Cohort study to evaluate nursing team performance in a theoretical test after training in cardiopulmonary arrest

O objetivo deste estudo foi avaliar o conhecimento teórico da equipe de enfermagem quanto ao atendimento a vítimas de parada cardiorrespiratória (PCR) antes, imediatamente após e decorridos seis meses de treinamento. Usou-se o método estudo de coorte, conduzido em um hospital especializado em cardiologia, Porto Alegre, RS (novembro/2005 a maio/2006). Incluíu-se enfermeiros (35 no pré-teste, 34 no pós e o mesmo número após seis meses), técnicos e auxiliares (232 no pré, 227 no pós e 104 após seis meses). Aplicou-se um questionário nos três períodos, considerando-se 'conhecimento satisfatório' 75% de acertos. Os resultados mostraram, no pré-teste, que 62,9% dos enfermeiros atingiram o percentual considerado satisfatório, no pós, 94,1% e decorridos seis meses, 64,7%. Entre os técnicos e auxiliares, no pré, 36,2% atingiram o percentual considerado satisfatório, no pós, 79,3% e 62,5% decorridos seis meses. Conclui-se que o treinamento em PCR melhora o conhecimento da equipe logo após o treinamento, havendo redução do escore de acertos após 6 meses.El objetivo de este estudio fue evaluar el conocimiento teórico del equipo de enfermería en lo que se refiere a la atención de víctimas de paro cardiorrespiratorio (PCR) antes, inmediatamente después y transcurridos seis meses después del entrenamiento. Se utilizó el método estudio de cohorte, conducido en un hospital especializado en, Porto Alegre, RS (de noviembre/2005 a mayo/2006). Se incluyeron enfermeros, (35 en la pre-prueba, 34 en la post prueba y el mismo número después de seis meses), técnicos y auxiliares (232 en la pre, 227 en la post y 104 después de seis meses). Se aplicó un cuestionario en los tres períodos; se consideró 'conocimiento satisfactorio' a 75% de aciertos. Los resultados mostraron, en la pre-prueba, que 62,9% de los enfermeros alcanzaron el porcentaje considerado satisfactorio, en la post 94,1% y transcurridos seis meses, 64,7%. Entre los técnicos y auxiliares, en la pre, 36,2% alcanzaron el porcentaje considerado satisfactorio, en la post 79,3% y 62,5% después de transcurridos seis meses. Se concluye que el entrenamiento en PCR mejora el conocimiento del equipo inmediatamente después del entrenamiento, habiendo una reducción del puntaje de aciertos después de 6 meses.OBJECTIVES: To evaluate nursing professionals' theoretical knowledge of cardiopulmonary arrest (CPA) treatment before specific training, immediately after, and six months later. METHODS: Cohort study, performed in a cardiology hospital in Porto Alegre, Rio Grande do Sul (November/2005 to May/2006), Brazil. Nurses, nursing technicians and assistants were included. A questionnaire was administered in the three periods, and 75% of correct answers was considered a satisfactory result. RESULTS: Thirty-five nurses participated in the pre-test, and 34 in the immediate and 6-month tests. Among technicians and assistants, 232, 227, and 104 participated in the pre-test, immediate, and 6-months tests, respectively. Among nurses, 62.9% achieved an adequate percentage of correct answers in the pre-test, 94.1% in the immediate, and 64.7% in the 6-months test; for nursing technicians and assistants, these values were 36.2%, 79.3%, and 62.5%, respectively. CONCLUSION: Training in CPA improved the nursing professionals' knowledge immediately after its administration, with a reduction in the rate of correct answers after 6 months

Adesão ao tratamento de pacientes com insuficiência cardíaca em um hospital universitário

A baixa adesão ao tratamento de pacientes com insuficiência cardíaca (IC) é um dos fatores relacionado a reinternações. Nesta perspectiva, este estudo, conduzido em um hospital universitário no Rio Grande do Sul, buscou descrever a adesão ao tratamento farmacológico e não farmacológico de pacientes admitidos com IC descompensada, relacionando-a com o número de internações e re-internações hospitalares no período de um ano. A adesão farmacológica foi avaliada pela escala de Morisky, e a não farmacológica por meio de um questionário previamente validado. Incluíram-se 252 pacientes, idade média 63±13 anos e 151 (60%) do sexo masculino. Quanto à adesão ao tratamento farmacológico, 118 (47%) referiram alta adesão e 45 (18%) eram aderentes ao tratamento não farmacológico. Não houve relação entre adesão ao tratamento (farmacológico e não farmacológico) e re-internações. Conhecimento prévio dos cuidados não farmacológicos, identificação dos sintomas de congestão e aqueles que já faziam tratamento para IC foram relacionados à adesão

