The impact of social cohesion and risk communication on excess mortality due to COVID-19 in 213 countries: a retrospective analysis.

BACKGROUND: Tools for assessing a country's capacity in the face of public health emergencies must be reviewed, as they were not predictive of the COVID-19 pandemic. Social cohesion and risk communication, which are related to trust in government and trust in others, may have influenced adherence to government measures and mortality rates due to COVID-19. OBJECTIVE: To analyse the association between indicators of social cohesion and risk communication and COVID-19 outcomes in 213 countries. RESULTS: Social cohesion and risk communication, in their dimensions (public trust in politicians, trust in others, social safety nets, and equal distribution of resources index), were associated with lower excess mortality due to COVID-19. The number of COVID-19-related disorder events and government transparency were associated with higher excess mortality due to COVID-19. The lower the percentage of unemployed people, the higher the excess mortality due to COVID-19. Most of the social cohesion and risk communication variables were associated with better vaccination indicators, except for social capital and engaged society, which had no statistically significant association. The greater the gender equality, the better the vaccination indicators, such as the number of people who received all doses. CONCLUSION: Public trust in politicians, trust in others, equal distribution of resources and government that cares about the most vulnerable, starting with the implementation of programs, such as cash transfers and combating food insecurity, were factors that reduced the excess mortality due to COVID-19. Countries, especially those with limited resources and marked by social, economic, and health inequalities, must invest in strengthening social cohesion and risk communication, which are robust strategies to better cope with future pandemics.

National governance and excess mortality due to COVID-19 in 213 countries: a retrospective analysis and perspectives on future pandemics.

BACKGROUND: National governance may have influenced the response of institutions to the Covid-19 pandemic, being a key factor in preparing for the next pandemics. The objective was to analyze the association between excess mortality due to COVID-19 (daily and cumulative per 100 thousand people) and national governance indicators in 213 countries. METHOD: Multiple linear regression models using secondary data from large international datasets that are in the public domain were performed. Governance indicators corresponded to six dimensions: (i) Voice and Accountability; (ii) Political Stability and Absence of Violence/Terrorism; (iii) Government Effectiveness; (iv) Regulatory Quality; (v) Rule of Law and (vi) Control of Corruption. The statistical analysis consisted of adjusting a multiple linear regression model. Excess mortality due to COVID-19 was adjusted for potential confounding factors (demographic, environmental, health, economic, and ethnic variables). RESULTS: The indicators Control of Corruption, Government Effectiveness, Regulatory Quality and Rule of Law had a significant inverse association (p < 0.0001) with the estimated excess mortality in 2020, 2021 and 2022. Furthermore, the governance indicators had a direct significant association (p < 0.0001) with the vaccination variables (People_fully_vaccinated; Delivered population; The total number of vaccination doses administered per 100 people at the country level), except for the variables Vaccination policies and Administration of first dose, which were inversely associated. In countries with better governance, COVID-19 vaccination was initiated earlier. CONCLUSION: Better national governance indicators were associated with lower excess mortality due to COVID-19 and faster administration of the first dose of the COVID-19 vaccine.

Care relationships and the autonomy of people with physical disabilities.

As a form of functional diversity, spinal cord injury expressed by tetraplegia is one of the most serious events that can impact people, affecting their family and socioeconomic life. The type of care relationship established in these cases will be essential for preserving autonomy. The objective of this study was to understand how care relationships influence the autonomy of people with tetraplegia and the dynamics that trigger practices of autonomy violation, maintenance and promotion. This research is inspired by problematization as a methodology using the Arch of Maguerez as an analytical approach strategy that enables an engagement between empirical and theoretical data. Some models of care relationships identified in this study either promote or violate autonomy: the protectionist model, based on the biomedical interpretation model of disability and the bodily impediments caused by spinal cord injury; the participatory model, involving the patient's interest in adapting to their new condition of family and community life, seeking to understand the practical aspects of daily life; the sharing model, in which the complicity and understanding of new forms of bodily expression allow the caregiver to be almost an extension of the tetraplegic person's body; the delegate model, which occurs in relationships with professional caregivers; and the emancipatory model, which seeks to empower the patient, highlight potentialities, and encourage autonomy. The key components of these conceptual care models guided the elaboration of hypotheses for intervention with the objective of maintaining and promoting the autonomy of people with tetraplegia through supported care.

