Conhecimento de enfemeiras sobre a criança com doença falciforme / Conocimiento de enfemeiras sobre el niño con enfermedad falciforme / Knowledge of nurses about children with sickle cell disease

Objetivo: conhecer a percepção das enfermeiras sobre a criança com doença falciforme. Método: pesquisa qualitativa Convergente-Assistencial, ocorrida em hospital público pediátrico, da qual participaram 12 enfermeiras da emergência no período de julho de 2020 a abril de 2021, após submissão ao Comitê de Ética. As técnicas de coleta de dados foram: sondagem do conhecimento por entrevista semiestruturada, grupos de convergência e observação participante. Os dados foram analisados conforme referencial da Pesquisa Convergente-Assistencial e suas fases, sendo elas concepção, instrumentalização, teorização, transferência e análise. Resultados: as enfermeiras reconheceram a doença pela principal manifestação clínica, a crise álgica, a qual foi citada como característica marcante da criança com doença falciforme. Considerações finais: as enfermeiras atuantes na emergência pediátrica conhecem alguns aspectos da doença falciforme e revelaram conhecimento incipiente sobre a fisiopatologia da doença.

Objetivo: conocer la percepción de las enfermeras sobre el niño con enfermedad falciforme. Método: Investigación cualitativa Convergente-Asistencial, ocurrida en hospital público pediátrico, de la cual participaron 12 enfermeras de la emergencia en el período de julio de 2020 a abril de 2021, tras sumisión al Comité de Ética. Las técnicas de recolección de datos fueron: sondeo del conocimiento por entrevista semiestructurada, grupos de convergencia y observación participante. Los datos fueron analizados conforme referencial de la Investigación Convergente-Asistencial y sus fases, siendo ellas concepción, instrumentalización, teorización, transferencia y análisis. Resultados: las enfermeras reconocieron la enfermedad por la principal manifestación clínica, la crisis álgica, la cual fue citada como característica distintiva del niño con enfermedad falciforme. Consideraciones finales: las enfermeras que actúan en la emergencia pediátrica conocen algunos aspectos de la enfermedad falciforme y revelaron conocimiento incipiente sobre la fisiopatología de la enfermedad.

Objective: to know the perception of nurses about the child with sickle cell disease. Method: qualitative Convergent-Care research, occurred in a public pediatric hospital, in which 12 emergency nurses participated from July 2020 to April 2021, after submission to the Ethics Committee. The data collection techniques were: survey of knowledge by semi-structured interview, convergence groups and participant observation. The data were analyzed according to the referential of the Convergent-Care Research and its phases, being them conception, instrumentalization, theorization, transfer and analysis. Results: the nurses recognized the disease by the main clinical manifestation, the pain crisis, which was cited as a striking characteristic of the child with sickle cell disease. Final considerations: the nurses working in the pediatric emergency know some aspects of sickle cell disease and revealed incipient knowledge about the pathophysiology of the disease.

Pediatric triage modifications based on vital signs: a nationwide study.

OBJECTIVE: To analyze the clinical significance of a heart rate (HR) or respiratory rate (RR) higher or lower than the normal in pediatric triage. METHODS: A retrospective observational study was conducted with data from the Korean National Emergency Department Information System. The subjects were children <15 years of age in 2016. Reported HRs and RRs were divided into seven groups: grade -3 (3 or more standard deviations [SDs]normal), grade 2 (2 SDs>normal), and grade 3 (3 or more SDs>normal). The main outcomes were hospitalization and intensive care unit (ICU) admission rates. Logistic regression analysis was used to analyze the relationship of the outcomes according to grade in each group. RESULTS: Data for 981,297 patients were analyzed. Hospitalization and ICU admission rates increased significantly in the higher HR group (grades 1 to 3; odds ratio [OR], 1.353; P<0.001; OR, 1.747; P<0.001; respectively) and in the higher RR group (OR, 1.144; P<0.001; OR, 1.396; P<0.001; respectively), compared with grade 0 group. In the lower HR group (grades -1 to -3), the hospitalization rate decreased (OR, 0.928; P<0.001), whereas the ICU admission rate increased (OR, 1.207; P=0.001). Although the hospitalization rate increased. In the lower RR group (OR, 1.016; P=0.008), the ICU admission rate did not increase (OR, 0.973; P=0.338). CONCLUSION: Deviations in HR and RR above normal are related to increased risks of hospitalization and ICU admission. However, this association may not apply to deviations below normal.

Perfil de pacientes com infarto agudo do miocárdio em um pronto socorro do distrito federal / Perfil de los pacientes con infarto agudo de miocardio en una urgencias del distrito federal / Profile of patients with acute myocardial infarction in an emergency room of the federal district

Objetivo: identificar o perfil sociodemográfico, epidemiológico, clínico e os desfechos dos pacientes com infarto agudo do miocárdio em um pronto socorro. Método: estudo descritivo, transversal, quantitativo, realizado através de dados secundários de pacientes infartados. Resultados: a idade predominante foi entre 50-59 anos, sendo em sua maioria homens, pardos, casados. Foram acometidos com infarto com Supradesnivelamento de ST, apresentando precordialgia, sendo hipertensos, diabéticos, com sobrepeso/obesidade além de histórico de tabagismo. Os infartados apresentaram quadro hipertensivo na admissão, e durante a internação necessitaram de drogas vasoativas e suporte de oxigênio. O principal tratamento utilizado foi uso de fibrinolíticos, tendo como desfecho a transferência para hospitais cardiológicos. Conclusão: Há necessidade de aprimorar e intensificar a prevenção de fatores de riscos, elaborar protocolos e dispor de recursos capazes de proporcionar um atendimento adequado(AU)

Objective: to identify the sociodemographic, epidemiological, clinical profile and outcomes of patients with acute myocardial infarction in an emergency department. Method: descriptive, cross-sectional, quantitative study carried out using secondary data from infarcted patients. Results: the predominant age was between 50-59 years, being mostly men, brown, married. They were affected with infarction with ST elevation, presenting chest pain, being hypertensive, diabetic, overweight/ obese, in addition to a history of smoking. The infarcted patients presented with hypertension on admission, and during hospitalization they required vasoactive drugs and oxygen support. The main treatment used was the use of fibrinolytics, with the outcome being transfer to cardiology hospitals. Conclusion: There is a need to improve and intensify the prevention of risk factors, develop protocols and have resources capable of providing adequate care.(AU)

Objetivo: identificar el perfil sociodemográfico, epidemiológico, clínico y evolución de los pacientes con infarto agudo de miocardio en un servicio de urgencias. Método: estudio descriptivo, transversal, cuantitativo, realizado con datos secundarios de pacientes infartados. Resultados: la edad predominante fue entre 50-59 años, siendo en su mayoría hombres, morenos, casados. Se encontraban afectados de infarto con elevación del segmento ST, presentaban dolor torácico, eran hipertensos, diabéticos, con sobrepeso/obesidad, además de antecedentes de tabaquismo. Los pacientes infartados presentaban hipertensión arterial al ingreso y durante la hospitalización requirieron fármacos vasoactivos y soporte de oxígeno. El principal tratamiento utilizado fue el uso de fibrinolíticos, con resultado de traslado a hospitales de cardiología. Conclusión: Existe la necesidad de mejorar e intensificar la prevención de los factores de riesgo, desarrollar protocolos y contar con recursos capaces de brindar una atención adecuada(AU)

Drastic Reduction Inpatient Visits to the Emergency Department in a Hospital in Israel During the COVID-19 Outbreak, Compared to the H1N1 2009.

BACKGROUND: On February 26, 2020, the first case of coronavirus disease 2019 (COVID-19) was detected in Israel. The Ministry of Health (MoH) instructed people to take isolation measures and restrict their movement. Similarly, there was a gradual decrease in the number of visits to our emergency department (ED). OBJECTIVES: To describe the decline in the referrals to the ED and in-hospital beds occupancy during the COVID-19 pandemic and to compare it to the H1N1 2009 pandemic. METHODS: Employing a cross-sectional epidemiologic study, the pattern of visits to the ED during the COVID-19 was compared with the pattern of visits during the 2009 H1N1 pandemic, as well as a year without a pandemic. The data was adjusted to consider changes in population size. The Welch t test for unpaired, unequal samples was used to analyze the data. RESULTS: Within 2 months of the COVID-19 outbreak, the average number of visits to the ED dropped by 30.2% and the hospital occupancy by 29.2% (a minimum of 57%), compared to the same period, the year before. In comparison to the same period during the H1N1 outbreak, we witnessed a significant decline in the number of visits to the ED during the COVID-19 outbreak. CONCLUSION: The behavior of people during the COVID-19 pandemic was different from their behavior during the H1N1 pandemic. People seemed to avoid visiting the ED. The boundary between precaution and panic in the generation of the media could be very thin. Decision-makers must take this into account.

Epidemiological Study of Violence against Children and Its Increase during the COVID-19 Pandemic.

The aim of this study was to identify the epidemiological profiles of violence against children, victims, and their aggressors, and their correlations between socioeconomic and demographic factors analyzed before and during the COVID-19 pandemic. This was a cross-sectional, retrospective observational study based on a review of Individual Notification Forms from the Information System for Notifiable Diseases, including child victims of violence, under 18 years, assisted by a pediatric emergency service in Brazil, from 2016-2020. Data were stratified, then statistical analysis was performed using the two-proportion equality test and the Chi-square test, with p < 0.05 and a 95% confidence interval. A total of 609 notifications were analyzed and a prevalence of sexual violence (63.2%) was reported. The prevalent profile of victim was female (76.7%), aged between 2-9 years (38.1%) and 14-18 years (35.6%). The violence occurs in the victim's home (58.9%). The prevalent profile of perpetrator was male (82.4%), young adolescent (59.2%), living as family (64%), mainly the parents (18.4%). No correlation was found between the classified socioeconomic and demographic variables and violence. There was an increase in notifications during the COVID-19 pandemic, compared to the same period in the previous year; self-harm was reported in 59.7% of physical violence in 2020. Prevalence of sexual violence was higher for females, aged between 2-9 and 14-18 years, victimized in their homes, by male offenders, living as family, mainly by their parents. No association was found between child violence and the socioeconomic and demographic.

VALIDITY OF THE INSTRUMENT interRAI EMERGENCY SCREENER FOR PSYCHIATRY FOR THE BRAZILIAN CONTEXT

Objective: The aim of this study was to carry out the translation and present the evidence of validity of the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP). Method: this is a cross-sectional study conducted in a municipal hospital in the metropolitan region of Porto Alegre, Rio Grande do Sul. A total of 161 patients were evaluated in the first 24 hours of emergency arrival using ESP. Exploratory factor analyses of the sections of the instrument and reliability analyses were conducted using Cronbach's alpha and McDonald's Omega. Results: the analyses suggested an appropriate structure to the purpose of the instrument, two sections containing two factors instead of the expected one-dimensional structure. However, sections with two factors have interpretability and theoretical consistency. The factors presented internal consistency. Conclusion: the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP) demonstrates adequate psychometric properties through the internal structure of the instrument. Future studies should investigate the relationship of the scores produced by the instrument with clinical diagnosis and with covariates relevant to mental health outcomes.

Objetivo: El objetivo de este estudio era realizar la traducción y presentar la evidencia de validez del examinador de emergencia interRAI para psiquiatría (ESP). Método: se trata de una encuesta transversal realizada en un hospital municipal de la región metropolitana de Porto Alegre, Rio Grande do Sul. Un total de 161 pacientes fueron evaluados en las primeras 24 horas de llegada de emergencia utilizando ESP. Los análisis exploratorios de factores de las secciones del instrumento y los análisis de fiabilidad se llevaron a cabo utilizando Cronbach's alpha y McDonald's Omega. Resultados: los análisis sugirieron una estructura adecuada a los propósitos del instrumento, dos secciones que contienen dos factores en lugar de la estructura unidimensional esperada. Sin embargo, las secciones con dos factores tienen interpretabilidad y consistencia teórica. Los factores presentaron consistencia interna. Conclusión: la versión brasileña del Examinador de Emergencia InterRAI para Psiquiatría (ESP) demuestra propiedades psicométricas adecuadas a través de la estructura interna del instrumento. Los estudios futuros deben investigar la relación de las puntuaciones producidas por el instrumento con el diagnóstico clínico y con covariables relevantes para los resultados de salud mental.

Objetivo: O objetivo do estudo foi realizar a tradução e apresentar as evidências de validade do interRAI Emergency Screener for Psychiatry (ESP). Método: trata-se de uma pesquisa transversal realizada em um hospital municipal da região metropolitana de Porto Alegre, Rio Grande do Sul. Foram avaliados 161 pacientes nas primeiras 24 hs da chegada a emergência utilizando o ESP. Foram conduzidas análises fatoriais exploratórias das seções do instrumento e análises de fidedignidade por meio do alfa de Cronbach e Ômega de McDonald. Resultados: as análises sugeriram uma estrutura adequada ao propósito do instrumento, sendo duas seções contendo dois fatores ao invés da estrutura unidimensional esperada. Contudo, as seções com dois fatores possuem interpretabilidade e consistência teórica. Os fatores apresentaram consistência interna. Conclusão: a versão brasileira do interRAI Emergency Screener for Psychiatry (ESP) demonstra adequadas propriedades psicométricas por meio da estrutura interna do instrumento. Estudos futuros deverão investigar a relação dos escores produzidos pelo instrumento com diagnóstico clínico e com covariáveis relevantes para os desfechos de saúde mental.

Expedited and Comprehensive Management of Low-Risk TIA Patients in the Emergency Department is Safe and Less Costly.

OBJECTIVES: Transient ischemic attack (TIA) can be a warning sign of an impending stroke. The objective of our study is to assess the feasibility, safety, and cost savings of a comprehensive TIA protocol in the emergency room for low-risk TIA patients. MATERIALS AND METHODS: This is a retrospective, single-center cohort study performed at an academic comprehensive stroke center. We implemented an emergency department-based TIA protocol pathway for low-risk TIA patients (defined as ABCD2 score < 4 and without significant vessel stenosis) who were able to undergo vascular imaging and a brain MRI in the emergency room. Patients were set up with rapid outpatient follow-up in our stroke clinic and scheduled for an outpatient echocardiogram, if indicated. We compared this cohort to TIA patients admitted prior to the implementation of the TIA protocol who would have qualified. Outcomes of interest included length of stay, hospital cost, radiographic and echocardiogram findings, recurrent neurovascular events within 30 days, and final diagnosis. RESULTS: A total of 138 patients were assessed (65 patients in the pre-pathway cohort, 73 in the expedited, post-TIA pathway implementation cohort). Average time from MRI order to MRI end was 6.4 h compared to 2.3 h in the pre- and post-pathway cohorts, respectively (p < 0.0001). The average length of stay for the pre-pathway group was 28.8 h in the pre-pathway cohort compared to 7.7 h in the post-pathway cohort (p < 0.0001). There were no differences in neuroimaging or echocardiographic findings. There were no differences in the 30 days re-presentation for stroke or TIA or mortality between the two groups. The direct cost per TIA admission was $2,944.50 compared to $1,610.50 for TIA patients triaged through the pathway at our institution. CONCLUSIONS: This study demonstrates the feasibility, safety, and cost-savings of a comprehensive, emergency department-based TIA protocol. Further study is needed to confirm overall benefit of an expedited approach to TIA patient management and guide clinical practice recommendations.

Emergency physicians' role in telemedicine care during the coronavirus disease pandemic: Experiences from Taiwan.

Taiwan's response to the coronavirus disease pandemic received international recognition. Among various epidemic control measures, telemedicine services are provided for people under home quarantine. Although this service presents no policy, cost or equipment problems, the medical needs of people under home quarantine are diverse. Further, there are no clear guidelines regarding which specialists should be included in a multidisciplinary team. Moreover, many physicians are unwilling to participate in telemedicine, creating a big challenge for hospitals providing these services. Emergency physicians (EPs) have unique experiences in crisis management and can provide a number of effective public health measures. We advocate that EPs should be the first specialists to contact patients in a multidisciplinary team. Currently, there is a lack of literature on this subject, and Taiwan's epidemic control experience is used as an example to prove our viewpoint and provide recommendations for future EPs.

