Visita domiciliar melhora conhecimento, autocuidado e adesão na insuficiência cardíaca: ensaio clínico randomizado HELEN-I

OBJECTIVE: To verify the effect of an educative nursing intervention composed of home visits and phone calls on patients' knowledge about the disease, self-care and adhesion to the treatment. METHODS: Randomized clinical trial with patients with recent hospitalization caused by decompensated heart failure. There were two groups: the intervention group, which has received four home visits and four phone calls to reinforce the guidelines during six months of follow up; and the control group, which has received conventional follow up with no visits or phone calls. RESULTS: Two hundred patients were randomized (101 in the intervention group and 99 in the control group). After six months, a significant improvement was observed in self-care and knowledge about the disease in the intervention group (P=0.001 and POBJETIVO: Verificar el efecto de una intervención educativa de enfermería combinada de visita domiciliaria y contacto telefónico en pacientes con internación reciente por insuficiencia cardiaca descompensada, en el conocimiento de la enfermedad, las habilidades para el autocuidado y la adhesión al tratamiento comparado con el acompañamiento convencional de pacientes en el período de seis meses. MÉTODOS: Ensayo Clínico Aleatorizado en pacientes que fueron ingresados recientemente por insuficiencia cardiaca descompensada. El grupo intervención recibió cuatro visitas domiciliarias y cuatro contactos telefónicos para reforzar las orientaciones en seis meses de acompañamiento; el grupo control recibió acompañamiento convencional sin visitas y sin contactos telefónicos. RESULTADOS: Fueron aleatorizados doscientos pacientes (101: intervención y 99: control). Tras seis meses, se observó una mejoría significativa en el conocimiento y el autocuidado para el grupo intervención (P=0,001 y POBJETIVO: verificar o efeito de uma intervenção educativa de enfermagem combinada, caracterizada por visita domiciliar e contato telefônico, em pacientes com internação recente por insuficiência cardíaca descompensada, no conhecimento da doença, nas habilidades para o autocuidado e na adesão ao tratamento, comparado ao acompanhamento convencional de pacientes no período de seis meses. MÉTODOS: nsaio línico randomizado com pacientes que tiveram internação recente por insuficiência cardíaca descompensada. O grupo-intervenção recebeu quatro visitas domiciliares e quatro contatos telefônicos para reforço das orientações, em seis meses de acompanhamento; o grupo-controle recebeu acompanhamento convencional sem visitas e sem contatos telefônicos. RESULTADOS: duzentos pacientes foram randomizados (101: intervenção e 99: controle). Após seis meses, observou-se melhora significativa no conhecimento e autocuidado para o grupo-intervenção (p=0,001 e

Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC

Objective The objective of the study is to evaluate the effectiveness of nursing interventions (NIC) using nursing outcomes (NOC) and based on NANDA-I nursing diagnoses in patients with heart failure in home care. Method In this longitudinal study, 23 patients with heart failure were followed for 6 months, in four home visits. During the visits, nursing diagnoses were established, outcomes assessed, and interventions implemented. Results Of the 11 NIC interventions implemented, eight proved effective, that is, showed significant improvement between the first and the fourth visit, according to scores obtained for six outcomes: knowledge: treatment regimen, knowledge: medication, compliance behavior, symptom control, activity tolerance, and energy conservation. Conclusion NIC interventions health education, self-modification assistance, behavior modification, teaching: prescribed medication, teaching: disease process, nutritional counseling, telephone consultation, and energy conservation showed effective outcomes based on NOC scores, suggesting that the NANDA-I, NIC, and NOC linkage is useful in patients with heart failure in home care

Detection and quantification of Campylobacter spp. in Brazilian poultry processing plants

Introduction: Campylobacteriosis is considered the most common bacteria-caused human gastroenteritis in the world. Poultry is a major reservoir of Campylobacter. Human infection may occur by consumption of raw and undercooked poultry or by contamination of other foods by these items. The aim of this study was to assess the prevalence of Campylobacter spp. in poultry processing plants with conventional culture method and real-time PCR. Methodology: A total of 108 poultry processing plant samples were collected to test with conventional microbiology and qPCR. Sampling included cloacal swabs, swabs of transport crates (before and after the cleaning and disinfection process) and carcasses (after the chiller, cooled at 4°C and frozen at −12°C). Results: Positivity in cloacal swabs indicated that poultry arrived contaminated at the slaughterhouse. Contamination in transport cages was substantially increased after the cleaning process, indicating that the process was ineffective. The detection of Campylobacter on carcasses was higher than that on cloacal swabs, which could indicate cross-contamination during the slaughtering process. Conventional microbiology and molecular methods revealed a prevalence of 69.4% and 43.5%, respectively. Lower detection by qPCR can be attributed to the high specificity of the kit and to biological components that could inhibit PCR reactions. Conclusions: Our results indicate that poultry arrive contaminated at the slaughterhouse and that contamination can increase during the slaughtering process due to cross-contamination. The isolation of Campylobacter in cooled and frozen carcasses corroborates the bacterial survival even at temperatures considered limiting to bacterial growth which are routinely used for food preservation

Detection of virulence genes in Salmonella Heidelberg isolated from chicken carcasses

During the last years, Brazilian government control programs have detected an increase of Salmonella Heidelberg in poultry slaughterhouses a condition that poses a threat to human health However, the reasons remain unclear. Differences in genetic virulence profiles may be a possible justification. In addition, effective control of Salmonella is related to an efficient epidemiological surveillance system through genotyping techniques. In this context, the aim of this study was the detection of 24 virulence-associated genes in 126 S. Heidelberg isolates. We classified the isolates into 56 different genetic profiles. None of the isolates presented all the virulence genes. The prevalence of these genes was high in all tested samples as the lowest number of genes detected in one isolate was 10/24. The lpfA and csgA (fimbriae), invA and sivH (TTSS), and msgA and tolC (intracellular survival) genes were present in 100% of the isolates analyzed. Genes encoding effector proteins were detected in the majority of SH isolates. No single isolate had the sefA gene. The pefA gene was found in only four isolates. We have also performed a screening of genes associated with iron metabolism: 88.9% of isolates had the iroN gene and 79.4% the sitC gene. Although all the isolates belong to the same serotype, several genotypic profiles were observed. These findings suggest that there is a diversity of S. Heidelberg isolates in poultry products. The fact that a single predominant profile was not found in this study indicates the presence of variable sources of contamination caused by SH. The detection of genetic profiles of Salmonella strains can be used to determine the virulence patterns of SH isolates

Wooden breast e white striping : ocorrência em três empresas avícolas

To increase the amount of meat produced, researchers have promoted intensive genetic selection for growth rate and muscling and have improved nutrition and management conditions. However, there has been an increase in the number of reports of breast muscle myopathies observed in poultry processing plants, including white striping (WS) and wooden breast (WB). This study aimed to evaluate and to compare the occurrence of WS and WB myopathies in three poultry processing plants and to perform an anatomopathological characterization, including macroscopic and microscopic analyses. A total of 408,334 carcasses were condemned or downgraded due to the presence of WB or WS, which represents 0.73% of the total number of slaughtered animals during the evaluated period. WB was more frequent than WS, but the occurrence of each myopathy varied significantly according to each establishment. WB was more frequent in the establishment which includes only male flocks, an average age of 45 days, and an average live weight of 2775g (B). WS was more frequent in establishment with male, female and mixed flocks, average ages ranging from 41 to 44 days, and average live weight 1731g-2830g (A). It is probably related with specific condition of each poultry company, including genetics, age, nutrition and management conditions. Macroscopically, WB and WS lesions are characterized by hypertrophy and stiffness of the pectoralis major muscle. Under microscopy, the myopathies showed similarities regarding the detected histological abnormalities, characterized by a process of myodegeneration, although the connective tissue infiltrate was more severe in the breasts with WB than in those with WS myopathy. The results found in this study demonstrate that the rates of condemnation for these myopathies are high, vary significantly among the analyzed companies and may cause major economic losses for the productive sector in the region.Para melhorar a quantidadede carne produzida, os pesquisadores têm promovido ao longo dos anos uma seleção genética intensiva para a taxa de crescimento e desenvolvimento de músculos, além de melhorias nas condições nutricionais, sanitárias e de manejo. No entanto, houve um aumento no número de relatos de miopatias dos músculos do peito observados em abatedouros-frigoríficos de aves, incluindo white striping (WS) e wooden breast (WB). O objetivo deste estudo foi avaliar a ocorrência de WB e WS em três abatedouros-frigoríficos de aves e realizar uma caracterização anatomopatológica, incluindo análises macroscópicas e microscópicas. Um total de 408.334 carcaças foi condenado (total ou parcialmente) devido à presença WB ou WS, o que representou 0,73% do número total de animais abatidos durante o período avaliado. Apesar de a ocorrência de WB ter sido maior do que a de WS, a frequência de cada uma variou significativamente de acordo com o estabelecimento. WB foi mais frequente no estabelecimento que incluía apenas lotes de machos, com média de 45 dias de idade e peso médio ao abate de 2775g (B). WS foi mais frequente no estabelecimento com lotes de machos, fêmeas e mistos, com idade entre 41 e 44 dias e peso médio ao abate entre 1731g-2830g (A). Isto pode ser justificado por condições específicas de cada empresa, incluindo genética, idade das aves, nutrição e condições de manejo. Macroscopicamente, as lesões de WB e de WS foram caracterizadas principalmente por hipertrofia e rigidez do músculo pectoralis major. À microscopia, ambas as miopatias mostraram semelhanças em relação às anormalidades histológicas detectadas, caracterizadas principalmente por um processo de miodegeneração. Nos músculos apresentando WB, o infiltrado de tecido conjuntivo foi mais intenso quando comparado àqueles com WS. Os resultados encontrados neste trabalho demonstram que os índices de condenação por essas miopatias são altos, variam significativamente entre as empresas analisadas e podem causar grandes perdas econômicas para o setor produtivo da região

