Atención de Enfermería al paciente sometido a terapia electroconvulsiva

Objetivo: relatar a rotina das equipes de Enfermagem no atendimento a pacientes submetidos à eletroconvulsoterapia. Resultados: a eletroconvulsoterapia é um procedimento realizado em centro cirúrgico ambulatorial para tratamentos psiquiátricos, sendo, em alguns casos, a última intervenção em transtornos graves e refratários. É realizado três vezes por semana, de segunda a sexta-feira, com intervalo de um dia entre as sessões. São agendados 15 pacientes/dia. Devido à COVID-19, houve a redução para oito pacientes/dia. A equipe é composta por Enfermagem Psiquiátrica e Cirúrgica e médicos de Psiquiatria e Anestesiologia. O procedimento requer medidas de segurança específicas, como o jejum absoluto de oito horas. Tal cuidado, típico da Enfermagem, ganha enredo especial em pacientes psiquiátricos graves. Controlar a não ingestão alimentar e hídrica em pacientes desorientados globalmente e com risco de agressão por qua-dros delirantes é apenas um dos desafios. O procedimento só é realizado após sanadas as condições de relaxamento e anestesia com a liberação da estimulação por ondas eletromagnéticas. As principais complicações em sala de recupera-ção estão relacionadas à hipoventilação. Considerações finais: ressalta-se a importância da Enfermagem no que con-cerne à integralidade do cuidado, evidenciada pela sua permanência contínua antes, durante e após a realização deste procedimentoObjective: to report the routine of the Nursing teams in the care of patients undergoing electroconvulsive therapy. Re-sults: electroconvulsive therapy is a procedure performed in an outpatient surgery center for psychiatric treatments, being, in some cases, the last intervention in severe and refractory disorders. It is performed three times a week, from Monday to Friday, with a one-day break between sessions; 15 patients per day are scheduled. Due to COVID-19, there was a reduction to eight patients per day. The team is composed of Psychiatric and Surgical Nurses and Psychiatry and Anesthesiology doctors. The procedure requires specific safety measures, such as an eight-hour fast. Such care, typical of Nursing, gains special plot in severe psychiatric patients. Controlling the ingestion of food and water in globally disoriented patients and those at risk of aggression due to delirium is only one of the challenges. The procedure is only performed after the conditions of relaxation and anesthesia have been met with the release of the electromagnetic wave stimulation. The main complications in the recovery room are related to hypoventilation. Final considerations: it is important to emphasize the importance of Nursing in terms of the integrality of care, evidenced by its continuous pres-ence before, during and after the performance ofthis procedure.Objetivo: informar sobre la rutina de los equipos de enfermería en el cuidado de pacientes sometidos a terapia electro-convulsiva. Resultados: la terapia electroconvulsiva es un procedimiento que se realiza en un centro quirúrgico ambu-latorial para tratamientos psiquiátricos, siendo, en algunos casos, la última intervención en trastornos severos y refrac-tarios. Se lleva a cabo tres veces por semana, de lunes a viernes, con un descanso de un día entre las sesiones. Se programan 15 pacientes / día. Debido a COVID-19, hubo una reducción a ocho pacientes / día. El equipo está compuesto por médicos de Enfermería Psiquiátrica y Quirúrgica y Psiquiatría y Anestesiología. El procedimiento requiere medidas de seguridad específicas, como un ayuno absoluto de ocho horas. Este cuidado, propio de la Enfermería, adquiere una trama especial en los pacientes psiquiátricos críticamente enfermos. Controlar la falta de ingesta de alimentos y agua en pacientes globalmente desorientados y en riesgo de agresión debido a condiciones delirantes es solo uno de los desafíos. El procedimiento solo se realiza después de que las condiciones de relajación y anestesia se hayan resuelto con la liberación de estimulación por ondas electromagnéticas. Las principales complicaciones en la sala de recuperación están relacionadas con la hipoventilación. Consideraciones finales: enfatiza la importancia de la Enfermería con respecto a la atención integral, evidenciada por su permanencia continua antes, durante y después de este procedimiento

Irrigação transanal em paciente pós cirurgia de reconstrução do trânsito intestinal