Measles outbreak: preliminary report on a case series of the first 8,070 suspected cases, Manaus, Amazonas state, Brazil, February to November 2018.

We report an ongoing measles outbreak in Manaus, Amazonas state, Brazil. As at 3 November 2018, 1,631 cases were confirmed corresponding to an incidence of 75.3 per 100,000 inhabitants; all five sanitary districts presented confirmed cases. Reintroduction of measles virus in Manaus is likely related to the current outbreak in Venezuela and due to recent decline in measles vaccine coverage. Given the current scenario, prevention and control measures should target individuals aged 15-29 years.

[Analysis of the Vaccine Adverse Event Reporting System in Brazil, 2014 to 2016Análisis del Sistema de Información de Vigilancia de Eventos Adversos Posvacunación en Brasil, 2014 a 2016]. / Análise do Sistema de Informação da Vigilância de Eventos Adversos Pós-Vacinação no Brasil, 2014 a 2016.

OBJECTIVE: To describe the characteristics of vaccine adverse events (VAE) reports in the online VAE Reporting System (VAE-RS) after 2 years of operation. METHOD: A descriptive analysis of VAE reports entered into the VAE-RS between July 2014 and June 2016 was performed. RESULTS: During the study period, 24 732 VAE were reported. Of 5 570 Brazilian municipalities, 2 571 (46.2%) reported at least one VAE; however, only 1 622 (6.6%) reports had been completed/closed at the end of the study period. Of these, 89.9% referred to mild VAE. Among the completed reports, 19.7% did not provide information on "type of medical care provided," and 98.7% had no information regarding laboratory tests. Systemic neurological symptoms were the most frequent serious VAE among closed reports (59.5% of serious signs/symptoms). Concerning age, the highest VAE reporting coefficients were recorded for children aged ≤ 4 years. CONCLUSION: The VAE-RS is useful to monitor immunization safety. However, municipal services must increase adherence to the system and perform the required investigation and reporting of VAE, with timely and adequate completion of the VAE-RS form. Knowledge regarding VAE can be used in the daily routine of surveillance services, improving the safety of immunobiological agents.

OBJETIVO: Describir las características de las notificaciones de eventos adversos posvacunación (EAPV) en el Sistema de Información de Vigilancia de EAPV (SI-EAPV, un sistema en línea, durante los primeros 2 años de ejecución del sistema. MÉTODO: Se realizó un estudio descriptivo de los registros de EAPV notificados en el SI-EAPV entre julio de 2014 y junio de 2016. RESULTADOS: Durante el período del estudio, se registraron 24 732 notificaciones. De 5 570 municipios brasileños, 2 571 (46,2%) notificaron algún EAPV. Sin embargo, solamente 1 622 (6,6%) notificaciones estaban cerradas al momento del estudio; de ellas, el 89,9% no presentó gravedad. Respecto a las notificaciones cerradas, en el 19,7% no fue anotada la variable "atención médica" y el 98,7% no presentó registro de exámenes de laboratorio. Entre los eventos adversos graves cerrados, las manifestaciones clínicas sistémicas neurológicas fueron las más frecuentes, representado el 59,5% de los signos y síntomas. En cuanto a la edad, los mayores coeficientes de notificación se registraron entre los menores de 4 años. CONCLUSIÓN: El SI-EAPV es útil para el monitoreo de la seguridad de las vacunas. Sin embargo, los municipios necesitan ampliar la adhesión al sistema, así como realizar las investigaciones y notificaciones de los EAPV, llenando la ficha de notificación de forma adecuada y oportuna. El conocimiento sobre EAPV puede ser aplicado en la práctica de los servicios de vigilancia en salud, mejorando la seguridad en la utilización de los productos inmunobiológicos.

[Sanitary regulation as part of health policy in Brazil: gaps and challenges]. / A regulação sanitária brasileira como parte da política de saúde: lacunas e desafios.

