COMPLEJIDAD DE LA ASISTENCIA EN UNIDAD DE TERAPIA INTENSIVA: SUBSIDIOS PARA DIMENSIÓN DE PERSONAL DE ENFERMERÍA

Estudo desenvolvido com objetivo de classificar os pacientes de uma Unidade de Tratamento Intensivo Cardiológica, e dimensionar o pessoal de enfermagem. Estudo de coorte prospectivo realizado entre janeiro e março de 2011. Utilizou-se a Escala de Gradação da Complexidade Assistencial proposta por Fugulin. Essa escala classifica os pacientes em: assistência mínima, intermediária, alta dependência, semi-intensiva, intensiva. Todos os pacientes internados durante a realização do estudo foram incluídos. Foram avaliados 117 pacientes, predominantes do sexo masculino (65%), com idade média de 66±12 anos, procedentes da emergência. Os pacientes foram classificados majoritariamente com cuidados de alta dependência e intensivo. Não há concordância entre o atual dimensionamento da equipe de enfermagem com o que está recomendado pelo Conselho Federal de Enfermagem.Study developed aiming to classify patients of a Cardiac Intensive Care Unit, and to dimension the nursing staff. Prospective cohort study carried out between January and March 2011. The Care Complexity Grading Scale proposed by Fugulin was used. This scale classifies patients as: minimal, intermediate, high dependency, semi-intensive, and intensive care. All patients hospitalized during the study period were included. In total, 117 patients were evaluated, predominantly male (65%), coming from the emergency department, with a mean age 66±12 years. The patients were mostly classified as high dependency and intensive care. There is no correlation between the current dimensioning of the nursing staff and what is recommended by the Federal Nursing Council.Estudio desarrollado con objetivo de clasificar los pacientes de una Unidad de Tratamiento Intensivo Cardiológica, y dimensionar el personal de enfermería. Estudio prospectivo realizado entre enero y marzo de 2011. Fue utilizada la Escala de Gradación de la Complejidad Asistencial propuesta por Fugulin. Esa escala clasifica los pacientes en: asistencia mínima, intermediaria, alta dependencia, semintensiva, intensiva. Todos los pacientes internados durante la realización del estudio fueron incluidos. Fueron evaluados 117 pacientes, predominantes del sexo masculino (65%), con edad media de 66±12 años, procedentes de la emergencia. La mayor parte de los pacientes fueron clasificados como de cuidados de alta dependencia e intensivo. No hay concordancia entre la actual dimensión del equipo de enfermería con lo que recomienda el Consejo Federal de Enfermería

Comparative analysis of mastectomies and breast reconstructions performed in the Brazilian Unified Health System in the last 5 years

Introduction: Breast cancer is the second most common malignant neoplasm in women in Brazil. A great challenge for health professionals and to reconcile the waiting line for both oncological and reconstructive surgeries. The objective is to evaluate the last 5 years of breast cancer surgeries compared to the number of reconstructive surgeries performed in the same period. Methods: This is a descriptive study with a transversal and retrospective approach on mastectomies, segmentectomies and breast reconstructions performed at SUS, between the years 2015 and 2020. According to the procedures and codes chosen and tabulated in the Microsoft Excel 365 software, the data were collected in the SUS data transfer service. Results: 204,569 breast cancer surgeries were performed, with 57% segmentectomies/quadrantectomies and 43% mastectomies. In the same period, 17,927 reconstructive plastic breast surgeries were performed with implants after mastectomy, with only 20.52% of mastectomized women undergoing immediate reconstruction with implants. Conclusion: The number of reconstructive breast surgeries in Brazil is below the ideal level, leaving most women mastectomized with sequelae for a long time

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 <= 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

Effect of insecticide spray in lethal chlorosis (Zucchini lethal chlorosis virus - ZLCV) epidemiology in Cucurbita pepo L.

O manejo de fitoviroses muitas vezes é realizado com o uso de inseticidas para o controle do vetor. Para o patossistema Frankliniella zucchini / Cucurbita pepo / Zucchini lethal chorosis virus (ZLCV) não existe informação na literatura sobre a eficiência do controle da doença por meio do controle químico do vetor. Para tanto foi proposto este trabalho, que tem ainda por objetivo uma melhor compreensão da epidemiologia da doença em seus aspectos temporal e espacial. Os experimentos foram conduzidos na estação experimental de Fitopatologia da Escola Superior de Agricultura \"Luiz de Queiroz\" no período de março de 2010 a dezembro de 2011. Campos de abobrinha de moita foram divididos em parcelas com e sem aplicação do inseticida neonicotinóide Imidacloprid. As avaliações da doença foram feitas com base nos sintomas foliares característicos da doença, em intervalos de três a quatro dias, e confirmados por meio de teste ELISA. A Clorose Letal apresentou incidências de 11,58% e 52,55% em parcelas com inseticida e de 21,36% e 69,89% em parcelas sem inseticida, para os anos de 2010 e 2011, respectivamente. Em todos os casos, o modelo monomolecular apresentou melhor ajuste aos dados temporais e as plantas sintomáticas distribuíram-se aleatoriamente nas parcelas. Esses resultados sugerem que a disseminação primária é o processo predominante na epidemiologia da doença. A disseminação primária, neste caso, dá-se pelo influxo de vetores virulíferos de fora para dentro da plantação. O pequeno efeito benéfico do uso de inseticida está ligado ao controle da disseminação secundária da doença, de planta infectada para planta sadia dentro da plantação. Para o manejo racional da Clorose Letal é importante a determinação de hospedeiros alternativos do vírus e sua importância epidemiológica. O uso de inseticida, feito isoladamente, não é uma maneira eficiente de controlar da doença.Management of virus diseases is often accomplished with insecticide spray to vector control. For pathosystem Frankliniella zucchini / Cucurbita pepo / Zucchini lethal chlorosis virus (ZLCV) there are no information about the efficiency of disease control by mean of vector chemical control. This research was proposed to fill this gap and, additionally, to better understand the epidemiology of the disease in its temporal and spatial aspects. Experiments were conducted at the experimental station of the Plant Pathology Department of ESA Luiz de Queiroz from March 2010 to December 2011. Fields of zucchini plants were divided into parcels, with and without insecticide application (Imidacloprid). Disease assessments were made based on disease symptoms at intervals of three to four days and confirmed by ELISA test. Lethal Chlorosis presented incidences of 11.58% and 52.55% in parcels with insecticide and of 21.36% and 69.89% in parcels without insecticide, for years 2010 and 2011, respectively. In all cases, the monomolecular model fitted better temporal data and symptomatic plants were distributed at random. These results suggest that primary dissemination is the predominant process in the epidemiology of the disease. Primary dissemination, in this case, is represented by the influx of viruliferous vectors from outside the field. The small effect caused by the use of insecticide is linked to the control of secondary dissemination inside the field. To manage rationally Letal Chlorosis it is important to identify the alternative hosts of virus and to determine its epidemiological relevance. Only to spray insecticide is not an efficient way for disease control in this case

INCLUSÃO DIGITAL PARA IDOSOS E ADULTOS: NOVAS OPORTUNIDADES

O crescente uso da tecnologia no século XXI traz oportunidades de comunicação entre pessoas distantes como também a troca de informações rápidas em todo o mundo através de vários tipos de dispositivos eletrônicos. Apesar da facilidade de socialização, o não conhecimento do uso dessas tecnologias possibilita a exclusão de tais indivíduos. Nesse contexto de inserção e aprendizagem das tecnologias que circundam a vida das pessoas, os idosos e adultos buscam adaptar-se a este novo meio de comunicação para se sentirem introduzidos na sociedade atual. Com base nisso, a inclusão digital é o objetivo proposto para idosos e adultos que participam das atividades desenvolvidas nos laboratórios de informática do campus da PUC Minas em Arcos