Indicadores como instrumento de qualidade para a prática da enfermagem: relato de experiência

Indicadores são variáveis desenvolvidas devido à necessidade de tratar a informação, na forma original, tornando-a quantificável. O objetivo deste estudo é descrever a experiência sobre a utilização de indicadores como ferramenta da produtividade do serviço de enfermagem ambulatorial no atendimento aos usuários do Sistema Único de Saúde (SUS) de um Complexo Hospitalar Universitário. Foram utilizados os bancos de dados do Sistema de Informação do próprio serviço, nos meses de julho de 2011 a julho de 2012 Os dados foram transferidos para o Excell e analisados em números absolutos e índices percentuais. As variáveis analisadas foram: consultas de enfermagem, administração de medicação, atividade educativa, pulsoterapia, curativos e glicemia capilar. Após análise estatística, evidenciou-se maior produtividade dos profissionais de nível médio. Concluiu-se que a utilização destes indicadores é eficaz para a tomada de decisão gerencial e assistencial, para o planejamento estratégico e para a implementação de medidas, visando a melhoria do cuidado prestado, controle da produtividade do serviço pelos gestores e para cumprir as metas organizacionais; servem ainda como elementos que possibilitam certificações e acreditações. PALAVRAS-CHAVE: Indicador. Eficiência. Organizações.Indicators are variables developed due to the need to deal with information in its original format making it quantifiable. The aim of this study is to describe the experience on the use of indicators as productivity tools of the Ambulatory Care Nursing in caring the patients of the Brazilian Unified health System (SUS) at a University Hospital. The SUS database system was used for this intent, from July 2011 to July 2012. The data were transferred to Excell and were analyzed according to absolute numbers and percentage rates. The analyzed variables were: nursing appointments, medicine management, educational activity, pulse therapy, bandages and capillary blood glucose testing. A higher productivity from the mid-level professionals was demonstrated after statistical analysis. It can be concluded that the use of indicators is efficient for decision-making on management and welfare and it is efficient for the strategic planning and implementation of measures with the purpose of improving the quality of the care. Moreover, the use of indicators help in the control of productivity of the service provided by the management of the organization in order to fulfill organizational goals and yet, it serves as elements that permit certification and accreditations

Gestão de estoque organizacional: relato de experiência

A gestão de estoque é parte fundamental de qualquer organização que produza itens ou serviços de valor econômico. O objetivo do estudo é descrever a experiência de enfermeiras no gerenciamento de materiais em um serviço ambulatorial de um hospital universitário. Trata-se de um relato de experiência de gestão informatizada de material, realizado no período de julho de 2010 a julho de 2012. A informatização do controle de material ratifica a necessidade de revisão dos processos e mudança na cultura organizacional relacionada a tal procedimento. Constatou-se, após a implementação do controle informatizado de estoque, maior resolutividade na previsão, distribuição conforme a necessidade, menos desperdício e redução em relação à falta de material. Esse projeto mostrou-se efetivo e resolutivo, com redução de custos e garantia da qualidade e quantidade dos materiais utilizados na assistência dos pacientes atendidos no ambulatório, visando à melhoria nos serviços prestados aos usuários do Sistema Único de Saúde. PALAVRAS-CHAVE: Gestão. Tecnologia. Trabalho. Enfermagem. The inventory management is a fundamental part of any organization that produces items or services of economic value. The objective of this study is to describe the experiences of nurses in the management of materials in an outpatient care of a university hospital. This is an experience report of computerized material management, conducted from July 2010 to July 2012. The computerization of material control confirms the need to review the processes and change in organizational culture related to the procedure. It was found out after the implementation of computerized inventory control a better resolution in forecasting, distribution with less waste and less material shortage. This project was effective and decisive to work with the control and the validity of the stored products, aiming the improvement of services provided to users of the public health system

High anti-SARS-CoV-2 antibody seroconversion rates before the second wave in Manaus, Brazil, and the protective effect of social behaviour measures: results from the prospective DETECTCoV-19 cohort

