Fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos

Resumo Objetivo Identificar os fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos. Métodos Estudo de coorte prospectivo conduzido em unidade de terapia intensiva com recém-nascidos submetidos à instalação de 401 cateteres centrais de inserção periférica. Características clínicas do neonato, técnica de inserção do cateter, terapia intravenosa e tempo de permanência do cateter foram testados como fatores de risco para remoção por infecção de corrente sanguínea associada ao cateter, por meio de análise bivariada e análise multivariada com regressão de Poisson. Resultados Os dados sugerem que as menores médias de peso e idade gestacional corrigida, bem como o maior tempo de permanência do cateter estiveram associados à ocorrência de infecção de corrente sanguínea associada ao cateter. A menor idade gestacional corrigida, os diagnósticos clínicos de transtorno transitório do metabolismo e apneia, e o uso do cateter de duas vias foram identificados como fatores de risco. Conclusão A menor idade gestacional corrigida do neonato, os diagnósticos clínicos de transtorno transitório do metabolismo e apneia, e o uso do cateter de duas vias foram identificados como fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos

Effect of positional asymmetry palpatory models on improvement and retention of accuracy during pelvic asymmetry assessments

Context: Asymmetry of bony landmarks, such as the anterior superior iliac spine (ASIS) or posterior superior iliac spine (PSIS), is often utilized to identify somatic dysfunction in the pelvis. However, establishing good accuracy for these assessments can be challenging, so objective training models have been developed to enhance learning and accuracy. Objectives: The objective of this study was to determine the effect of training with positional asymmetry models with objective feedback on the improvement and retention of pelvic asymmetry assessment accuracy. Methods: First-year osteopathic medical students and undergraduate interns were recruited for model training. After a basic technique demonstration, they completed a 72-question baseline assessment on the ASIS and PSIS models. Subsequent training was conducted for 5 h per week (1 h/day) for two consecutive weeks. Model accuracy was assessed four times at baseline, midpoint, final, and retention. Assessments were scored as a percent of the correctly identified asymmetries, and change scores were calculated by comparison with the previous assessment score (i.e., baseline to midpoint, midpoint to final, final to retention) and overall (baseline to retention). Results: Twelve students (age range, 20.3–29.2 years) participated. At baseline, overall scores were 57.6 % for ASIS and 72.9 % for PSIS models. For ASIS models, the change scores improved from baseline to midpoint (+18.9 %, p\u3c0.001) and from midpoint to final (+6.6 %, p=0.01) but decreased from final to retention (−7.2 %, p=0.01). The overall retention scores were higher than baseline (+18.3 %, p\u3c0.001). For PSIS models, the change scores improved from baseline to midpoint (+13.0 %, p\u3c0.001), and the overall retention scores were higher than baseline (+15.0 %, p\u3c0.001). Conclusions: Training with positional asymmetry models with objective feedback resulted in significant sustained improvements in ASIS and PSIS positional asymmetry assessment accuracy. Integration of these models into the standard medical curriculum should be considered