Educational nursing intervention to reduce the hyperphosphatemia in patients on hemodialysis

Objective: to evaluate the effectiveness of an educational nursing intervention to reduce hyperphosphataemia in chronic renal patients on hemodialysis. Method: quasi-experimental study with 63 hyperphosphatemic patients on hemodialysis. The intervention consisted of developing and providing a printed and illustrated manual to patients containing information on disease control. The participant was asked to complete a daily checklist with the aim to reinforce aspects provided in the manual. Laboratory tests and itching intensity were analyzed at the beginning of the study, and at 30 and 60 days after the educational intervention. Results: the mean age of participants was 58 +/- 13.1 years, with a treatment time of 51.1 +/- 44.7 months. A reduction in serum phosphorus values of 7.06 +/- 1.43 to 5.80 +/- 1.53 (p <0.001) and the intensity of itching after the intervention was observed. Conclusion: the educational nursing intervention was effective in reducing phosphate and decreasing itching in hyperphosphatemic patients.Objetivo: avaliar a efetividade de uma intervenção educacional de enfermagem para redução da hiperfosfatemia em pacientes renais crônicos em hemodiálise. Método: estudo quase experimental realizado com 63 pacientes hiperfosfatêmicos em hemodiálise. A intervenção se constituiu em orientar e disponibilizar um manual impresso e ilustrado aos pacientes, contendo informações sobre o controle da doença. Foi solicitado o preenchimento de um checklist diário, com finalidade recordatória dos aspectos abordados no manual. Os exames laboratoriais e a intensidade do prurido foram analisados no início do estudo, aos 30 e 60 dias após a intervenção educacional. Resultados: a média de idade dos participantes foi 58±13,1 anos e tempo de tratamento de 51,1±44,7 meses. Houve redução dos valores séricos do fósforo de 7,06±1,43 para 5,80±1,53 (p<0,001) e da intensidade do prurido após a intervenção. Conclusão: a Intervenção Educacional de Enfermagem foi efetiva para redução do fosfato e diminuição do prurido nos pacientes hiperfosfatêmicos.Univ Reg Noroeste Estado Rio Grande do Sul, Dept Hlth Sci, Nursing Course, Ijui, RS, BrazilUniv Fed Santa Maria, North Higher Educ Ctr, Palmeira Das Missoes, RS, BrazilUniv Fed Santa Maria, Hlth Sci Ctr, Dept Nursing, Santa Maria, RS, BrazilUniv Fed Santa Maria, Univ Hosp Santa Maria, Santa Maria, RS, BrazilUniv Fed Sao Paulo, Paulista Sch Nursing, Dept Nursing, Sao Paulo, BrazilUniv Fed Sao Paulo, Paulista Sch Nursing, Dept Med, Sao Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem. São Paulo-SP, BrasilUniversidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina. São Paulo-SP, BrasilWeb of Scienc

Nurses' performance in classifying heart failure patients based on physical exam : comparison with cardiologist's physical exam and levels of N-terminal pro-B-type natriuretic peptide

Aim.The purpose of this study is to compare clinical assessment of congestion performed by a nurse to that performed bycardiologist and correlate them with NT-ProBNP levels.Background.The nurses’ role in heart failure has been strongly focused in therapeutic, educational and self-care interventions.The diagnostic performance of nurses in heart failure outpatients is not well explored. N-terminal pro-B-type natriuretic peptideis a cardiac marker that reflects elevated filling pressures.Design.Cross-sectional contemporaneous study.Methods.Heart failure outpatients underwent a systematic clinical assessment of clinical congestion score performed by car-diologist and nurse during the same visit. Assessments were performed independently and N-terminal pro-B-type natriureticpeptide levels obtained. The nurses’ ability to classify patients in hemodynamic profile was compared to the cardiologist’s.Results.Eighty-nine assessments were performed in 63 patients with heart failure. The correlation of clinical congestion scoresobtained by nurse with those obtained by cardiologist wasrs=0Æ86;p<0Æ001. The correlation of clinical congestion scoresfrom nurse and cardiologist with levels of N-terminal pro-B-type natriuretic peptide were as follows:rs=0Æ45;p<0Æ0001 andrs=0Æ51, respectively,p<0Æ0001. Patients with clinical congestion score‡3 had levels of NT-ProBNP significantly higher thanthose with clinical congestion score<3, in the assessment performed by the cardiologist (1866 SD 1151 vs. 757 SD 988 pg/ml;p<0Æ0001) and by the nurse (1720 SD 1228 vs. 821 SD 914 pg/ml;p<0Æ0001). The nurse and cardiologist had similarcapacity in classifying patients in congested quadrants (p=0Æ027) or in dry quadrants (p=0Æ03), according to the levels ofN-terminal pro-B-type natriuretic peptide. Area under the receiver-operating characteristic curve of the nurse and cardiologist todetect congestion was, respectively, 0Æ77 and 0Æ72. Conclusions.Our data suggests that nurses trained in heart failure may have a similar performance to that of the cardiologistfor the clinical detection of congestion and assessment of the hemodynamic profile in patients with chronic heart failure