Objective: To report the experience of caring for a patient with fecal incontinence after intestinal transit reconstruction surgery and the use of transanal irrigation. Method: Descriptive study, to case report of carried out in January 2022, during the residency internship in Public Health. Results: In order to reconstitute the control over the intestinal elimination, the transanal irrigation technique is used, which corresponds to the administration of water at body temperature, through the anuses, allowing the patient to program his evacuations and keep the colon empty for periods longer. The training to carry out this procedure is carried out by a stomatherapist nurse or a trained professional who will guide the procedure to be carried out in the home environment. It is evident the importance of training in the use of the device for intestinal irrigation adapted for transanal intestinal irrigation, once patients manage to manipulate it with ease and independently, after or training. Final considerations: The transanal intestinal irrigation procedure is successful, given tolerance by the patient, or it can lead to a significant improvement in intestinal function and quality of life.Objetivo: Relatar a experiência no atendimento a um paciente com incontinência fecal pós cirurgia de reconstrução do trânsito intestinal e o uso da irrigação transanal. Método: Estudo descritivo, do tipo relato de caso, realizado em janeiro de 2022, durante o estágio de residência em Saúde Pública. Resultados: Com a finalidade de reconstituir o domínio sobre a eliminação intestinal, utiliza-se a técnica da irrigação transanal, que corresponde a administração de água na temperatura corporal, através do ânus, permitindo ao paciente programar suas evacuações e manter o cólon vazio por períodos mais longos. O treinamento para efetuar este procedimento é realizado pelo enfermeiro estomaterapeuta ou profissional capacitado que orientará o procedimento para ser realizado no ambiente domiciliar. Evidenciou-se a importância da capacitação na utilização do dispositivo para irrigação intestinal adaptado para irrigação intestinal transanal, uma vez que os pacientes conseguem manipulá-lo com facilidade e de forma independente, após o treinamento. Considerações finais: O procedimento de irrigação intestinal transanal obteve sucesso, visto tolerância pelo paciente, o que pode levar a uma significativa melhora da função intestinal e da qualidade de vida

Trends in invasive bacterial diseases during the first 2 years of the COVID-19 pandemic: analyses of prospective surveillance data from 30 countries and territories in the IRIS Consortium.

BACKGROUND The Invasive Respiratory Infection Surveillance (IRIS) Consortium was established to assess the impact of the COVID-19 pandemic on invasive diseases caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Streptococcus agalactiae. We aimed to analyse the incidence and distribution of these diseases during the first 2 years of the COVID-19 pandemic compared to the 2 years preceding the pandemic. METHODS For this prospective analysis, laboratories in 30 countries and territories representing five continents submitted surveillance data from Jan 1, 2018, to Jan 2, 2022, to private projects within databases in PubMLST. The impact of COVID-19 containment measures on the overall number of cases was analysed, and changes in disease distributions by patient age and serotype or group were examined. Interrupted time-series analyses were done to quantify the impact of pandemic response measures and their relaxation on disease rates, and autoregressive integrated moving average models were used to estimate effect sizes and forecast counterfactual trends by hemisphere. FINDINGS Overall, 116 841 cases were analysed: 76 481 in 2018-19, before the pandemic, and 40 360 in 2020-21, during the pandemic. During the pandemic there was a significant reduction in the risk of disease caused by S pneumoniae (risk ratio 0·47; 95% CI 0·40-0·55), H influenzae (0·51; 0·40-0·66) and N meningitidis (0·26; 0·21-0·31), while no significant changes were observed for S agalactiae (1·02; 0·75-1·40), which is not transmitted via the respiratory route. No major changes in the distribution of cases were observed when stratified by patient age or serotype or group. An estimated 36 289 (95% prediction interval 17 145-55 434) cases of invasive bacterial disease were averted during the first 2 years of the pandemic among IRIS-participating countries and territories. INTERPRETATION COVID-19 containment measures were associated with a sustained decrease in the incidence of invasive disease caused by S pneumoniae, H influenzae, and N meningitidis during the first 2 years of the pandemic, but cases began to increase in some countries towards the end of 2021 as pandemic restrictions were lifted. These IRIS data provide a better understanding of microbial transmission, will inform vaccine development and implementation, and can contribute to health-care service planning and provision of policies. FUNDING Wellcome Trust, NIHR Oxford Biomedical Research Centre, Spanish Ministry of Science and Innovation, Korea Disease Control and Prevention Agency, Torsten Söderberg Foundation, Stockholm County Council, Swedish Research Council, German Federal Ministry of Health, Robert Koch Institute, Pfizer, Merck, and the Greek National Public Health Organization

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries