Catheter-associated urinary tract infection: why do not we control this adverse event?

Objetivo: Identificar factores relacionados con la ocurrencia de infección del tracto urinario asociado con el uso del catéter vesical. Método: Estudio longitudinal, de cohorte retrospectivo, realizado por análisis de la ficha electrónica de pacientes ingresados en unidad de cuidados intensivos de un hospital de alta complejidad, de julio de 2016 a junio de 2017. Se evaluaron los datos demográficos y clínicos, por análisis descriptivo y analítico. Resultados: La densidad de incidencia de la infección urinaria relacionada con el uso del catéter vesical fue de 4,8 por 1.000 catéter/día, siendo la mayoría (80,6%) sin indicación para uso del catéter y, en el 86,7%, no había prescripción para inserción y/o mantenimiento. El tiempo medio entre inserción del catéter vesical y diagnóstico de infección fue de 111,3±6,3 días (6 a 28 días). Los factores estadísticamente significativos (p<0,001) relacionados con la infección urinaria relacionada con el uso del catéter vesical fueron tiempo de estancia hospitalaria en la unidad (12,7±6,9 días) y uso de antimicrobianos en la unidad de cuidados intensivos (8,6±6,3 días). Conclusión: La asociación de la ausencia de la indicación y del registro de la necesidad de mantenimiento posiblemente potenció la ocurrencia de infección urinaria relacionada con el uso del catéter vesical.Objective: To identify factors related to the occurrence of urinary tract infection associated with urinary catheter use. Method: A longitudinal, retrospective cohort study carried out by analyzing the electronic medical records of patients admitted to an intensive care unit of a high-complexity hospital from July 2016 to June 2017. Demographic and clinical data were analyzed by descriptive and analytical analysis. Results: The incidence density of urinary tract infection related to urinary catheter use was 4.8 per 1000 catheters/day, the majority (80.6%) with no indication for catheter use, and there was no prescription for insertion and/or maintenance in 86.7%. The mean time between catheter insertion and infection diagnosis was 11.3 ± 6.3 days (6 to 28 days). Statistically significant factors (p < 0.001) related to urinary infection linked to catheter use were hospitalization time in the unit (16.7 ± 9 days), catheter permanence time (12.7 ± 6.9 days), and the use of antimicrobials in the intensive care unit (8.6 ± 6.3 days). Conclusion: The association of indication absence and the record of the need for maintenance possibly potentiated the occurrence of urinary tract infection associated to catheter use.Objetivo: Identificar fatores relacionados à ocorrência de infecção do trato urinário associada ao uso do cateter vesical. Método: Estudo longitudinal, coorte retrospectivo, realizado pela análise do prontuário eletrônico de pacientes admitidos em unidade de terapia intensiva de um hospital de alta complexidade, de julho de 2016 a junho de 2017. Avaliaram-se dados demográficos e clínicos, por análise descritiva e analítica. Resultados: A densidade de incidência da infecção urinária relacionada ao uso do cateter vesical foi de 4,8 por 1.000 cateter/dia, sendo a maioria (80,6%) sem indicação para uso do cateter e, em 86,7%, não havia prescrição para inserção e/ou manutenção. O tempo médio entre inserção do cateter vesical e diagnóstico de infecção foi de 11,3±6,3 dias (6 a 28 dias). Os fatores estatisticamente significativos (p<0,001) relacionados à infecção urinária relacionada ao uso do cateter vesical foram tempo de internação na unidade (16,7±9 dias), tempo de permanência do cateter vesical (12,7±6,9 dias) e uso de antimicrobianos na unidade de terapia intensiva (8,6±6,3 dias). Conclusão: A associação da ausência da indicação e do registro da necessidade de manutenção possivelmente potencializou a ocorrência de infecção urinária relacionada ao uso do cateter vesical

Biofilme em cateter vesical de demora e a segurança do paciente: uma revisão da literatura

Introduction: Urinary tract infection associated with indwelling urinary catheter accounts for about 40.0% of health care-related infection. Objective: To identify, based on literature review, the factors associated with biofilm formation in an indwelling urinary catheter. Method: An integrative review conducted in the databases: Medline, Lilacs, IBECS, PubMed and Portal Capes, using the descriptors “urinary tract infections”, “urinary catheters” and “biofilm”, with articles published in full between 2009 and 2016 in English, Spanish or Portuguese. Results: Eight articles were selected, four systematic reviews and four observational studies. A biofilm on an indwelling urinary catheter is formed by the fixation that is initiated by the deposition of urine on the surface of the catheter. The factors associated with biofilm formation on an indwelling urinary catheter were type of microorganisms (87.5%) (presence of flagella, motility and production of urease), structural conformation (37.5%) in latex (irregular hydrophobic and hydrophilic surfaces) that allow the adhesion and colonization by several microorganisms, and the female sex (12.5%). Conclusion: This review identified the factors that were associated with biofilm formation in an indwelling urinary catheter and contributes to the proposal of effective prevention measures focused on patient safety.Introdução: A infecção do trato urinário associada a cateter vesical de demora (ITU-CVD) representa cerca de 40,0% das infecções relacionadas à assistência à saúde (IRAS). Objetivo: Identificar através da literatura os principais fatores associados à formação do biofilme em cateter vesical de demora (CVD). Método: Revisão nas bases de dados: Lilacs, Ibecs PubMed e Portal Capes, utilizando os descritores: “infecção do trato urinário”; “cateteres urinários” e “biofilme” de artigos publicados na íntegra entre 2009 e 2016, nos idiomas inglês, espanhol ou português. Resultados: Foram selecionados oito artigos, sendo quatro revisões sistemáticas e quatro estudos observacionais. Os biofilmes nos CVD são formados pela fixação de patógenos que se inicia pela deposição de urina na superfície do cateter. Os fatores associados à formação do biofilme no CVD foram: tipo de microrganismos (87,5%), presença de flagelos, motilidade e produção de urease, conformação estrutural (37,5%) em látex (superfícies irregulares hidrofóbicas e hidrofílicas) que permitem a adesão e colonização por vários microrganismos, e o sexo feminino (12,5%). Conclusões: a presente revisão identificou os fatores associados à formação do biofilme no CVD e assim contribuiu para a proposição de medidas eficazes na prevenção com foco na segurança do paciente

Exploring the relationship between the acceptability of a Flying phobia treatment delivered via the Internet and clinical outcomes

Acceptability (i.e. patients' expectation and satisfaction with the treatment) is claimed as an important and additional criterion besides efficacy. Nevertheless, the literature addressing this issue in the field of Interet-based treatments for specific phobias is scarce, and no studies for Flying Phobia (FP) are available. This study aims to explore the relationship between expectations and satisfaction with treatment and clinical variables in patients who have received an Intemet-based treatment for FP (NO-FEAR Airlines). The sample included 46 participants from a randomized controlled trial. Clinical measures were: Fear of Flying Questionnaire-II, Fear of Flying scale, Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement Scale. Results showed significant correlations between expectations, satisfaction and the change on different clinical variables. Patients' expectations significantly correlated and predicted satisfaction with the treatment. Results also revealed that satisfaction with the treatment remained as a significant predictor of the change on all clinical variables. In sum, this study offers data on the relationship between acceptability measurements and clinical variables in patients receiving an Internet-based treatment for FP

A formação humana integra a educação integral? o que as práticas pedagógicas têm a nos dizer

O artigo aborda como a formação humana pode integrar a educação integral nos contextos de resistência à estrutura escolar, em que tempos e espaços cindidos promovem reprodução de relações desumanizantes. Com uma abordagem qualitativa da pesquisa, contextualizou-se política e conceitualmente o tema. Em seguida, foi feito o registro narrativo da experiência com alfabetização de uma professora de escola pública para refletir sobre como as dimensões ética e estética podem se materializar na educação integral. Essa materialização indica a potência de recriação do trabalho pedagógico como ato responsável para o reconhecimento das crianças como autoras de seu processo de aprendizagem3910

Infecção do trato urinário associada ao cateter vesical em unidade de terapia intensiva

