Relação entre saída precoce do leito na unidade de terapia intensiva.

Backgound and Objectives: The incidence of complications arising from the deleterious effects of immobility in the intensive care unit contributes to functional decline, increased length of hospital stay and reduced functionality. Physical therapy is able to promote recovery and preservation of functionality, which can minimize these complications - through early mobilization. To evaluate the functionality and independence of patients who underwent a early bed output in the Intensive Care Unit. Methods: A randomized controlled clinical trial was conducted with patients admitted to the Intensive Care Unit (ICU) of the Santa Cruz Hospital and having a physiotherapy prescription. The patients were divided into conventional therapy group- control group and intervention group, who performed the protocol of early mobilization, promoting the bed output. The functionality was measured three times (retroactive to hospitalization, at discharge from the ICU and on hospital discharge) through the instrument Functional Independence Measure (FIM). Results: Preliminary data indicates that the intervention group (n = 4) presented lower loss of functionality after discharge from the ICU, with a deficit of 19%, having recovered until the hospital discharge 97% of the prehospitalization measure. The control group (n = 5) showed higher loss in the ICU of 47.6%, and was discharged from hospital with only 72% of their basal rate. Conclusion: There was a lower loss rate and better recovery of functionality in the studied population when those were submitted to a systematized and early protocol of mobilization as well as shorter hospital stay.Justificativa e Objetivos: A incidência de complicações decorrentes dos efeitos deletérios da imobilidade na unidade de terapia intensiva contribui para o declínio funcional, aumento do tempo de internação e redução da funcionalidade. A fisioterapia é capaz de promover a recuperação e preservação da funcionalidade, podendo minimizar estas complicações – através da mobilização precoce. Objetivos: Avaliar a funcionalidade e independência de pacientes que realizaram a saída do leito precocemente na Unidade de Terapia Intensiva. Métodos: Ensaio clínico controlado e randomizado, realizado com pacientes internados na Unidade de Terapia Intensiva (UTI) do Hospital Santa Cruz com prescrição médica de fisioterapia. Os pacientes foram divididos em grupo de fisioterapia convencional – grupo controle e o grupo intervenção, que realizou o protocolo de mobilização precoce, promovendo a saída do leito. A funcionalidade foi medida em três tempos (retroativo a internação, na alta da UTI e na alta hospitalar) através do instrumento Functional Independence Measure (FIM). Resultados: Dados preliminares mostram que o grupo intervenção (n=4) apresentou menor perda da funcionalidade após a alta da UTI, com déficit de 19%, tendo recuperado até a alta hospitalar 97% da medida pré-hospitalização, enquanto o grupo controle (n=5) apresentou maior perda na UTI com 47,6%, e tendo alta hospitalar com apenas 72% do seu índice basal. Conclusão: Houve menor perda e melhor recuperação da taxa de funcionalidade na amostra estudada quando submetida a um protocolo de mobilização precoce e sistematizado, bem como menor tempo de internação

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

Avaliação da tolerância ao exercício através do teste da caminhada de seis minutos em crianças com bronquiolite obliterante pós-infecciosa e crianças saudáveis

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Aula dialogada na educa??o m?dica : um estudo quantitativo

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS ([email protected]) on 2015-12-01T10:30:54Z No. of bitstreams: 1 476508 - Texto Completo.pdf: 2272243 bytes, checksum: 4ba343814611baa515a889610cb2a13a (MD5)Made available in DSpace on 2015-12-01T10:30:54Z (GMT). No. of bitstreams: 1 476508 - Texto Completo.pdf: 2272243 bytes, checksum: 4ba343814611baa515a889610cb2a13a (MD5) Previous issue date: 2015-09-29Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPESStudy the medical education process is part of a worldwide movement of health review, motivating important initiatives, represented in Brazil by the national curriculum guidelines of the courses in this area, presented by the Ministry of Education in 2001. In order to compare the effects of content learning/retention (outcome) of dialogued lecture (factor under study), we carried out a randomized controlled trial by groups, blinded to the research subjects with medical students from the 7th and 8 th semester from a private university in southern Brazil, with grade five assigned by the Higher Education Personal Improvement Commission (CAPES). 150 subjects were evaluated between March 2012 and June 2014, average age 24.7 years and a predominance of females (62.7%); 69 (46%) allocated for dialogued lecture (intervention group) and 81 (54%) to traditional lecture (control group). The performance of groups was evaluated by the same theoretical knowledge test administered before and after class, where students in the control group showed greater variation between the first and second test (8.6 vs. 6.7 p = 0.0001) result reinforced by the magnitude of the effect also higher in this group (2,526 vs. 1,350). In the pretest, without distinction by group, the overall student achievement was 50%, with a higher average score of the intervention group (p = 0.003) and those students tested in the 7th semester. In this study, the expository dialogue-class determined final results similar to traditional classroom (20.2 vs. 20.0 points in the final test) no impairment in short-term learning was noticed.Estudar o processo de educa??o m?dica ? parte de um movimento mundial de revis?o da sa?de, motivando iniciativas importantes, representadas no Brasil pelas diretrizes curriculares nacionais dos cursos desta ?rea, apresentadas pelo Minist?rio da Educa??o no ano de 2001. Com o objetivo de comparar os efeitos de aprendizagem/reten??o de conte?do (desfecho) da aula expositiva dialogada (fator em estudo), realizou-se um estudo controlado randomizado por grupos, cegado para os sujeitos de pesquisa com alunos do 7? e 8? semestre do curso de medicina de uma Faculdade privada do sul do Brasil, com conceito cinco atribu?do pela Comiss?o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES). Foram avaliados 150 sujeitos, entre mar?o de 2012 e junho de 2014, m?dia de idade de 24,7 anos e predom?nio do sexo feminino (62,7%); 69 (46%) alocados para a aula expositiva dialogada (grupo interven??o) e 81 (54%) para aula expositiva tradicional (grupo controle). O desempenho dos grupos foi avaliado por um mesmo teste te?rico de conhecimento aplicado antes e ap?s a aula, onde os alunos do grupo controle demonstraram maior varia??o entre o primeiro e segundo teste (8,6 vs. 6,7 p=0,0001) resultado refor?ado pela magnitude do efeito tamb?m maior neste grupo (2,526 vs. 1,350). No pr?-teste, sem distin??o por grupo, o aproveitamento geral dos alunos foi de 50%, sendo maior a pontua??o m?dia do grupo submetido ? interven??o (p=0,003) e daqueles alunos testados no 7? semestre. Neste estudo, a aula expositiva dialogada determinou resultados finais similares ? aula tradicional (20,2 vs. 20,0 pontos no teste final) n?o sendo observado preju?zo na aprendizagem de curto prazo

Avaliação da tolerância ao exercício através do teste da caminhada de seis minutos em crianças com bronquiolite obliterante pós-infecciosa e crianças saudáveis

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NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

Neotropical freshwater fisheries : A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data