Cryolipolysis on More than One Body Area Increases Lipid Peroxidation without Changing Lipid Profile and Inflammatory Markers.

In the present study, the effects of cryolipolysis on one and multiple body areas, assessing body composition, lipid profile and peroxidation and inflammatory markers were investigated. Twenty-four women aged between 20 and 59 years were randomly assigned to three groups: (1) control, (2) cryolipolysis on the abdomen and (3) cryolipolysis on the abdomen + flanks. Anthropometric measurements, bioimpedance and ultrasound were performed, as well serum lipid profile, lipid peroxidation markers (malondialdehyde and myeloperoxidase) and inflammatory markers (C-reactive protein and Interleukin-1ß) were determined. In addition, food consumption and physical activity level were evaluated. Data were obtained at 0, 10 and 30 days (t0, t10 and t30) after cryolipolysis. Cryolipolysis did not change anthropometric measurements, body composition or lipid profile. Interestingly, the abdomen + flanks group had significantly increased plasma myeloperoxidase activity at t0, t10 and t30, and increased malondialdehyde levels at t0 and t10 when compared to the other groups. Furthermore, there were no differences between macronutrient intake and total energy value, physical activity level, malondialdehyde and interleukin-1ß at t30. Cryolipolysis did not change body composition, lipid profile or inflammatory markers investigated. On the other hand, when used on the abdomen and flanks, it produced an increase in lipid peroxidation markers, malondialdehyde and myeloperoxidase.

Enfermeiros e as práticas recomendadas no manejo de delirium: estudo transversal / Enfermeras y mejores prácticas en el manejo del delirio: estudio transversal / Nurses and the best practices in the management of delirium: cross-sectional study

Objetivos:descrever a concordância dos enfermeiros quanto à avaliação, diagnóstico e prevenção de delirium em uma Unidade de Terapia Intensiva e verificar a associação da concordância ao perfil sociodemográfico dos profissionais. Método:estudo transversal realizado nas Unidades de Terapia Intensiva geral e cardiológica de um hospital de alta complexidade, entre janeiro e fevereiro de 2018. Participaram 61 enfermeiros por meio de surveyeletrônica com dezessete questões, sendo excluídos os que estavam em férias ou licença médica durante a coleta de dados. Resultados:A mediana de afirmativas com alta concordância foi de 11 por profissional, com 64% da amostra obtendo baixa concordância. As afirmativas com melhor concordância incluíram fatores de risco, algoritmo de avaliação, atuação do enfermeiro e conhecimento sobre sinais da síndrome. Conclusão:Os enfermeiros apresentaram baixa concordância às diretrizes de melhores práticas no manejo do delirium e não foi encontrada associação entre a alta concordância e ascaracterísticas sociodemográficas

Objectives:to describe nurses' agreement to regarding the assessment, diagnosis and preventionof delirium in the Intensive Care Unit and to verify the association of agreement with the sociodemographic profile of professionals. Method:cross-sectional study carried out in the general and cardiac Intensive Care Units of a high-complexity hospital, between January and February 2018. Sixty one nurses participated in an electronic survey with seventeen questions, excluding those who were on vacation or sick leave during the data collection. Results:The median of statements with high agreement was 11 per professional, with 64% of the sample obtaining low agreement. The statements with the best agreement included risk factors, assessment algorithm, nurse's role and knowledge about signs of the syndrome. Conclusion:Nurses showed low agreement with the guidelines for best practices in the management of delirium and no association was found between high agreement and sociodemographic characteristics.

Objetivos:describir la concordancia de enfermeras sobre la evaluación, diagnóstico y prevencióndel delirio en la Unidad de Cuidados Intensivos y verificar la asociación de concordancia con el perfil sociodemográfico de los profesionales. Método:estudio transversal realizado en las Unidades de Cuidados Intensivos Generales y Cardíacos de un hospital de alta complejidad, entre enero y febrero de 2018. Participaron 61 enfermeras en una encuesta electrónica con diecisiete preguntas, excluyendo a las que se encontraban de vacaciones o baja laboral durante la recopilación de datos. Resultados:La mediana de enunciados con alta concordancia fue de 11 por profesional, con un 64% de la muestra obteniendo baja concordancia. Los enunciados con mejor concordancia incluyeron factores de riesgo, algoritmo de evaluación, rol de la enfermera y conocimiento sobre los signos del síndrome. Conclusión:las enfermeras mostraron bajo acuerdo con las guías de buenas prácticas en el manejo del delirio y no se encontró asociación entre alto acuerdo y características sociodemográficas

Efficacy and Safety of Regional Anticoagulation with 4% Trisodium Citrate Versus Heparin in Extended Hemodialysis among Critical Patients with Cancer and Acute Kidney Injury.

