Translation and cross-cultural adaptation of the Pediatric Confusion Assessment Method for the Intensive Care Unit into Brazilian Portuguese for the detection of delirium in pediatric intensive care units. / Tradução e adaptação transcultural para o Brasil do Pediatric Confusion Assessment Method for the Intensive Care Unit para detecção de delirium em unidades de terapia intensiva pediátrica.

OBJECTIVE: To undertake the translation and cross-cultural adaption into Brazilian Portuguese of the Pediatric Confusion Assessment Method for the Intensive Care Unit for the detection of delirium in pediatric intensive care units, including the algorithm and instructions. METHODS: A universalist approach for the translation and cross-cultural adaptation of health measurement instruments was used. A group of pediatric critical care specialists assessed conceptual and item equivalences. Semantic equivalence was evaluated by means of a translation from English to Portuguese by two independent translators; reconciliation into a single version; back-translation by a native English speaker; and consensus among six experts with respect to language and content understanding by means of Likert scale responses and the Content Validity Index. Finally, operational equivalence was assessed by applying a pre-test to 30 patients. RESULTS: The back-translation was approved by the original authors. The medians of the expert consensus responses varied between good and excellent, except for the feature "acute onset" of the instructions. Items with a low Content Validity Index for the features "acute onset" and "disorganized thinking" were adapted. In the pre-test, the expression "signal with your head" was modified into "nod your head" for better understanding. No further adjustments were necessary, resulting in the final version for Brazilian Portuguese. CONCLUSION: The Brazilian version of the Pediatric Confusion Assessment Method for the Intensive Care Unit was generated in agreement with the international recommendations and can be used in Brazil for the diagnosis of delirium in critically ill children 5 years of age or above and with no developmental cognitive disabilities.

Tradução e adaptação transcultural para o Brasil do Pediatric Confusion Assessment Method for the Intensive Care Unit para detecção de delirium em unidades de terapia intensiva pediátrica / Translation and cross-cultural adaptation of the Pediatric Confusion Assessment Method for the Intensive Care Unit into Brazilian Portuguese for the detection of delirium in pediatric intensive care units

RESUMO Objetivo: Traduzir e adaptar transculturalmente para o português do Brasil o instrumento Pediatric Confusion Assessment Method for the Intensive Care Unit para detecção de delirium em unidades de terapia intensiva pediátrica, incluindo algoritmo e instruções. Métodos: Utilizou-se a abordagem universalista para tradução e adaptação transcultural de instrumentos de aferição em saúde. Um grupo de especialistas em terapia intensiva pediátrica avaliou as equivalências conceitual e de itens. Em seguida, a avaliação da equivalência semântica consistiu de tradução do inglês para o português por dois tradutores independentes; conciliação em uma única versão; retradução por um nativo de língua inglesa; e consenso de seis especialistas quanto à compreensão de linguagem e de conteúdo, por meio de respostas do tipo Likert e Índice de Validade de Conteúdo. Finalmente, avaliou-se a equivalência operacional, aplicando-se um pré-teste em 30 pacientes. Resultados: A retradução foi aprovada pelos autores originais. As medianas das respostas do consenso variaram de boa a excelente, exceto na característica "início agudo" das instruções. Itens com Índice de Validade de Conteúdo baixo, relativos às características "início agudo" e "pensamento desorganizado", foram adaptados. No pré-teste, a expressão "acene com a cabeça" foi modificada para "balance a cabeça", para melhor compreensão. Não houve necessidade de outros ajustes, resultando na versão final para o português do Brasil. Conclusão: A versão brasileira do Pediatric Confusion Assessment Method for the Intensive Care Unit foi obtida segundo as recomendações internacionais, podendo ser utilizada no Brasil para o diagnóstico de delirium em crianças graves com 5 anos de idade ou mais, sem atraso de desenvolvimento cognitivo.

ABSTRACT Objective: To undertake the translation and cross-cultural adaption into Brazilian Portuguese of the Pediatric Confusion Assessment Method for the Intensive Care Unit for the detection of delirium in pediatric intensive care units, including the algorithm and instructions. Methods: A universalist approach for the translation and cross-cultural adaptation of health measurement instruments was used. A group of pediatric critical care specialists assessed conceptual and item equivalences. Semantic equivalence was evaluated by means of a translation from English to Portuguese by two independent translators; reconciliation into a single version; back-translation by a native English speaker; and consensus among six experts with respect to language and content understanding by means of Likert scale responses and the Content Validity Index. Finally, operational equivalence was assessed by applying a pre-test to 30 patients. Results: The back-translation was approved by the original authors. The medians of the expert consensus responses varied between good and excellent, except for the feature "acute onset" of the instructions. Items with a low Content Validity Index for the features "acute onset" and "disorganized thinking" were adapted. In the pre-test, the expression "signal with your head" was modified into "nod your head" for better understanding. No further adjustments were necessary, resulting in the final version for Brazilian Portuguese. Conclusion: The Brazilian version of the Pediatric Confusion Assessment Method for the Intensive Care Unit was generated in agreement with the international recommendations and can be used in Brazil for the diagnosis of delirium in critically ill children 5 years of age or above and with no developmental cognitive disabilities.