Objective To outline and discuss the main challenges for sanitary regulation contained in the federal-level Brazilian health policy. Methods For the present qualitative study, based on the analysis of public policies, information was collected from documents and interviews. Document analysis provided a historical overview of the insertion of sanitary regulation into the Brazilian health policy between 1999 and 2009 (first decade of existence of the national health surveillance agency, Anvisa). In addition, 13 interviews were carried out with actors selected for their historical, technical, or academic role in the field. Content analysis was used to define themes emerging from the materials analyzed with a focus on the "content" category, which refers to strategic and operational guidelines of policy programs, projects, initiatives, and normative framework. Results Content analysis revealed five themes that reflect the challenges to sanitary regulation in Brazil: 1) objects under regulation treated as isolated cases; 2) a Brazilian-specific model of sanitary regulation that is different from other international models; 3) ignorance regarding the role of sanitary surveillance in health care; 4) absence of an information system; and 5) absence of performance indicators and assessment tools. Conclusions Sanitary surveillance must have a mission that is disentangled from inspection tasks to become an effective instrument of health protection. For that, an information system that brings the National Sanitary Surveillance System together toward major objectives is essential. The adoption of tools for assessment of action is also required, with the establishment of adequate indicators.

Ethics education in research involving human beings in undergraduate medicine curriculum in Brazil.

INTRODUCTION: The Brazilian national curriculum guidelines for undergraduate medicine courses inspired and influenced the groundwork for knowledge acquisition, skills development and the perception of ethical values in the context of professional conduct. OBJECTIVE: The evaluation of ethics education in research involving human beings in undergraduate medicine curriculum in Brazil, both in courses with active learning processes and in those with traditional lecture learning methodologies. METHODS: Curricula and teaching projects of 175 Brazilian medical schools were analyzed using a retrospective historical and descriptive exploratory cohort study. Thirty one medical schools were excluded from the study because of incomplete information or a refusal to participate. Active research for information from institutional sites and documents was guided by terms based on 69 DeCS/MeSH descriptors. Curriculum information was correlated with educational models of learning such as active learning methodologies, tutorial discussions with integrated curriculum into core modules, and traditional lecture learning methodologies for large classes organized by disciplines and reviewed by occurrence frequency of ethical themes and average hourly load per semester. RESULTS: Ninety-five medical schools used traditional learning methodologies. The ten most frequent ethical themes were: 1--ethics in research (26); 2--ethical procedures and advanced technology (46); 3--ethic-professional conduct (413). Over 80% of schools using active learning methodologies had between 50 and 100 hours of scheduled curriculum time devoted to ethical themes whereas more than 60% of traditional learning methodology schools devoted less than 50 hours in curriculum time to ethical themes. CONCLUSION: The data indicates that medical schools that employ more active learning methodologies provide more attention and time to ethical themes than schools with traditional discipline-based methodologies. Given the importance of ethical issues in contemporary medical education, these findings are significant for curriculum change and modification plans in the future of Brazilian medical education.

[Nurse undergraduate students' perception of quality of life]. / Percepção sobre qualidade de vida de estudantes de graduaçao em enfermagem.

The research objective was to know nurse undergraduate students' perception of quality of life. A cross-sectional study was conducted from August 2010 to August 2011 with 56 nursing students of the Faculty of Health Sciences, University of Brasilia, Brazil. A specific questionnaire was used (sociodemographic, academic and health profile) and the WHOQOL-BREF. Statistical analyzes included a description of frequency, central tendency and dispersion measures, and comparison between domains. The Psychological and Environment domains were assessed as the best and worst scores, respectively. The facets called Thinking, learning, memory and concentration, Sleep and rest Energy and fatigue, Activities of daily living, Work Capacity, Participation in and opportunities for recreation/leisure activities,financial resources and negative feelings were affected. The facets with the worst score influenced negatively the quality of life for students and might trigger negative feelings such as bad mood, desperation anxiety and depression.

Quality of life assessment of patients undergoing palliative chemotherapy.

BACKGROUND: Palliative chemotherapy uses systemic antineoplastic agents to treat an incurable malignancy. The results of cancer treatment need to be measured in terms of what physical and psychological limitations it brings to the patient. Therefore, there is a need to evaluate and establish the impact of the disease and its treatment on the patient's quality of life. OBJECTIVE: To evaluate the quality of life of cancer patients undergoing palliative antineoplastic chemotherapy. METHOD: A cross-sectional study with quali-quantitative unfolding. Three research instruments were applied: sociodemographic and clinical data; European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30); interview script with predefined open questions. RESULTS: The quality of life of the participants was considered good. Fatigue and financial difficulty were the main factors that interfered in daily activities. Three analytical categories emerged from the content analysis of the interviews: communication between the health team and the patient; patient's perception of their health/disease; concerns vs prospects. CONCLUSION: The evaluation of quality of life for people who are at the end of life needs to balance technological and therapeutic advances, alongside aspects such as the perspective of these patients and the context of their lives.

Research integrity guidelines in the academic environment: The context of Brazilian institutions with retracted publications in health and life sciences.

Although research misconduct is responsible for most retractions in health and life sciences from authors affiliated with Brazilian institutions, there are few studies evaluating retraction notices and research misconduct in the country. Understanding the form of research misconduct may share light on the weaknesses and strengths of individual, organizational, and structural factors toward the implementation of a research integrity culture. This review on policies and practices aims to access the available information from research integrity offices and the guidelines from Brazilian funding institutions and universities who were involved in retractions in health and life science publications based on a previously published systematic review. Additionally, we summarize the available guidelines and policies for research integrity in the country. Additionally, we searched publicly available guidelines and offices for research integrity. In total, 15 institutions were analyzed: five funding agencies and 10 universities. Approximately 40% of the funding agencies promoted local research, and 60% promoted national research. Considering national funding agencies, 66% had the commission on research integrity. Approximately 30% of the universities do not have the official office for research integrity or any publicly available guidelines. Most institutions involved in retractions due to some form of research misconduct. Brazilian institutions involved in publication retractions lack instruments to prevent, supervise, and sanction research misconduct. Institutions of the country have insufficiently developed a system to promote and sustain research integrity practices. Nevertheless, there is a positive movement of researchers who are engaged in the investigation of research integrity, policy creation and training. This study emphasizes increased influence of Brazilian scientific collaboration and production globally as well as the impact of retractions in medical sciences. In contrast, it addresses the need for clear research integrity policies to foster high-quality and trustworthy research.

The teaching of good obstetric practices from the Residency preceptors' perspective. / O ensino das boas práticas obstétricas na perspectiva dos preceptores da Residência.

The aim of this study was to understand how the topic of good obstetric practices is taught in residency programs according to the preceptors' perception. This is a descriptive, exploratory study, with data triangulation, with a qualitative approach. A total of 35 professionals participated in the study, of which 21 were physicians and 14 nurses. Data were collected from March to June 2018. The analysis was supported by NVivo software. The nuclei of meanings and categories were identified in the different stages, in pedagogical projects: the structuring aspects, competence profile and guiding policies for normal childbirth; in the interviews: theoretical-practical approach and the practices present in the training and, in participant observation: aspects related to the structure of the scenarios and the use of practices. Possibilities and limits were observed in the role of preceptors in the training process, constituting an area that requires continuous attention, aimed at the strengthening of the pedagogical processes in order to expand the disruptive potential of new health professionals.

Este trabalho teve como objetivo compreender como o tema das boas práticas obstétricas é ensinado nos programas de residência na percepção dos preceptores. Trata-se de um estudo descritivo, exploratório, com triangulação de dados, de abordagem qualitativa. Participaram da pesquisa 35 profissionais, sendo 21 médicos e 14 enfermeiros. Os dados foram coletados entre março e junho de 2018. A análise teve o suporte do Software NVivo. Os núcleos de sentidos e as categorias foram identificados nas diversas etapas: nos projetos pedagógicos - os aspectos estruturantes, perfil de competências e políticas norteadoras do parto normal; nas entrevistas - abordagem teórico-prática e as práticas presentes na formação; e na observação participante - aspectos relacionados à estrutura dos cenários e à utilização das práticas. Foram observados possibilidades e limites na atuação dos preceptores no processo de formação, configurando-se em uma área que requer atenção contínua e direcionada ao fortalecimento dos processos pedagógicos, de forma a ampliar o potencial disruptivo dos novos profissionais de saúde.

Decrease in compulsory notifications registered by the Brazilian National Hospital Epidemiological Surveillance Network during the COVID-19 pandemic: a descriptive study, 2017-2020. / Decréscimo nas notificações compulsórias registradas pela Rede Nacional de Vigilância Epidemiológica Hospitalar do Brasil durante a pandemia da COVID-19: um estudo descritivo, 2017-2020.

OBJECTIVE: To describe compulsorily notifiable diseases, health conditions and public health events (DAEs as per the Brazilian acronym) registered by the National Hospital Epidemiological Surveillance Network (RENAVEH as per the Brazilian acronym), before and during the COVID-19 pandemic. METHODS: This was a descriptive ecological study using records held on the Notifiable Health Conditions Information System (SINAN as per the Brazilian acronym) between Epidemiological Week (EW) 1 of 2017 (January 1st, 2017) and 52 of 2020 (December 26, 2020). RESULTS: Between 2017 and 2020, RENAVEH notified 1,258,455 DAE form records, with only 225,081 (17.9%) notifications in 2020, representing a decrease of 146,340 records compared to 2019. The temporal analysis showed a decrease per EW of more than 1,000 notified records with effect from EW 12. CONCLUSION: There was a decrease in compulsorily notifiable DAEs registered by RENAVEH in Brazil taking the period analyzed as a whole, in particular in 2020.