INTRODUCTION: Patients with cancer admitted to critical care units are at increased risk of being affected with acute kidney injury (AKI) and mortality. Sustained low-efficiency dialysis (SLED) combines the cardiovascular stability of continuous therapy with the operational facility of conventional hemodialysis (HD). Citrate has become an alternative to heparin in anticoagulation because it favors the maintenance of filter patency and reduces bleeding. We analyzed the efficacy and safety of citrate versus heparin use in extended HD for patients with cancer and AKI. METHODS: This retrospective cohort study evaluated patients with cancer and dialytic AKI who received SLED with anticoagulation using citrate versus heparin from January 2014 to June 2017. After stratifying patients by the type of anticoagulation received, we evaluated demographic and clinical data, plus SLED session characteristics. We also analyzed dialysis outcomes, including insufficient session time, hypotension, poor catheter flow, line inversion, and dialysis system coagulation. RESULTS: We identified 423 SLED sessions among 124 patients (41 patients in the heparin group and 83 patients in the citrate group). More sessions with citrate (26.6 vs. 40.9%, p < 0.001) had serum platelet concentrations <50,000/mm3 or <100,000/m3 and ionic calcium (Ca++) values <1.16 mmol/L (33.2 vs. 18.5%, p < 0.001). Dialysis intercurrence occurred in 27% of sessions. The highest odds were associated with heparin sessions (OR 2.88). Compared with the citrate group, the heparin group was subject to more dialysis system coagulation (12.3%), the need for line reversal (9.8%), and insufficient session time (23.9%). CONCLUSION: Citrate represents a safe and effective anticoagulant for SLED for cancer patients with AKI undergoing treatment in the intensive care unit.

A restrição da jornada de trabalho do médico e seu impacto na segurança do paciente: uma revisão integrativa / Physicians' working time restriction and its impact on patient safety: an integrative review

Introdução: Apesar da jornada de trabalho em regime de plantão ser marco da rotina do profissional médico, há controvérsias em relação à duração dos turnos, bem como aos intervalos de repouso apropriados que tornam a atividade desse profissional segura. Se, por um lado, jornadas longas de trabalho podem gerar impacto negativo à assistência segura do paciente por alterar o funcionamento psicológico e físico do profissional, por outro, a redução do tempo de jornada de trabalho pode prejudicar a segurança do paciente por reduzir a continuidade do cuidado. Objetivo: Avaliar o impacto da restrição da jornada de trabalho médico na segurança do paciente. Método: Estudo do tipo revisão integrativa da literatura. Foi realizado um levantamento das publicações relacionadas a restrições na jornada de trabalho do médico e à segurança do paciente disponíveis nas bases de dados National Library of Medicine (PubMed) e Scientific Electronic Library Online (SciELO) até maio de 2018. Foram selecionados 35 artigos que atenderam aos critérios de inclusão. Resultados: Os desfechos relacionados à segurança do paciente avaliados pelos estudos foram mortalidade, eventos adversos, continuidade do cuidado, complicações intra-hospitalares, taxa de readmissões e duração da internação. A restrição à jornada de trabalho gerou impacto variável quanto aos indicadores de segurança do paciente entre os estudos. No entanto, frequentemente não modificaram sua performance. Conclusão: As restrições à jornada de trabalho frequentemente não resultam em melhora da performance dos indicadores de segurança do paciente. O foco em intervenções com propósito único de limitar a carga de trabalho médico é insuficiente para gerar melhoras consistentes ao cuidado do paciente.

Background: Although shift work is a part of the physicians' routine, there is controversy on the length of shifts and adequate rest for safe professional practice. If on the one hand long working hours might have negative impact on patient safety by interfering with the psychological and physical functioning of physicians, on the other shorter working hours might impair the safety of patients due to interference with the continuity of care. Objective: To analyze the impact of restrictions to physicians' working hours on patient safety. Method: Integrative literature review in which we surveyed studies on restriction to physicians' working time and patient safety included in databases National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO) until May 2018. Thirty-five studies which met the inclusion criteria were included. Results: Patient safety outcomes analyzed in the included studies were mortality, adverse events, continuity of care, in-hospital complications, readmission rate and length of stay at hospital. Restriction to working time was associated with variable impact on patient safety indicators, but often did not modify their performance. Conclusion: Restrictions to physicians' working time did not always improved patient safety indicators. Focusing on interventions which only seek to limit the workload of physicians might be insufficient to bring consistent improvement to patient care