Prevalence of burnout in pediatric intensivists: an observational comparison with general pediatricians.

OBJECTIVE: To study the prevalence of burnout in general pediatricians and pediatric intensivists and to evaluate factors that may be associated with this syndrome. DESIGN: Observational cohort study. SETTING: Pediatric departments of two hospitals in south Brazil. PATIENTS: Pediatric intensivists working in two regional PICUs and general pediatricians working in the outpatient departments in the same hospitals. INTERVENTION: Two researchers, blinded to the workplace of the physicians, undertook the assessment of burnout using the Maslach Burnout Inventory scale. Burnout was defined as high score in the domains for "emotional exhaustion" or "depersonalization" or a low score in the "professional accomplishment" domain. MEASUREMENTS AND MAIN RESULTS: The PICU and general pediatrician groups were similar demographically, and each had 35 recruits. Burnout was present in 50% of the study recruits and was more frequent among pediatric intensivists than general pediatricians (71% vs 29%, respectively, p < 0.01). In regard to the individual Maslach Burnout Inventory domains, the average score was higher for emotional exhaustion and depersonalization and lower for professional accomplishment in the PICU group (p < 0.01). A cluster analysis showed that pediatric intensivists were more likely to develop the burnout syndrome involving all Maslach Burnout Inventory domains. The multivariate analysis found that the odds ratio for burnout in pediatric intensivists was 5.7 (95% CI, 1.9-16.7; p < 0.01). CONCLUSIONS: Burnout is frequent among pediatric intensivists and characterized by cumulative involvement of emotional exhaustion, depersonalization, and professional accomplishment. Earlier recognition of emotional exhaustion may be important in preventing the development of a complete burnout syndrome. Improvement in workplace characteristics and measures to improve physician resilience are entirely warranted.

Doença de Gaucher / Gaucher disease

A Doença de Gaucher é caracterizada por uma falta hereditária da enzima glicocrebrosidade que leva ao acúmulo de glicosilceramida nas células monocítico-fagocitárias do fígado e baço, principalmente. Devido aos constantes avanços na terapia desta doença, é feita uma abordagem clínica inicial e subsequente atualizaçãoquanto ao diagnóstico e tratamento. Os dados foram coletados através de análise de artigos e da rede internacional de computadores. Foi feita uma seleção da bibliografia, dando ênfaseaos diagnósticos, prognósticos e terapêuticos...

Doença de Chagas: revisäo de 8 casos simultâneos de miocardite aguda chagásica; 25 anos após / Chagas disease: review of 8 simultaneous cases of acute Chagas myocarditis; 25 years after

Objetivo - Relatar a evoluçäo de pacientes após 25 anos após uma miciroepidemia de doença de Chagas, surgida em Teotônia-RS em 1965 e discutir a importância da transnissäo via oral (VO) como porta de entrada. Métodos - Oito pacientes de um grupo de 17 pessoas acometidas de infecçäo chagásica aguda, em 1965, estäo fichadas no IC/FUC do RS com diagnóstico de doença de Chagas. Foram examinadas clinicamente e se submeteram a exames laboratoriais de rotina, provas específicas para o Trypanozoma cruzi, eletrocardiograma (ECG), radiografia de tórax (RX) e ecocardiograma (ECO) em 1991. Resultados - Nenhum dos 8 pacientes apresentou manifestaçöes orgânicas da doença de Chagas, os exames laboratoriais, ECG, RX e ECO foram normais. Na imunofluorescência somente um paciente apresentou indice 1/20. Conclusäo - 1) A evoluçäo dos oito casos nestes 25 anos foi benigna, näo apresentando nenhum sinal ou manifestaçäo orgânica de doença de Chagas e, especificamente, sem miocardiopatia; 2) a transmissäo VO deve ser considerada definitivamente como porta de entrada para a doença de Chagas e, provavelmente, influi na evoluçäo da fase crônica

Purpose - To analyse the evolution of 8 cases of Chagas' disease after a microepidemy of 17 cases which ocurred in Teotonia - RS - in 1965 and to discuss the importance of oral contamination in Chagas' disease. Methods - All 8 patients are followed at the IC/ FUC - RS - Brazil since 1980. Clinical examinations, blood tests, ECG, Cx-Ray and Echo were made in 1991. Results - None of the eight cases presented any sign of chronic Chagas' disease manifestation. The blood tests, ECG, Cx-Ray and Echo were normais. Only one case showed a imunofluorescence of 1/20. Conclusion - 1) The follow-up after 25 years in all the 8 cases did not show clinical alterations or any chronic manifestation of Chagas' disease. All the tests performed had normal results; 2) the oral transmission must be considered definitive in Chagas' disease