Diagnóstico Situacional da Unidade de Saúde Ouro Verde

Trabalho de Conclusão de Curso apresentado ao Instituto Latino-Americano de Ciências da Vida e da Natureza, como requisito parcial à obtenção do título de Bacharel em Medicina.A atenção primária à saúde se traduz como a reorganização do cuidado, visando a prevenção e a promoção. Atrelado à APS, o processo de diagnóstico situacional é importante para entender as potencialidades e deficiências do território onde se aplica as diretrizes da atenção básica. Tendo em vista esse contexto, o trabalho em questão teve como objetivo a realização do diagnóstico situacional da UBS Ouro Verde, localizada no município de Foz do Iguaçu, por meio da coleta de dados dos relatórios do e-SUS e do RP saúde, agrupados em perfis populacionais, e do processo de experiência dentro desse local. Identificou-se que a unidade apresenta uma população predominantemente adulta jovem, que está sob a responsabilidade de uma eSF. Os principais pontos a serem destacados são a inadequação do espaço físico às normas vigentes do MS, com a falta de salas para o funcionamento de serviços, a inadequada continuidade do cuidado, com o não comparecimento às consultas de rotina pelas populações de risco, e o precário registro dos parâmetros dos relatórios institucionais referentes à população adscrita. Portanto, a reflexão oriunda do diagnóstico situacional descortina os problemas advindos de uma gestão com algumas incompletudes, mas que pode reajustar sua maneira de trabalhar a partir da visualização dessas questõe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research