an integrative review

OBJECTIVE: to identify the main complications in the late postoperative period of surgical patients. METHOD: an integrative review from the CINAHL, LILACS, Science direct, Web of Science, SCOPUS, Europe PMC, and MEDLINE databases. Descriptors and keywords were combined without language or time restriction. R RESULTS: ten primary studies were included. Infectious complications were the most common, especially surgical site infection, pneumonia and urinary tract infection. The presence of complications was linked to increased mortality, need for reoperations and worse survival. Few studies report on monitoring frequency, follow-up time and/or when complications started to be observed.  CONCLUSION: infectious complications were the most prevalent postoperatively. The scarcity of guidelines that guide the monitoring of complications regarding monitoring frequency, follow-up time and classification makes it difficult to establish an overview of them and consequently propose intervention strategies. Objetivo: identificar as principais complicações ocorridas no pós-operatório tardio de pacientes cirúrgicos. Método: revisão integrativa a partir das bases CINAHL, LILACS, Science Direct, Web of Science, SCOPUS, Europe PMC e MEDLINE. Combinaram-se descritores e palavras-chave, sem restrição de idioma ou tempo. Resultados: dez estudos primários foram incluídos. As complicações infecciosas foram as mais comuns, com destaque para infecção do sitio cirúrgico, pneumonia e infecção urinária. A presença de complicações esteve ligada ao aumento na mortalidade, necessidade de reoperações e pior sobrevida. Poucos estudos relatam a frequência de monitoramento, tempo de seguimento e/ou quando as complicações começaram a serem observadas. Conclusão: as complicações infecciosas foram as mais prevalentes no pós-operatório. A escassez de diretrizes que guiem a vigilância das complicações no que concerne a frequência de monitoramento, tempo de seguimento e classificação dificulta estabelecer um panorama das mesmas e consequentemente propor estratégias de intervenção. Objetivo: identificar las principales complicaciones que ocurren en el postoperatorio tardío de los pacientes quirúrgicos. Método:   revisión integradora de CINAHL, LILACS, Science Direct, Web of Science, SCOPUS, Europe PMC y MEDLINE. Descriptores y palabras clave fueron combinadas sin restricción de idioma o tiempo. Resultados:   se incluyeron diez estudios primarios. Las complicaciones infecciosas fueron las más comunes, especialmente la infección del sitio quirúrgico, la neumonía y la infección del tracto urinario. La presencia de complicaciones se relacionó con un aumento de la mortalidad, la necesidad de reoperaciones y una peor supervivencia. Pocos estudios informan sobre la frecuencia de monitoreo, el tiempo de seguimiento y/o cuándo comenzaron a observarse complicaciones. Conclusión: las complicaciones infecciosas fueron las más frecuentes después de la operación. La escasez de pautas que guían la vigilancia de las complicaciones con respecto a la frecuencia de monitoreo, el tiempo de seguimiento y la clasificación hace que sea difícil establecer una visión general de las mismas y, en consecuencia, proponer estrategias de intervención.publishersversionpublishe

Occupational accidents among nursing professionals working in critical units of an emergency service

Objetivo: identificar a prevalência de acidentes ocupacionais entre profissionais de enfermagem atuantes em setores críticos de um pronto-socorro e apreender a vivência profissional dentre os acidentados. Métodos: pesquisa descritiva, transversal, realizada em duas etapas consecutivas, com 75 profissionais. A análise quantitativa foi realizada por estatística descritiva, enquanto os depoimentos foram processados no software IRaMuTeQ, analisados de acordo com a Classificação Hierárquica Descendente. Os achados foram fundamentados no método do Discurso do Sujeito Coletivo. Resultados: a prevalência geral de acidentes foi de 26,7%. Destes, 72,2% envolviam material perfurocortante e, em 84,2% deles, o sangue foi o principal agente biológico envolvido. Registraram-se três classes: "Vivenciando o Acidente Ocupacional"; "Condutas Pós-Exposição" e "Prevenção do Acidente Ocupacional". Conclusão: registrou-se alta taxa de profissionais acidentados, com maior prevalência entre aqueles de nível técnico. A vivência do acidente parece encontrar-se imageticamente ligada a momentos (antes, após e durante), causas, consequências e sentimentos.Objective: identify the prevalence of occupational accidents among nursing professionals working in critical units of an emergency service and understand the professional experience among the injured professionals. Methods: a descriptive cross-sectional study was conducted with 75 professionals, in two consecutive stages. A quantitative analysis was performed by descriptive statistics, and the participants' statements were processed in the IRaMuTeQ software, and analyzed according to the hierarchical descending classification. The findings were based on the collective subject discourse method. Results: the overall prevalence of accidents was 26.7%. Of these, 72.2% involved sharp materials and blood was the main biological agent involved in 84.2% of the accidents. Three classes were defined: "Experiencing an occupational accident"; "Post-exposure conduct" and "Occupational accident prevention". Conclusion: a high rate of injured professionals was observed, with a higher prevalence among those at a technical level. The experience of suffering an accident seems to be closely related to moments (before, after and during), causes, consequences and feelings.Objetivo: identificar la prevalencia de accidentes de trabajo entre los profesionales de enfermería activos en sectores críticos de una emergencia y comprender la experiencia profesional entre los heridos. Métodos: estudio descriptivo transversal, realizado en dos etapas consecutivas, con 75 profesionales. El análisis cuantitativo se realizó mediante estadística descriptiva, mientras que los informes fueron procesados en el software IRaMuTeQ, analizados de acuerdo a la Clasificación Jerárquica Descendente. Los hallazgos se basan en el método del Discurso del Sujeto Colectivo. Resultados: la prevalencia global de accidentes fue de 26,7%. De estos 72,2% fueron causados por objetos punzantes y en 84,2% la sangre era el principal agente biológica implicado. Tres clases fueron encontradas: "Experimentar Accidente de Trabajo"; "Post-Exposición Tuberías" y "Prevención de Accidentes de Trabajo". Conclusión: se grabó alta tasa de accidentes que se encuentran con mayor prevalencia entre las personas de nivel técnico. La experiencia del accidente parece estar vinculada a momentos (antes, durante y después) por imagen, las causas, las consecuencias y los sentimientos

IDENTIFICAÇÃO E RECUPERAÇÃO DA FUNÇÃO RENAL EM PACIENTES NÃO DIALÍTICOS NO CENÁRIO DE TERAPIA INTENSIVA

RESUMO Objetivos: determinar o grau de comprometimento da função renal de pacientes que evoluíram com LRA não dialítica e identificar a frequência de recuperação da função renal na unidade de terapia intensiva (UTI). Método: estudo observacional, prospectivo e quantitativo desenvolvido com 90 pacientes após admissão na UTI. O acompanhamento ocorreu por 15 dias. Os dados foram coletados a partir dos registros do prontuário. Foram considerados significativos os resultados com

Frequência e perfil de suscetibilidade aos carbapenêmicos de bastonetes Gram-negativos não fermentadores de glicose isolados de amostras clínicas entre 2007 e 2012

Introdução: Um dos grandes problemas nos serviços de saúde é a ocorrência de infecções relacionadas com assistência à saúde (IRAS) por microrganismos resistentes a vários antimicrobianos. Objetivos: Descrever a frequência e o perfil de suscetibilidade de Pseudomonas aeruginosa e Acinetobacter baumannii aos carbapenêmicos no hospital da Fundação Santa Casa de Franca, São Paulo, Brasil. Métodos: Retrospectivamente, a suscetibilidade de P. aeruginosa e A. baumannii aos carbapenêmicos foi analisada em 304 isolados clínicos entre 2007 e 2012, a partir de um banco de dados do setor de microbiologia do laboratório clínico do hospital da Fundação Santa Casa de Franca, São Paulo, Brasil. Resultados: Das cepas isoladas e identificadas, 236 (5,3%) P. aeruginosa eram suscetíveis a imipenem (2007 - 69,6% a 2012 - 41,7%) e meropenem (2007 - 63,3% a 2012 - 25%). Além disso, todos os 68 (1,7%) isolados de A. baumannii eram suscetíveis aos dois antibióticos. Conclusão: Não foi identificada resistência de A. baumannii aos carbapenêmicos, no entanto houve diminuição da suscetibilidade aos carbapenêmicos no decorrer dos anos para P. aeruginosa.Introduction: One of the major problems in health services is the occurrence of healthcare-associated infections (HAIs) by microorganisms resistant to various antimicrobials. Objectives: To describe the frequency and susceptibility profile of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenems in the hospital from Fundação Santa Casa de Franca, São Paulo, Brazil. Methods: The susceptibility of P. aeruginosa and A. baumannii to carbapenems from 304 clinical isolates between 2007 and 2012 was retrospectively analyzed from a microbiology database at the clinical laboratory of the hospital of Fundação Santa Casa de Franca, São Paulo, Brazil. Results: From isolated and identified strains, 236 (5.3%) P. aeruginosa were susceptible to imipenem (2007 - 69.6% to 2012 - 41.7%) and meropenem (2007 - 63.3% to 2012 - 25%). In addition, all 68 (1.7%) A. baumannii isolates were susceptible to both antibiotics. Conclusion: A. baumannii resistance to carbapenems was not identified; however, there was a decrease in susceptibility to carbapenems over the years for P. aeruginosa

Aquisição teórico-prática de tópicos relevantes à segurança do paciente : dilemas na formação de enfermeiros

Objetivo: investigar conteúdos relacionados à segurança do paciente, contemplados nos currículos de cursos de graduação em Enfermagem de duas Instituições de Ensino Superior brasileiras. Método: estudo descritivo, tipo survey, realizado com 119 alunos de cursos de Enfermagem (Licenciatura e Bacharelado), no período de agosto a setembro de 2016. Os tópicos investigados foram baseados no Patient safety curriculum guide: multi-professional edition. De posse dos dados, realizaram-se análises univariadas e bivariadas. Resultados: dos 46 conteúdos investigados no questionário, dois tiveram escores elevados de não obtenção em atividades teóricas e/ou práticas, que são: "Cultura de culpa" e "Infecção comunitária". Alunos da Licenciatura e Bacharelado referiram maior aquisição em aulas teóricas (p = 0,012), enquanto os do Bacharelado atribuíram de forma equivalente teoria e prática (p = 0,013). Conclusão: os conteúdos estiveram contemplados, em sua maioria, na abordagem teórica e prática, ao menos uma vez no decorrer do curso. No entanto, quando se tratou de conteúdos ligados a aspectos socioculturais relacionados à segurança do paciente registraram-se escores menores.Objective: to investigate content associated with patient safety included in the curricula of undergraduate nursing courses of two Brazilian higher educational institutions. Method: a descriptive survey study was carried out with 119 students of nursing courses (licentiate and bachelor degree), from August to September 2016. The topics investigated were based on the WHO patient safety curriculum guide: multi-professional edition. Armed with the data, univariate and bivariate analyses were carried out. Results: of the 46 content areas investigated in the questionnaire, two scored high in non-achievement in theoretical or practical activities, namely "the culture of blame" and "community-acquired infection." Licentiate and bachelor degree students reported a higher acquisition in theoretical classes (p = 0.012), whereas bachelor degree students reported similar acquisition in theory and practice (p = 0.013). Conclusion: the content mostly included theoretical and practical approaches at least once throughout the course. However, when considering content associated with patient safety-related sociocultural aspects, lower scores were found.Objetivo: investigar contenidos relacionados a seguridad del paciente, contemplados en programas de cursos de grado en Enfermería de dos Instituciones de Enseñanza Superior brasileñas. Método: estudio descriptivo, tipo survey, realizado con 119 alumnos de cursos de Enfermería (Licenciatura y Bachillerato), de agosto a setiembre de 2016. Los tópicos investigados estaban basados en el Patient safety curriculum guide: multi-professional edition. Se realizaron análisis univariados y bivariados de los datos. Resultados: de 46 contenidos investigados, dos obtuvieron alto grado de desaprobación en actividades teóricas y/o prácticas: "Cultivo de culpa" e "Infección comunitaria". Los alumnos de Licenciatura y Bachillerato reportaron mayor adquisición en clases teóricas (p = 0,012), mientras los de Bachillerato reportaron equivalentemente a teoría y práctica (p = 0,013). Conclusión: los contenidos estuvieron mayoritariamente contemplados en abordajes teóricos y prácticos al menos una vez durante el curso; aunque se registraron puntajes menores respecto de contenidos vinculados a aspectos socioculturales relacionados a seguridad del paciente

SIMULAÇÃO COMO ESTRATÉGIA PARA O APRENDIZADO EM PEDIATRIA

RESUMO Introdução: a simulação é importante para situações que exijam habilidades psicomotoras ou decisões rápidas, como as de urgência e emergência. Objetivo: avaliar o uso da simulação clínica em Pediatria como estratégia para o aprendizado de alunos do curso de Enfermagem da Faculdade de Ceilândia. Método: estudo transversal de natureza descritivo, com 47 alunos do curso de enfermagem da Faculdade de Ceilândia. Os instrumentos de coleta de dados foram questionários relacionados às Diretrizes da American Heart Association (AHA) e à influência da simulação clínica no aprendizado do aluno. Resultados: os alunos possuem conhecimento relevante das diretrizes e afirmaram que a simulação foi produtiva, que deve ser inserida no cronograma do curso e realizada com outros temas. Conclusão: a pesquisa evidenciou o conhecimento acentuado dos graduandos em Enfermagem da UnB/Ceilândia das Diretrizes de RCP da AHA e concluiu que a prática da simulação clínica foi benéfica para o processo de ensino e aprendizagem

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Monitorização de complicações pós-operatórias no ambiente domiciliar

Objective: to propose a guideline for monitoring postoperative complications in patients in the home environment. Methods: research developed using the Delphi technique with 45 Brazilian health professionals. Google Forms were used for data collection and a Likert scale was used for consensus purposes. The data were analyzed using qualitative (content analysis) and quantitative (frequency and percentage analysis) techniques. Results: sixteen complications eligible to aid in the monitoring of surgical patients after discharge were listed, as well as signs and symptoms to be observed, and frequency and time of monitoring. According to the judges, surgical patients must be monitored at least once a day (68.8%). The maximum monitoring time varied from 48 hours to 30 days in case of risk of infection. Conclusion: the guideline is valid to be used to detect complications in surgical patients in the home environment and to anticipate the need for readmission.Objetivo: propor uma diretriz de monitorização de complicações pós-operatórias de pacientes no ambiente domiciliar. Métodos: pesquisa desenvolvida por meio da técnica Delphi com 45 profissionais de saúde brasileiros. Utilizaram-se o Google Forms para coleta de dados e a escala Likert para fins de consenso. Os dados foram analisados utilizando técnicas qualitativas (análise de conteúdo) e quantitativas (análise de frequências e percentuais). Resultados: foram elencadas 16 complicações elegíveis para serem utilizadas no monitoramento de pacientes cirúrgicos no pós-alta, sinais e sintomas a serem observados, frequência e tempo de monitoramento. De acordo com os juízes, é necessário o monitoramento, ao menos uma vez por dia (68,8%), do egresso cirúrgico. O tempo máximo de monitoramento apresentou variação de 48 horas até 30 dias, no caso de risco de infecção. Conclusão: a diretriz se mostra válida para ser usada na detecção de complicações em egressos cirúrgicos no domicílio e antever a necessidade de reinternação