Vivências de enfermeiros e médicos de unidades de pronto atendimento no enfrentamento da covid-19 / Experiencias de enfermeros y médicos de unidades de urgencias en el enfrentamiento del covid-19 / Experiences of nurses and doctors of emergency care units in coping with covid-19

Objetivo: descrever vivências de enfermeiros e médicos de Unidades de Pronto Atendimento no enfrentamento da pandemia da Covid-19. Método: estudo descritivo-exploratório de abordagem qualitativa, realizado com sete médicos e sete enfermeiros atuantes em duas Unidades de Pronto Atendimento, referência para Covid-19. As entrevistas ocorreram entre setembro e novembro de 2020 e foram guiadas por questionário semiestruturado. Os depoimentos foram gravados, transcritos e submetidos a Análise de Conteúdo. Resultados: surgiram duas categorias de análise: "A gente se sente esgotado": a vivência de enfermeiros e médicos e Estratégias para enfrentar os percalços no contexto da pandemia. Considerações finais: os profissionais vivenciaram diversos desafios, como falta de protocolo institucional, falta de estrutura física, material, recursos humanos e capacitação, dificuldade para sensibilizar a população e preocupação de contaminar-se e contaminar a família. Entretanto, apoiaram-se em diferentes estratégias, como autoisolamento preventivo, apoio familiar, troca de experiências com outros profissionais e manter-se atualizado sobre a doença.

Objetivo: describir las experiencias de enfermeros y médicos de Unidades de Urgencias en el enfrentamiento de la pandemia de Covid-19. Método: estudio descriptivo-exploratorio con abordaje cualitativo, realizado con siete médicos y siete enfermeros que trabajan en dos Unidades de Urgencias, referencia para Covid-19. Las entrevistas tuvieron lugar entre septiembre y noviembre de 2020 y se guiaron por un cuestionario semiestructurado. Las declaraciones fueron grabadas, transcritas y sometidas a Análisis de Contenido. Resultados: surgieron dos categorías de análisis: "Nos sentimos agotados": la experiencia de enfermeros y médicos y Estrategias para enfrentar los percances en el contexto de la pandemia. Consideraciones finales: los profesionales experimentaron varios desafíos, como la falta de protocolo institucional, la falta de estructura física, material, recursos humanos y capacitación, la dificultad para sensibilizar a la población y la preocupación por contaminar a sí mismo y a la familia. Sin embargo, se apoyaron en diferentes estrategias, como el autoaislamiento preventivo, el apoyo familiar, el intercambio de experiencias con otros profesionales y mantenerse al día sobre la enfermedad.

Objective: to describe experiences of nurses and doctors of Emergency Care Units in coping with the Covid-19 pandemic. Method: descriptive-exploratory study with a qualitative approach, conducted with seven doctors and seven nurses working in two Emergency Care Units, reference for Covid-19. The interviews took place between September and November 2020 and were guided by a semi-structured questionnaire. The statements were recorded, transcribed and submitted to Content Analysis. Results: two categories of analysis emerged: "We feel exhausted": the experience of nurses and doctors and Strategies to face the mishaps in the pandemic context. Final considerations: the professionals experienced several challenges, such as lack of institutional protocol, lack of physical structure, material, human resources and training, difficulty in sensitizing the population and concern to contaminate oneself and the family. However, they relied on different strategies, such as preventive self-isolation, family support, exchange of experiences with other professionals and keeping up to date on the disease.

Vítimas com traumatismo cranioencefálico na sala de emergência e fator associado à permanência no setor / Víctimas con traumatismo craneoencefálico en urgencias y factor asociado a permanencia en el sector / Victims with traumatic brain injury in the emergency room and factor associated with permanence in the sector

Objetivo: analisar a evolução das vítimas de traumatismo cranioencefálico contuso na sala de emergência e identificar fatores independentes para tempo de permanência nesse serviço. Método: coorte prospectiva que incluiu todas as vítimas que atenderam aos critérios de elegibilidade e foram admitidas entre julho e dezembro de 2017 em hospital referência para trauma. Foi aplicado o Rapid Emergency Medicine Score para identificar a evolução das vítimas até 6 horas após admissão e aplicadas estatísticas descritivas e análise bivariada. Resultados: entre a admissão e 2 horas, foram observadas mudanças desfavoráveis em 35,1% das vítimas, entre 2-4 horas em 13,6% e entre 4-6 horas, em 42,8%; foi observada melhora entre 27% e 28,6% da casuística. Suporte hemodinâmico foi fator independente para tempo de permanência. Conclusão: a evolução desfavorável foi mais frequente entre a admissão e 2 horas e após 4 horas. A maior permanência na sala de emergência ocorreu em vítimas com suporte hemodinâmico.

Objetivo: analizar la evolución de las víctimas de traumatismo craneoencefálico contundente en la sala de urgencias e identificar factores independientes para la duración de la estancia en este servicio. Método: cohorte prospectiva que incluyó a todas las víctimas que cumplieron con los criterios de elegibilidad y estuvieron ingresadas entre julio y diciembre de 2017 en un hospital de referencia por traumatismo. Se aplicó el Rapid Emergency Medicine Score para identificar la evolución de las víctimas hasta 6 horas después del ingreso y se aplicó estadística descriptiva y análisis bivariado. Resultados: entre el ingreso y 2 horas, se observaron cambios desfavorables en 35,1% de las víctimas, entre 2-4 horas en 13,6% y entre 4-6 horas, en 42,8%; se observó mejoría entre el 27% y el 28,6% de la muestra. El soporte hemodinámico fue un factor independiente para la duración de la estancia. Conclusión: la evolución desfavorable fue más frecuente entre el ingreso y 2 horas y después de 4 horas. La estancia más larga en la sala de urgencias ocurrió en víctimas con soporte hemodinámico.

Objective: analyzing the evolution of victims of blunt traumatic brain injury in the emergency room and identifying independent factors for length of stay in this service. Method: a prospective cohort that included all victims who met the eligibility criteria and were admitted between July and December 2017 in a reference hospital for trauma. The Rapid Emergency Medicine Score was applied to identify the evolution of the victims up to 6 hours after admission and descriptive statistics and bivariate analysis were applied. Results: between admission and 2 hours, unfavorable changes were observed in 35.1% of the victims, between 2-4 hours in 13.6% and between 4-6 hours, in 42.8%; improvement was observed between 27% and 28.6% of the sample. Hemodynamic support was an independent factor for length of stay. Conclusion: unfavorable evolution was more frequent between admission and 2 hours and after 4 hours. The longest stay in the emergency room occurred in victims with hemodynamic support.

Preanalytical errors in emergency department samples: Investigating error sources.

BACKGROUND: The presence of preanalytical errors is a recurring fact in all areas of healthcare that send samples to laboratories. Increasing the knowledge of possible sources of error in the preanalytical phase has been the objective of this group during the last 10 years. METHODS: In this study, descriptive research has been carried out using professionals' opinions obtained by means of the Strengths, Weaknesses, Opportunities, and Threats method in a focus group. RESULTS: The opinions expressed within the focus group have emphasised the importance of patients' safety and willingness for the introduction of a computerized analytical module. The most commented weakness in both hospitals was the transport of samples through the pneumatic tube. Improving the duration of workers' contracts, especially in the laboratory, and creating a circuit for professional's localization during the work shift to facilitate potential error solving are some opportunities for the future. CONCLUSIONS: Different approaches have been developed depending on the healthcare scenario. For this, establishing a flow of information between the different professionals allows identifying identical aspects through a priori, different points of view. The line to follow is to improve the safety of the patient and also to give professionals an opportunity to express themselves.

Nursing Students' Experiences of Clinical Practices in Emergency and Intensive Care Units.

Clinical practices are key environments for skill acquisition during the education of nursing students, where it is important to encourage reflective learning. This study sought to explore the experience of final year nursing students during their clinical placement in emergency and intensive care units and to identify whether differences exist between female and male students. Using qualitative methodology, a documentary analysis of 28 reflective learning journals was carried out at a public university in Northern Spain. Four themes were identified: "an intense emotional experience", "the importance of attitudes over and above techniques", "identifying with nurses who dominate their environment and are close to the patient in complex and dehumanized units" and "how to improve care in critically ill patients and how to support their families". The female students displayed a more emotional and reflective experience, with a strong focus on patient care, whereas male students identified more with individual aspects of learning and the organization and quality of the units. Both male and female students experienced intense emotions, improved their learning in complex environments and acquired attitudes linked to the humanization of care. However, the experience of these clinical rotations was different between female and male students.

[Children's consultations for dental emergency. Retrospective study in Île-de-France]. / Consultations pour urgence bucco-dentaire chez les enfants : étude rétrospective en Île-de-France.

BACKGROUND: In France, the children oral health status has improved but the use of care remains insufficient. The complexity of the acts, the access to care difficulties and the programs of prevention and care for children lack of knowledge contribute to late care and often, in emergency. This study aims to describe the young patients' characteristics consulting in dental emergency and analyse the modalities of recourse. METHODS: A retrospective study was conducted on medical records. An extraction of data was carried out concerning all children under the age of 16, admitted to the Dental Emergency Functional Unit of the Pitié-Salpêtrière Hospital Group in 2015. Several variables of interest were analysed: socio-demographic characteristics, the time of the visit and the diagnostic category (tooth pathologies, facial trauma, infections, periodontal diseases and other emergencies). Descriptive and bivariate analyses were conducted. RESULTS: On the 62,500 dental emergency consultations in 2015, 5359 were for patients under 16 years of age (8%). Data were available for 5044 children. Among these, children aged 6 to 11 accounted most of consultations (43.9%). There were more boys (57.2%). The most frequent emergency diagnoses were related to a tooth pathology (42.9%) and traumatic event (38.4%). Consultations were more held on the evening schedule on weekdays and the day on weekends. Patients aged 0 to 5 years consulted more at night (P<10-3) and were, proportionally, the most affected by traumatic events (39.2%). Children aged 6 to 11 and 12 to 16 years consulted more often during the day (P<10-3), for emergencies related to a carious event (43.9% and 43.6%). Patients residing in Seine-Saint-Denis accounted for 22.6% of total visits and those living in Paris accounted for 20.8%. CONCLUSION: A large proportion of children presenting for dental emergencies, have most of the time, only the need for usual care. An offer of dental care, adapted to the territory needs, is necessary for the children dental health management. Preventive measures from an early age and early recourse would be favourable.

Sepse: avaliação da qualidade do atendimento em setor de urgência e emergência / Sepsis: assessment of healthcare quality in an urgency and emergency unit

Introduction:Sepsis is a serious condition caused by unregulated immune response to an infection and is considered one of the leading causes of death worldwide. Objective:To assess the quality of care provided to septic patients in the emergency unit ofa university hospital, according to the guidelines provided by the Surviving Sepsis Campaign. Methods:Longitudinal study conducted with septic patients in an emergency unit. Data were collected from sepsis notifications and medical records. The statistical analysis was performed by measures of central tendency and binary logistic regression. Results:We assessed 139 patients from the Surviving Sepsis Campaign perspective. The adequacy of the behaviors related to the performance of exams reached 64.2% for lactate, and 55.3% for blood cultures. In the first hour, 49.6% of the patients had received antimicrobial therapy. There was no compliance with the treatment for hypotension and hyperlactatemia in 69.8% of cases. Mortality reached 61.2% of the cases, and the associated risk factors were: multiple organ dysfunctions; high APACHE II and SOFA scores; hyperlactatemia; and mechanical ventilation. Conclusion:Care provided to patients with sepsis in the emergency unit followed most Surviving Sepsis Campaign guidelines; however, it is possible to increase compliance with the recommendations, thus resulting in better prognoses.

Introdução: A sepse é uma condição grave causada por resposta imune desregulada a uma infecção e é considerada uma das principais causas de morte no mundo.Objetivo:Avaliar a qualidade do atendimento ao paciente séptico no setor de urgência e emergência de um hospital universitário, conforme as diretrizes preconizadas pela Surviving Sepsis Campaign. Métodos:Estudo longitudinal, realizado com pacientes sépticos em um setor de urgência e emergência. Os dados foram coletados nas notificações de sepse e prontuários. A análise estatística foi realizada por medidas de tendência central e regressão logística binária. Resultados: Foram avaliados 139 pacientes na perspectiva da Surviving Sepsis Campaign. A adequação das condutas relacionadas às coletas de exames atingiu 64,2% para o lactato e 55,3% para hemoculturas. Receberam terapia antimicrobiana na primeira hora 49,6% dos pacientes. Não houve adesão ao tratamento da hipotensão e hiperlactatemia em 69,8% dos casos. A mortalidade atingiu 61,2% dos casos e os fatores de risco associados foram: múltiplas disfunções orgânicas; pontuação elevada nos escores APACHE II e SOFA; hiperlactatemia; e ventilação mecânica. Conclusão: O atendimento ao paciente com sepse no setor de urgência e emergência seguiu a maioria das diretrizes da Surviving Sepsis Campaign;porém, é possível aumentar a adesão às recomendações, resultando em melhores prognósticos.

Use of Emergency Departments by Frail Elderly Patients: Temporal Patterns and Case Complexity.

Emergency department (ED) care for frail elderly patients is associated with an increased use of resources due to their complex medical needs and frequently difficult psycho-social situation. To better target their needs with specially trained staff, it is vital to determine the times during which these particular patients present to the ED. Recent research was inconclusive regarding this question and the applied methods were limited to coarse time windows. Moreover, there is little research on time variation of frail ED patients' case complexity. This study examines differences in arrival rates for frail vs. non-frail patients in detail and compares case complexity in frail patients within vs. outside of regular GP working hours. Arrival times and case variables (admission rate, ED length of stay [LOS], triage level and comorbidities) were extracted from the EHR of an ED in an urban German teaching hospital. We employed Poisson time series regression to determine patterns in hourly arrival rates over the week. Frail elderly patients presented more likely to the ED during already high frequented hours, especially at midday and in the afternoon. Case complexity for frail patients was significantly higher compared to non-frail patients, but varied marginally in time only with respect to triage level and ED LOS. The results suggest that frailty-attuned emergency care should be available in EDs during the busiest hours. Based on EHR data, hospitals thus can tailor their staff needs.

Percepções da equipe de enfermagem de uma Unidade de Pronto Atendimento sobre urgência e emergência / Perceptions of the nursing team in an Emergency Care Unit on urgency and emergency

Objetivo: conhecer as percepções da equipe de enfermagem de um Pronto Atendimento sobre o atendimento de Urgência e Emergência. Metodologia: exploratório-descritivo de abordagem qualitativa. O cenário da pesquisa foi a Unidade de Pronto Atendimento de Gravataí, Rio Grande do Sul. Os participantes da pesquisa foram integrantes da equipe de enfermagem que atuam nesta instituição. A coleta de dados ocorreu por meio de entrevista. Foi realizada análise do conteúdo. Resultados: emergiram as categorias: Conhecimento sobre Urgência e Emergência, Processo de trabalho e Questões gerenciais. Evidenciou-se que os profissionais percebem as unidades de pronto atendimento como locais de extrema importância no que se refere ao atendimento rápido e resolutivo nos casos de urgência e emergência, mas deixam claro, a forma equivocada, na qual as unidades vêm sendo utilizadas como porta de entrada para casos que poderiam ser atendidos nas unidades básicas de saúde. Considerações finais: destacou-se o importante papel dos serviços de urgência e emergência. É indispensável a qualificação do fluxo de encaminhamentos, bem como a melhoria do contexto organizacional.

