Attendance and Certification Modules in the Management System for Tele-education of the Telehealth Center - HUUFMA

The Telehealth Brazil Networks Programme is a national action that seeks to improve the quality of care and primary care in the Unified Health System (SUS), which offers conditions to promote Tele-assistance and Tele-education. One of the major areas, Tele-education, is based on the use of information technologies to provide web conferences, courses, and classes. Due to the limitation of the broadcasting platforms to track the detailed users’ information, it was necessary to the Telehealth Center of the University Hospital of the Federal University of Maranhão (HUUFMA) the development of a web system to automatically gather this data. The current release of the system enables users to register in web conferences activities, and the information such as professional area, location, personal info are stored, so the system can track all the activities the user has participated and then automatically generate certificates at any time after the end of the activity

Application Tool for Improvement of the Metrics of Unread and Unevaluated Teleconsultations of the Telehealth Center - HUUFMA

The Brazil Telehealth Networks Programme is a project that contributes to the quality of services provided by the Unified Health System (SUS), which offers conditions to promote Tele-assistance and Tele-education. In the area of tele-assistance, the Telehealth Centre of the University Hospital of the Federal University of Maranhão (NTS-HUUFMA) has built up Teleconsultation services, which provide communication tools to assist health professionals. The process of a teleconsultation starts with a question on the online platform and finishes with the response sent by a qualified health professional. Previously, monitoring of this task was done by using a digital spreadsheet. It was necessary to develop an application to monitor and manage the inactivated and unevaluated teleconsultations. Before the development of the system, the Telehealth Centre had around 25% of teleconsultations that were not responded to, and this number has decreased significantly since its deployment

PROTOZOÁRIOS E HELMINTOS EM INTERAÇÃO COM IDOSOS ALBERGADOS EM LARES GERIÁTRICOS NO ESTADO DO RIO DE JANEIRO, BRASIL

Idosos albergados em Lares Geriátricos de três municípios no estado do Rio de Janeiro, com idades entre 60 e 88 anos foram investigados quanto a interações entre helmintos e protozoários do intestino, o sexo e a procedência dos anciãos de Nova Iguaçu, Paty do Alferes, e Santa Cruz. Das 62 pessoas que formaram a amostra, 37 eram homens e 25 eram mulheres, indicativo de maior número de homens albergados; destes 27,78% dos homens e 34,62% das mulheres estavam infectados. Cinco espécies de helmintos (Ascaris lumbricoides, Enterobius vermicularis, Strongyloides stercoralis, Trichuris trichiura, e Hymenolepis nana) e cinco de protozoários (Cryptosporidium sp., Endolimax nana, Entamoeba coli, Entamoeba histolytica, Giardia lamblia) foram diagnosticadas, sendo dominante T. trichiura, mas a dominância foi diferentes entre os homens e as mulheres. Em Nova Iguaçu a frequência de infecção foi significativamente maior que nos outros dois Lares Geriátricos; os resultados foram encaminhados para o mesmo médico que atende as três instituições e serviram de base para a intervenção. Palavras chave: Parasitismo em idoso; nematóides intestinais; cestoide no intestino

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

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