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1.
Metas enferm ; 22(10): 22-27, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185328

RESUMO

Objetivo: determinar el grado de satisfacción de los usuarios del servicio de hemodiálisis tras una innovación organizacional. Método: estudio descriptivo transversal realizado en usuarios del servicio de hemodiálisis del Hospital de la Santa Creu (Tarragona). Se administró el cuestionario SERVQHOS modificado para hemodiálisis y se comparó la satisfacción reportada previa y posterior al cambio. La comparación de medias se analizó mediante la t de Student para muestras relacionadas. Resultados: de 80 usuarios que cumplían los criterios de inclusión se obtuvieron 43 encuestas válidas. El perfil mayoritario del usuario que contestó fue el de un varón (76,2%), de 71,7 años, sin estudios o con estudios primarios (85,7%), pensionista o jubilado (90,5%). Aunque en la satisfacción global la opción "muy satisfecho" disminuyó un 7,5% después del cambio, el resultado no fue estadísticamente significativo, como tampoco fueron las diferencias de los 20 ítems del cuestionario. Conclusiones: el mantenimiento de la satisfacción obtenido refuerza el aumento de eficiencia alcanzado con el cambio organizativo y confirma factores de éxito en innovación, animando en la búsqueda de estrategias para reducir costes sin comprometer buenos resultados


Objective: to determine the level of satisfaction of the users of the Hemodialysis Unit after an organizational innovation. Method: a descriptive cross-sectional study conducted in users of the Hemodialysis Unit of the Hospital de la Santa Creu (Tarragona). The SERVQHOS questionnaire modified for hemodialysis was administered, and the satisfaction previously reported was compared with the satisfaction after the change. The comparison of means was analyzed through Student's t test for paired samples. Results: out of those 80 users who met the inclusion criteria, 43 valid surveys were obtained. The predominant profile of the user who answered the survey was: male (76.2%), 71.7-year-old, no formal education or primary school completed (85.7%), pensioner or retired (90.5%). Even though in Overall Satisfaction, there was a 7.5% reduction in the "Very Satisfied" option after the change, this result and the differences in the 20 questionnaire items were not statistically significant. Conclusions: the sustained satisfaction achieved reinforces the increase in efficiency reached with the organizational change, and confirms factors of success in innovation, encouraging the search for strategies in order to reduce costs without compromising good results


Assuntos
Humanos , Masculino , Feminino , Idoso , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Satisfação do Paciente , Unidades Hospitalares de Hemodiálise/organização & administração , Inovação Organizacional , Estudos Transversais , Inquéritos e Questionários , Benchmarking
2.
Indian J Public Health ; 63(2): 157-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31219068

RESUMO

Renal replacement therapy in India is predominantly a private health-care-driven initiative making it an expensive treatment option due to high out-of-pocket expenditures. Moreover, with the rapid increase in the number of chronic kidney disease patients requiring dialysis, hemodialysis units (HDUs) are getting saturated. Community "stand-alone" dialysis centers could be an important alternative to HDUs in meeting the growing demand in an affordable model. The aim of this study was to find hemodialysis (HD) delivery in "stand-alone" dialysis units (SAUs) with respect to expanding coverage, patient costs, and patient safety safeguards. The total number of HD sessions was collected at three points. The information regarding patient safety safeguards at SAUs and impact of SAUs on patient costs were collected by interviews and from hospital records. There was 11.5 times increase in HD sessions from 2008 to 2017, out of which 75.3% was provided at SAUs. Following objective clinical and safety measures, high-quality dialysis was delivered at SAUs and it significantly reduced the mean patient cost of treatment per session.


Assuntos
Diálise Renal , Terapia de Substituição Renal , Feminino , Unidades Hospitalares de Hemodiálise/organização & administração , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal/métodos
3.
Enferm. nefrol ; 22(1): 27-33, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-183591

RESUMO

Los pacientes en hemodiálisis son una población susceptible de padecer eventos adversos por fallos en el proceso asistencial. Objetivo: Evaluar la eficacia de las medidas correctoras en un plan de seguridad del paciente en hemodiálisis para disminuir los eventos adversos. Material y Método: Estudio descriptivo y retrospectivo del registro de hemodiálisis de una unidad hospitalaria. Como método de evaluación se utilizó la metodología propia de nuestro centro (MIDEA) basado en el método Global Trigger Tools. Se revisaron todas las sesiones de hemodiálisis de marzo, mayo y julio de 2016: 2.080 sesiones; y los mismos meses en 2017: 1953 sesiones. Después del análisis de 2016, se implantaron las siguientes medidas correctoras: revisión del procedimiento de anticoagulación del circuito extracorpóreo, actualización del manejo de los accesos vasculares y actualización del procedimiento ante hipotensiones. Resultados: En el año 2016, se revisaron las gráficas de 208 pacientes. Se detectaron 255 eventos adversos (11,8% de las sesiones), siendo los más frecuentes: 85 hipotensiones, 74 coagulaciones del circuito sanguíneo, 31 problemas del acceso vascular y 65 otros eventos adversos. En el año 2017, se revisaron las gráficas de 258 pacientes. Se detectaron 155 eventos adversos (7,9% de las sesiones), siendo los más frecuentes: 60 hipotensiones, 36 coagulaciones del circuito, 30 problemas del acceso vascular y 29 otros eventos adversos. Conclusiones: Los eventos adversos disminuyeron un 39,2% en 2017, y aunque siguen siendo las hipotensiones, coagulaciones del circuito sanguíneo y los problemas derivados del acceso vascular los más frecuentes, pensamos que las medidas correctoras están siendo eficaces


Patients on hemodialysis (HD) are a population susceptible to suffering adverse events (AD) due to failures in the healthcare process. Objective: To evaluate the efficacy of corrective measures in a HD patient safety plan to reduce AD. Material and Method: Descriptive and retrospective study of the HD records of a hospital unit. As an evaluation method, we used the methodology of our center (MIDEA) based on the Global Trigger Tools method. All the HD sessions of March, May and July 2016 were reviewed: 2,080 sessions; and the same months in 2017: 1953 sessions. After the 2016 analysis, the following corrective measures were implemented: revision of the anticoagulation procedure of the extracorporeal circuit, updating of the vascular access management and updating of the procedure before hypotension. Results: In 2016, the clinical records of 208 patients were reviewed. 255 EA were detected (11.8% of the sessions). The most frequent AEs were: 85 hypotension, 74 blood circuit coagulations, 31 vascular access problems and 65 other AD. In 2017, the clinical records of 258 patients were reviewed. 155 AE were detected (in 7.9% of the sessions). The most frequent AEs were: 60 hypotension, 36 circuit coagulations, 30 vascular access problems and 29 other AE. Conclusions: Adverse events decreased by 39.2% in 2017, and although hypotension, blood circuit coagulation and vascular access problems are the most frequent, we consider that corrective measures are being effective


Assuntos
Humanos , Diagnóstico de Enfermagem/métodos , Diálise Renal/efeitos adversos , Unidades Hospitalares de Hemodiálise/normas , Dano ao Paciente/prevenção & controle , Doença Iatrogênica/prevenção & controle , Insuficiência Renal Crônica/terapia , Avaliação de Resultado de Ações Preventivas , Segurança do Paciente/normas , Estudos Retrospectivos
4.
Enferm. nefrol ; 22(1): 42-50, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-183593

RESUMO

Objetivo: Determinar los eventos adversos más prevalentes y los factores asociados a su desarrollo en el paciente que se somete a hemodiálisis en el estado de Guerrero, México. Material y Método: Estudio observacional, longitudinal, retrospectivo en 157 pacientes en hemodiálisis afiliados al Instituto Mexicano del Seguro Social en Guerrero, atendidos en 5 unidades privadas y 2 públicas. Se recolectaron variables socio-demográficas, mediciones de laboratorio, evolución de la enfermedad, complicaciones propias de la enfermedad y del tratamiento dialítico. Resultados: Los eventos adversos se presentaron en el 73% de la población estudiada, la principal causa etiológica fue Diabetes mellitus tipo 2 (DM2) e hipertensión arterial. Los eventos adversos más frecuentes fueron: hipotensión (35,5%) infección de angioacceso (24%), cefalea (22,3%), crisis hipertensiva (14,5%), mareos (9,9%), escalofríos (9,9%), y trombosis de fístula arteriovenosa (9,9%). Los factores que se asociaron a su desarrollo fueron: pacientes mayores de 65 años, (OR=6,859IC 95%;1,55-30,35), ser obeso, (OR=1,70, IC95%:1,60-4,81), e hipoalbuminemia (OR=0,251, IC 95%: 0,160-0,593). Conclusión: Los pacientes mayores de 65 años, obesos, con hipertensión diastólica e hipoalbuminemia tienen mayor probabilidad de desarrollar eventos adversos durante el periodo de hemodiálisis


Objective: To determine the most prevalent adverse events and the risk factors associated in the patient undergoing hemodialysis in the state of Guerrero, Mexico. Material and Method: Observational, longitudinal, retrospective study in 157 hemodialysis patients affiliated to the Mexican Institute of Social Security in Guerrero, assisted in 5 private and 2 public units. Socio-demographic variables, laboratory measurements, evolution of the disease, complications of the disease and dialysis treatment were collected. Results: Adverse events occurred in 73% of the studied population, the main etiological cause was Diabetes mellitus type 2 (DM2) and arterial hypertension. The most frequent adverse events were: hypotension (35.5%) angioaccess infection (24.0%), headache (22.3%), hypertensive crisis (14.5%), dizziness (9.9%), chills (9.9%), and thrombosis of arteriovenous fistula (9.9%). The associated risk factors: patients over 65, (OR=6.859, 95% CI:1.55-30.35) being obese, (OR=1.70, 95% CI: 1.60-4.81), and hypoalbuminemia (OR=0.251, 95% CI:0.160-0.593). Conclusion: Patients over 65, obese, with diastolic hypertension and hypoalbuminemia are more likely to develop adverse events during the hemodialysis


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Diagnóstico de Enfermagem/métodos , Diálise Renal/efeitos adversos , Unidades Hospitalares de Hemodiálise/normas , Dano ao Paciente/prevenção & controle , Doença Iatrogênica/prevenção & controle , Insuficiência Renal Crônica/terapia , Segurança do Paciente/normas , Estudos Retrospectivos , México/epidemiologia , Fatores de Risco , Obesidade/complicações , Hipertensão/complicações
5.
Gastroenterol. hepatol. (Ed. impr.) ; 42(3): 164-170, mar. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-182131

RESUMO

Introduction: In the interferon era, the treatment of hepatitis C virus (HCV) infection in patients on haemodialysis (HD) was limited due to the significant number of treatment-related adverse events (AEs). Direct-acting antivirals (DAAs) have demonstrated their efficacy and safety in the treatment of HCV in patients with advanced chronic kidney disease on haemodialysis. The objective of the study was to evaluate the success in eliminating HCV infection from our dialysis unit using DAAs, and to assess the impact of HCV elimination on clinical and analytical outcomes. Patients and methods: This is a prospective, interventional, single-center study at Hospital Clínic de Barcelona. All HCV-RNA positive patients who received antiviral therapy with DAAs within a 3-year period (2014-2017) were analyzed (n=20). Data on virologic response, adverse events, and biochemical and hematological parameters during and after DAA therapy were analyzed. Results: All patients achieved sustained virologic response (SVR) and only 40% of patients presented with mild AEs. None of the patients presented with HCV reinfection after a 1-year follow-up period, and thus HCV was eliminated from our HD unit. SVR was associated with a significant increase in hemoglobin and hematocrit, and a tendency toward the need for lower doses of iron supplementation with no changes in darbepoetin dose. Conclusion: HCV infection can be safely eliminated from HD units with the use of DAAs, preventing new infections in patients and healthcare staff. In the short term, the achievement of SVR is associated with an improvement in the control of anemia


Introducción: En la época del interferón, el tratamiento del virus de la hepatitis C (VHC) en pacientes en hemodiálisis (HD) se veía limitado por la presencia de efectos adversos relacionados con el tratamiento. Los agentes antivirales directos (AAD) han demostrado ser seguros y eficaces en el tratamiento del VHC en pacientes con insuficiencia renal crónica en hemodiálisis. El objetivo del estudio fue evaluar el éxito en eliminar la infección por VHC de nuestra unidad de diálisis con el uso de AAD, y determinar el impacto clínico y analítico de la curación de la infección. Pacientes y métodos: Para ello se realizó un estudio prospectivo de intervención en el Hospital Clinic de Barcelona y su centro de diálisis. Se incluyeron todos los pacientes (n=20) con ARN-VHC positivo que recibieron tratamiento antiviral con AAD durante un periodo de 3 años (2014-2017). Se analizaron los datos de respuesta virológica, efectos adversos y parámetros hematológicos y bioquímicos durante y después del tratamiento. Resultados: Todos los pacientes alcanzaron una respuesta viral sostenida (RVS) y solo una 40% presentaron efectos adversos leves. Ningún paciente presentó reinfección por el VHC y por ello tras un año de seguimiento se consideró la eliminación del VHC de nuestra unidad de diálisis. La RVS se asoció con aumento significativo de la hemoglobina y el hematocrito, y una tendencia a la necesidad de una dosis más baja de suplemento de hierro sin cambios en la dosis de darbepoetina. Conclusión: Con la utilización de AAD, la infección por el VHC puede ser eliminada de forma segura de las unidades de diálisis, previniendo la transmisión de la infección a pacientes y personal sanitario. A corto plazo, la RVS se asoció con una mejoría en el control de la anemia


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Hepatite C/terapia , Anemia/terapia , Antivirais/administração & dosagem , Resposta Viral Sustentada , Resultado do Tratamento , Anemia/prevenção & controle , Unidades Hospitalares de Hemodiálise , Estudos Prospectivos , Antivirais/efeitos adversos
6.
BMC Health Serv Res ; 19(1): 116, 2019 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-30755191

RESUMO

BACKGROUND: Are creativity and compliance mutually exclusive? In clinical settings, this question is increasingly relevant. Hospitals and clinics seek the creative input of their employees to help solve persistent patient safety issues, such as the prevention of bloodstream infections, while simultaneously striving for greater adherence to evidence-based guidelines and protocols. Extant research provides few answers about how creativity works in such contexts. METHODS: Cross-sectional survey data were collected from employees in 24 different U.S.-based outpatient hemodialysis clinics. Linear mixed-effects models were utilized to test study hypotheses. Professional status, clinic climate variables, and interaction terms were modeled as fixed effects, with a random effect for clinic included in all models. RESULTS: Our results show that high status employees contributed more creative patient safety improvement ideas compared to low status employees. However, when high status employees were part of clinics with a stronger safety climate of compliance, they contributed fewer creative ideas compared to their counterparts working in clinics with a reduced compliance orientation. We also predicted low status employees working in less punitive clinics would contribute more creative ideas, but this hypothesis was not fully supported. CONCLUSIONS: This study suggests that in hospitals and clinics that rely on strict protocols and formal hierarchies to meet their goals, the factors that promote creativity may be distinctively context-dependent. Implications for theory, practice, as well as future directions for research examining creativity in healthcare and safety critical contexts are discussed.


Assuntos
Criatividade , Segurança do Paciente/normas , Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/normas , Estudos Transversais , Unidades Hospitalares de Hemodiálise/normas , Hospitais/normas , Humanos , Cooperação do Paciente , Melhoria de Qualidade , Diálise Renal/normas
7.
Semin Dial ; 32(2): 127-134, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30569604

RESUMO

Hepatitis C virus (HCV) infection is more common among hemodialysis patients than the general population and transmission of HCV in dialysis clinics has been reported. In the context of the increased morbidity and mortality associated with HCV infection in the end stage renal disease population, it is important that dialysis clinics have processes in place for ensuring recommended infection control practices, including Standard Precautions, through regular audits and training of the staff. This review will summarize the epidemiology of HCV infection and risk factors for HCV transmission among hemodialysis patients. In addition, the proper protocols are required to investigate suspected cases of HCV transmission in dialysis facilities and recommendations for prevention of HCV transmission in will be reviewed.


Assuntos
Unidades Hospitalares de Hemodiálise , Hepatite C/prevenção & controle , Hepatite C/transmissão , Controle de Infecções , Falência Renal Crônica/terapia , Diálise Renal , Humanos , Falência Renal Crônica/virologia
8.
J Hosp Infect ; 101(3): 333-338, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30500385

RESUMO

BACKGROUND: Haemodialysis is a risk factor for hepatitis C virus (HCV) transmission. Two patients receiving haemodialysis in a Dutch dialysis unit in The Hague were found to seroconvert to HCV in December 2016 after the yearly routine control for blood-borne viruses. Following the presumed time of infection, three chronically infected HCV patients were identified as possible index cases. AIM: To confirm inter-patient transmission and to identify the source. METHODS: Molecular investigation and review of medical records were performed. FINDINGS: Both of the incident cases and one of the three possible index cases were demonstrated to be infected with HCV genotype 2b based on 5'UTR sequencing. Epidemiological relatedness between these viruses was further investigated by sequencing of the NS5A region. Phylogenetic analysis clearly identified the incident cases and the index case to represent a cluster distinct from unrelated controls with HCV genotype 2b. Detailed review of the medical records identified two possible incidents that might have resulted in the HCV transmission cases: contamination of the venous pressure-sensing port due to high venous pressures or incomplete compliance with infection control precautions of the unit staff during handling of two incidents, that occurred at the same time in a single haemodialysis session with the index patient as well as both incident cases present. CONCLUSION: This study demonstrates that detailed incident recording in combination with state-of-the-art molecular investigations such as sequencing of the NS5A region resulted in unravelling a set of two HCV transmissions that occurred at a haemodialysis unit.


Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Transmissão de Doença Infecciosa , Genótipo , Hepacivirus/classificação , Hepatite C/epidemiologia , Proteínas não Estruturais Virais/genética , Infecção Hospitalar/transmissão , Unidades Hospitalares de Hemodiálise , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/transmissão , Humanos , Epidemiologia Molecular , Países Baixos/epidemiologia , Filogenia , Análise de Sequência de DNA
10.
Rev. enferm. UERJ ; 26: e26480, jan.-dez. 2018. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-969830

RESUMO

Objetivo: analisar a satisfação dos pacientes em tratamento dialítico com relação aos cuidados de enfermagem. Método: estudo descritivo, de abordagem quantitativa de campo, realizado de maio a agosto de 2016, em um hospital universitário do Rio de Janeiro. A amostra foi de 37 pacientes que realizam hemodiálise ou diálise peritoneal no hospital por tempo igual ou superior a três meses, maiores de 18 anos. Utilizou para a coleta de dados o Instrumento de Satisfação do Paciente. Resultados: a média de satisfação geral dos pacientes foi de 3,89 para os três itens: educação, confiança e teórico-prático, sendo que os pacientes da hemodiálise apresentaram a média de satisfação de 3,69 e os pacientes da diálise peritoneal de 4,44. Conclusão: os pacientes em tratamento dialítico do hospital se encontram satisfeitos com os cuidados de enfermagem que lhes são prestados.


Objective: to examine dialysis patient satisfaction with related nursing care. Method: this descriptive study was conducted, on a quantitative field approach, from May to August 2016, at a university hospital in Rio de Janeiro. The sample comprised 37 patients over 18 years old, who had been on hemodialysis or peritoneal dialysis at the hospital for three months or more. Data were collected using a patient satisfaction questionnaire. Results: overall patient satisfaction was 3.89 for the three items: education, trust, and theoretical and practical skill, with hemodialysis patients returning 3.69 overall satisfaction, and peritoneal dialysis patients, 4.44. Conclusion: patients in peritoneal dialysis at the hospital were satisfied with the nursing care provided.


Objetivo: analizar la satisfacción de los pacientes en tratamiento de diálisis en relación con los cuidados de enfermería. Método: estudio descriptivo, de abordaje cuantitativa de campo, realizado entre mayo y agosto de 2016, en un hospital universitario de Río de Janeiro. La muestra consistió en 37 pacientes en hemodiálisis o diálisis peritoneal en el hospital por tiempo igual o superior a tres meses, mayores de 18 años. Se utiliza, para la recolección de datos, el instrumento de satisfacción del paciente. Resultados: el promedio de satisfacción general de los pacientes fue de 3,89 para los tres ítems: educación, confianza y teórico-práctico. Los pacientes de hemodiálisis presentaron un promedio de satisfacción de 3,69 y los pacientes de diálisis peritoneal de 4,44. Conclusión: los pacientes en tratamiento de diálisis del hospital están satisfechos con la atención de enfermería que se les proporciona.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Diálise Renal/enfermagem , Satisfação do Paciente , Unidades Hospitalares de Hemodiálise , Cuidados de Enfermagem , Brasil , Epidemiologia Descritiva , Estudos Transversais
11.
Managua; s.n; dic. 2018. 77 p. tab, graf.
Tese em Espanhol | LILACS | ID: biblio-1008137

RESUMO

OBJETIVO: Determinar la accesibilidad de los pacientes con Enfermedad Renal Crónica a la Unidad de Hemodiálisis del Hospital Bautista 2017. METODOLOGÍA: Estudio descriptivo de corte transversal. Realizado en la Unidad de Hemodiálisis del Hospital Bautista. La información fue obtenida por medio de entrevistas realizadas a los pacientes que cumplieron los criterios de inclusión. RESULTADOS: El 78% de los pacientes eran hombres, de los cuales el 23% se encontraba en edades de 38-47 años. El 66% eran casados y 47% con escolaridad primaria. El 45% de los pacientes procedían de Managua, sin embargo, la mayoría de éstos acudían de municipios alejados como Villa El Carmen, San Rafael del Sur y Tipitapa, por lo que el 44% de los pacientes tardaba de 1-2 horas y viajaba de 20-99 Km para acudir a sus sesiones de hemodiálisis. El costo promedio por acudir a cada sesión de hemodiálisis fue superior a C$200 en el 65% de los pacientes, refiriendo además que en el 45% de las familias sólo provee económicamente 1 persona, con ingresos mensuales entre C$5,000 ­ C$9,999. El 65% de los pacientes refirió una atención excelente por el personal de salud y la percepción de la atención no demostró relación con las inasistencias. El 51% refirió fallar a sus sesiones principalmente por causas financieras. El 66% acudía a sus hemodiálisis sin acompañamiento, y de éstos, el 19% fallaron en promedio a 4 sesiones programadas en el mes. CONCLUSIONES: La barrera geográfica en la mayoría de los pacientes del Programa de Hemodiálisis es evidente, sin embargo, la mayor limitación es la barrera económica para acudir a sus sesiones