Objectives: to know the perception of the nursing team of Emergency Service on Emergency and Emergency care. Methodology: it is an exploratory-descriptive qualitative approach. The research scenario was the Gravataí Emergency Care Unit, Rio Grande do Sul. The research participants were members of the nursing team that work at this institution. The data collection took place through an interview. Content analysis was performed. Results: categories emerged were: Knowledge about Emergency and Emergency, Work process and Management issues. It was evidenced that the professionals perceive the units of prompt service as places of extreme importance so that the patient has a fast and decisive attention in cases of urgency and emergency, but they make it clear, the mistaken form, that the units are being used as door of cases that could be taken care of in basic health units. Consideration finales: the important role of emergency and emergency services was highlighted. It is indispensable the qualification of the flow of referrals as well as the improvement of the organizational context.

Improving the Prediction of Emergency Department Crowding: A Time Series Analysis Including Road Traffic Flow.

BACKGROUND: Crowding in emergency departments (ED) has a negative impact on quality of care and can be averted by allocating additional resources based on predictive crowding models. However, there is a lack in effective external overall predictors, particularly those representing public activity. OBJECTIVES: This study, therefore, examines public activity measured by regional road traffic flow as an external predictor of ED crowding in an urban hospital. METHODS: Seasonal autoregressive cross-validated models (SARIMA) were compared with respect to their forecasting error on ED crowding data. RESULTS: It could be shown that inclusion of inflowing road traffic into a SARIMA model effectively improved prediction errors. CONCLUSION: The results provide evidence that circadian patterns of medical emergencies are connected to human activity levels in the region and could be captured by public monitoring of traffic flow. In order to corroborate this model, data from further years and additional regions need to be considered. It would also be interesting to study public activity by additional variables.

Strategies to minimize medication errors in emergency units: an integrative review / Estrategias para minimizar los errores de medicación en unidades de emergencia: una revisión integrativa / Estratégias para minimizar erros de medicação em unidades de emergência: revisão integrativa

ABSTRACT Objective: To assess the strategies used by the Nursing team to minimize medication errors in emergency units. Method: Integrative literature review in the PubMed, BDenf, Cochrane and LILACS databases. Timeless research, without language limitation, performed by peers. Articles published in full that answered the guiding question were included in research. Results: Educational strategies (conducting campaigns, elaborating explanatory manuals, creating a multidisciplinary committee involved in the prevention and reduction of adverse drug events); organizational (meetings, Deviance positive, creation of protocols and changes in the work process) and new technologies (implementation of prescription by computerized system, introduction of the unit doses and of the bar code in the administration of medicines) were evidenced in the studies with the purpose of minimizing medication errors in an emergency unit. Conclusion: The strategies identified were effective in minimizing medication errors in emergency units.

RESUMEN Objetivo: Evaluar las estrategias utilizadas por el equipo de Enfermería para minimizar los errores de medicación en las unidades de emergencia. Método: Revisión integrativa de la literatura realizada en las bases de datos PubMed, BDenf, Cochrane y LILACS. Búsqueda atemporal, sin limitación de idioma, realizada por pares. Se incluyeron en esta investigación artículos publicados en su totalidad que respondieran a la pregunta orientadora. Resultados: Las estrategias educativas (realización de campañas, elaboración de manuales explicativos, creación de una comisión multidisciplinaria involucrada con la prevención y la reducción de los eventos adversos a los medicamentos); organizacionales (reuniones, Deviance positive, creación de protocolos y cambios en el proceso de trabajo) y nuevas tecnologías (la aplicación de prescripciones por un sistema informatizado, la implantación de la dosis unitaria y el código de barras en la administración de medicamentos) fueron evidenciadas en los estudios con la finalidad de minimizar los errores de medicación en la unidad de emergencia. Conclusión: Las estrategias identificadas se mostraron eficaces para minimizar los errores de medicación en las unidades de emergencia.

RESUMO Objetivo: Avaliar as estratégias utilizadas pela equipe de Enfermagem para minimizar os erros de medicação nas unidades de emergência. Método: Revisão integrativa da literatura realizada nas bases de dados PubMed, BDenf, Cochrane e LILACS. Pesquisa atemporal, sem limitação de idioma, realizada por pares. Foram incluídos nesta pesquisa artigos publicados na íntegra que respondessem à pergunta norteadora. Resultados: As estratégias educacionais (realização de campanhas, elaboração de manuais explicativos, criação de comissão multidisciplinar envolvida com a prevenção e redução dos eventos adversos aos medicamentos); organizacionais (reuniões, Deviance positive, criação de protocolos e mudanças no processo de trabalho) e novas tecnologias (implementação de prescrição por sistema informatizado, implantação da dose unitária e do código de barras na administração de medicamentos) foram evidenciadas nos estudos com a finalidade de minimizar os erros de medicação em unidade de emergência. Conclusão: As estratégias identificadas mostraram-se eficazes para minimizar erros de medicação nas unidades de emergência.

Ações para segurança na prescrição, uso e administração de medicamentos em unidades de pronto atendimento / Acciones para la seguridad en la prescripción, consumo y administración de medicamentos en una unidad de pronta atención / Actions for safety in the prescription, use and administration of medications in emergency care units

Resumo OBJETIVO Identificar os riscos e incidentes relacionados ao processo de terapia medicamentosa no cenário de uma Unidade de Pronto Atendimento (UPA) e propor ações de gerenciamento e práticas seguras, na percepção da equipe de enfermagem. MÉTODO Pesquisa qualitativa, na modalidade pesquisa-ação, desenvolvida no cenário de uma UPA, localizada no interior de São Paulo. A coleta dos dados foi realizada por meio de entrevistas e grupos focais com 33 profissionais, entre junho de 2015 a abril de 2016. Para o tratamento dos dados utilizou-se a Técnica de Análise de Conteúdo. RESULTADOS E DISCUSSÃO A partir dos relatos dos participantes foram organizadas categorias temáticas, sendo os riscos e incidentes relacionados ao processo de terapia medicamentosa uma das categorias elencadas, assim como propostas de ações. CONCLUSÃO O estudo possibilitou a implementação de ações de segurança ao paciente relacionadas à administração de medicamentos em uma UPA, oferecendo maior qualidade do cuidado.

