PROTOCOLOS DE TRIAGEM E CLASSIFICAÇÃO DE RISCO EM SERVIÇOS DE URGÊNCIA E EMERGÊNCIA: UMA REVISÃO DA LITERATURA

Introduction: Screening and risk classification are fundamental processes in urgent and emergency services, aiming to identify and prioritize care for patients according to the severity of their condition. Triage, as the healthcare team's first contact with the patient, consists of an initial assessment to determine the urgency of each case. Subsequently, patients are classified into risk categories, indicating the priority level for care. Objectives: To describe the functionality of triage and risk classification in urgency and emergency environments, and its essential role in prioritizing care based on needs. Methodology: Research carried out in March 2024, based on an integrative review of scientific literature in the SciELo and PubMed databases, using the descriptors: "Manchester Triage", "Start Method", "Urgency and emergency" and "Classification and risk". Results and Discussion: Screening and risk classification are carried out by trained professionals, who evaluate patients based on a series of clinical criteria, such as vital signs, complaints and medical history. This assessment makes it possible to quickly identify cases that require immediate care and referral to appropriate sectors, contributing to the efficient management of patient flow and avoiding overcrowding in emergency units. Conclusion: The adoption of protocols, such as Manchester and the START Method, have been widely used in emergency services in Brazil. These systems classify patients into different priority levels, based on the colors red, orange, yellow, green, and blue. These systematizations allow for a quick and effective assessment of patients, ensuring adequate prioritization of care, reduced waiting times and greater safety in the management of emergencies. This contributes to the quality of care provided and the improvement of clinical results.Introdução: A triagem e classificação de risco, são processos fundamentais em serviços de urgência e emergência, visando identificar e priorizar o atendimento aos pacientes de acordo com a gravidade de sua condição. A triagem, como primeiro contato da equipe de saúde com o paciente, consiste em uma avaliação inicial para determinar a urgência de cada caso. Posteriormente, os pacientes são classificados em categorias de risco, indicando o nível de prioridade para o atendimento. Objetivos: Descrever a funcionalidade da triagem e classificação de risco em ambientes de urgência e emergência, e seu papel essencial na priorização dos atendimentos com base em necessidades. Metodologia: Pesquisa realizada em março de 2024, com base em uma revisão integrativa da literatura científica nas bases de dados SciELo e PubMed, utilizando os descritores: "Triagem de Manchester", "Método Start", "Urgência e emergência" e "Classificação e risco". Resultados e Discussão: A triagem e a classificação de risco são realizadas por profissionais capacitados, que avaliam os pacientes com base em uma série de critérios clínicos, como sinais vitais, queixas e histórico médico. Essa avaliação permite identificar rapidamente os casos que requerem atendimento imediato e encaminhamento para setores adequados, contribuindo para a gestão eficiente do fluxo de pacientes e evitando a superlotação nas unidades de emergência. Conclusão: A adoção de protocolos, como o de Manchester e o Método START, tem sido amplamente eficaz em serviços de urgência no Brasil. Esses sistemas classificam os pacientes em diferentes níveis de prioridades, com base nas cores vermelha, laranja, amarela, verde e azul. Essas sistematizações permitem uma avaliação rápida e eficaz dos pacientes, garantindo uma adequada priorização dos atendimentos, redução do tempo de espera e maior segurança no manejo das emergências. O que contribui para a qualidade do atendimento prestado e para a melhoria dos resultados clínicos

O PAPEL CRUCIAL DA AMAMENTAÇÃO NA PRIMEIRA HORA DE VIDA: IMPACTO NA SAÚDE E DESENVOLVIMENTO NEONATAL

Introdução: O leite materno desempenha um papel vital no contexto da nutrição e do cuidado infantil, oferecendo uma série de benefícios que contribuem para o seu crescimento cognitivo, proteção contra doenças e fortalecimento do vínculo emocional com a mãe. Além da nutrição, o leite materno apresenta propriedades imunológicas notáveis, sendo uma fonte rica em anticorpo, células imunológicas e fatores de crescimento que contribuem para fortalecer o sistema imunológico do bebê e protegê-lo contra uma variedade de infecções e doenças. Objetivos: Descrever a importância da amamentação precoce no desenvolvimento neonatal. Metodologia: Pesquisa realizada em março de 2024, com base em uma revisão integrativa da literatura científica nas bases de dados SciELo e PubMed, utilizando os descritores: "Golden Hour", "Importância da amamentação", “Aleitamento precoce” e "Primeira hora de vida". Resultados e discussão: Em termos de saúde a longo prazo, a amamentação exclusiva iniciada na primeira hora de vida, e se estendendo até os primeiros meses, está associada a uma redução significativa do risco de desenvolvimento de doenças crônicas na vida adulta, como obesidade, diabetes tipo 2 e doenças cardiovasculares. Esses benefícios duradouros ressaltam a importância da amamentação como um investimento na saúde e no bem-estar ao longo da vida da criança. Conclusão: A amamentação precoce desempenha um papel de suma importância no desenvolvimento neonatal, conferindo uma série de benefícios que vão além da simples nutrição. Ao fortalecer o sistema imunológico, fomentar o desenvolvimento cognitivo e estabelecer um vínculo emocional entre mãe e filho, a amamentação na primeira hora de vida estabelece as bases para uma vida saudável

