Perfil clínico e atuação fisioterapêutica em pacientes atendidos na emergência pediátrica de um hospital público de Goiás

Nos últimos anos, tem-se ampliado a atuação fisioterapêutica no setor de urgência e emergência, visando reduzir complicações e tempo de internação hospitalar. Os objetivos deste estudo foram traçar o perfil dos pacientes admitidos na sala de reanimação do Serviço de Referência em Urgência Pediátrica (SERUPE) do Hospital das Clínicas da Universidade Federal de Goiás (HC/UFG) e descrever a atuação fisioterapêutica nesse setor. Trata-se de um estudo observacional, prospectivo, realizado entre fevereiro e junho de 2012, para o qual foram acompanhados todos os pacientes admitidos na sala de reanimação do SERUPE. Foram avaliados 47 pacientes, 53,2% (n=25) do sexo masculino, idade média de 5,2±4,1 anos e 74,5% (n=35) apresentavam doenças prévias. A queixa principal mais frequente foi dispneia em 26,1% (n=29) dos casos e as hipóteses diagnósticas mais identificadas foram doenças respiratórias em 69,4% (n=43). Do total de pacientes, 76,6% (n=36) necessitaram de oxigenoterapia, 21,3% (n=10), de assistência ventilatória e 31,9% (n=15) tiveram acompanhamento fisioterapêutico, 86,7% (n=13) com abordagem respiratória e motora. O tempo médio de permanência na sala de reanimação foi de 1,9±1,5 dias; subsequentemente, 63,8% (n=30) dos pacientes foram internados em enfermaria. Portanto, verifica-se que, no setor de emergência, existe uma grande demanda de pacientes com desordens respiratórias que podem se beneficiar com a presença de um fisioterapeuta.En los últimos años, la actuación fisioterapéutica tiene sido ampliada en el sector de urgencia con el objetivo de reducir las complicaciones y el tiempo de internación hospitalaria. Los objetivos de este estudio fueron reportar el perfil de los pacientes admitidos en la sala de reanimación del Servicio de Referencia en Urgencia Pediátrica (SERUPE) del Hospital das Clínicas de la Universidad Federal de Goiás (HC/UFG) y describir la actuación fisioterapéutica en esto sector. Estudio observacional, prospectivo, realizado entre febrero y junio del 2012, para lo cual fueron acompañados todos los pacientes admitidos en la sala de reanimación del SERUPE. Fueron evaluados 47 pacientes, incluyendo el 53,2% (n=25) del género masculino, con edad media de 5,2±4,1 años y el 74,5% (n=35) presentaba enfermedades previas. La más frecuente queja fue disnea en el 26,1% (n=29) de los casos y las hipótesis diagnosticas que fueron más identificadas fueron enfermedades respiratorias en el 69,4% (n=43). Del total de pacientes, el 76,6% (n=36) necesitó de oxigenoterapia, el 21,3% (n=10) de asistencia ventilatória y el 31,9% (n=15) tubo acompañamiento fisioterapéutico, el 86,7% (n=13) con abordajes respiratorio y motor. El periodo medio de permanencia en la sala de reanimación fue de 1,9±1,5 días; subsecuentemente el 63,8% (n=30) de los pacientes fueron internados en enfermaría. Por lo tanto, se verificó que en el sector de urgencia hay una grande demanda de pacientes con disturbios respiratorios, los cuales pueden beneficiarse con la presencia de un fisioterapeuta.In recent years, Physiotherapy's role has increased in the emergency departments, to reduce complications and the time of hospital internment. The objectives of this study were to describe the profile of patients admitted at the resuscitation room of Reference Service in Pediatric Emergency (SERUPE), of Hospital das Clínicas of the Universidade Federal de Goiás (HC/UFG), and to characterize the Physiotherapy's role in this sector. This is an observational and prospective study, conducted between February and June 2012, in which all the patients admitted to the resuscitation room of SERUPE were monitored. Forty-seven patients were evaluated, 53.2% (n=25) male, average age of 5.2±4.1 years, and 74.5% (n=35) had previous diseases. The most common chief complaint was dyspnea in 26.1% (n=29) of the cases, and the diagnostic hypotheses more identified were respiratory disease in 69.4% (n=43). Of all patients, 76.6% (n=36) needed oxygen therapy, 21.3% (n=10) needed ventilatory support, and 31.9% (n=15) had physiotherapeutic care, 86.7% (n=13) with chest associated to motor physiotherapy. The average time of permanence in the resuscitation room was 1.9±1.5 days; thereafter, 63.8% (n=30) of the patients were hospitalized to the ward. Therefore, it was verified that in the emergency departments there is a great demand of patients with respiratory disorders who may benefit from the presence of a physiotherapist

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research