Carga de trabalho da enfermagem requerida por pacientes durante internação numa UTI: estudo de coorte

Objective: To identify the nursing workload required by adult patients during hospitalization in an Intensive Care Unit (ICU) and in relation to the clinical outcome.Methods: Prospective cohort with 53 patients admitted to an adult ICU between July and September 2018. The Nursing Activities Score (NAS) was used for data collection. Descriptive and inferential statistics were used to compare means. The value of p < 0.05 was considered significant. This study was approved by the Research Ethics Committee (Opinion 2,014,344).Results: There was a predominance of female patients (28 - 52.83%), aged between 17 and 96 years, from the urgency/emergency service (34 - 65.38%), and admitted due to diseases of the circulatory system (18 - 33.96%). The severity of patients according to the SAPS 3 score was 52.32 points and the estimated mortality was of 25.34%. The length of hospital stay ranged from 2 to 38 days and discharge prevailed among the outcomes (39 - 73.58%). The average NAS was 57.41%, equivalent to 13.78 hours of nursing care in a 24-hour period. The average nursing workload at admission was higher than the average measured at the time of clinical outcome (p < 0.001). Patients who died during hospitalization had an average NAS higher than that of patients who survived (p = 0.022).Conclusions: The nursing workload varied over the hospitalization period, being greater on the first day of hospitalization and in the care of patients with a poor prognosis (death).Objetivo: Identificar la carga de trabajo de enfermería requerida por pacientes adultos durante su estadía en una UCI y en relación con el desenlace clínico.Métodos: Estudio de cohorte prospectivo realizado con 53 pacientes hospitalizados en una UCI de adultos entre julio y septiembre de 2018. Se utilizó el Nursing Activities Score (NAS) para la recopilación de datos. Se emplearon estadísticas descriptivas e inferenciales para comparar los promedios. Se consideró el valor de p<0,05 como significativo. Este estudio fue aprobado por el Comité de Ética en Investigación (Opinión 2.014.344). Resultados: Hubo un predominio de pacientes del género femenino (28-52,83%), con edades comprendidas entre 17 y 96 años, procedentes del servicio de urgencia/emergencia (34-65,38%), debido a enfermedades del sistema circulatorio (18-33,96%). La severidad promedio por el SAPS 3 fue de 52,32 puntos y la estimación de mortalidad fue de 25,34%. La duración de la estancia hospitalaria osciló entre 2 y 38 días y prevaleció el alta de los pacientes (39-73,58%). El promedio de NAS fue de 57,41%, equivalente a 13,78 horas de atención de enfermería, durante un período de 24 horas. La carga de trabajo de enfermería promedio al momento de la entrada fue mayor que el promedio medido al momento del desenlace clínico (p<0,001). Los pacientes que progresaron a la muerte durante la hospitalización tuvieron un puntaje NAS promedio más alto que el de los pacientes que sobrevivieron (p=0,022).Conclusiones: La carga de trabajo de enfermería osciló durante el período de estancia hospitalaria, siendo mayor el primer día de hospitalización y en la atención de pacientes con un pronóstico reservado (muerte).Objetivo: Identificar a carga de trabalho da enfermagem requerida por pacientes adultos durante a internação em uma UTI e em relação ao desfecho clínico. Métodos: Coorte prospectiva realizada com 53 pacientes internados em uma UTI de adultos entre julho e setembro de 2018. Utilizou-se o Nursing Activities Score (NAS) para a coleta de dados. Realizou-se a estatística descritiva e inferencial para comparação de médias. Considerou-se como significativo o valor de p <0,05. Este estudo obteve foi aprovado pelo Comitê de Ética em Pesquisa (Parecer 2.014.344). Resultados: Houve predomínio de pacientes do sexo feminino (28 – 52,83%), com idade entre 17 e 96 anos, proveniente do serviço de urgência/emergência (34 – 65,38%), devido a doenças do aparelho circulatório (18 – 33,96%). A gravidade pelo SAPS 3 média foi de 52,32 pontos e estimativa de mortalidade de 25,34%. O tempo de internação variou de 2 a 38 dias e a alta dos pacientes prevaleceu (39 - 73,58%). A média do NAS foi de 57,41%, equivalendo-se a 13,78 horas de assistência de enfermagem, no período de 24 horas. A média da carga de trabalho da enfermagem no momento da admissão foi maior que a média mensurada no momento do desfecho clínico (p<0,001). Os pacientes que evoluíram para o óbito durante a internação apresentaram uma pontuação média no score NAS superior à dos pacientes que sobreviveram (p=0,022). Conclusões: A carga de trabalho da enfermagem variou ao longo do período de internação sendo maior no primeiro dia de internação e no cuidado dos pacientes com prognóstico reservado (óbito)

Evaluation of the oxidative profile of critical patients hospitalized in adult intensive care unit

The objective of this work was to evaluate and correlate the oxidative stress in patients with uncontrolled blood glucose levels (hyperglycemia or hypoglycemia) hospitalized in an intensive care unit (ICU). This was a cross-sectional study, performed with 26 patients in an ICU of a hospital in the Zona da Mata in Minas Gerais. Patients with uncontrolled blood glucose levels were evaluated in two moments: on the day of admission (T0) and one day after the uncontrolled glycaemia (DG1). The evaluation of the oxidative profile was determined by the dosage of serum total antioxidant capacity, based on the ability of ferric reduction, determination of enzymatic activity of Superoxide Dismutase, Catalase and Glutathione S-Transferase, lipid peroxidation products and carbonylated proteins. The levels of ferric reducing ability decreased significantly, whereas the activity of the Superoxide Dismutase enzyme increased significantly after uncontrolled glycaemia in relation to the initial time. Although the lipid peroxidation did not change between the times evaluated, the damage marker significantly reduced, shown by carbonylation of proteins after the uncontrolled glycaemia. The critical patients evaluated in this study present altered oxidative profile after the uncontrolled glycaemia, a common problem that imposes the worst prognoses

Effects of dry and traditional bed bathing on respiratory parameters: a randomized pilot study

Objetivo: comparar el tiempo de ejecución del baño en la cama a seco y con el tradicional, y observar los efectos sobre la saturación del oxígeno transcutáneo arterial y la frecuencia respiratoria, en pacientes críticos adultos. Método: estudio piloto de un ensayo clínico aleatorizado crossover, abierto, realizado con 15 pacientes críticos adultos. Cada paciente recibió el baño en la cama, a seco y de forma tradicional. Se utilizó el análisis de variancia con medidas repetidas adoptando el valor p≤0,05. Resultados: la mayoría de los pacientes era del sexo masculino (73,3%), blancos (66,7%), con media de edad de 69,7 años. El baño a seco fue más rápido (20,0 minutos) que el tradicional (30,0 minutos) (p<0,001). No hubo diferencia significativa entre los promedios de saturación de los pacientes entre los baños (p=0,381), siendo 94,7% en el baño a seco y 95,2% en el tradicional. Durante el baño tradicional la media, de la frecuencia respiratoria, de los pacientes fue mayor (24,2 incursiones por minuto) y estadísticamente diferente (p<0,001) del valor obtenido en el baño a seco (20,5 incursiones por minuto). Conclusión: El baño a seco tuvo una duración menor que el tradicional, resultando en una menor exposición de los pacientes. El tradicional baño en la cama generó efecto negativo sobre la frecuencia respiratoria de los pacientes, elevándola. Registro Brasileño de Ensayos Clínicos (ReBEC): RBR-5qwkqd.Objetivo: comparar o tempo de execução do banho no leito a seco e do tradicional, e os seus efeitos sobre a saturação transcutânea de oxigênio arterial e a frequência respiratória em pacientes críticos adultos. Método: estudo piloto de um ensaio clínico randomizado crossover, aberto, realizado com 15 pacientes críticos adultos. Cada paciente recebeu o banho no leito a seco e o tradicional. Utilizou-se a análise de variância com medidas repetidas, adotando-se o valor p≤0,05. Resultados: a maioria dos pacientes era do sexo masculino (73,3%), brancos (66,7%), com média de idade de 69,7 anos. O banho a seco foi mais rápido (20,0 minutos) que o tradicional (30,0 minutos) (p<0,001). Não houve diferença significativa entre as médias de saturação dos pacientes entre os banhos (p=0,381), sendo 94,7% no banho a seco e 95,2% no tradicional. Durante o banho tradicional, a média da frequência respiratória dos pacientes foi maior (24,2 incursões por minuto) e estatisticamente diferente (p<0,001) do valor obtido no banho a seco (20,5 incursões por minuto). Conclusão: o banho a seco teve uma duração menor que o tradicional, resultando em uma menor exposição dos pacientes. O tradicional banho no leito gerou efeito negativo sobre a frequência respiratória dos pacientes, elevando-a. Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-5qwkqd.Objective: to compare the time for performance of dry and traditional bed bathing and its effects on transcutaneous arterial oxygen saturation and respiratory rates in critical adult patients. Method: pilot study of a randomized, open, crossover clinical trial, performed with 15 adult critically ill patients. Each patient received a dry and a traditional bed bath. Analysis of variance with repeated measures was used, adopting p-value ≤ 0.05. Results: most patients were male (73.3%), white (66.7%), with a mean age of 69.7 years. The dry bath was faster (20.0 minutes) than the traditional bath (30.0 minutes) (p<0.001). There was no significant difference between the patients’ saturation means between baths (p=0.381), with 94.7% for the dry bath and 95.2% for the traditional bath. During the traditional bath, the patients’ respiratory rate mean was higher (24.2 incursions per minute) and statistically different (p<0.001) from the value obtained for the dry bath (20.5 incursions per minute). Conclusion: the dry bath had a shorter duration than did the traditional bath, resulting in less patient exposure. The traditional bed bath had a negative effect on patients’ respiratory rate, increasing it. Brazilian Registry of Clinical Trials (ReBEC): RBR-5qwkqd

Nursing workload required by patients during ICU admission: a cohort study

Objetivo: Identificar la carga de trabajo de enfermería requerida por pacientes adultos durante su estadía en una UCI y en relación con el desenlace clínico. Métodos: Estudio de cohorte prospectivo realizado con 53 pacientes hospitalizados en una UCI de adultos entre julio y septiembre de 2018. Se utilizó el Nursing Activities Score (NAS) para la recopilación de datos. Se emplearon estadísticas descriptivas e inferenciales para comparar los promedios. Se consideró el valor de p<0,05 como significativo. Este estudio fue aprobado por el Comité de Ética en Investigación (Opinión 2.014.344). Resultados: Hubo un predominio de pacientes del género femenino (28-52,83%), con edades comprendidas entre 17 y 96 años, procedentes del servicio de urgencia/emergencia (34-65,38%), debido a enfermedades del sistema circulatorio (18-33,96%). La severidad promedio por el SAPS 3 fue de 52,32 puntos y la estimación de mortalidad fue de 25,34%. La duración de la estancia hospitalaria osciló entre 2 y 38 días y prevaleció el alta de los pacientes (39-73,58%). El promedio de NAS fue de 57,41%, equivalente a 13,78 horas de atención de enfermería, durante un período de 24 horas.La carga de trabajo de enfermería promedio al momento de la entrada fue mayor que el promedio medido al momento del desenlace clínico (p<0,001). Los pacientes que progresaron a la muerte durante la hospitalización tuvieron un puntaje NAS promedio más alto que el de los pacientes que sobrevivieron (p=0,022). Conclusiones: La carga de trabajo de enfermería osciló durante el período de estancia hospitalaria, siendo mayor el primer día de hospitalización y en la atención de pacientes con un pronóstico reservado (muerte).RESUMO: Objetivo: Identificar a carga de trabalho da enfermagem requerida por pacientes adultos durante a internação em uma UTI e em relação ao desfecho clínico. Métodos: Coorte prospectiva realizada com 53 pacientes internados em uma UTI de adultos entre julho e setembro de 2018. Utilizou-se o Nursing Activities Score (NAS) para a coleta de dados. Realizou-se a estatística descritiva e inferencial para comparação de médias. Considerou-se como significativo o valor de p <0,05. Este estudo obteve foi aprovado pelo Comitê de Ética em Pesquisa (Parecer 2.014.344). Resultados: Houve predomínio de pacientes do sexo feminino (28 – 52,83%), com idade entre 17 e 96 anos, proveniente do serviço de urgência/emergência (34 – 65,38%), devido a doenças do aparelho circulatório (18 – 33,96%). A gravidade pelo SAPS 3 média foi de 52,32 pontos e estimativa de mortalidade de 25,34%. O tempo de internação variou de 2 a 38 dias e a alta dos pacientes prevaleceu (39 - 73,58%). A média do NAS foi de 57,41%, equivalendo-se a 13,78 horas de assistência de enfermagem, no período de 24 horas. A média da carga de trabalho da enfermagem no momento da admissão foi maior que a média mensurada no momento do desfecho clínico (p<0,001). Os pacientes que evoluíram para o óbito durante a internação apresentaram uma pontuação média no score NAS superior à dos pacientes que sobreviveram (p=0,022). Conclusões: A carga de trabalho da enfermagem variou ao longo do período de internação sendo maior no primeiro dia de internação e no cuidado dos pacientes com prognóstico reservado (óbito).ABSTRACT: Objective: To identify the nursing workload required by adult patients during hospitalization in an Intensive Care Unit (ICU) and in relation to the clinical outcome. Methods: Prospective cohort with 53 patients admitted to an adult ICU between July and September 2018. The Nursing Activities Score (NAS) was used for data collection. Descriptive and inferential statistics were used to compare means. The value of p < 0.05 was considered significant. This study was approved by the Research Ethics Committee (Opinion 2,014,344). Results: There was a predominance of female patients (28 - 52.83%), aged between 17 and 96 years, from the urgency/emergency service (34 - 65.38%), and admitted due to diseases of the circulatory system (18 - 33.96%). The severity of patients according to the SAPS 3 score was 52.32 points and the estimated mortality was of 25.34%. The length of hospital stay ranged from 2 to 38 days and discharge prevailed among the outcomes (39 - 73.58%). The average NAS was 57.41%, equivalent to 13.78 hours of nursing care in a 24-hour period. The average nursing workload at admission was higher than the average measured at the time of clinical outcome (p < 0.001). Patients who died during hospitalization had an average NAS higher than that of patients who survived (p = 0.022). Conclusions: The nursing workload varied over the hospitalization period, being greater on the first day of hospitalization and in the care of patients with a poor prognosis (death)

Optimization of adsorptive removal of α-toluic acid by CaO2 nanoparticles using response surface methodology

The present work addresses the optimization of process parameters for adsorptive removal of α-toluic acid by calcium peroxide (CaO2) nanoparticles using response surface methodology (RSM). CaO2 nanoparticles were synthesized by chemical precipitation method and confirmed by Transmission electron microscopy (TEM) and high-resolution TEM (HRTEM) analysis which shows the CaO2 nanoparticles size range of 5–15 nm. A series of batch adsorption experiments were performed using CaO2 nanoparticles to remove α-toluic acid from the aqueous solution. Further, an experimental based central composite design (CCD) was developed to study the interactive effect of CaO2 adsorbent dosage, initial concentration of α-toluic acid, and contact time on α-toluic acid removal efficiency (response) and optimization of the process. Analysis of variance (ANOVA) was performed to determine the significance of the individual and the interactive effects of variables on the response. The model predicted response showed a good agreement with the experimental response, and the coefficient of determination, (R2) was 0.92. Among the variables, the interactive effect of adsorbent dosage and the initial α-toluic acid concentration was found to have more influence on the response than the contact time. Numerical optimization of process by RSM showed the optimal adsorbent dosage, initial concentration of α-toluic acid, and contact time as 0.03 g, 7.06 g/L, and 34 min respectively. The predicted removal efficiency was 99.50%. The experiments performed under these conditions showed α-toluic acid removal efficiency up to 98.05%, which confirmed the adequacy of the model prediction

Clinical and genetic characteristics of late-onset Huntington's disease

Background: The frequency of late-onset Huntington's disease (&gt;59 years) is assumed to be low and the clinical course milder. However, previous literature on late-onset disease is scarce and inconclusive. Objective: Our aim is to study clinical characteristics of late-onset compared to common-onset HD patients in a large cohort of HD patients from the Registry database. Methods: Participants with late- and common-onset (30–50 years)were compared for first clinical symptoms, disease progression, CAG repeat size and family history. Participants with a missing CAG repeat size, a repeat size of ≤35 or a UHDRS motor score of ≤5 were excluded. Results: Of 6007 eligible participants, 687 had late-onset (11.4%) and 3216 (53.5%) common-onset HD. Late-onset (n = 577) had significantly more gait and balance problems as first symptom compared to common-onset (n = 2408) (P &lt;.001). Overall motor and cognitive performance (P &lt;.001) were worse, however only disease motor progression was slower (coefficient, −0.58; SE 0.16; P &lt;.001) compared to the common-onset group. Repeat size was significantly lower in the late-onset (n = 40.8; SD 1.6) compared to common-onset (n = 44.4; SD 2.8) (P &lt;.001). Fewer late-onset patients (n = 451) had a positive family history compared to common-onset (n = 2940) (P &lt;.001). Conclusions: Late-onset patients present more frequently with gait and balance problems as first symptom, and disease progression is not milder compared to common-onset HD patients apart from motor progression. The family history is likely to be negative, which might make diagnosing HD more difficult in this population. However, the balance and gait problems might be helpful in diagnosing HD in elderly patients