GERENCIAMENTO DA SARCOPENIA: INTEGRANDO EXERCÍCIOS E NUTRIÇÃO PARA PROMOVER A SAÚDE MUSCULAR EM IDOSOS

Introduction: Sarcopenia is characterized by the progressive loss of muscle mass and strength in the elderly, resulting in physical frailty and an increased risk of falls and mortality. Physical exercise is fundamental in the prevention and treatment of sarcopenia, but its prescription for the elderly requires careful consideration of several factors, including the severity of sarcopenia and comorbidities. Methodology: A systematic review was carried out using the PubMed, Scielo and LILACS databases, and the descriptors ((Sarcopenia" AND (Exercise)) AND (Health of the Elderly), resulting in 25 articles selected for analysis. In addition, guidelines from the Brazilian Society of Geriatrics and Gerontology were consulted for additional information. Results: Sarcopenia involves the gradual loss of muscle mass and is associated with multiple pathophysiological mechanisms, including satellite cell senescence and chronic inflammation. Diagnosis is based on clinical criteria and imaging tests, particularly dual-energy X-ray absorptiometry. Physical exercise, especially resistance training, is fundamental in the treatment of sarcopenia, but the prescription must be adapted to the individual needs of the elderly, taking into account their frailty and comorbidities. Conclusion: Sarcopenia represents a significant health challenge for the elderly, requiring a multidisciplinary approach that includes adapted physical exercise, nutritional interventions and, when necessary, specific supplementation. Although evidence for drug interventions is limited, evidence-based individualization of treatment is crucial to promote healthy and functional aging.Introducción: La sarcopenia se caracteriza por la pérdida progresiva de masa y fuerza muscular en los ancianos, lo que provoca fragilidad física y un mayor riesgo de caídas y mortalidad. El ejercicio físico es fundamental en la prevención y el tratamiento de la sarcopenia, pero su prescripción para los ancianos requiere una cuidadosa consideración de varios factores, incluyendo la gravedad de la sarcopenia y las comorbilidades. Metodología: Se realizó una revisión sistemática utilizando las bases de datos PubMed, Scielo y LILACS, y los descriptores ((Sarcopenia" AND (Ejercicio)) AND (Salud del Anciano), resultando en 25 artículos seleccionados para análisis. Además, se consultaron las directrices de la Sociedad Brasileña de Geriatría y Gerontología para obtener información adicional. Resultados: La sarcopenia consiste en la pérdida gradual de masa muscular y se asocia a múltiples mecanismos fisiopatológicos, incluyendo la senescencia de las células satélite y la inflamación crónica. El diagnóstico se basa en criterios clínicos y pruebas de imagen, especialmente la absorciometría de rayos X de doble energía. El ejercicio físico, especialmente el entrenamiento de resistencia, es fundamental en el tratamiento de la sarcopenia, pero la prescripción debe adaptarse a las necesidades individuales de los ancianos, teniendo en cuenta su fragilidad y comorbilidades. Conclusiones: La sarcopenia representa un importante reto para la salud de las personas mayores, que requiere un enfoque multidisciplinar que incluya ejercicio físico adaptado, intervenciones nutricionales y, cuando sea necesario, suplementación específica. Aunque la evidencia de las intervenciones farmacológicas es limitada, la individualización del tratamiento basada en la evidencia es crucial para promover un envejecimiento saludable y funcional.Introdução: A sarcopenia é caracterizada pela perda progressiva de massa e força muscular em idosos, resultando em fragilidade física e maior risco de quedas e mortalidade. O exercício físico é fundamental na prevenção e tratamento da sarcopenia, mas sua prescrição para idosos requer consideração cuidadosa de vários fatores, incluindo a gravidade da sarcopenia e comorbidades. Metodologia: Uma revisão sistemática foi realizada utilizando as bases de dados PubMed, Scielo e LILACS, e os descritores ((Sarcopenia” AND (Exercise)) AND (Health of the Elderly), resultando em 25 artigos selecionados para análise. Além disso, foram consultadas diretrizes da Sociedade Brasileira de Geriatria e Gerontologia para informações adicionais. Resultados: A sarcopenia envolve a perda gradual de massa muscular e está associada a múltiplos mecanismos fisiopatológicos, incluindo senescência das células satélites e inflamação crônica. O diagnóstico é baseado em critérios clínicos e exames de imagem, com destaque para a absorciometria de raios X de dupla energia. O exercício físico, especialmente o treinamento resistido, é fundamental no tratamento da sarcopenia, mas a prescrição deve ser adaptada às necessidades individuais dos idosos, levando em consideração sua fragilidade e comorbidades. Conclusão: A sarcopenia representa um desafio significativo para a saúde dos idosos, exigindo uma abordagem multidisciplinar que inclua exercícios físicos adaptados, intervenções nutricionais e, quando necessário, suplementação específica. Embora as evidências para intervenções medicamentosas sejam limitadas, a individualização do tratamento com base em evidências é crucial para promover o envelhecimento saudável e funcional

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries