a longitudinal study for public hospitals, 2009-2014

BACKGROUND: The global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which also included the health sector. The aim of this study was to analyse factors associated with HIV/AIDS patients' length of stay (LOS) among Portuguese hospitals, and the potential impact of the EFAP measures on hospitalizations among HIV/AIDS patients. METHODS: Data used in this analysis were collected from the Portuguese database of Diagnosis Related Groups (DRG). We considered only discharges classified under MCD 24 created for patients with HIV infection. A total of 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals were included in the analysis. The outcome was the number of days between hospital admission and discharge dates (LOS). Hierarchical Poisson regression model with random effects was used to analyse the relation between LOS and patient, treatment and setting characteristics. To more effectively analyse the impact of the EFAP implementation on HIV/AIDS hospitalizations, yearly variables, as well as a variable measuring hospitals' financial situation (current ratio) was included. RESULTS: For the 5% level, having HIV/AIDS as the principal diagnosis, the number of secondary diagnoses, the number of procedures, and having tuberculosis have a positive impact in HIV/AIDS LOS; while being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital's current ratio contribute to the decrease of LOS. Additionally, LOS between 2010 and 2014 was significantly shorter in comparison to 2009. Differences in LOS across hospitals are significant after controlling for these variables. CONCLUSION: Following the EFAP, a number of cost-containment measures in the health sector were implemented. Results from our analysis suggest that the implementation of these measures contributed to a significant decrease is LOS among HIV/AIDS patients in Portuguese hospitals.publishersversionpublishe

Reabilitação de transplantado ao coração com covid-19 em uci- caso clínico

Solid-organ transplant patients have a high risk of severe infection related to COVID-19 disease. In heart transplanted patients the impact of this infection remains unknown, as well as importance of rehabilitation, on recovery process. Objective: To describe intervention of rehabilitation nurse in a case of a heart transplanted person infected with COVID-19 in UCI. Methods: Case report follow CARE guidelines. This case represents a 60-year-old man, a heart transplant recipient, who presented with a 5-day history of cough, fever, and activity intolerance, who required hospitalization in intensive care. Rehabilitation nursing intervention in respiratory and functional functions was due 2 times a day, during 30-45minutes, adapted to the evolution of the person. Results: This case supports the possibility and impact of rehabilitation nursing intervention, in the multidisciplinary team, on the improvement of the person, either through the improvement/resolution of the rehabilitation nursing diagnosis status or on the clinical improvement of the person. Demonstrates the possibility of prescribing early mobilization interventions, breathing exercises in the context of the transplanted person with severe covid disease, admitted to the ICU, using different techniques. Conclusion: Rehabilitation Nursing interventions, in this case, translated into an improvement in the respiratory and functional function of a heart transplant patient infected with COVID-19during UCI care.info:eu-repo/semantics/publishedVersio

Safety assessment of the 6-minute walking test-heart transplant recipients

Heart transplantation is considered the gold standard treatment for selected patients with end-stage heart disease when medical therapy has been unable to halt progression of the underlying pathology. Scientific evidence suggests that cardiac rehabilitation (CR), with a focus on exercise, can be effective in reversing the consequences of previous physical deconditioning, pathophysiological changes associated with cardiac denervation and prevented adverse reactions induced by immunosuppression. Prescribing and evaluating interventions in the context of CR is a complex process, and the instruments to be used for measuring and prescribing exercise are not always consensual. The 6-minute gait test (6MWT) has been used as a way of assessing functional capacity, clinical staging, cardiovascular prognosis and monitoring of the rehabilitation program. Safety and metabolic impact are poorly described in the literature with regard to heart transplant recipients. Objective: To Evaluate the safety of the 6-minute Gait Test in cardiac transplant recipients, in phase III of Cardiac Rehabilitation. Methods: 31 heart transplanted patients, 25 men and 6 women, with a mean age of 58.19 (9.57) years and an average transplant time of 5.47 (4.40) years. They were submitted to evaluation using the 6MWT, with electrocardiographic monitoring by telemetry and with initial and final recording of heart rate, systolic and diastolic blood pressure. The Modified Borg Scale was also applied before and after the 6MWT. Anthropometric parameters were also recorded: height, weight and the body mass index was inferred. The 6MWT was performed according to the guidelines of the American Thoracic Society. To calculate the expected 6MWT distance (D6MWT) the equations define by Enright & Sherrill to the health population was used: ♂: D6MWT = (7,57 x staturecm) – (5,02 x ageyears) – (1,76 x weightkg) – 309; r2 = 0,42 ♀: D6MWT = (2,11 x staturecm) – (2,29 x weightkg) – (5,78 x ageyears) + 667; r2 = 0,38 Inclusion criteria: freely and voluntarily participate in the study, transplanted for more than 3 months and without any clinical contraindication for participation in the evaluations. Results: There are statistically significant changes when comparing the assessments before and after performing 6MWT, regarding Modificed Borg scale (p=0,000) and Heart Rate (p=0,007). It should also be noted that the results of the evaluated 6MWT are statistically inferior (p=0,000) than the expected ones. Of the 31 evaluated patients, only one gave up halfway through, having completed 3.5 minutes of the test. There were no adverse events. None of the evaluated had a 6MWT result higher than the expected. Conclusion: Heart transplant patients have more intolerance to activity than healthy people. Clinical and electrocardiographic behavior suggests that this method of assessment is safe, but it can be considered of high intensity for some transplant recipients. Variables related to 6MWT performance can facilitate exercise prescription and outcome monitoring in Rehabilitation Nursing intervention programs, as well as measure post-transplant functional capacity.info:eu-repo/semantics/publishedVersio

Intervenciones para cuidadores de personas integradas en un programa de rehabilitación cardíaca: protocolo de revisión de alcance

A Reabilitação Cardíaca (RC) é um programa multifactorial, geralmente composto por exercício físico estruturado, apoio psicológico e educação para promover mudanças positivas no estilo de vida de pessoas com doença cardíaca. A maioria dos estudos define que é importante envolver a família (cuidadores) após o diagnóstico de doença cardíaca para garantir o sucesso do tratamento, e na RC não é diferente. Não sendo um objetivo implícito no cariz de prevenção secundária da RC, percebe-se que algumas das intervenções incluídas no programa podem ter um impacto positivo para os cuidadores. É fundamental compreender quais as intervenções da RC que podem ser utilizadas para promover o papel do cuidador e a sua saúde.info:eu-repo/semantics/publishedVersio

Heart transplant person with Covid-19 UCI care – rehabilitation nursing

Critical illness associated with SARS-COV2 infection is often associated with prolonged periods of intensive care treatment, with a consequent negative impact on clinical and functional results in the short and medium term It is therefore predictable and desirable to actively participate in ICU rehabilitation In heart transplanted persons the impact of COVID 19 remains unknown, particularly in the recent post transplant period, as well as the impact of rehabilitation on the recovery process.Objective: to describe outcomes resulting from rehabilitation nursing care in respiratory and mobility functions. Methods: Case report following CARE guidelines. Presentation of the case: A 60 years old male, 9 months post heart transplant, infected with Covid 19 needed to be admitted in intensive care unit He had rehabilitation nursing intervention in the respiratory and functional function, 2 times a day, during 45 60 mints. Conclusion: In this case, it is clear that R ehabilitation Nursing interventions seems to translate an improvement in the respiratory and functionalinfo:eu-repo/semantics/publishedVersio

Interventions for caregivers of heart disease patients in rehabilitation: scoping review

Map the interventions/components directed to the caregivers of heart disease patients in cardiac rehabilitation programs that promote their role and health. Methods: The Joanna Briggs Institute method was used to guide this scoping review. Two independent reviewers assessed articles for relevance and extracted and synthesized data. Inclusion criteria comprised articles published in English, Spanish, and Portuguese since 1950. The following databases were searched: CINAHL Complete (Via EBSCO), Medline (via PubMed), Scopus, PEDro, and Repositórios Científicos de Acesso Aberto de Portugal (RCAAP). Results: From 351 articles retrieved, 10 were included in the review. The interventions identified directed to the caregiver were: educational interventions and lifestyle changes; physical exercise; psychological interventions/stress management; and a category “Other” with training interventions in basic life support, elaboration of guidelines/recommendations, and training for the role of caregiver. Conclusions: It was found that most of the related cardiac rehabilitation interventions are aimed at the dyad heart failure patient and their caregivers/family. Including specific interventions targeting caregivers improves the caregiver’s health and empowers them. Patient care planning should include interventions specifically aimed at them that result in health gains for caregivers and patients, striving to improve the quality of care. This study was not registered.info:eu-repo/semantics/publishedVersio

Characterization of mycobacteria and mycobacteriophages isolated from compost at the São Paulo Zoo Park Foundation in Brazil and creation of the new mycobacteriophage Cluster U

Background: A large collection of sequenced mycobacteriophages capable of infecting a single host strain of Mycobacterium smegmatis shows considerable genomic diversity with dozens of distinctive types (clusters) and extensive variation within those sharing evident nucleotide sequence similarity. Here we profiled the mycobacterial components of a large composting system at the São Paulo zoo. Results: We isolated and sequenced eight mycobacteriophages using Mycobacterium smegmatis mc2155 as a host. None of these eight phages infected any of mycobacterial strains isolated from the same materials. The phage isolates span considerable genomic diversity, including two phages (Barriga, Nhonho) related to Subcluster A1 phages, two Cluster B phages (Pops, Subcluster B1; Godines, Subcluster B2), three Subcluster F1 phages (Florinda, Girafales, and Quico), and Madruga, a relative of phage Patience with which it constitutes the new Cluster U. Interestingly, the two Subcluster A1 phages and the three Subcluster F1 phages have genomic relationships indicating relatively recent evolution within a geographically isolated niche in the composting system. Conclusions: We predict that composting systems such as those used to obtain these mycobacteriophages will be a rich source for the isolation of additional phages that will expand our view of bacteriophage diversity and evolution

El proceso de transición y capacitación de la persona trasplantada al corazón y familia: ensayo teórico

La persona trasplantada de corazón y la familia experimentan diferentes tipos de transición, y un acompañante facilitador de su formación para una transición saludable es fundamental. La Enfermería de Rehabilitación (ER), debido a sus habilidades, puede ayudar a las personas a recuperar la estabilidad y el bienestar, sin embargo, existe poca difusión de su fundamento en las teorías de enfermería. Objetivo: Analizar el aporte de la Teoría de las Transiciones en la práctica de la enfermería rehabilitadora orientada al empoderamiento de la persona trasplantada al corazón y a la familia. Metodología: Estudio crítico-reflexivo guiado por la Teoría de las Transiciones de Afaf Meleis y por la legislación reguladora para la práctica del enfermero rehabilitador. Resultado: Se percibe que la teoría de las Transiciones sustenta la intervención de Enfermería de Rehabilitación en las áreas de conocimiento y aprendizaje de habilidades de la persona trasplantada cardíaca y su familia, conduciendo a su empoderamiento, toma de decisiones y acción, haciendo que la persona se sienta empoderada para superar los retos diarios derivados de su proceso de transición. Conclusión: Es fundamental demostrar la conceptualización en la práctica de enfermería, siendo la transición un foco significativo para la Enfermería de Rehabilitación.info:eu-repo/semantics/publishedVersio

Gene diversity in grevillea populations introduced in Brazil and its implication on management of genetic resources.

A variabilidade isoenzimática para seis populações de Grevillea robusta, oriundas de um teste de procedências/progenies, implantado no delineamento em blocos casualizados com 5 plantas por parcela, no Sul do Brasil, é descrita. A estrutura genética da população foi analisada utilizando-se marcadores bioquímicos, aos 5 anos de idade, especificamente para os locos MDH-3, PGM-2, DIA-2, PO-1, PO-2, SOD-1, e SKDH-1. As procedências do norte de ocorrência natural (Rathdowney e Woodenbong) apresentaram divergência genética superior, em relação à média das progênies, considerando o número de alelos por locus, (Ap), a riqueza alélica (Rs), a diversidade genética de Nei (H), e o coeficiente de endogamia (f). A endogamia foi detectada em diversos graus. A testemunha comercial apresentou o maior coeficiente de endogamia, (f = 0,4448), comparativamente à média das procedências (f = 0,2306), possivelmente devido à insuficiente amostragem populacional na região de origem (Austrália). Apesar de sua ocorrência natural restrita, observou-se correlação positiva entre divergência genética e distância geográfica entre as populações originais. A distância genética e análise de cluster, baseada no modelo bayesiano, mostrou três grupos de procedências distintos: 1) Rathdowney- QLD e Woodenbong-QLD; 2) Paddy?s Flat-NSW; e 3) Mann River-NSW, Boyd River-NSW e a testemunha comercial (material utilizado no Brasil). O agrupamento da testemunha com as procedências Mann River-NSW e Boyd River-NSW sugere um maior potencial das procedências do norte para o melhoramento genético visando à produção de madeira no Brasil, devido a sua elevada diversidade genética e baixo coeficiente de endogamia

Risk classification in an emergency room: agreement level between a Brazilian institutional and the Manchester Protocol

The aim of this study was to assess the level of agreement between an institutional protocol and the Manchester protocol for the risk assessment of patients attended in an emergency room of a public hospital in Belo Horizonte - MG - Brazil. This is a descriptive and comparative study, in which 382 patients' reports were evaluated and the risk was classified, using the institutional protocol and the Manchester protocol. Rates were calculated through weighted and unweighted kappa, in order to determine the level of agreement between the protocols. The results showed that the correlation between the protocols is average when considering that classification errors occurred between neighboring colors (kappa=0.48), and good when considering that classification errors occurred between extreme colors (kappa=0.61). The Manchester protocol increased the patients' level of priority of patients and has been considered more inclusive.Este estudio tuvo por objetivo verificar el grado de concordancia entre un protocolo institucional y el protocolo de Manchester para la clasificación de riesgo de pacientes atendidos en primeros auxilios de un hospital público de Belo Horizonte - MG - Brasil. Se trata de estudio descriptivo comparativo en el cual 382 fichas fueron evaluadas y, realizada la clasificación de riesgo utilizando los protocolos mencionados encima, a partir del registro realizado por los enfermeros. Índices kappa ponderado y no ponderado fueron calculados para determinar el grado de concordancia entre los protocolos. Los resultados mostraron que la concordancia entre los protocolos es media, cuando considerados los errores de clasificación ocurridos entre colores vecinos (kappa=0,48) y buena, cuando considerados los errores de clasificación ocurridos entre colores extremos (kappa=0,61). Se concluye que el protocolo de Manchester aumentó el nivel de prioridad de los pacientes, demostrando ser un protocolo que incluye más.Este estudo teve por objetivo verificar o grau de concordância entre um protocolo institucional e o protocolo de Manchester, para a classificação de risco de pacientes atendidos no pronto-socorro de um hospital público de Belo Horizonte, MG, Brasil. Trata-se de estudo descritivo comparativo, no qual 382 prontuários foram avaliados e realizada a classificação de risco, utilizando os protocolos mencionados acima, a partir do registro realizado pelos enfermeiros. Índices Kappa ponderado e não ponderado foram calculados para determinar o grau de concordância entre os protocolos. Os resultados mostraram que a concordância entre os protocolos é média, quando considerados os erros de classificação, ocorridos entre cores vizinhas (Kappa=0,48) e boa, quando considerados os erros de classificação, ocorridos entre cores extremas (Kappa=0,61). Conclui-se que o protocolo de Manchester aumentou o nível de prioridade dos pacientes, demonstrando ser protocolo mais inclusivo