, fatores de risco para IRA, dados laboratoriais, a necessidade de terapia renal substitutiva e a mortalidade. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA) e RIFLE foram registrados no dia de admissão na UTI. Determinamos a incidência da IRA, mortalidade e os preditores independentes de IRA e de óbito utilizando o modelo de regressão logística. Resultados: A idade média foi de 57,1 ± 20 anos e 60,1% eram masculinos. IRA não dialítica ocorreu em 81 pacientes (53,2%) e a IRA dialítica ocorreu em 19 pacientes (12,4%). A mortalidade global foi de 35,9%, enquanto que a taxa de mortalidade nos pacientes com IRA não dialítica foi de 43,2% e a dos com IRA dialítica de 84,2%. Na análise multivariada, a ventilação mecânica invasiva, a creatinina e a ureia elevadas na admissão foram fatores de risco independentes para IRA, enquanto que diagnóstico clínico, uso de ventilação mecânica invasiva, ureia e lactato aumentados e hipernatremia foram fatores de risco independentes para mortalidade na UTI. Conclusão: A incidência e a mortalidade de IRA na UTI foram elevadas neste estudo, apesar dos avanços que vêm surgindo no seu manejo. .

Introduction and Objectives: To compare clinical characteristics and outcomes of patients with and without acute kidney injury (AKI), to evaluate the incidence and mortality of AKI and predictors of AKI and death in patients hospitalized in an Intensive Care Unit (ICU). Methods: A retrospective study analyzed 152 patients admitted to a single ICU. We assessed age, gender, reason for hospitalization, risk factors for ARF, laboratory data, the need for renal therapy substitutive and mortality. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA) and RIFLE were recorded on the day of ICU admission. We determined the incidence of AKI, mortality and the independent predictors of AKI and death using logistic regression model. Results: Mean age was 57.1 ± 20 years, ranging between 19 to 88 years, and 60.1% were male. Non-dialysis dependent AKI occurred in 81 patients (53.2%) while the ARF requiring dialysis occurred in 19 patients (12.4%). The overall mortality rate in the ICU was 35.9%, whereas the mortality rate in patients with non-dialysis dependent AKI was 43.2% and the IRA with dialysis of 84.2%. In multivariate analysis, invasive mechanical ventilation, elevated creatinine and urea at admission were independent risk factors for AKI, whereas clinical diagnosis, invasive mechanical ventilation, increased lactate and urea and hypernatremia were independent risk factors for ICU mortality. Conclusion: The incidence and mortality of AKI in ICU were high in this study, despite the advances that have been emerging in their management. .

Nursing Activities Score and workload in the intensive care unit of a university hospital.

OBJECTIVE: The nursing workload consists of the time spent by the nursing staff to perform the activities for which they are responsible, whether directly or indirectly related to patient care. The aim of this study was to evaluate the nursing workload in an adult intensive care unit at a university hospital using the Nursing Activities Score (NAS) instrument. METHODS: A longitudinal, prospective study that involved the patients admitted to the intensive care unit of a university hospital between March and December 2008. The data were collected daily to calculate the NAS, the Acute Physiology and Chronic Health Evaluation (APACHE II), the Sequential Organ Failure Assessment (SOFA) and the Therapeutic Intervention Scoring System (TISS-28) of patients until they left the adult intensive care unit or after 90 days of hospitalization. The level of significance was set at 5%. RESULTS: In total, 437 patients were evaluated, which resulted in an NAS of 74.4%. The type of admission, length of stay in the intensive care unit and the patients' condition when leaving the intensive care unit and hospital were variables associated with differences in the nursing workload. There was a moderate correlation between the mean NAS and APACHE II severity score (r=0.329), the mean organic dysfunction SOFA score (r=0.506) and the mean TISS-28 score (r=0.600). CONCLUSION: We observed a high nursing workload in this study. These results can assist in planning the size of the staff required. The workload was influenced by clinical characteristics, including an increased workload required for emergency surgical patients and patients who died.

Nursing Activities Score e carga de trabalho em unidade de terapia intensiva de hospital universitário / Nursing Activities Score and workload in the intensive care unit of a university hospital

Objetivo: A carga de trabalho de enfermagem é constituída pelo tempo dispendido pela equipe de enfermagem para realizar as atividades de sua responsabilidade, relacionadas direta ou indiretamente ao atendimento do paciente. O objetivo deste estudo foi avaliar a carga de trabalho de enfermagem em uma unidade de terapia intensiva adulto de hospital universitário com o uso do instrumento Nursing Activities Score (NAS). Métodos: Estudo longitudinal, prospectivo, envolvendo pacientes admitidos na unidade de terapia intensiva de um hospital universitário no período de março a dezembro de 2008. Foram coletados dados para o cálculo do NAS, do Acute Physiology and Chronic Health Evaluation (APACHE II), do Sequential Organ Failure Assessment (SOFA) e do Therapeutic Intervention Scoring System (TISS-28), diariamente até a saída da unidade de terapia intensiva adulto ou 90 dias de internação. O nível de significância adotado foi de 5%. Resultados: Foram avaliados 437 pacientes, resultando em NAS de 74,4%. O tipo de internação, tempo de permanência na unidade de terapia intensiva e condição de saída do paciente da unidade de terapia intensiva e do hospital foram variáveis associadas a diferenças na carga de trabalho da enfermagem. Houve correlação moderada do NAS médio com o escore de gravidade APACHE II (r=0,329), com o escore de disfunção orgânica SOFA médio (r=0,506) e com o TISS-28 médio (r=0,600). Conclusão: Encontramos elevada carga de trabalho de enfermagem no estudo. Esse resultado pode subsidiar planejamento para dimensionamento da equipe. A carga de trabalho sofreu influência de caraterísticas clínicas, sendo observado aumento do trabalho nos pacientes cirúrgicos de urgência e nos não sobreviventes. .

Objective: The nursing workload consists of the time spent by the nursing staff to perform the activities for which they are responsible, whether directly or indirectly related to patient care. The aim of this study was to evaluate the nursing workload in an adult intensive care unit at a university hospital using the Nursing Activities Score (NAS) instrument. Methods: A longitudinal, prospective study that involved the patients admitted to the intensive care unit of a university hospital between March and December 2008. The data were collected daily to calculate the NAS, the Acute Physiology and Chronic Health Evaluation (APACHE II), the Sequential Organ Failure Assessment (SOFA) and the Therapeutic Intervention Scoring System (TISS-28) of patients until they left the adult intensive care unit or after 90 days of hospitalization. The level of significance was set at 5%. Results: In total, 437 patients were evaluated, which resulted in an NAS of 74.4%. The type of admission, length of stay in the intensive care unit and the patients' condition when leaving the intensive care unit and hospital were variables associated with differences in the nursing workload. There was a moderate correlation between the mean NAS and APACHE II severity score (r=0.329), the mean organic dysfunction SOFA score (r=0.506) and the mean TISS-28 score (r=0.600). Conclusion: We observed a high nursing workload in this study. These results can assist in planning the size of the staff required. The workload was influenced by clinical characteristics, including an increased workload required for emergency surgical patients and patients who died. .

Prevalência e fatores associados à doença periodontal em puérperas atendidas em maternidade pública em Londrina, Paraná / Prevalence and Factors Associated with Periodontal Disease in Postpartum Women from a Public Maternity of Londrina, Paraná State, Brazil

Estimar a prevalência e identificar fatores associados à doença periodontal em puérpera. Foramentrevistadas e examinadas 472 puérperas em maternidade pública do município de Londrina, Paraná,no período de junho a julho de 2009. Para o exame bucal e diagnóstico da doença periodontal utilizou-seo Índice Periodontal Comunitário, que foi realizado por três cirugiões-dentistas, previamente treinadose calibrados (kinter=0,87). A prevalência da doença periodontal foi de 41,1%. Entre a puérperas como agravo, 8,2% apresentaram sangramento gengival, 49,0% cálculo e 42,8% bolsa periodontal (4-5mm) como o pior resultado. O modelo final da Regressão de Poisson apontou associação (p<0,05) da doença periodontal entre as puérperas com 20 anos de idade ou mais, com baixa escolaridade (≤ 4 anos de estudo), sangramento gengival (autorreferido) anterior à gestação e hábito de fumar há mais de 10 anos. Os resultados reforçam a necessidade da melhoria no acesso ao atendimento odontológicopelo Sistema Único de Saúde, por meio de ações que promovam, previnam e recuperem a saúde bucal individual e coletiva, incluindo a atenção especializada de periodontia.

This study aimed to estimate the prevalence and related factors with periodontal disease in puerperalwomen. The study interviewed and examined 472 puerperal women in a public hospital at Londrina, Paraná, Brazil, during the period of June and July 2009. An oral examination was performed in order to diagnosis the periodontal disease using the The Community Periodontal Index, by three previously trained and calibrated dentists (kinter=0.87). Prevalence of periodontal disease was 41.1%. Amongthe puerperal women with the injury, 8.2% presented gingival bleeding, 49.0% calculus and 42.8% periodontal pocket (4-5mm) as the worst outcome. The final model of Poisson regression showed association (p<0.05) of periodontal disease with mother’s age (≥ 20 years old), schooling (≤ 4 years ofstudy), gingival bleeding (self-reported) prior to pregnancy and smoking habit for more than 10 years.The results reinforce the importance of improving access to dental care by Brazilian National Health Service, using measures of promotion, prevention and recovery of individual and collective oral health, with emphasis on specialized periodontics care.

Risk factors for foot ulcers--a cross sectional survey from a primary care setting in Brazil.

AIMS: To identify the prevalence of higher risk of foot ulceration and associated factors among patients with diabetes mellitus (DM) at primary health care services. METHODS: Individuals with DM, registered at primary health care services in a municipality in southern Brazil, were interviewed and underwent foot examinations. Their risk of ulceration was classified in accordance with the recommendations of the International Working Group on the Diabetic Foot. Poisson bivariate and multivariate analyses were performed and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. RESULTS: The prevalence of higher risk of foot ulceration among the 337 interviewees was 27.9% (95% CI 23.1-32.9). The following factors were associated with this risk: having been diagnosed with DM for more than 10 years (Adjusted-PR 1.669; 95% CI 1.175-2.373; p=0.004); having had previous diagnoses of acute myocardial infarction (Adjusted-PR 1.873; 95% CI 1.330-2.638; p<0.001) and stroke (Adjusted-PR 1.684; 95% CI 1.089-2.604; p=0.019); presenting interdigital mycosis (Adjusted-PR 1.539; 95% CI 1.030-2.300; p=0.035) and calluses (Adjusted-PR 1.654; 95% CI 1.117-2.451; p=0.012). CONCLUSIONS: The prevalence of higher risk of ulceration was high, which reinforces the importance of continued education for health care professionals in order to prevent complications in the feet of these patients.

Potential fate of ingested Lactobacillus plantarum and its occurrence in human feces.

Lactobacillus plantarum has been used in human clinical trials to promote beneficial effects in the immune system, to alleviate intestinal disorders, and to reduce the risk of cardiovascular disease. It is also involved in many fermentation processes in the food industry. However, information on the fate of ingested L. plantarum is limited. In this study, 61 subjects received daily doses of fermented milk containing 2 × 10(11) cells of L. plantarum Lp115 for different periods of time. The target microorganism was monitored in the fecal microbiota via quantitative PCR (qPCR). L. plantarum was detected and quantified in all of the subjects during the ingestion periods. The differences between the L. plantarum levels at time zero and during all the different ingestion periods were statistically significant (P = 0.001). However, at 15 and 45 days after discontinuing supplementation, the number of lactobacilli was reduced to the baseline level (those at time zero). A longer period with L. plantarum in the diet did not result in increased levels of this bacterium in the stool, based on postconsumption evaluations (P = 0.001). The qPCR method was specific and sensitive for L. plantarum quantification in such a complex microbial environment as the gastrointestinal tract.

Prevalência de fatores de risco cardiovascular em pessoas com 40 anos ou mais de idade, em Cambé, Paraná (2011): estudo de base populacional / Prevalence of cardiovascular risk factors in people aged 40 years or more from the city of Cambé, PR, Brazil (2011): a population-based study

Objetivo: estimar a prevalência de fatores de risco para doenças cardiovasculares segundo sexo e classe econômica. Métodos: estudo transversal de base populacional com indivíduos com 40 anos ou mais de idade, no município de Cambé, Estado do Paraná, Brasil; realizaram-se entrevistas domiciliares, aferições antropométricas e exames laboratoriais, no primeiro semestre de 2011; foram calculadas prevalências, razões de prevalências (RP) e intervalos de confiança de 95 por cento (IC95 por cento). Resultados: entrevistaram-se 1.180 pessoas; os fatores de risco com prevalência mais elevada foram inatividade física no lazer (71,4 por cento), sobrepeso/obesidade (68,3 por cento), hipertensão arterial (55,9 por cento) e baixo consumo de frutas (54,3 por cento) e verduras (35,5 por cento); a prevalência de sobrepeso/obesidade foi inferior entre homens, frente às mulheres (RP 0,82; IC95% 0,73-0,92); inatividade física no lazer, baixo consumo de frutas, verduras e legumes foram mais prevalentes entre homens e mulheres das classes socioeconômicas mais baixas. Conclusão: observaram-se elevadas prevalências de fatores de risco para doenças cardiovasculares, especialmente entre indivíduos menos favorecidos socioeconomicamente.

Objective: to estimate the prevalence of cardiovascular disease risk factors by sex and socioeconomic status. Methods: cross-sectional population-based representative sample of people aged 40 or older, living in Cambé-PR. Household interviews were conducted, collecting anthropometric measurements and laboratory tests in the first half of 2011. Prevalence, prevalence ratios (PR) and 95 por cento confidence intervals (95 per cent CI) were calculated. Results: 1,180people were interviewed. Most prevalent risk factors were physical inactivity during leisure (71.4 per cent), overweight/obesity (68.3 per cent), hypertension (55.9 per cent) and low consumption of fruit (54.3 per cent) and vegetables (35.5 per cent). Overweight/obesity prevalence was lower among men compared to women (PR 0.82, 95 per cent CI 0.73-0.92). Physical inactivity during leisure, as well as low fruit and vegetable consumption were more prevalent among men and women of lower socioeconomic classes. Conclusion: high cardiovascular disease risk factor prevalence was found, especially among individuals from lower socioeconomic classes.