Ethics, COVID-19 and nursing vulnerability: analysis of photographs released by the media.

OBJECTIVES: to analyze nursing vulnerability through photos released by the media amidst the COVID-19 pandemic. METHODS: a documentary study, with a qualitative approach. The object of analysis were photographic images selected between January 2020 and March 2021, published by the main news portals in countries such as Brazil, the United States, France, Spain, England and Germany. Thematic categorical analysis was the method of analysis used. RESULTS: we found 74 photographs that portrayed nursing professionals in different work situations. It was possible to identify stigma and social devaluation about this class's representation and professional attribution. Moreover, we found an underrepresentation of black professionals in Brazilian portals and the man as the prominent figure in the spaces of claims. FINAL CONSIDERATIONS: the photographs represented an important tool for the social analysis of nursing vulnerability, favoring the unveiling of situations that may go unnoticed by nursing and society.

Profile of hospitalizations for neoplasms in the Brazilian Unified Health System: a time-series study.

OBJECTIVE: Describe the profile of hospitalizations for cancer diagnosis in Brazil from 2008 to 2018 at Unified Health System (SUS). METHODS: Time series study of hospitalization rate for malignant neoplasms at SUS. Data were extracted from the Hospital Information System of DataSUS. The trend was estimated using generalized linear regression, applying the Prais-Winsten estimation procedure. RESULTS: From 2008 to 2018, the hospitalization rate for malignant neoplasms showed an increasing trend at SUS, with an annual variation of 10.7% (p < 0.001; CI = 9.4-11.7). An increasing trend of hospitalizations in all regions of Brazil was observed, except in the Northern region, which remained unchanged. The Northeastern region presented the highest annual variation (13.5%; p < 0.001), whereas the Southern and Southeastern regions had the highest hospitalization rates per 100,000 inhabitants, resulting in 506 and 325 hospitalizations, respectively. We observed a significant increasing trend in hospitalizations of children aged 0 to 9 years (annual variation = 10.9%; p < 0.001); young people, 10 and 19 years (annual variation = 6.9%; p < 0.001); and older adults; over 60 years (annual variation = 7.9%; p < 0.001). Among women, hospitalizations occurred mainly due to malignant neoplasm of the breast (annual variation = 13.2%; p < 0.001); and among men, malignant neoplasm of the prostate (annual variation = 4.7%; p < 0.001). CONCLUSION: Hospitalizations for malignant neoplasms showed an increasing trend, in line with the increased incidence of cancer, in particular, the most frequent neoplasms between men and women. Although the Northeastern region showed the highest variation in the period, the Southern and Southeastern regions had the highest hospitalization rates in the country. We also observed an increase in hospitalizations among the young (between 0 and 19 years old) and older adults (over 60 years) population. Hospitalizations for neoplasm of the cervix in women, although still the third cause of hospitalizations, showed decreasing behavior.

Bioethics in Childbirth Care: Protocol for a Scoping Review.

BACKGROUND: Ensuring women's rights during childbirth care based on humanized and bioethical principles results in better quality of care and patient safety and provides positive childbirth experiences. OBJECTIVE: We aim to explore the available evidence on the application of bioethical principles in the general context of childbirth care. METHODS: Our scoping review will follow the Joanna Briggs Institute Reviewer's Manual. Published and unpublished bibliographic materials will be considered based on the following inclusion criteria: reports of the application of bioethical principles (concept) in assistance to the predelivery, childbirth, and postpartum periods (population) in the hospital context (context). We will search for relevant studies in PubMed and the Virtual Health Library, including MEDLINE, LILACS, BDENF, SCiELO, Web of Science, and Google Scholar. Two reviewers will perform the screening of titles and abstracts, read the full texts, and extract data from the selected articles. The data will then be organized and expressed into categories based on their content. RESULTS: The analyzed data will be presented through flowcharts, tables, and descriptive narratives. A paper summarizing the findings from this review will be published in a peer-reviewed journal. In addition, a synthesis of the key findings will be disseminated to health services linked to university hospitals in Brazil. They will also be shared with the academic community and policy makers involved in the Childbirth Assistance Network, which will potentially adopt our recommendations in their decision-making process regarding childbirth care practice in Brazil. CONCLUSIONS: The findings from this review will inform, through the translation of knowledge, childbirth support groups, feminist movements, movements in favor of humanization of childbirth, and other childbirth support networks in the country. TRIAL REGISTRATION: Open Science Framework; https://osf.io/kczyr/.