Resumen OBJETIVO Identificar cuáles son los riesgos e incidentes relacionados con el proceso de terapia medicamentosa en una Unidad de Pronta Atención (UPA) y presentar propuestas de acciones de gestión y prácticas seguras en la percepción del equipo de enfermería. MÉTODO Investigación cualitativa, en la modalidad investigación-acción, desarrollada en el escenario de una UPA, ubicada en el interior de San Pablo. Se recolectaron los datos a través de entrevistas y grupos focales con 33 profesionales, entre junio de 2015 y abril de 2016. Para procesar los datos, se utilizó la Técnica de Análisis de Contenido. RESULTADOS Y DISCUSIÓN A partir de los relatos de los participantes, se organizaron categorías temáticas, siendo los riesgos e incidentes relacionados al proceso de terapia medicamentosa una de las categorías enumeradas, así como las propuestas de acciones. CONCLUSIÓN El estudio permitió implementar acciones de seguridad del paciente relacionadas con la administración de medicamentos en una UPA, ofreciendo mayor calidad del cuidado.

ABSTRACT Objective: To identify what risks and incidents related to the drug therapy process are presented in an Emergency Care Unit (UPA) and to present proposals for management actions and safe practices, in the perception of the nursing team. Method: Qualitative research, in the research-action modality, developed in the scenario of UPA, located in the interior of São Paulo. Data collection was done through interviews and focus groups with 33 professionals, between June 2015 and April 2016. For the data treatment, the Content Analysis Technique was used. Results and discussion: From the participants' reports, thematic categories were organized, with the risks and incidents related to the drug therapy process being one of the listed categories, as well as proposals for actions. Conclusion: The study allowed the implementation of patient safety actions related to the administration of drugs in a PAU, offering a higher quality of care.

Turnover of nursing workers in an adult emergency unit / Rotatividad de los trabajadores de enfermería en una unidad de emergencia adulto / Rotatividade dos trabalhadores de enfermagem em uma unidade de emergência adulto

ABSTRACT Objective: to calculate the overall turnover rate of nursing workers from the adult emergency unit of a general teaching hospital in the period between January 2005 and December 2013. Method: quantitative, exploratory, descriptive, retrospective study; data collection performed on documents/work schedules of the unit. Turnover rate calculated considering monthly entry/exit of workers at the unit's work schedules. Results: 171 professionals worked in the emergency unit in this period; 101 left the unit (57 migrated to other areas and 44 left the institution). Time of service presented trend of nine years and median of two years and four months. Global turnover above 3% in four months in 2006; October/2008; April to September/2009; four months in 2010; July/2011; and May/2013. Conclusion: considering the effects of staff turnover for nursing care, it is recommended to adopt indicators for management/control of this condition.

RESUMEN Objetivo: calcular la tasa de rotatividad global de los trabajadores de enfermería de la emergencia adulto de un hospital general universitario, en el período entre enero de 2005 y diciembre de 2013. Método: estudio cuantitativo, exploratorio, descriptivo, retrospectivo; recolección de datos realizada en documentos/escalas de trabajo de la unidad. Tasa de rotación calculada considerando entrada/salida mensual de trabajadores en las escalas de trabajo de la unidad. Resultados: 171 trabajadores actuaron en la emergencia en este período; 101 se desligaron de la unidad (57 migrar a otras áreas y 44 dejaron la institución). El tiempo de servicio presentó la moda de nueve años y mediana de dos años y cuatro meses. Rotatividad global superior al 3%, en cuatro meses de 2006; octubre/2008; abril a septiembre / 2009; cuatro meses de 2010; julio/2011; y mayo / 2013. Conclusión: considerando los efectos de la rotatividad de personal para la asistencia de enfermería, se recomienda la adopción de indicadores para gestión/control de esta condición.

RESUMO Objetivo: calcular a taxa de rotatividade global dos trabalhadores de enfermagem da emergência adulto de um hospital geral universitário, no período entre janeiro de 2005 e dezembro de 2013. Método: estudo quantitativo, exploratório, descritivo, retrospectivo; coleta de dados realizada em documentos/escalas de trabalho da unidade. Taxa de rotatividade calculada considerando entrada/saída mensal de trabalhadores nas escalas de trabalho da unidade. Resultados: 171 trabalhadores atuaram na emergência neste período; 101 desligaram-se da unidade (57 migraram para outras áreas e 44 deixaram a instituição). Tempo de serviço apresentou moda de nove anos e mediana de dois anos e quatro meses. Rotatividade global superior a 3%, em quatro meses de 2006; outubro/2008; abril a setembro/2009; quatro meses de 2010; julho/2011; e maio/2013. Conclusão: considerando os efeitos da rotatividade de pessoal para a assistência de enfermagem, recomenda-se a adoção de indicadores para gerenciamento/controle desta condição.