O PET-Saúde no Centro de Saúde Cafezal: promovendo hábitos saudáveis de vida

Trata-se de um de relato de experiência dos monitores bolsistas e voluntários de alguns cursos da área de saúde da Universidade Federal de Minas Gerais (UFMG) no projeto PET-Saúde, sob supervisão de cinco preceptores e de um tutor do projeto realizado na Unidade Básica de Saúde (UBS) Cafezal. O objetivo é descrever a experiência desse grupo tutorial do PET-Saúde Cafezal na promoção de hábitos saudáveis de vida. Os monitores puderam vivenciar a rotina do serviço de Atenção Primária, através do acompanhamento de diferentes atividades em diversos setores da UBS Cafezal e perceberam que os aspectos mais relevantes do projeto foram o trabalho interdisciplinar e multiprofissional, de acordo com os princípios de respeito e ética, a observação da rotina e do funcionamento da UBS, bem como a oportunidade de aplicarem seus conhecimentos acadêmicos adquiridos previamente. O modelo utilizado como estratégia de ensino-aprendizagem permitiu-lhes um meio de aprendizado teórico-prático dos preceitos adotados pelo SUS, uma vez que, devido ao princípio da indissociabilidade entre extensão, ensino e pesquisa, são realizados diversos trabalhos em campo e desenvolvidas pesquisas com equipes multidisciplinares

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status