Social model: a new approach of the disability theme.

The experience of disability is part of the daily lives of people who have a disease, lesion or corporal limitation. Disability is still understood as personal bad luck; moreover, from the social and political points of view, the disabled are seen as a minority. The aim of this study is to contribute to the knowledge about the experience of disability. The research presents a new approach on the theme: the social model. This approach appeared as an alternative to the medical model of disability, which sees the lesion as the primary cause of social inequality and of the disadvantages experienced by the disabled, ignoring the role of social structures in their oppression and marginalization. The study permits reflecting on how the difficulties and barriers society imposed on people considered different make disability a reality and portray social injustice and the vulnerability situation lived by excluded groups.

Clinical conditions and complications associated with parenteral nutrition use in critically ill patients admitted to an intensive care unit of a general hospital.

INTRODUCTION: Objective: the aim of this study was to evaluate the clinical conditions, the existing complications, and the drug prescription profile of patients who received parenteral nutrition in the intensive care unit. Material and methods: this retrospective, analytical cohort study was carried out among individuals admitted to a public general hospital ICU. For data collection, the electronic medical records for the entire period of inpatient treatment were analyzed. Results: in total, 213 individuals who had received parenteral nutrition for a period greater than 48 hours were included in the study. Most participants were male and mean age was < 60 years; death occurred in 75 % of patients, and abdominal surgery was the main indication for parenteral nutrition. Hyperglycemia was the most common complication. The Mann-Whitney test showed that the individuals who died were using a higher number of medications. The increased use of medications correlated with use of PN and led to an increase in hospital length of stay and death rate (p-value < 0.001). There was a higher proportion of deaths among patients using standard parenteral nutrition solutions (76.9 %) as compared to the period when patients started receiving custom-made parenteral nutrition solutions (71.7 %). However, there was no statistical evidence of the association between type of nutrition and the outcome of death (p-value = 0.395). Conclusions: custom-made parenteral nutrition may result in benefits for the patients, such as a decrease in the number of medications used. The relationship between type of nutrition and the outcome of death did not prove to be statistically significant.

INTRODUCCIÓN: Objetivo: el objetivo de este estudio fue evaluar las condiciones clínicas, las complicaciones existentes y el perfil de prescripción de medicamentos de los pacientes que recibieron nutrición parenteral en la unidad de cuidados intensivos. Material y métodos: este estudio de cohortes analítico y retrospectivo se llevó a cabo entre individuos ingresados en una UCI de un hospital público general. Para la recopilación de datos se analizaron los registros médicos electrónicos de todo el período de tratamiento hospitalario. Resultados: en total se incluyeron en el estudio 213 individuos que habían recibido nutrición parenteral durante un período superior a 48 horas. La mayoría de los participantes eran hombres y la edad media era < 60 años; se produjo la muerte en el 75 % de los pacientes y la cirugía abdominal fue la principal indicación de la nutrición parenteral. La hiperglucemia fue la complicación más común. La prueba de Mann-Whitney mostró que las personas que murieron estaban usando una mayor cantidad de medicamentos. El aumento en el uso de medicamentos se correlacionó con el uso de la PN y condujo a un aumento de la duración de la estancia hospitalaria y de la mortalidad (valor p < 0,001). Hubo una mayor proporción de muertes entre los pacientes que usaron soluciones de nutrición parenteral estándar (76,9 %) en comparación con el período en que los pacientes comenzaron a recibir soluciones de nutrición parenteral hechas a medida (71,7 %). Sin embargo, no hubo evidencia estadística de la asociación entre el tipo de nutrición y el resultado de la muerte (valor p = 0,395). Conclusiones: la nutrición parenteral hecha a medida puede generar beneficios para los pacientes, como una disminución de la cantidad de medicamentos utilizados. La relación entre el tipo de nutrición y el resultado de la muerte no resultó ser estadísticamente significativa.