Background: The city of Manaus, Brazil, has seen two collapses of the health system due to the COVID-19 pandemic. We report anti-SARS-CoV-2 nucleocapsid IgG antibody seroconversion rates and associated risk factors in Manaus residents before the second wave of the epidemic in Brazil. Methods: A convenience sample of adult (aged ≥18 years) residents of Manaus was recruited through online and university website advertising into the DETECTCoV-19 study cohort. The current analysis of seroconversion included a subgroup of DETECTCoV-19 participants who had at least two serum sample collections separated by at least 4 weeks between Aug 19 and Oct 2, 2020 (visit 1), and Oct 19 and Nov 27, 2020 (visit 2). Those who reported (or had no data on) having a COVID-19 diagnosis before visit 1, and who were positive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at visit 1 were excluded. Using an in-house ELISA, the reactivity index (RI; calculated as the optical density ratio of the sample to the negative control) for serum anti-SARS-CoV-2 nucleocapsid IgG antibodies was measured at both visits. We calculated the incidence of seroconversion (defined as RI values ≤1·5 at visit 1 and ≥1·5 at visit 2, and a ratio >2 between the visit 2 and visit 1 RI values) during the study period, as well as incidence rate ratios (IRRs) through cluster-corrected and adjusted Poisson regression models to analyse associations between seroconversion and variables related to sociodemographic characteristics, health access, comorbidities, COVID-19 exposure, protective behaviours, and symptoms. Findings: 2496 DETECTCoV-19 cohort participants returned for a follow-up visit between Oct 19 and Nov 27, 2020, of whom 204 reported having COVID-19 before the first visit and 24 had no data regarding previous disease status. 559 participants were seropositive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at baseline. Of the remaining 1709 participants who were seronegative at baseline, 71 did not meet the criteria for seroconversion and were excluded from the analyses. Among the remaining 1638 participants who were seronegative at baseline, 214 showed seroconversion at visit 2. The seroconversion incidence was 13·06% (95% CI 11·52–14·79) overall and 6·78% (5·61–8·10) for symptomatic seroconversion, over a median follow-up period of 57 days (IQR 54–61). 48·1% of seroconversion events were estimated to be asymptomatic. The sample had higher proportions of affluent and higher-educated people than those reported for the Manaus city population. In the fully adjusted and corrected model, risk factors for seroconversion before visit 2 were having a COVID-19 case in the household (IRR 1·49 [95% CI 1·21–1·83]), not wearing a mask during contact with a person with COVID-19 (1·25 [1·09–1·45]), relaxation of physical distancing (1·31 [1·05–1·64]), and having flu-like symptoms (1·79 [1·23–2·59]) or a COVID-19 diagnosis (3·57 [2·27–5·63]) between the first and second visits, whereas working remotely was associated with lower incidence (0·74 [0·56–0·97]). Interpretation: An intense infection transmission period preceded the second wave of COVID-19 in Manaus. Several modifiable behaviours increased the risk of seroconversion, including non-compliance with non-pharmaceutical interventions measures such as not wearing a mask during contact, relaxation of protective measures, and non-remote working. Increased testing in high-transmission areas is needed to provide timely information about ongoing transmission and aid appropriate implementation of transmission mitigation measures. Funding: Ministry of Education, Brazil; Fundação de Amparo à Pesquisa do Estado do Amazonas; Pan American Health Organization (PAHO)/WHO.World Health OrganizationRevisión por pare

Intake, digestibility and performance of lambs fed with diets containing cassava peels

Sheep farming is designated to economic exploitation, and dry matter intake is the most important factor that influences the performance of animal, thus seeking alternative foods. This study aimed to evaluate the effects of inclusion levels of cassava peel on intake, digestibility and performance of feedlot lambs. We used 32 crossbred lambs Santa Inês uncastrated, mean body weight of 21 ± 1.5 kg. Treatments were arranged in a randomized design to animals, with inclusion levels of cassava peel (0, 10, 20, 30%) in the diet dry matter and forage cassava leaf hay. During 70 days, there have been weighing the food provided, leftovers, and animals, and feces collection. The intake of dry matter (DMI), organic matter (OMI), crude protein (CPI), ether extract (EEI), neutral detergent fiber corrected for ash and protein (NDIap), total carbohydrates (CTI), non-fiber carbohydrates (NFCI), total digestible nutrients (TDNI), as well as DMI and NDFap/kgCP, DMI and NDFIap/PC0.75 levels have not been affected by the inclusion of cassava peel. Similar results for DM digestibility, NDF, CP, MO, CT and the TDN. DEE had a growing linear effect whereas DNFC presented a quadratic effect. Average daily gain (ADG), feed conversion (FC), initial body weight (BWinitial), final body weight (BWfinal), warm carcass weight (WCW) and warm carcass yield (WCR) showed no changes. It is concluded that the peel cassava may be included in diet until 30%, without change dry matter intake and animal performance

ERITEMA INDURADO DE BAZIN EM UMA MULHER PORTADORA DE HIV

Introdução: O Eritema Indurado de Bazin é uma das manifestações cutâneas que podem ocorrer na Tuberculose Extrapulmonar (TBEP). As lesões se caracterizam por nódulos eritemato - violáceos, dolorosos, isolados ou coalescentes formando uma placa nodular que evolui para úlcera com drenagem de material necrótico ou necropuruleto em membros inferiores, mas membros superiores, face, região glúteas podem também ser acometidas. Essa manifestação de TBEP é mais frequente no sexo feminino, associada a imunossupressão. Descrição do caso: Paciente, sexo feminino, 50 anos, HIV +, com história de nódulo subcutâneo em membro inferior direito há 5 meses que evoluiu com drenagem de secreção serossanguinolenta. Fez uso de cefalexina, penicilina e sulfadiazina de prata sem regressão da lesão. Ao exame físico apresentava nódulo eritemato - violáceo, doloroso, com drenagem de secreção sero - hemática. Foram solicitados exames laboratoriais admissionais que evidenciaram PCR 7,5, VHS 40, leucócitos 7100, FAN, fator reumatóide, ANCA, VDRL e sorologias virais não reagentes. Além disso, PPD positivo (25 mm), histopatológico que evidenciou paniculite granulomatosa lobular, composta de linfócitos, histiócitos epitelióides e neutrófilos, acompanhado de células de Langhans, e PCR positivo para Mycobacterium tuberculosis, favorecendo o diagnóstico de Eritema Indurado de Bazin. Dessa forma, foi iniciado Prednisona 40 mg/dia por conta da paniculite, com melhora das lesões e da dor, recebendo alta hospitalar e prescrito o esquema Rifampicia, Isoniazida, Pirazinamida e Etambutol para o tratamento ambulatorial da tuberculose. Comentários: O Eritema Indurado de Bazin, é uma manifestação da Tuberculose Extrapulmonar de difícil suspeição. Nesse sentido, deve ser lembrada em lesões eritemato - violáceas em face posterior dos membros inferiores em pacientes imunossuprimidos. Seguindo essa lógica, a úlcera possui bordas nítidas, elevadas, fundo hemorrágico, crosta e base infiltrada, evolui com regressão da ulceração com cicatriz e chance de recidiva. O diagnóstico é firmado com base no quadro clínico e exames complementares: PPD, histopatológico e PCR para DNA da M. tuberculosis, fazendo diagnóstico diferencial com Sarcoidose, Poliarterite Nodosa e Síndrome de Sweet. O tratamento é baseado na poliquimioterapia para Tuberculose

Glicerina bruta na dieta de ovinos confinados: Composição centesimal e perfil de ácidos graxos do longissimus dorsi

The aim was to evaluate the centesimal composition and fatty acids profile of longissimus dorsi of wethers fed diets with increasing levels (0; 2.65; 5.33 e 8.06% in dry matter) of crude glycerin (CG). Were used 20 crossbred, castrated lambs Dorper x St. Ines, with 24 ± 2.0 kg of weight, housed in individual pens. The experimental design was completely randomized with four treatments and five replications. Diet samples were collected to fatty acids profile analyses. After 84 days of assessment and data collection, the animals were slaughtered. Longissimus dorsi samples were collected and frozen for subsequent analysis of fatty acids by gas chromatography. There was no effect of treatments on the ash content and protein, however, there was influence (P0.05) by increasing levels of crude glycerin in the diet. There was decreased linear effect (P0,05) pelos níveis crescentes de glicerina bruta na dieta. Houve efeito linear decrescente (P<0,05) para o ácido graxo saturado palmítico (16:0) e efeito quadrático (P<0,05) para o ácido graxo mirístico (14:0) em função dos níveis crescentes de glicerina na dieta. A adição de glicerina na dieta influenciou de forma quadrática (P<0,05) o total de ácido graxo poliinsaturado (AGPI) e ômega 6. Houve efeito linear crescente (P<0,05) para o somatório total do ácido linoleico conjugado (CLA) e para razão AGPI/AGS. Não foram influenciados pelos níveis crescentes de glicerina na dieta o total de ácidos graxos saturados (AGS), ácidos graxos monoinsaturados, ácidos da família ômega 3 e para razão ômega 6/ômega 3. A inclusão de glicerina proporcionou alterações na composição centesimal e perfil de ácidos graxos no longissimis dorsi, porém, essas modificações não alteraram a qualidade da carne.

Crude glycerin in diets for wethers in feedlot: intake, digestibility, performance, carcass and meat traits

O objetivo foi avaliar os efeitos dos níveis de glicerina bruta (GB) (0; 2,65; 5,33; 8,06 e 10,84% na base da matéria seca) sobre o consumo, digestibilidade, desempenho, medidas morfométricas da carcaça e qualidade da carne de ovinos terminados em confinamento. Foram utilizados 25 cordeiros mestiços Santa Inês x Dorper, machos, castrados, com peso corporal médio de 24 ± 2,0 kg, alojados em baias individuais, em delineamento inteiramente casualizado. Os níveis de GB na dieta provocaram efeito linear decrescente (P0,05) dos níveis de glicerina sobre o desempenho dos animais. Não foram observadas diferenças (P>0,05) no peso da carcaça quente, peso da carcaça resfriada, rendimento da carcaça quente, rendimento da carcaça resfriada, perda por resfriamento, estado de engorduramento, comprimento de carcaça, comprimento de perna, profundidade de perna, profundidade de peito, área de olho de lombo, textura, marmoreio e cor. Entretanto, foi observada influência (P 0.05) levels of glycerin on animal performance. For morphometric measurements of carcass and meat characteristics, no significant difference (P>0.05) levels of glycerin for hot carcass weight, chilled carcass weight, hot carcass yield, Chilled carcass yields, loss cooling, state of greasing, carcass length, leg length, depth of leg, chest depth, loin eye area, texture, marbling and color. However, the influence was observed (P<0.05) of increasing levels of crude glycerin on carcass conformation and carcass fat thickness. The use of crude glycerin reduced nutrient intake of the animals, however, did not influence the performance and carcass characteristics and is indicated its use in the diet of sheep

Economic viability of crude glycerin in diets for lambs finished in feedlot

The aim was to evaluate the economic viability of increasing levels of crude glycerin (CG) in diets for finishing lambs. The trial was carried out at Southwest State University of Bahia, Itapetinga-BA. Twenty five crossbred, Santa Inês x Dorper, with 24 ± 2,0 kg, were housed in individual pens. The experimental design was completely randomized with five treatments and five replications. Treatments consisted of increasing levels of dietary CG (0, 2.65, 5.33, 8.06 and 10.84%) and the roughage used was the Tifton 85 hay. Diets were formulated to meet the nutritional requeriments, aiming a gain of 200 g day-1. The analysis was based on use of economic indicators Net Present Value (NPV) and Internal Rate of Return (IRR). The animals dry matter intake decreased linearly (P0.05) on performance and meat production results. None of the treatments showed economic viability