Assuntos
Humanos , Diálise Renal , Insuficiência Renal , Insuficiência Renal Crônica , Unidades Hospitalares de Hemodiálise , Administração em Saúde
12.
Enferm. nefrol ; 21(4): 386-392, oct.-dic. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-180185

RESUMO

Introducción: El tratamiento con inmunoadsorción no selectiva fue introducido en nuestra unidad de hemodiálisis hospitalaria con el objetivo de permitir la desensibilización previa a un trasplante renal con incompatibilidad de grupo sanguíneo y el tratamiento del rechazo mediado por anticuerpos. Objetivo: Analizar los resultados de la técnica de inmunoadsorción no selectiva, en una unidad de hemodiálisis hospitalaria. Material y Método: Estudio retrospectivo, descriptivo, de los primeros 18 pacientes tratados en nuestro centro con inmunoadsorción no selectiva (años 2012-2017) en las indicaciones de acondicionamiento del trasplante ABOi y tratamiento del rechazo humoral. Resultados: Durante un periodo de 5 años se analizaron un total de 128 sesiones de inmunoadsorción no selectiva. El 38,9% (n=7) de los casos para desensibilización previa al trasplante renal con incompatibilidad de grupo sanguíneo y el 61,1% (n=11) restante para el tratamiento del rechazo mediado por anticuerpos. En el primer caso, realizaron una media de 8±0,6 sesiones de inmunoadsorción previas al trasplante renal y el 57,1% se complementaron 2 sesiones posteriores. El tratamiento concomitante fue el protocolizado con Rituximab e inmunoglobulinas, requiriendo el 57,1% la realización de recambios plasmáticos. En el segundo caso, realizaron una media de 5,9±2 sesiones de inmunoadsorción. El tratamiento concomitante fue el mismo y el 27,3% realizaron recambios plasmáticos. Conclusiones: El trasplante renal de donante vivo ABOi tras la desensibilización fue posible en el 100% de los pacientes. El 72,7% de los pacientes tratados para el rechazo mediado por anticuerpos mantienen actualmente la funcionalidad del injerto


Introduction: The non-selective immunoadsorption treatment was introduced in our hospital hemodialysis unit with the aim of allowing desensitization prior to a kidney transplant with blood group incompatibility and the treatment of antibody-mediated rejection. Aim: To analyze the results of the non-selective immunoadsorption technique in a hospital hemodialysis unit. Material and methods: Retrospective descriptive study of the first 18 patients treated in our center with non-selective immunoadsorption (years 2012-2017) in the indications for ABOi transplant conditioning and treatment of humoral rejection. Results: During a period of 5 years, 128 non-selective immunoadsorption sessions were analyzed. 38.9% (n= 7) of cases for desensitization prior to renal transplantation with incompatibility of blood group and 61.1% (n=11) remaining for the treatment of antibody-mediated rejection. In the first case, an average of 8±0.6 sessions of immunoadsorption prior to kidney transplantation were performed and 57.1% were complemented by 2 subsequent sessions. The concomitant treatment was protocolled with rituximab and immunoglobulins, 57.1% requiring plasma exchanges. In the second case, an average of 5.9±2 immunoadsorption sessions were carried out. The concomitant treatment was the same and 27.3% performed plasma exchanges. Conclusions: Kidney transplantation from ABOi living donor after desensitization was possible in 100% of patients. 72.7% of patients treated for antibody-mediated rejection currently maintain graft functionality


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Técnicas de Imunoadsorção/enfermagem , Transplante de Rim/métodos , Diálise Renal/métodos , Incompatibilidade de Grupos Sanguíneos/imunologia , Dessensibilização Imunológica/enfermagem , Estudos Retrospectivos , Imunologia de Transplantes , Unidades Hospitalares de Hemodiálise/organização & administração , Rejeição de Enxerto/prevenção & controle , Rituximab/uso terapêutico , Doadores Vivos
13.
Rev. pesqui. cuid. fundam. (Online) ; 10(4): 926-931, out.-dez. 2018.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-915531

RESUMO

Objetivo: Conhecer as percepções dos pacientes hemodialíticos acerca das mudanças e limitações da doença e do tratamento na sua vida. Métodos: Pesquisa qualitativa, com 12 pacientes que hemodializam em um centro de hemodiálise na região noroeste do Rio Grande do Sul, Brasil, em 2014. Os dados foram coletados por entrevista semiestruturada submetidos à análise de conteúdo. Resultados: Evidenciam que os sentimentos de indignação e negação se modificam, enquanto os pacientes se fortalecem para o enfrentamento da doença e tratamento. Restrições alimentares e hídricas, bem como limitação das atividades de trabalho foram as dificuldades identificadas. Entretanto, ocorre o fortalecimento de vínculos familiares, de amizades e uma proximidade com a religião. Conclusão: As percepções negativas devido às restrições impostas pela situação deste adoecimento. Aponta-se a necessidade de apoio e fortalecimento da rede de relações destes pacientes, que lhes facilite o convívio com as limitações impostas pela doença e tratamento visando à melhor qualidade de vida


Objective: To know the perceptions of hemodialytic patients about the changes and limitations of the disease and treatment in their life. Methods: Qualitative research with 12 patients who hemodialised at a hemodialysis center in the Northwest region of RS, Brazil, in 2014. Data were collected through semi-structured interviews submitted to Content Analysis. Results: They show that the feelings of indignation and denial change, while patients are strengthened to cope with the disease and treatment. Food and water restrictions, limitation of work activities were identified difficulties. However, there is the strengthening of familyties, of friendships and a closeness to religion. Conclusion: The negative perceptions due to the restrictions imposed by the situation of this illness. It is necessary to support and strengthen the network of relationships of these patients, which facilitates them to live with the limitations imposed by the disease and treatment aiming at a better quality of life


Objetivo: Conocer las percepciones de los pacientes de hemodiálisis sobre los cambios y las limitaciones de la enfermedad y el tratamiento em su vida. Métodos: estudio cualitativo con 12 pacientes hemodializam em un centro de hemodiálisis en el noroeste de RS, Brasil, en 2014. Los datos se recogieron mediante entrevista semiestructurada sometido a análisis de contenido. Resultados: Este estudio evidencia que los sentimientos de indignación y la negación del cambio, mientras que los pacientes están fortalecidos para hacer frente a la enfermedad y el tratamiento. restricciones de comida y agua, lo que limita las actividades de trabajo eran las dificultades identificadas. Sin embargo, no es el fortalecimiento de los lazos familiares, amistades y la cercanía a la religión. Conclusión: Las percepciones negativas debido a las restricciones impuestas por la situación de esta enfermedad. Apunta a la necesidad de apoyar y fortalecer la red de relaciones de estos pacientes, lo que facilita la vida con las limitaciones impuestas por la enfermedad y el tratamiento de la mejor calidad de vida


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Diálise Renal/enfermagem , Diálise Renal/psicologia , Insuficiência Renal Crônica/terapia , Unidades Hospitalares de Hemodiálise , Insuficiência Renal Crônica/enfermagem
14.
BMC Nephrol ; 19(1): 227, 2018 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-30208851

RESUMO

The present increase in life span has been accompanied by an even higher increase in the burden of comorbidity. The challenges to healthcare systems are enormous and performance measures have been introduced to make the provision of healthcare more cost-efficient. Performance of hospitalisation is basically defined by the relationship between hospital stay, use of hospital resources, and main diagnosis/diagnoses and complication(s), adjusted for case mix. These factors, combined in different indexes, are compared with the performance of similar hospitals in the same and other countries. The reasons why an approach like this is being employed are clear.Cutting costs cannot be the only criteria, in particular in elderly, high-comorbidity patients: in this population, although social issues are important determinants of hospital stay, they are rarely taken into account or quantified in evaluations. Quantifying the impact of the "social barriers" to care can serve as a marker of the overall quality of treatment a network provides, and point to specific out-of-hospital needs, necessary to improve in-hospital performance. We therefore propose a simple, empiric medico-social checklist that can be used in nephrology wards to assess the presence of social barriers to hospital discharge and quantify their weight.Using the checklist should allow: identifying patients with social frailty that could complicate hospitalisation and/or discharge; evaluating the social needs of patient and entourage at the beginning of hospitalisation, adopting timely procedures, within the partnership with out-of-hospital teams; facilitating prioritization of interventions by social workers.The following ten items were empirically identified: reason for hospitalisation; hospitalisation in relation to the caregiver's problems; recurrent unplanned hospitalisations or early re-hospitalisation; social/family isolation; presence of a dependent relative in the patient's household; lack of housing or unsuitable housing/accommodation; loss of autonomy; lack of economic resources; lack of a safe environment; evidence of physical or psychological abuse.The simple tool here described needs validation; the present proposal is aimed at raising attention on the importance of non-medical issues in medical organisation in our specialty, and is open to discussion, to allow its refinement.


Assuntos
Lista de Checagem/tendências , Unidades Hospitalares de Hemodiálise/tendências , Hospitalização/tendências , Nefrologia/tendências , Determinantes Sociais da Saúde/tendências , Idoso , Idoso de 80 Anos ou mais , Lista de Checagem/economia , Lista de Checagem/métodos , Feminino , Unidades Hospitalares de Hemodiálise/economia , Hospitalização/economia , Humanos , Masculino , Nefrologia/economia , Nefrologia/métodos , Alta do Paciente/economia , Alta do Paciente/tendências , Determinantes Sociais da Saúde/economia
15.
BMC Nephrol ; 19(1): 236, 2018 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-30231860

RESUMO

BACKGROUND: Metabolic syndrome (MetS) has been established as a risk for cardiovascular diseases and mortality in hemodialysis patients. Energy intake (EI) is an important nutritional therapy for preventing MetS. We examined the association of self-reported dietary EI with metabolic abnormalities and MetS among hemodialysis patients. METHODS: A cross-sectional study design was carried out from September 2013 to April 2017 in seven hemodialysis centers. Data were collected from 228 hemodialysis patients with acceptable EI report, 20 years old and above, underwent three hemodialysis sessions a week for at least past 3 months. Dietary EI was evaluated by a three-day dietary record, and confirmed by 24-h dietary recall. Body compositions were measured by bioelectrical impedance analysis. Biochemical data were analyzed using standard laboratory tests. The cut-off values of daily EI were 30 kcal/kg, and 35 kcal/kg for age ≥ 60 years and < 60 years, respectively. MetS was defined by the American Association of Clinical Endocrinologists (AACE-MetS), and Harmonizing Metabolic Syndrome (HMetS). Logistic regression models were utilized for examining the association between EI and MetS. Age, gender, physical activity, hemodialysis vintage, Charlson comorbidity index, high sensitive C-reactive protein, and interdialytic weight gains were adjusted in the multivariate analysis. RESULTS: The prevalence of inadequate EI, AACE-MetS, and HMetS were 60.5%, 63.2%, and 53.9%, respectively. Inadequate EI was related to higher proportion of metabolic abnormalities and MetS (p <  0.05). Results of the multivariate analysis shows that inadequate EI was significantly linked with higher prevalence of impaired fasting glucose (OR = 2.42, p <  0.01), overweight/obese (OR = 6.70, p <  0.001), elevated waist circumference (OR = 8.17, p <  0.001), AACE-MetS (OR = 2.26, p <  0.01), and HMetS (OR = 3.52, p <  0.01). In subgroup anslysis, inadequate EI strongly associated with AACE-MetS in groups of non-hypertension (OR = 4.09, p = 0.004), and non-cardiovascular diseases (OR = 2.59, p = 0.012), and with HMetS in all sub-groups of hypertension (OR = 2.59~ 5.33, p <  0.05), diabetic group (OR = 8.33, p = 0.003), and non-cardiovascular diseases (OR = 3.79, p <  0.001). CONCLUSIONS: Inadequate EI and MetS prevalence was high. Energy intake strongly determined MetS in different groups of hemodialysis patients.


Assuntos
Ingestão de Energia/fisiologia , Unidades Hospitalares de Hemodiálise/tendências , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/metabolismo , Diálise Renal/tendências , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/terapia , Pessoa de Meia-Idade , Prevalência , Autorrelato
16.
Infect Control Hosp Epidemiol ; 39(12): 1400-1405, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30253815

RESUMO

BACKGROUND: Antimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%-35% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed. OBJECTIVE: To quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.Study design and settingAn interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period. RESULTS: Implementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible Staphylococcus aureus infections and discontinuation of antimicrobials when criteria for presumed infection were not met. CONCLUSIONS: Within 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Infecções Bacterianas/tratamento farmacológico , Uso de Medicamentos/normas , Unidades Hospitalares de Hemodiálise , Idoso , Infecções Bacterianas/prevenção & controle , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , New Jersey , Pacientes Ambulatoriais , Diálise Renal
17.
Enferm. nefrol ; 21(3): 250-254, jul.-sept. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-174061

RESUMO

Objetivo: Determinar la utilidad de la ecografía-doppler vascular en la sala de hemodiálisis, en la identificación de pacientes portadores de catéter venoso tunelizado susceptibles de la construcción de una fístula arteriovenosa. Material y Método: Estudio descriptivo transversal en pacientes en hemodiálisis crónica portadores de un catéter venoso tunelizado. Se realizaron evaluaciones mediante ecografía portátil modo B, en 3 puntos diferentes de ambos brazos (proximal, medio y distal), y sobre 2 puntos de ambos antebrazos (proximal y distal), recogiéndose un promedio de las determinaciones realizadas. Se recogieron parámetros morfológicos cualitativos (presencia/ausencia de calcificación arterial) y cuantitativos (diámetro y profundidad) de la arteria radial, la humeral y la vena basílica de ambas extremidades superiores. Resultados: De las 63 personas en hemodiálisis, 9 eran portadores de un catéter tunelizado yugular (14,3%). Los valores medios de diámetro y profundidad (mm) fueron los siguientes: 4,7±3,0 y 9,2±2,7 (arteria humeral derecha), 4,8±0,6 y 10,5±3,3 (arteria humeral izquierda), 2,6±0,4 y 6,6±2,0 (arteria radial derecha), 2,7±0,7 y 6,0±1,6 (arteria radial izquierda), 4,3±0,6 y 10,1±2,1 (vena basílica derecha), 5,1±0,5 y 10,1±2,1 (vena basílica izquierda). En la mayoría de los casos (66,7%) se evidenció ausencia de calcificaciones, una placa aislada de calcificación en un caso (11,1%) y más de una en dos casos (22,2%). Conclusión: El ecógrafo portátil utilizado "in situ" en la sala de HD es una exploración útil para conseguir un cambio en el tipo de acceso vascular, es decir, para la conversión de un catéter venoso tunelizado en una fístula arteriovenosa en las personas en hemodiálisis crónica


Objective: To determine the utility of vascular ultrasound/Doppler in the hemodialysis unit about the identification of patients with tunneled venous catheter, who can be candidates for an arteriovenous fistula. Material and Method: Cross-sectional descriptive study in patients on chronic hemodialysis with tunneled venous catheters. Evaluations were carried out by B mode portable ultrasound, in 3 different points of both arms (proximal, middle and distal), and on 2 points of both forearms (proximal and distal), collecting an average in such determinations. Qualitative morphological parameters (presence/absence of arterial calcification) and quantitative parameters (diameter and depth) of the radial, humeral and basilic veins of both upper extremities were collected. Results: Of the 63 people on hemodialysis, 9 were carriers of a tunnelled jugular catheter (14.3%). The mean values of diameter and depth (mm) were the following: 4.7±3.0 and 9.2±2.7 (right humeral artery), 4.8±0.6 and 10.5±3.3 (left humeral artery), 2.6±0.4 and 6.6±2.0 (right radial artery), 2.7±0.7 and 6.0±1.6 (left radial artery), 4, 3±0.6 and 10.1±2.1 (right basilic vein), 5.1±0.5 and 10.1±2.1 (left basilic vein). In the majority of cases (66.7%), absence of calcifications was evidenced, an isolated plaque of calcification in one case (11.1%) and more than one in two cases (22.2%). Conclusion: The portable ultrasound system used “in situ” in the HD unit is a useful exploration to achieve a change in the type of vascular access, that is, for the conversion of a tunneled venous catheter to an arteriovenous fistula in people with chronic hemodialysis


Assuntos
Humanos , Cateterismo Venoso Central/enfermagem , Ultrassonografia Doppler em Cores/métodos , Derivação Arteriovenosa Cirúrgica/métodos , Insuficiência Renal Crônica/terapia , Diálise Renal/enfermagem , Cuidados de Enfermagem/métodos , Testes Imediatos , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos
18.
BMC Nephrol ; 19(1): 186, 2018 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-30064380

RESUMO

BACKGROUND: Both dialysis facilities and hospitals are accountable for 30-day hospital readmissions among U.S. hemodialysis patients. We examined the association of post-hospitalization processes of care at hemodialysis facilities with pulmonary edema-related and other readmissions. METHODS: In a retrospective cohort comprised of electronic medical record (EMR) data linked with national registry data, we identified unique patient index admissions (n = 1056; 2/1/10-7/31/15) that were followed by ≥3 in-center hemodialysis sessions within 10 days, among patients treated at 19 Southeastern dialysis facilities. Indicators of processes of care were defined as present vs. absent in the dialysis facility EMR. Readmissions were defined as admissions within 30 days of the index discharge; pulmonary edema-related vs. other readmissions defined by discharge codes for pulmonary edema, fluid overload, and/or congestive heart failure. Multinomial logistic regression to estimate odds ratios (ORs) for pulmonary edema-related and other vs. no readmissions. RESULTS: Overall, 17.7% of patients were readmitted, and 8.0% had pulmonary edema-related readmissions (44.9% of all readmissions). Documentation of the index admission (OR = 2.03, 95% CI 1.07-3.85), congestive heart failure (OR = 1.87, 95% CI 1.07-3.27), and home medications stopped (OR = 1.81, 95% CI 1.08-3.05) or changed (OR = 1.69, 95% CI 1.06-2.70) in the EMR post-hospitalization were all associated with higher risk of pulmonary edema-related vs. no readmission; lower post-dialysis weight (by ≥0.5 kg) after vs. before hospitalization was associated with 40% lower risk (OR = 0.60, 95% CI 0.37-0.96). CONCLUSIONS: Our results suggest that some interventions performed at the dialysis facility in the post-hospitalization period may be associated with reduced readmission risk, while others may provide a potential existing means of identifying patients at higher risk for readmissions, to whom such interventions could be efficiently targeted.


Assuntos
Unidades Hospitalares de Hemodiálise/tendências , Hospitalização/tendências , Falência Renal Crônica/terapia , Readmissão do Paciente/tendências , Diálise Renal/tendências , Idoso , Estudos de Coortes , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Diálise Renal/métodos , Estudos Retrospectivos
19.
Rev Lat Am Enfermagem ; 26: e2944, 2018 Jul 16.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-30020331

RESUMO

OBJECTIVE: to analyze the mean direct cost of the constituent procedures of conventional hemodialysis, performed in three public teaching and research hospitals. METHOD: quantitative, exploratory-descriptive study, of the multiple case study type. The mean direct cost was calculated by multiplying the time (timed) spent by nursing professionals, on the execution of procedures, by the unit cost of direct labor, added to the cost of materials and solutions/medications. RESULTS: the total mean direct cost, in patients with an arteriovenous fistula corresponded to US$25.10 in hospital A, US$37.34 in hospital B and US$25.01 in hospital C, and in patients with a dual lumen catheter, US$32.07 in hospital A, US$40.58 in hospital B and US$30.35 in hospital C. The weighted mean values obtained were US$26.59 for hospital A, US$38.96 for hospital B and US$27.68 for hospital C. It was noted that the "installation and removal of hemodialysis fistula access" caused a significantly lower economic impact compared to "installation and removal of hemodialysis catheter access". CONCLUSION: with the knowledge developed it will be possible to support hospital managers, technical managers and nursing professionals in the decision making process, with a view to the rational allocation of the necessary inputs for the performance of conventional hemodialysis.


Assuntos
Custos de Cuidados de Saúde/normas , Unidades Hospitalares de Hemodiálise/economia , Recursos Humanos de Enfermagem/economia , Diálise Renal/economia , Insuficiência Renal/enfermagem , Lesão Renal Aguda/enfermagem , Derivação Arteriovenosa Cirúrgica/economia , Brasil , Cateteres de Demora/economia , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Humanos , Falência Renal Crônica , Diálise Renal/instrumentação , Diálise Renal/enfermagem
20.
Rev. enferm. UFPE on line ; 12(7): 1841-1852, jul. 2018. ilus, graf, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-986528

RESUMO

Objetivo: averiguar o conhecimento dos pacientes com doença renal crônica acerca do autocuidado com a fístula arteriovenosa (FAV). Método: estudo quantitativo, transversal, descritivo-exploratório, que envolveu 32 pacientes. Coletaram-se os dados mediante a realização de uma entrevista, utilizando-se um roteiro semiestruturado. Analisaram-se os dados segundo o programa SPSS versão 22.0 e R3.33. Resultados: 59,4% sexo masculino; 13 (40,6%) com idade entre 41-60 anos; 46,9% casados; 46,9% ensino fundamental incompleto; 46,9% com renda de até um salário mínimo; 30 (93,8%) desempregado; etiologia da DRC: hipertensão e diabetes mellitus; 17 (53,1%) submeteram-se à realização de duas ou mais FAV; 16 (50%) FAV confeccionada em região radiocefálica. O score de acertos das questões relacionadas ao autocuidado variou de 15 (62,5 %) a 24 (100%). Conclusão: os pacientes mostraram-se conhecedores das ações necessárias para a realização do autocuidado, apesar de haver lacunas do conhecimento acerca destes. Diante disso, é importante a equipe de enfermagem estimular a prática do autocuidado para garantir maior durabilidade da FAV e, consequentemente, melhorar a qualidade de vida dos pacientes.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Autocuidado , Derivação Arteriovenosa Cirúrgica , Conhecimentos, Atitudes e Prática em Saúde , Fístula Arteriovenosa , Diálise Renal , Insuficiência Renal Crônica , Equipe de Enfermagem , Relações Profissional-Paciente , Qualidade de Vida , Educação em Saúde , Estudos Transversais , Unidades Hospitalares de Hemodiálise , Cuidados de Enfermagem
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