Comparison of Heart Autonomic Control between Hemodynamically Stable and Unstable Patients during Hemodialysis Sessions: A Bayesian Approach.

Intradialytic hypotension is a common complication during hemodialysis sessions. The analysis of successive RR interval variability using nonlinear methods represents a promising tool for evaluating the cardiovascular response to acute volemic changes. Thus, the present study aims to compare the variability of successive RR intervals between hemodynamically stable (HS) and unstable (HU) patients during a hemodialysis session, through linear and nonlinear methods. Forty-six chronic kidney disease patients volunteered in this study. Successive RR intervals and blood pressures were recorded throughout the hemodialysis session. Hemodynamic stability was defined based on the delta of systolic blood pressure (higher SBP-lower SBP). The cutoff for hemodynamic stability was defined as 30 mm Hg, and patients were stratified as: HS ([n = 21]: ≤29.9 mm Hg) or HU ([n = 25]: ≥30 mm Hg). Linear methods (low-frequency [LFnu] and high-frequency [HFnu] spectra) and nonlinear methods (multiscale entropy [MSE] for Scales 1-20, and fuzzy entropy) were applied. The area under the MSE curve at Scales 1-5 (MSE1-5), 6-20 (MSE6-20), and 1-20 (MSE1-20) were also used as nonlinear parameters. Frequentist and Bayesian inferences were applied to compare HS and HU patients. The HS patients exhibited a significantly higher LFnu and lower HFnu. For MSE parameters, Scales 3-20 were significantly higher, as well as MSE1-5, MSE6-20, and MSE1-20 in HS, when compared to HU patients (p < 0.05). Regarding Bayesian inference, the spectral parameters demonstrated an anecdotal (65.9%) posterior probability favoring the alternative hypothesis, while MSE exhibited moderate to very strong probability (79.4 to 96.3%) at Scales 3-20, and MSE1-5, MSE6-20, and MSE1-20. HS patients exhibited a higher heart-rate complexity than HU patients. In addition, the MSE demonstrated a greater potential than spectral methods to differentiate variability patterns in successive RR intervals.

Manifestações bucais em pacientes internados na UTI de um hospital público / Oral manifestations in patients admitted to the ICU of a Public Hospital

Introdução: durante a permanência em Unidades de Terapia Intensiva (UTIs), os pacientes internados apresentam maior vulnerabilidade a alterações na cavidade oral decorrentes do uso de equipamentos de respiração artificial e do estado imunocomprometido em que se encontram. Objetivo: identificar as principais manifestações bucais em pacientes internados em uma UTI bem como verificar o conhecimento dos profissionais responsáveis pela higienização bucal. Metodologia: trata-se de um estudo quantitativo descritivo com delineamento transversal. Os dados foram obtidos nos prontuários médicos dos pacientes e através de um exame clínico intraoral. Para os profissionais responsáveis pela higiene bucal, foi utilizado um questionário. As análises foram realizadas no programa SPSS versão 21.0 de forma descritiva. Resultados: as manifestações bucais com maior incidência foram saburra lingual, biofilme dentário, candidíase, devido a qualidade da higiene bucal prestada e a baixa imunidade. Os achados bucais e sistêmicos relacionados aos pacientes com maior tempo de internação foram ressecamento labial, queilite angular, língua despapilada, candidíase e pneumonia. Todos os profissionais responsáveis pela higienização bucal dos pacientes tinham formação técnica em enfermagem e desconheciam alterações importantes como biofilme dentário e pneumonia nosocomial. Conclusão: os dados deste estudo permitem concluir que apesar da constância com que é realizada a higienização bucal, verifica-se alta frequência de lesões bucais nos pacientes críticos da UTI. Evidenciando o papel da assistência da higienização bucal de qualidade, destacando a importância da atuação do cirurgião dentista em equipes multiprofissionais, visto que o risco de focos infecciosos bucais pode contribuir para o agravo e piora do quadro clínico dos pacientes.

Introduction: during the stay in Intensive Care Units (ICUs), hospitalized patients are more vulnerable to changes in the oral cavity resulting from the use of artificial respiration equipment and the immunocompromised state in which they are found. Objective: to identify the main oral manifestations in patients admitted to an ICU, as well as to verify the knowledge of professionals responsible for oral hygiene. Methodology: this is a descriptive quantitative study with cross-sectional design. Data were obtained from the patient's medical records and through an intraoral clinical examination. For professionals responsible for oral hygiene, a questionnaire was used. The analyses were performed in the SPSS version 21.0 program in a descriptive way. Results: the oral manifestations with the highest incidence were tongue coating, dental biofilm, candidiasis, due to the quality of oral hygiene provided and low immunity. Oral and systemic findings related to patients with longer hospital stays were lip dryness, angular cheilitis, depapilated tongue, candidiasis and pneumonia. All professionals responsible for oral hygiene of patients had technical training in nursing and were unaware of important alterations such as dental biofilm and nosocomial pneumonia. Conclusion: the data from this study allow us to conclude that despite the constancy with which oral hygiene is performed, there is a high frequency of oral lesions in critical ICU patients. Evidencing the role of quality oral hygiene assistance, highlighting the importance of the dentist's role in multidisciplinary teams, since the risk of oral infectious foci can contribute to the aggravation and worsening of the clinical condition of patients.

Lower limb strength, but not sensorial integration, explains the age-associated postural control impairment.

INTRODUCTION: The aging process leads to functional decline of sensorial organs, muscle mass and strength, as well as the sensorimotor integration, culminating in age-associated postural control impairments. The purpose of this study was to compare the balance, the sensorial integration process and the lower limb strength among three old aged groups. METHODS: Eighty-one community-dwelling healthy old people (58% women), assigned into three age groups [60-69 years (n=30), 70-79 years (n=40), and ≥80 years (n=11)], participated in this study. All participants were submitted to anthropometric and stabilometric evaluation, and carried out a Chair stand test. Stabilometric parameters obtained from time [amplitude displacement of center of pressure (CoP)] and frequency (oscillations of CoP at sub 0.3 Hz and 1-3 Hz bands) domain analysis were used as the indicators of balance performance and sensorial integration, respectively. RESULTS: Our results revealed that the CoP amplitude displacement was significantly greater in the older aged group, without differences in spectral bands, while the performance in the Chair stand test was smaller in the older aged group. CONCLUSION: These data indicate that the age-associated postural control impairment is explained by the lower limb strength declines, but not by the age-associated changes in sensorial integration. LEVEL OF EVIDENCE: III.

Avaliação do Programa Mais Médicos como política de fortalecimento da atenção básica / Evaluation of the “Mais Médicos” (“More Doctors”) program as a strengthening policy of primary healthcare

The Mais Médicos(More Doctors) Program in Brazil aims to solve the shortage of doctors by providing Brazilian and foreign professionals towork in cities with difficult access and marked socioeconomic vulnerability. This study aims to describe existing researches on the implementation of the Mais Médicos (More Doctors) Program on Primary Healthcare. This is a descriptive research, in the form of anintegrative review of literature according to data collection in the online databases: BVS and Scielo, with interrelations of Boolean operatorsand and or. The studies analyzed are: opinion articles, editorials, open space technology and debates, denoting the scarcity of original research carried out in this area. It is perceived that SUS (Brazilian Unified Health System)needs to develop much more to guarantee the universal right to health, since the population, besides the necessity of more doctors, also needsbetter perspectives of health and social justice.

O Programa Mais Médicos no Brasil tem como objetivo suprir a carência de médicos através do provimento de profissionais brasileiros e estrangeiros para atuar em municípios de difícilacesso e acentuada vulnerabilidadesocioeconômica. Esse estudo objetiva descrever as pesquisas existentes sobre a implantação do Programa Mais Médicos na Atenção Básica. Trata-se de uma pesquisa descritiva, sob a forma de revisão integrativa de literatura mediante coleta de dados nas bases on-line BVS, Scielo e Web of Science, com interrelação dos operadores booleanos and e or. Os estudos encontrados sãodo tipo artigos de opinião, editoriais, espaço aberto e debates, denotando a escassez de pesquisas originais conduzidas nessa vertente. Percebe-se que o SUS precisa de muito mais paragarantir o direito universal à saúde, pois a população além de necessitar de mais médicos, precisa também de melhores perspectivas de saúde e de justiça social.