ACT variation after a weight-based heparin bolus before CPB is not predictable in infant

BackgroundIn pediatric cardiac surgery, anticoagulation protocols are derived from adult protocols. Age, Antithrombin III level, and capacity to generate thrombin are factors that affect unfractionated heparin (UFH) action in children. A starting UFH dose of 400 UI/kg is recommended to get an Activated Clotting Time (ACT) target over 400seconds. In our daily practice, we noticed a wide range of ACT increase (ΔACT) after this standardized weight based bolus of UFH.ObjectiveTo define factors affecting UFH effectiveness based on ΔACT before CPB initialization in pediatric cardiac surgery.MethodsA retrospective chart review of patient undergoing cardiac surgery requiring CPB in a single university hospital was performed. Patients receiving preoperative anticoagulation therapy or platelet aggregation inhibitors were excluded. We searched predictive factors for ΔACT. We defined 2 groups: hyperrespondents (HR; ΔACT>500) and normorespondents (NR; ΔACT<500).ResultsSeventy-nine charts were reviewed. Median [25–75] age and weight were respectively 13.8 [5–72] months and 8.7 kg [5.5–18.8]. UFH pre CPB bolus was 384 [358–410] to increase pre operative ACT from 124 [115–137] to 536 s[463–582]. HR are younger (4.9 [3.7–13] vs 24.6 [5.7–76] months, P<0.05) and have smaller weight (6,1 [4.6–7.8] vs 10 kg[5,8–19.5], P<0,05) than NR. ΔACT is correlated to UFH dose for patients>5 months (r=0.59 P=0.00001) and>5kg (r=0.54 P=0.00001) for with a predictive ΔACT of 386 s [325–443]. There is no correlation between ΔACT and UFH dose for patients<5 months and<5kg.ConclusionA dose UFH of 400 UI/kg before starting CPB in pediatrics is overestimated, especially for children<5 months and<5kg. Accurate dose for ACT target>400 s in this specific population should be calculated using other method that still needs to be developed to avoid complications associated to excessive dose of UFH

Best practice of nurse managers in risk management

OBJECTIVE: to identify the actions, undertaken by nurse managers in a risk management program, considered as best practice. METHOD: a case study undertaken in a private hospital in the south of Brazil. A risk manager and nurse managers working in a risk management program participated in this study. The data was collected between May and September 2011 through analysis of documents, semi-structured interviews and non-participant observation. Based on the triangulation, the data was analyzed through practical measures. RESULTS: educational actions, the critical analysis of the context, and the multiple dimensions of the management were evidenced as best practice. CONCLUSIONS: the broadening of understanding regarding risk management best practice offers further support for nurse managers to achieve excellence in their actions and thus provide safe and quality care

Governanca em enfermagem: revisao integrativa da literatura

O objetivo deste estudo foi identificar e caracterizar os tipos de governança em enfermagem, destacando seu impacto na prática dos enfermeiros e no cuidado em saúde. Trata-se de revisão integrativa a partir das bases de dados MEDLINE, CINAHL, LILACS e na biblioteca eletrônica SciELO, de 2007 a 2011, com os descritores Governança /Governance e Enfermagem/ Nursing, totalizando 25 artigos. Foram identificados três modelos de governança, estudados principalmente nos Estados Unidos e Inglaterra: governança compartilhada, governança clínica e governança pública. Entre os impactos desses modelos, destacam-se: melhoria da qualidade assistencial, maior autonomia profissional dos enfermeiros, melhoria da articulação entre os serviços de saúde e maior satisfação profissional entre enfermeiros. Pontua-se a necessidade da realização de estudos sobre a temática na América Latina, com o intuito de avaliar sua aplicabilidade em diferentes contextos

Secondary Health Care: best practices in the health services network

OBJECTIVE: to understand the organization of health practices, based on the interactions at the secondary care level, and to analyze how the actions and services at this level of care contribute to the development of best practice in health. METHOD: a qualitative approach, based in Grounded Theory. Data was obtained from individual interviews, with managers, health care professionals and health service users making up the sample group representing the secondary level of healthcare. The theoretical model was formulated based on four categories, analyzed based in the elements of the network modeling of health care theoretical framework. RESULTS: The organization of health practices at a secondary level is in the process of consolidation and is contributing to the development of best practices in the locale studied. CONCLUSION: The broadening of access to consultations and specialized procedures, and the articulation of the network's points, are aspects of this level of care which are considered essential for care which is effective and integral. This study contributes to the analysis of health practices from the perspective of network modeling, based on the interactions between secondary care and the health system's other health facilities, which are shown as going through a process of consolidation in the locale studied

Enfrentamento da violência contra a mulher: articulação intersetorial e atenção integral

Trata-se de um estudo descritivo-exploratório, de abordagem qualitativa e com objetivo de identificar elementos que interferem no processo de enfrentamento da violência contra a mulher. Realizou-se entrevista com representantes de 15 serviços que integram a Rede de Atenção a Pessoas em Situação de Violência na cidade de Salvador, Bahia, Brasil. Os dados foram organizados com base na análise temática de Bardin. O estudo mostrou que a articulação intersetorial e a atenção disponibilizada pelos serviços são elementos que interferem no enfrentamento da violência contra a mulher. Ambos os elementos guardam relação com o fortalecimento da rede de atenção a mulheres vítimas de violência. O estudo sinaliza para a necessidade de se conhecer as atribuições de outras instituições e reafirma a importância da articulação entre elas. Oferece ainda elementos que orientam o desenvolvimento de políticas e ações articuladas no sentido de favorecer o processo de enfrentamento da violência contra as mulheres