"I'm doing my best, considering" - the relationship between worker satisfaction with HRM practices and worker perception of individual performance in the healthcare sector

Throughout the world, hospitals are facing many challenges including increased costs, per capita decreases in government funding, technology that delivers both less invasive surgery (consequently capacity to perform more inpatient procedures) and the capacity to deal with more complex medical interventions; also, health care systems that include hospitals have been under constant and continuing pressure to deliver quality improvements, better accountability, consumer choice and cost savings (Kabene, 2006; Grimshaw et al, 2010). As such, it is arguable that one important area of improving and maintaining service delivery as well as facing current challenges is through the hospital’s arguably most important asset: the people that work in hospitals, the Human Resources (HR) (West et al., 2006)

Use of femoral vein catheters for the assessment of perfusion parameters

The use of central venous oxygen saturation (SvcO2) and arterial lactate in the diagnosis of severe tissue hypoperfusion is well established, and the optimization of these parameters is currently under investigation, particularly in patients with severe sepsis/septic shock. However, the only place for deep venous puncture or the first choice for puncture is often the femoral vein. Although venous saturation obtained from blood sampling from this catheter, instead of SvcO2, has already been used in the diagnosis of severe tissue hypoperfusion, little is known about the accuracy of the results. The venous lactate in place of arterial puncture has also been used to guide therapeutic decisions. We conducted this literature review to seek evidence on the correlation and concordance of parameters obtained by collecting femoral venous blood gases in relation to SvcO2 and arterial lactate. Few studies in the literature have evaluated the use of femoral venous oxygen saturation (SvfO2) or venous lactate. The results obtained thus far demonstrate no adequate agreement between SvfO2 and SvcO2, which limits the clinical use of SvfO2. However, the apparent strong correlation between arterial and peripheral and central venous lactate values suggests that venous lactate obtained from the femoral vein could eventually be used instead of arterial lactate, although there is insufficient evidence on which to base this procedure at this time.A utilização da saturação venosa central de oxigênio (SvcO2) e do lactato arterial no diagnóstico de hipoperfusão tecidual em doentes graves já está bem estabelecida, e a otimização desses parâmetros é buscada principalmente em pacientes com sepse grave/choque séptico. Contudo, em diversas ocasiões, o único sítio para punção venosa profunda ou a primeira escolha para punção é a veia femoral. Embora a saturação venosa obtida da coleta de sangue desse cateter, em substituição a SvcO2, já tenha sido utilizada, pouco se sabe a respeito da acurácia de seus resultados. A utilização do lactato venoso, em substituição da punção arterial, também tem norteado decisões terapêuticas. Realizamos esta revisão de literatura buscando evidências sobre a correlação e a concordância desses parâmetros, obtidos pela coleta de gasometria venosa femoral, em relação à SvcO2 e ao lactato arterial. Existem poucos estudos na literatura avaliando a utilização da saturação venosa femoral de oxigênio (SvfO2) ou de lactato venoso. Os resultados até então obtidos mostram não haver concordância adequada entre SvfO2 e SvcO2, o que limita sua utilidade clínica. No entanto, a aparente correlação forte entre os valores de lactato arterial e venoso, tanto periférico como central, sugere que o lactato venoso obtido da veia femoral poderia, eventualmente, ser utilizado em substituição do lactato arterial, embora não haja evidências suficientes para basear essa conduta no momento.Universidade Federal de São Paulo (UNIFESP)UNIFESP, EPMSciEL

Avaliação dos efeitos da transfusão de sanguínea na saturação venosa mista e nos níveis de lactato em pacientes com SIRS/sepse

PURPOSE: To evaluate the effects of red blood cell transfusion in patients with SIRS/sepsis who presented hemoglobin levels under 9.0 g/dL at intensive care unit admission, using two parameters of organ perfusion: mixed venous oxygen saturation and serum lactate levels. METHODS: All patients admitted to the intensive care unit with SIRS/sepsis, as defined by Consensus Conference in 1992, and hemoglobin levels under 9.0 g/dL were included. Hemoglobin levels, mixed venous oxygen saturation, and lactate levels were collected before red blood cell transfusion (pre-T) and up to 1 hour after transfusion (post-T). These variables were analyzed through a paired t test, and results were considered significant if P < .05. RESULTS: Twenty-nine patients (17 male, 12 female) with ages of 61.9 ± 15.1 (mean ± SD) years (range, 21-85 years) and a mean APACHE II score of 12.5 ± 3.75 (7-21) were transfused with a mean of 1.41 packed red cell units. A significant increase in hemoglobin levels was reached by blood transfusion, from 8.14 ± 0.64 g/dL (pre-T) to 9.4 ± 0.33 g/dL (post-T), with POBJETIVOS: Avaliar o efeito da transfusão de hemáceas em pacientes com SIRS/sepse que apresentaram níveis de hemoglobina abaixo de 9,0g/dL durante internação em unidade de terapia intensiva, usando dois parâmetros de perfusão orgânica, a saturação venosa mista de oxigênio e os níveis de lactato sérico. MÉTODOS: Todos os pacientes admitidos na Unidade de Terapia Intensiva com SIRS/sepse, como definido pela Conferência de Consenso de 1992, e níveis de hemoglobina abaixo de 9,0g/dL foram incluídos. Os níveis de hemoglobina, saturação venosa mista de oxigênio e lactato sérico foram coletados antes (pré-T) e após uma hora da transfusão de hemáceas (pós-T). Essas variáveis foram analisadas através do teste T de Student pareado e os resultados considerados significativos se

Salivary density of Streptococcus mutans and Streptococcus sobrinus and dental caries in children and adolescents with Down syndrome

Streptococcus mutans and Streptococcus sobrinus are strongly associated with dental caries. However, the relationship between oral streptococci and dental caries in children with Down syndrome is not well characterized. Objective To assess and compare dental caries experience and salivary S. mutans, S. sobrinus, and streptococci counts between groups of Down syndrome and non-Down syndrome children and adolescents. Material and Methods This study included a sample of 30 Down syndrome children and adolescents (G-DS) and 30 age- and sex-matched non-Down syndrome subjects (G-ND). Dental caries experience was estimated by the number of decayed, missing, and filled teeth in the primary dentition and the permanent dentition. Unstimulated whole saliva samples were collected from all participants. The fluorescence in situ hybridization technique was used to identify the presence and counts of the bacteria. The statistical analysis included chi-square, Student’s t-test and Spearman’s correlation. Results The G-DS exhibited a significantly higher caries-free rate (

Intestinal constipation in intensive care units

Constipation is a common complication identified among critically ill patients. Its incidence is highly variable due to lack of definition of such patients. Besides the already known consequences of constipation, in recent years it was observed that this complication may also be related to worse prognosis of critically ill patients. This review endeavors to describe the main available scientific evidence showing that constipation is a prognostic marker and a clinical representation of intestinal dysfunction, in addition to eventually interfering in the prognosis with treatment. Ogilvie syndrome, a major cause of morbidity and mortality in intensive care units was also reviewed. Considering the above cases it was concluded that more attention to this disorder is required in intensive care units as well as development of protocols for diagnosis and management of critically ill patients.A constipação intestinal é uma complicação comumente identificada entre pacientes graves. Sua incidência é bastante variável devido à carência de uma definição aplicável a estes pacientes. Além das consequências já conhecidas da constipação, nos últimos anos tem-se percebido que essa complicação também pode estar relacionada ao pior prognóstico de pacientes críticos. Ao longo desta revisão procurou-se descrever as principais evidências científicas disponíveis mostrando ser a constipação um marcador prognóstico e uma das representações clínicas da disfunção intestinal, além da possibilidade de interferir no prognóstico com o tratamento. Revisou-se também a síndrome de Ogilvie, importante causa de morbidade e mortalidade nas unidades de terapia intensiva. Conclui-se, por todo o exposto, ser necessária mais atenção a esse distúrbio nas unidades de terapia intensiva, com elaboração de protocolos de diagnóstico e manejo em pacientes graves.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Association Between Dental Caries Experience and Socioeconomic Determinants on Oral Health-Related Quality of Life among Children and their Families

Objective: To assess the association between dental caries experience, severe dental caries experience and socioeconomic determinants on oral health-related quality of life among children and their families. Material and Methods: This is a cross-sectional study whose sample was composed of children aged 4-12 years, who sought dental care in a dentistry school clinic, and their parents/caregivers. Dental caries experience and severe dental caries experience were assessed according to the DMF-T/dmf-t indexes. Parents/caregivers answered the Parental-Caregiver Perceptions Questionnaire (P-CPQ), the Family Impact Scale (FIS) and a questionnaire on socioeconomic and demographic conditions. Data analysis included the chi-square test and Poisson regression (PR). Results: The sample was composed of 105 children and their parents/caregivers. Severe dental caries experience in children was determinant for negative perception of children's OHRQoL by parents/caregivers (PR = 1.22; CI = 1.05-1.41). Negative impact on OHRQoL perceived by family members was determined by severe dental caries experience in children (PR = 1.22; CI = 1.05-1.42) and family income &lt;5 minimum wage (PR = 1.32; CI = 1.08-1.61). Conclusion: Severe dental caries experience was associated with a negative impact on OHRQoL perceived by children and their families. Low family income was associated with a negative impact on the OHRQoL perceived by children and their families

Late recognition and illness severity are determinants of early death in severe septic patients

OBJECTIVE: To identify the independent variables associated with death within 4 days after the first sepsis-induced organ dysfunction. METHODS: In this prospective observational study, severe sepsis and septic shock patients were classified into 3 groups: Group 1, survivors; Group 2, late non-survivors; and Group 3, early non-survivors. Early death was defined as death occurring within 4 days after the first sepsis-induced organ dysfunction. Demographic, clinical and laboratory data were collected and submitted to univariate and multinomial analyses. RESULTS: The study included 414 patients: 218 (52.7%) in Group 1, 165 (39.8%) in Group 2, and 31 (7.5%) in Group 3. A multinomial logistic regression analysis showed that age, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score after the first 24 hours, nosocomial infection, hepatic dysfunction, and the time elapsed between the onset of organ dysfunction and the sepsis diagnosis were associated with early mortality. In contrast, Black race and a source of infection other than the urinary tract were associated with late death. Among the non-survivors, early death was associated with Acute Physiology and Chronic Health Evaluation II score, chronic renal failure, hepatic dysfunction Sepsis-related Organ Failure Assessment score after 24 hours, and the duration of organ dysfunction. CONCLUSION: Factors related to patients' intrinsic characteristics and disease severity as well as the promptness of sepsis recognition are associated with early death among severe septic patients.Fundacao de Amparo a Pesquisa do Estado de Sao PauloFederal University of São Paulo Department of Anesthesiology Pain and Critical CareLatin American Sepsis InstituteFederal University of São Paulo Department of Infectious DiseasesSírio Libanês Hospital Intensive Care UnitHospital Israelita Albert Einstein Intensive Care UnitUNIFESP, Department of Anesthesiology Pain and Critical CareUNIFESP, Department of Infectious DiseasesSciEL

The Impact of Duration of Organ Dysfunction on the Outcome of Patients with Severe Sepsis and Septic Shock

OBJECTIVES: This study aimed to assess the impact of the duration of organ dysfunction on the outcome of patients with severe sepsis or septic shock. METHODS: Clinical data were collected from hospital charts of patients with severe sepsis and septic shock admitted to a mixed intensive care unit from November 2003 to February 2004. The duration of organ dysfunction prior to diagnosis was correlated with mortality. Results were considered significant if p<0.05. RESULTS: Fifty-six patients were enrolled. Mean age was 55.6 ± 20.7 years, mean APACHE II score was 20.6 ± 6.9, and mean SOFA score was 7.9 ± 3.7. Thirty-six patients (64.3%) had septic shock. The mean duration of organ dysfunction was 1.9 ± 1.9 days. Within the univariate analysis, the variables correlated with hospital mortality were: age (p=0.015), APACHE II (p=0.008), onset outside the intensive care unit (p=0.05), blood glucose control (p=0.05) and duration of organ dysfunction (p=0.0004). In the multivariate analysis, only a duration of organ dysfunction persisting longer than 48 hours correlated with mortality (p=0.004, OR: 8.73 (2.37-32.14)), whereas the APACHE II score remained only a slightly significant factor (p=0.049, OR: 1.11 (1.00-1.23)). Patients who received therapeutic interventions within the first 48 hours after the onset of organ dysfunction exhibited lower mortality (32.1% vs. 82.1%, p=0.0001). CONCLUSIONS: These findings suggest that the diagnosis of organ dysfunction is not being made in a timely manner. The time elapsed between the onset of organ dysfunction and initiation of therapeutic intervention can be quite long, and this represents an important determinant of survival in cases of severe sepsis and septic shock