Convivendo com a doença do irmão

The objective of this study is trying to reveal the reactions of healthy childrens facing their brothers oncologic illness trought their mothers perception. To collecting the data surveyng descriptive study with qualitative characteristics was realized. An interview with 8 mothers and the informations about their 13 children analysis allow us to know the reaction of these children facing their brothers diagnostic, hospitalization and parents different conducts.El estudio buscó descubrir las reacciones de un grupo de niños sanos frente a la enfermedad oncológica de su hermano(a), segun la percepción de las madres de ellos. Para tanto fué realizado un estudio exploratorio descriptivo com caracteristicas cualitativas. Fueron colectados declaraciones de 8 madres que hablaron de los reacciones de sus 13 hijos frente la enfermedad del hermano o hermana. La análisis de las declaraciones permitieron conocer la reaccíon del niño al saber sobre la enfermedad del hemano(a), el enfrentamiento de la hospitalización y los diferentes comportamientos de los padres en relación al hijo sano.O estudo buscou desvendar as reações de um grupo de crianças sadias frente a doença oncológica do irmão, segundo a percepção das mães. Para tanto, foi realizado um estudo exploratório descritivo com características qualitativas. Foram coletados depoimentos de oito (8) mães que verbalizaram as reações de seus treze (13) filhos frente a doença do irmão ou irmã. A análise dos depoimentos permitiu conhecer a reação da criança ao saber do diagnóstico do irmão, o enfrentamento da hospitalização do irmão e dos diferentes comportamentos dos pais em relação ao filho sadio

A SIMULAÇÃO COMO ESTRATÉGIA DE ENSINOAPRENDIZAGEM EM ENFERMAGEM: UMA REVISÃO INTEGRATIVA

Simulation, as teaching-learning methodology, is an instrument potentially transformative of formative practice in health, which focuses on the qualification of professionals and produces technical competence, ethics and politics in order to deal with the health problems in which these professionals are inserted. Given this, this study aims to analyze the use of simulation as a strategy for teaching-learning in Nursing. It is an integrative review of literature, from scientific publications indexed in the databases online Lilacs, Pubmed and Rev Enf., during 2010 and 2016. Following the search criteria, the sample was composed of 39 scientific articles, predominantly English-language articles 56% being the majority published in international journals, 59% (23) and 41% (16) published in national journals. The results demonstrated that most of them used the simulation with high-fidelity models in the process of nursing education for the development of knowledge and technical skills. The 39 studied articles were categorized in 3 main themes, which were: knowledge and skills, patience safety and self-confidence; thinking critically and reflecting the practice. From the analysis of these studies, the conclusion reached is that the simulation is an active methodology that contributes with the teaching and learning of Nursing since it streamlines the education through innovative strategies that make it possible to promote student’s autonomy, cognitive and psychomotor competence. Simulation is an educational resource which is able to promote a new paradigm in relation to traditional teaching. Keywords: Simulation. Education in Nursing. Learning. Educational TechnologyA simulação como metodologia de ensino-aprendizagem é um instrumento potencialmente transformador da prática formativa em saúde, atentando para a formação de profissionais mais qualificados, produzindo competência técnica, ética e política para o enfrentamento dos problemas de saúde nos quais estejam inseridos. Diante disso, este estudo objetiva analisar a utilização da simulação como estratégia de ensino-aprendizagem em enfermagem. Trata-se de uma revisão integrativa da literatura, a partir de publicações científicas indexadas nas bases de dados on-line Lilacs, Pubmed e Rev Enf., no período de 2010 a 2016. Seguindo os critérios de busca, a amostra foi composta por 39 artigos científicos, predominando artigos no idioma inglês (56%), sendo sua maioria publicada em periódicos internacionais, 59% (23), e 41% (16) publicados em periódicos nacionais. Os resultados demostraram que a maioria dos estudos utilizou a simulação com manequins de alta fidelidade no processo de ensino de enfermagem para o desenvolvimento de conhecimentos e habilidades técnicas. Os 39 artigos estudados foram categorizados em três temas principais, conhecimento e habilidades; segurança do paciente e autoconfiança; pensar criticamente e refletir a prática. A partir da análise desses estudos, concluiu-se que a simulação é uma metodologia ativa que contribui no ensino-aprendizagem de enfermagem, pois dinamiza o ensino através de estratégias inovadoras que possibilitam promover a autonomia, a competência cognitiva e a psicomotora dos estudantes. A simulação é um recurso educacional capaz de promover um novo paradigma em relação ao ensino tradicional. &nbsp

Convivendo com a doença do irmão

The objective of this study is trying to reveal the reactions of healthy childrens facing their brothers oncologic illness trought their mothers perception. To collecting the data surveyng descriptive study with qualitative characteristics was realized. An interview with 8 mothers and the informations about their 13 children analysis allow us to know the reaction of these children facing their brothers diagnostic, hospitalization and parents different conducts.El estudio buscó descubrir las reacciones de un grupo de niños sanos frente a la enfermedad oncológica de su hermano(a), segun la percepción de las madres de ellos. Para tanto fué realizado un estudio exploratorio descriptivo com caracteristicas cualitativas. Fueron colectados declaraciones de 8 madres que hablaron de los reacciones de sus 13 hijos frente la enfermedad del hermano o hermana. La análisis de las declaraciones permitieron conocer la reaccíon del niño al saber sobre la enfermedad del hemano(a), el enfrentamiento de la hospitalización y los diferentes comportamientos de los padres en relación al hijo sano.O estudo buscou desvendar as reações de um grupo de crianças sadias frente a doença oncológica do irmão, segundo a percepção das mães. Para tanto, foi realizado um estudo exploratório descritivo com características qualitativas. Foram coletados depoimentos de oito (8) mães que verbalizaram as reações de seus treze (13) filhos frente a doença do irmão ou irmã. A análise dos depoimentos permitiu conhecer a reação da criança ao saber do diagnóstico do irmão, o enfrentamento da hospitalização do irmão e dos diferentes comportamentos dos pais em relação ao filho sadio

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

International audienceBackground: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs).Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support.Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]).Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use