Bradykinin or Acetylcholine as Vasodilators to Test Endothelial Venous Function in Healthy Subjects

INTRODUCTION: The evaluation of endothelial function has been performed in the arterial bed, but recently evaluation within the venous system has also been explored. Endothelial function studies employ different drugs that act as endothelium-dependent vasodilatory response inductors. OBJECTIVES: The aim of this study is to compare the endothelium-dependent venous vasodilator response mediated by either acetylcholine or bradykinin in healthy volunteers. METHODS AND RESULTS: Changes in vein diameter after phenylephrine-induced venoconstriction were measured to compare venodilation induced by acetylcholine or bradykinin (linear variable differential transformer dorsal hand vein technique). We studied 23 healthy volunteers; 31% were male, and the subject had a mean age of 33 ± 8 years and a mean body mass index of 23 ± 2 kg/m2. The maximum endothelium-dependent venodilation was similar for both drugs (p = 0.13), as well as the mean responses for each dose of both drugs (r = 0.96). The maximum responses to acetylcholine and bradykinin also had good agreement. CONCLUSION: There were no differences between acetylcholine and bradykinin as venodilators in this endothelial venous function investigation

Sinais e sintomas de pacientes com insuficiência cardíaca descompensada: inferência dos diagnósticos de enfermagem prioritários

Objetivou-se identificar os sinais e sintomas de pacientes admitidos por insuficiência cardíaca (IC) descompensada visando inferir os diagnósticos de enfermagem (DE) prioritários. Estudo transversal realizado em um hospital universitário. Os dados foram coletados por enfermeiras treinadas em IC e registrados em uma ficha contendo itens de identificação, variáveis demográficas e clínicas. Foram incluídos 303 pacientes, a maioria dos pacientes encontrava-se em unidades de emergência (95,7%), com classe funcional III (65,7%). Os sinais e sintomas identificados no momento da admissão hospitalar foram dispnéia (91,4%), dispnéia paroxística noturna (87,5%), cansaço (67,3%), edema (63,7%), ortopnéia (55,4%) e distensão da veia jugular (28,7%). A partir dos sinais e sintomas levantados, que se constituíram no conjunto de pistas relevantes e consistentes como indicador para um DE, foi possível inferir que Débito Cardíaco Diminuído e Volume de Líquidos Excessivo foram os diagnósticos prioritários para a população estudada

Insuficiência cardíaca: avaliação e comparação do conhecimento da doença em pacientes ambulatoriais x hospitalizados

Objective: to evaluate and compare the knowledge of the disease among patients with heart failure (HF) in a hospital specialized in cardiology. Method: this is a cross-sectional study. A validated questionnaire about knowledge of disease was applied, as well as sociodemographic data and a cognitive assessment questionnaire. The patients were divided into two groups, those of the HF outpatient clinic (OC) and those hospitalized in the inpatient units (IU). Patients who scored between 51-57 points (score) had a great knowledge rating. Results: the sample was 98 patients, 49 in OC and 49 in IU, mostly male, mean age 62 ± 14 years. In OC, 51% had acceptable level of knowledge and in IU, 55% had poor knowledge. Conclusion: the knowledge of HF among outpatients and inpatients was different and suboptimal. Education activities developed by the multiprofessional team can contribute to better knowledge of the disease.Objetivo: avaliar e comparar o conhecimento da doença entre os pacientes com Insuficiência Cardíaca (IC) em um hospital especializado em cardiologia. Método: trata-se de um estudo transversal. Foi aplicado um questionário de conhecimento da doença validado, além de dados sociodemográficos e um questionário de avaliação cognitiva. Os pacientes foram divididos em dois grupos, os do ambulatório de IC (GA) e os hospitalizados nas unidades de internação clínica (GI). Os pacientes que somaram entre 51-57 pontos (escore) tiveram classificação ótima de conhecimento. Resultados: a amostra foi de 98 pacientes, 49 no GA e 49 no GI, maioria do sexo masculino, idade média de 62 ± 14 anos. No GA, 51% apresentou nível aceitável de conhecimento e no GI, 55% apresentou pouco conhecimento. Conclusão: o conhecimento da IC entre pacientes ambulatoriais e internados foram diferentes e subótimos. Atividades de educação desenvolvidas pela equipe multiprofissional podem contribuir para melhor conhecimento da doença