Background and Objectives: The urinary tract infections (UTI) related to the use long-term urinary catheter (LUC) (ITU-LUC) shows high prevalence in the Intensive Care Units (ICU). Therefore, the objective is to determine the prevalence of the factors associated with UTILUC at ICU. Methods: documental research and transversal with quantitative approach was done by the analyses of medical records of all inpatients in all IC from a University Hospital in the north of the state of Minas Gerais in the period from January of 2013 to December of 2014. The gathering and analyses of data were based in the medical records and notification sheets of Healthcare-associated Infections (HAI). The Poisson Regression was adopted with the confidence interval of 95.0%. Results: from 169 analyzed patients, 145 (85.8%) were undergone bladder catheterization. The prevalence of UTI-LUC was 16.6%. The factors associated were time interval ≥ 15 days (Prevalence ratio: 4.6) and use of urinary catheter ≥ 10 days (prevalence ratio: 7.4) Conclusion: the time of hospitalization and permanence of the LUC was directly proportional to the occurrence of UTI-LUC, orienting the commitment of health professionals in the monitoring of hospitalized patients, continue evaluation and strict indication use of LUC. Keywords: hospital infections, Catheter related Infections, Intensive Care Units, Bladder Catheter, Nurse Role.Justificación y Objetivos: Las infecciones del tracto urinario (ITU) relacionadas con el uso del catéter vesical de demora (CVD) (ITU-RC) representan una elevada prevalencia de las infecciones en la unidad de terapia intensiva (UTI). De este modo, se objetivó determinar la prevalencia y factores asociados a la ITU-RC en la UTI. Métodos: Investigación documental y transversal de abordaje cuantitativo, realizada en un UTI estudio transversal, realizado en un hospital universitario del norte de Minas Gerais. La recolección y análisis de datos se basaron en los prontuarios de los pacientes internados en la UTI y fichas de notificación de las IRAS. Se adoptó Regresión de Poisson con intervalo de confianza del 95,0%. Resultados: De los 169 pacientes analizados, 145 (85,8%) fueron sometidos a cateterizaciones vesicales. La prevalencia de ITU-RC fue del 16,6%. Los factores asociados fueron tiempo de internación ≥15 días (Razón de prevalencia: 4,6) y uso del catéter vesical ≥10 días (Razón de prevalencia: 7,4). Conclusión: El tiempo de internación y permanencia del CVD fue directamente proporcional a la ocurrencia de ITU-RC, dirigiendo hacia el compromiso de los profesionales de la salud en el monitoreo de la permanencia, evaluación continua e indicación estricta del uso del CVD.Justificativa e Objetivos:As infecções do trato urinário (ITU) relacionadas ao uso do cateter vesical de demora (CVD) (ITU-RC) apresentam alta prevalência em unidades de terapia intensiva (UTI). Desse modo, objetivou-se determinar a prevalência e fatores relacionados à ITU-RC na UTI. Métodos: Pesquisa documental e retrospectiva de abordagem quantitativa, realizada por meio da análise dos prontuários de todos os pacientes internados em uma UTI de um hospital universitário do norte de Minas Gerais no período de janeiro de 2013 a dezembro de 2014. A coleta e análise de dados foram baseados nos prontuários e fichas de notificação das infecções relacionadas à assistência à saúde (IRAS). Adotou-se regressão de Poisson com intervalo de confiança de 95%. Resultados:Dos 169 pacientes analisados, 145 (85,8%) foram submetidos a cateterizações vesicais. A prevalência de ITU-RC foi de 16,6%. Os fatores associados foram tempo de internação ≥15 dias (Razão de prevalência: 4,6) e uso do cateter vesical ≥10 dias (Razão de prevalência: 7,4). Conclusão:O tempo de inter-nação e permanência do CVD está diretamente relacionado à ocorrência de ITU-RC, direcionando para o compromisso dos profissionais da saúde no monitoramento da permanência, avaliação contínua e indicação estrita do uso do CVD. Descritores:Infecção Hospitalar. Infecções Relacionadas a Cateter. Unidade de Terapia Intensiva. Cateterismo Urinário. Papel do Profissional de Enfermagem

An Internet-based treatment for flying phobia (NO-FEAR Airlines): study protocol for a randomized controlled trial

Background: Flying phobia (FP) is a common and disabling mental disorder. Although in vivo exposure is the treatment of choice, it is linked to a number of limitations in its implementation. Particularly important, is the limited access to the feared stimulus (i.e., plane). Moreover, the economic cost of in vivo exposure should be specially considered as well as the difficulty of applying the exposure technique in an appropriate way; controlling important variables such as the duration of the exposure or the number of sessions. ICTs could help to reduce these limitations. Computer-assisted treatments have remarkable advantages in treating FP. Furthermore, they can be delivered through the Internet, increasing their advantages and reaching more people in need. The Internet has been established as an effective way to treat a wide range of mental disorders. However, as far as we know, no controlled studies exist on FP treatment via the Internet. This study aims to evaluate the efficacy of an Internetbased treatment for FP (NO-FEAR Airlines) versus a waiting list control group. Secondary objectives will be to explore two ways of delivering NO-FEAR Airlines, with or without therapist guidance, and study the patients’ acceptance of the program. This paper presents the study protocol. Methods/design: The study is a randomized controlled trial. A minimum of 57 participants will be randomly assigned to three conditions: a) NO-FEAR Airlines totally self-applied, b) NO-FEAR Airlines with therapist guidance, or c) a waiting list control group (6 weeks). Primary outcomes measures will be the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes will be included to assess other relevant clinical measures, such as the Fear and Avoidance Scales, Clinician Severity Scale, and Patient’s Improvement scale. Analyses of post-treatment flights will be conducted. Treatment acceptance and preference measures will also be included. Intention-to-treat and per protocol analyses will be conducted. Discussion: An Internet-based treatment for FP could have considerable advantages in managing in vivo exposure limitations, specifically in terms of access to treatment, acceptance, adherence, and the cost-effectiveness of the intervention. This is the first randomized controlled trial to study this issue. Trial registration: Clinicaltrials.gov: NCT02298478. Trial registration date 3 November 2014.Funding for the study was provided by grants: Ministerio de Economía y Competitividad (Spain) (Plan Nacional I + D + I. PSI2013-41783-R); Red de Excelencia (PSI2014-56303-REDT) PROMOSAM: Research in processes, mechanisms and psychological treatments for mental health promotion from the Ministerio de Economía y Competitividad (2014); a PhD grant from Generalitat Valenciana (VALi + d) (ACIF/2014/320), and CIBER: CIBER Fisiopatología de la Obesidad y Nutrición is an initiative of ISCIII

Anthropometric measurements, deficiency of vitamin d and calcium in patients in pre- and post-operative bariatric surgery / Medidas antropométricas, deficiência de vitamina d e cálcio em pacientes pré e pós-operatório de cirurgia bariátrica

Introduction: Bariatric surgery have been shown as an efficient tool for weight loss, however some nutritional deficiency could be occurred, like vitamin D and calcium. Aim: To evaluate the frequency of serum vitamin D and calcium deficiency, as well as body measurements in patients before and after bariatric surgery. Methodology: Longitudinal study involving patients submitted to Roux-en-Y gastric bypass (RYGB) and Sleeve gastrectomy. Anthropometric data and biochemical data were evaluated comparing them to surgical techniques and over time. Results: There was no difference in the comparison of weight loss (kg) between techniques after six months of surgery (p=0.151), however, there was a greater total weight loss in patients who underwent RYGB than in those underwent Sleeve gastrectomy (p=0.046) after 12 months after surgery. There was weight loss in percentage in relation to pre-surgery weight and in relation to ideal weight after surgery. No differences were observed in serum vitamin D and calcium concentrations at the beginning and at the end of the study, nor during the post-surgical time (p>0.05). Conclusion: Bariatric surgery in both techniques proved to be efficient for continuous body weight loss. No vitamin D and calcium deficiencies were found pre- and post-surgical

Motor and sensory performance of infants with and without Down syndrome: a pilot study

The study aimed at assessing motor and sensory performance of infants with Down syndrome (DS) comparing them to typical infants at the age of six months. Eight infants - 4 with typical development, 4 with DS - were assessed as to motor performance by the Alberta infant motor scale (AIMS) at supine, prone, sitting, and standing positions. Sensory performance was assessed by using the Infant/toddler sensory profile (ITSP), which classifies sensorial behaviours as"low registration" (difficulty in detecting sensory stimuli), sensation seeking, excessive sensitivity to stimuli, and sensation avoiding behaviours. Results show that infants with DS had significantly lower scores in low registration when compared to typical infants, suggesting that their higher sensory threshold lead to longer reaction times. At the AIMS, infants with DS had lower performance when compared to typical infants at the prone subscale, which may be due to deficits in postural and antigravity control. No correlation was found between ITSP and AIMS scores. Results then suggest that infants with Down syndrome may less frequently engage in environmental interactions, probably due both to difficulty in perceiving day-to-day stimuli (like diverse sounds or people's) and difficulty to explore the environment by using their limited motor abilities.O estudo visou avaliar o desempenho motor e sensorial de lactentes com e sem síndrome de Down (SD) aos seis meses de vida. Foram avaliados oito lactentes, sendo quatro com SD e quatro típicos, com 24 semanas de vida. Para verificar o desempenho motor foi utilizada a escala motora infantil de Alberta (AIMS), nas posturas supina, prona, sentada e em pé. O desempenho sensorial foi avaliado por meio de entrevista com o cuidador da criança utilizando o perfil sensorial infantil ITSP (infant/toddler sensory profile), que classifica comportamentos sensoriais como de"baixo registro" (dificuldade em registrar estímulos sensoriais), busca de estímulos, excessiva sensibilidade a estímulos e comportamentos de evitar estímulos. Os resultados no ITSP mostram que os lactentes com SD obtiveram piores escores em baixo registro, possivelmente por apresentarem altos limiares neurológicos, demorando mais para responder aos estímulos. Na AIMS os lactentes com SD tiveram um desempenho inferior quando comparados aos típicos na subescala prono, o que pode advir de dificuldades no controle postural e antigravitacional. Não foi encontrada correlação entre os escores do ITSP e da AIMS. Os resultados sugerem que os lactentes com SD podem se engajar com menos freqüência em atividades de interação com o ambiente, tanto por dificuldade em registrar estímulos cotidianos (como diferentes sons e pessoas), quanto por dificuldade em explorar o meio utilizando habilidades motoras

UMA ANÁLISE SOBRE ESTUDOS QUE RELACIONAM A LITERATURA INFANTIL E A MORALIDADE NA PERSPECTIVA CONSTRUTIVISTA PIAGETIANA

This paper is a theoretical essay that examines educational contributions of children's literature and studies on morality in Piagetian constructivist perspective. The aim was to identify and discuss what possible relationships established in the work surveyed, between children's literature and moral development. Were analyzed four papers that address the theme, selected from the titles, the theoretical line and key-words. We used a qualitative data analysis. In each selected article, we proceeded to discuss the theoretical approach, the description of the methodological procedures and proposed educational interventions (when present). This research aimed to contribute to discuss the importance of using children's literature texts for the development of morality and the lack of papers on the line of research.http://dx.doi.org/10.14572/nuances.v23i24.1895O presente trabalho é um ensaio teórico, que teve como finalidade analisar as contribuições pedagógicas de pesquisas que relacionam a Literatura Infantil e os estudos sobre a moralidade na perspectiva construtivista piagetiana. O objetivo foi o de identificar e discutir quais as possíveis relações estabelecidas, nos trabalhos pesquisados, entre Literatura Infantil e desenvolvimento moral. Foram analisados quatro artigos científicos que abordam a temática, selecionados a partir dos títulos, linha teórica e palavras-chave. Utilizou-se a análise qualitativa dos dados. Em cada artigo selecionado, procedeu-se a discussão da abordagem teórica, a descrição dos procedimentos metodológicos e das propostas de intervenções pedagógicas (quando presentes). Esta pesquisa pretendeu contribuir para a discussão sobre a importância do uso de textos da Literatura Infantil para o desenvolvimento da moralidade e a constatação da escassez de trabalhos nesta linha de pesquisa.http://dx.doi.org/10.14572/nuances.v23i24.189

Protocol for a randomized controlled dismantling study of an internet-based intervention for depressive symptoms: exploring the contribution of behavioral activation and positive psychotherapy strategies

Background: there are evidence-based interventions for depression that include different components. However, the efficacy of their therapeutic components is unknown. Another important issue related to depression interventions is that, up to now, their therapeutic components have only focused on reducing negative symptoms rather than on improving positive affect and well-being. Because the low levels of positive affect are more strongly linked to depression than to other emotional disorders, it is important to include this variable as an important treatment target. Positive psychotherapeutic strategies (PPs) could help in this issue. The results obtained so far are consistent and promising, showing that Internet-based interventions are effective in treating depression. However, most of them are also multi-component, and it is important to make progress in investigating what each component contributes to the intervention. Methods: the current study will be a three-armed, simple-blinded, randomized controlled clinical trial with a dismantling design. 192 participants will be randomly assigned to: a) an Internet-based Global Protocol condition, which includes traditional therapeutic components of evidence-based treatments for depression (Motivation for change, Psychoeducation, Cognitive Therapy, Behavioral Activation (BA), Relapse Prevention) and PPs component, offering strategies to enhance positive mood and promote psychological strengths; b) an Internet-based BA Protocol condition (without the PPs component), and c) an Internet-based PPs Protocol condition (without the BA component). Primary outcome measures will be the BDI-II and PANAS. Secondary outcomes will include other variables such as depression, anxiety and stress, quality of life, resilience, and wellbeing related measures. Treatment acceptance and usability will also be measured. Participants will be assessed at pre-, post-treatment, 3-, 6- and 12- month follow- ups. The data will be analyzed based on the Intention-to-treat principle. Per protocol analyses will also be performed. Discussion: to the best of our knowledge, this is the first randomized dismantling intervention study for depression with the aim of exploring the contribution of a PPs component and the BA component in an Internet-based intervention. The three protocols are online interventions, helping to reach many people who need psychological treatments and otherwise would not have access to them