Determinants of the exclusive breastfeeding abandonment: psychosocial factors

OBJECTIVE To assess the determinants of exclusive breastfeeding abandonment. METHODS Longitudinal study based on a birth cohort in Viçosa, MG, Southeastern Brazil. In 2011/2012, 168 new mothers accessing the public health network were followed. Three interviews, at 30, 60, and 120 days postpartum, with the new mothers were conducted. Exclusive breastfeeding abandonment was analyzed in the first, second, and fourth months after childbirth. The Edinburgh Postnatal Depression Scale was applied to identify depressive symptoms in the first and second meetings, with a score of ≥ 12 considered as the cutoff point. Socioeconomic, demographic, and obstetric variables were investigated, along with emotional conditions and the new mothers’ social network during pregnancy and the postpartum period. RESULTS The prevalence of exclusive breastfeeding abandonment at 30, 60, and 120 days postpartum was 53.6% (n = 90), 47.6% (n = 80), and 69.6% (n = 117), respectively, and its incidence in the fourth month compared with the first was 48.7%. Depressive symptoms and traumatic delivery were associated with exclusive breastfeeding abandonment in the second month after childbirth. In the fourth month, the following variables were significant: lower maternal education levels, lack of homeownership, returning to work, not receiving guidance on breastfeeding in the postpartum period, mother’s negative reaction to the news of pregnancy, and not receiving assistance from their partners for infant care. CONCLUSIONS Psychosocial and sociodemographic factors were strong predictors of early exclusive breastfeeding abandonment. Therefore, it is necessary to identify and provide early treatment to nursing mothers with depressive symptoms, decreasing the associated morbidity and promoting greater duration of exclusive breastfeeding. Support from health professionals, as well as that received at home and at work, can assist in this process

Características epidemiológicas de pacientes com Sepse e choque séptico

A sepse ocorre quando o sistema imunitário reage radicalmente a uma infecção. Febre alta, dificuldade respiratória, ritmo cardíaco acelerado e confusão são os principais sintomas. Para a prevenção de complicações que põem em risco a vida, é fundamental a atenção médica imediata. Este estudo teve como objetivo identificar características epidemiológicas de pacientes com sepse e choque séptico. Para isso, foi realizada uma revisão integrativa de literatura, utilizando-se LILACS e Medline como bases de pesquisa. A partir da análise qualitativa dos dados, concluiu-se que os principais fatores epidemiológicos se referem ao diagnóstico de sepse, o qual pode ser de difícil execução, realizado com atraso, de modo incorreto ou superdiagnosticado, e a inobservância das recomendações (práticas de enfermagem) para os cuidados com a sepse. Esses fatores contribuem para o agravamento da sepse, o atendimento de pacientes em unidades de terapia intensiva e o aumento dos níveis de mortalidade

Integrative epigenomics in Sjögren´s syndrome reveals novel pathways and a strong interaction between the HLA, autoantibodies and the interferon signature

Primary Sjögren's syndrome (SS) is a systemic autoimmune disease characterized by lymphocytic infiltration and damage of exocrine salivary and lacrimal glands. The etiology of SS is complex with environmental triggers and genetic factors involved. By conducting an integrated multi-omics study, we confirmed a vast coordinated hypomethylation and overexpression effects in IFN-related genes, what is known as the IFN signature. Stratified and conditional analyses suggest a strong interaction between SS-associated HLA genetic variation and the presence of Anti-Ro/SSA autoantibodies in driving the IFN epigenetic signature and determining SS. We report a novel epigenetic signature characterized by increased DNA methylation levels in a large number of genes enriched in pathways such as collagen metabolism and extracellular matrix organization. We identified potential new genetic variants associated with SS that might mediate their risk by altering DNA methylation or gene expression patterns, as well as disease-interacting genetic variants that exhibit regulatory function only in the SS population. Our study sheds new light on the interaction between genetics, autoantibody profiles, DNA methylation and gene expression in SS, and contributes to elucidate the genetic architecture of gene regulation in an autoimmune population

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe