Perfil dos pacientes e carga de trabalho de enfermagem na unidade de nefrologia

A doença renal crônica, frequentemente silenciosa, pode resultar em mudanças consideráveis na vida do indivíduo, e, dependendo do seu estágio, requer internações para tratamento clínico ou cirúrgico, o que demanda horas de enfermagem na assistência. Trata-se de um estudo descritivo, quantitativo que objetivou descrever o perfil dos pacientes internados na unidade de nefrologia e mensurar a carga de trabalho de enfermagem. Para a coleta de dados, foi utilizado o NursingActivities Score, durante 47 dias consecutivos. Os pacientes foram, em sua maioria, do sexo masculino, adulto jovem, em estágio crônico da doença e internados para transplante renal. A média da carga foi de 52%, correspondendo a 12,5 horas de assistência, por paciente, nas 24 horas. Esse perfil se assemelha aos pacientes assistidos na unidade deterapia intensiva, tornando importante para o gerente de enfermagem reavaliar o quadro de pessoal para a assistência, e outros estudos serão necessários para reavaliar a carga requerida por esse perfil de pacientes.

Star formation inside a galactic outflow

Recent observations have revealed massive galactic molecular outflows that may have the physical conditions (high gas densities) required to form stars. Indeed, several recent models predict that such massive outflows may ignite star formation within the outflow itself. This star-formation mode, in which stars form with high radial velocities, could contribute to the morphological evolution of galaxies, to the evolution in size and velocity dispersion of the spheroidal component of galaxies, and would contribute to the population of high-velocity stars, which could even escape the galaxy. Such star formation could provide $\textit{in situ}$ chemical enrichment of the circumgalactic and intergalactic medium (through supernova explosions of young stars on large orbits), and some models also predict it to contribute substantially to the star-formation rate observed in distant galaxies. Although there exists observational evidence for star formation triggered by outflows or jets into their host galaxy, as a consequence of gas compression, evidence for star formation occurring within galactic outflows is still missing. Here we report spectroscopic observations that unambiguously reveal star formation occurring in a galactic outflow at a redshift of 0.0448. The inferred star-formation rate in the outflow is larger than 15 solar masses per year. Star formation may also be occurring in other galactic outflows, but may have been missed by previous observations owing to the lack of adequate diagnostics.R.M., S.Car. and F.B. acknowledge support by the Science and Technology Facilities Council (STFC). R.M. acknowledges ERC Advanced Grant 695671 “QUENCH”. H.R.R. and A.C.F. acknowledge ERC Advanced Grant 340442. S.A., S.Caz., E.B. and L.C. acknowledge support from the Spanish Ministry of Economy, under grants AYA2012-32295 and ESP2015-68964-P

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa