APACHE II medido na saída dos pacientes da Unidade de Terapia Intensiva na previsão da mortalidade

OBJECTIVE: to analyze the performance of the Acute Physiology and Chronic Health Evaluation (APACHE II), measured based on the data from the last 24 hours of hospitalization in ICU, for patients transferred to the wards. METHOD: an observational, prospective and quantitative study using the data from 355 patients admitted to the ICU between January and July 2010, who were transferred to the wards. RESULTS: the discriminatory power of the AII-OUT prognostic index showed a statistically significant area beneath the ROC curve. The mortality observed in the sample was slightly greater than that predicted by the AII-OUT, with a Standardized Mortality Ratio of 1.12. In the calibration curve the linear regression analysis showed the R2 value to be statistically significant. CONCLUSION: the AII-OUT could predict mortality after discharge from ICU, with the observed mortality being slightly greater than that predicted, which shows good discrimination and good calibration. This system was shown to be useful for stratifying the patients at greater risk of death after discharge from ICU. This fact deserves special attention from health professionals, particularly nurses, in managing human and technological resources for this group of patients.OBJETIVO: analizar el desempeño del Acute Physiology and Chronic Health Evaluation (APACHE II), medido con base en los datos de la últims 24 horas de internación en la UTI, en los pacientes con transferencia para las enfermerías. MÉTODO: estudio observacional, prospectivo y cuantitativo con datos de 355 pacientes admitidos en la UTI entre enero y julio de 2010 que fueron transferidos para las enfermerías. RESULTADOS: el poder discriminatorio del índice pronóstico AII-SALIDA demostró un área debajo de la curva ROC estadísticamente significativa. La mortalidad observada en la muestra fue discretamente mayor que la prevista por el AII-SALIDA, con una Razón de Mortalidad Estandarizada de 1,12. En la curva de calibración, el análisis de la regresión linear demostró que el valor de R2 fue estadísticamente significativo. CONCLUSÍON: el AII-SALIDA fue capaz de predecir la mortalidad después de la salida de la UTI, siendo la observada discretamente mayor que la prevista, demostrando buena discriminación y buena calibración. Este sistema demostró ser útil para estratificar los pacientes con mayor riesgo de muerte después de la salida de la UTI. Este hecho merece especial atención de los profesionales de la salud, particularmente de los enfermeros, en la gestión de recursos humanos y tecnológicos para este grupo de pacientes.OBJETIVO: analisar o desempenho do Acute Physiology and Chronic Health Evaluation, medido com base nos dados das últimas 24 horas de internação na Unidade de Terapia Intensiva, nos pacientes com transferência para as enfermarias. MÉTODO: estudo observacional, prospectivo e quantitativo com dados de 355 pacientes, admitidos na Unidade de Terapia Intensiva entre janeiro e julho de 2010 que foram transferidos para as enfermarias. RESULTADOS: o poder discriminatório do índice prognóstico AII-SAÍDA demonstrou área sob a curva ROC estatisticamente significante. A mortalidade observada na amostra foi discretamente maior que a prevista pelo AII-SAÍDA, com Razão de Mortalidade Padronizada de 1,12. Na curva de calibração, a análise da regressão linear demonstrou que o valor de R2 foi estatisticamente significante. CONCLUSÃO: o AII-SAÍDA foi capaz de prever a mortalidade, após a saída da Unidade de Terapia Intensiva, sendo a observada discretamente maior que a prevista, demonstrando boa discriminação e boa calibração. Esse sistema demonstrou ser útil para estratificar os pacientes com maior risco de óbito, após a saída da Unidade de Terapia Intensiva. Tal fato merece especial atenção dos profissionais de saúde, particularmente dos enfermeiros, na gestão de recursos humanos e tecnológicos para esse grupo de pacientes

Risco de sarcopenia pode predizer pior qualidade de vida entre pacientes em hemodiálise?

Background: Sarcopenia and low quality of life (QOL) are widely found among hemodialysis (HD) patients. We aimed to verify whether risk of sarcopenia can predict QOL level in patients submitted to HD. Methods: The sample was formed by 147 chronic kidney disease patients undergoing HD in October 2020 at a single dialysis center.  Demographic and clinical data were collected. Risk of sarcopenia was classified using the SARC-F questionnaire. QOL was evaluated by the Brazilian version of the SF-36. QOL scores were compared between patients with and without risk of sarcopenia. Multivariate linear regression was performed to test risk of sarcopenia as an independent predictor of QOL scores. Results: There were 62 (42.2%) patients classified as having risk of sarcopenia. In the comparison of QOL scores between patients with and without risk of sarcopenia, scores of seven dimensions were significantly lower among patients with sarcopenia risk, the only exception being role-emotional. Risk of sarcopenia was an independent predictor of six dimensions of QOL, except for role-emotional and mental health. Conclusion: We found risk of sarcopenia to be an independent predictor of QOL among HD patients. Our results point to the possibility of improving patients’ QOL by intervening to minimize the risk of sarcopenia.Introdução: Sarcopenia e baixa qualidade de vida (QV) são amplamente encontradas entre pacientes em hemodiálise (HD). Nosso objetivo foi verificar se o risco de sarcopenia prediz o nível de QV nesta população. Métodos: A amostra foi formada por 147 pacientes em HD em outubro de 2020 em um único centro de diálise. Dados demográficos e clínicos foram coletados. O risco de sarcopenia foi classificado pelo questionário SARC-F. A QV foi avaliada pela versão brasileira do SF-36. Os escores de QV foram comparados entre pacientes com e sem risco de sarcopenia. A regressão linear multivariada foi realizada para testar o risco de sarcopenia como preditor independente dos escores de QV. Resultados: Havia 62 (42,2%) pacientes classificados como tendo risco de sarcopenia. Comparando os escores de QV entre pacientes com e sem risco de sarcopenia, os escores de 7 dimensões foram significativamente menores entre os pacientes com risco de sarcopenia, exceto aspectos emocionais. O risco de sarcopenia foi um preditor independente de 6 dimensões da QV, exceto para aspectos emocionais e saúde mental. Conclusão: O risco de sarcopenia é um preditor independente de QV entre os pacientes em HD. Nossos resultados apontam para a possibilidade de melhorar a QV dos pacientes intervindo para minimizar o risco de sarcopenia

Improving high availability and reliability of health interoperability systems

The accessibility and availability of patient clinical information are a constant need. The Agency for Interoperation, Diffusion and Archive of Medical Information (AIDA) was then developed to ensure the interoperability among healthcare information systems successfully. AIDA has demonstrated over time the need for greater control over its agents and their activities as the need for monitoring and preventing its machines and agents. This paper presents monitoring and prevention systems that were developed for machines and agents, which allow not only prevent faults, but also watch and evaluate the behaviour of these components through monitoring dashboards. The Biomedical Multiagent Platform for Interoperability (BMaPI) implemented in Centro Hospitalar do Porto (CHP) revealed provide the necessary data and functionalities capable to manage and to monitor agents’ activities. It was found that the prevention systems identified critical situations successfully, contributing to an increase in the integrity and availability of AIDA implemented in CHP

Exploring Nitrogen-Functionalized Graphene Composites for Urinary Catheter Applications

Graphene has been broadly studied, particularly for the fabrication of biomedical devices, owing to its physicochemical and antimicrobial properties. In this study, the antibiofilm efficacy of graphene nanoplatelet (GNP)-based composites as coatings for urinary catheters (UCs) was investigated. GNPs were functionalized with nitrogen (N-GNP) and incorporated into a polydimethylsiloxane (PDMS) matrix. The resulting materials were characterized, and the N-GNP/PDMS composite was evaluated against single- and multi-species biofilms of Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Both biofilm cell composition and structure were analyzed. Furthermore, the antibacterial mechanisms of action of N-GNP were explored. The N-GNP/PDMS composite showed increased hydrophobicity and roughness compared to PDMS. In single-species biofilms, this composite significantly reduced the number of S. aureus, P. aeruginosa, and K. pneumoniae cells (by 64, 41, and 29%, respectively), and decreased S. aureus biofilm culturability (by 50%). In tri-species biofilms, a 41% reduction in total cells was observed. These results are aligned with the outcomes of the biofilm structure analysis. Moreover, N-GNP caused changes in membrane permeability and triggered reactive oxygen species (ROS) synthesis in S. aureus, whereas in Gram-negative bacteria, it only induced changes in cell metabolism. Overall, the N-GNP/PDMS composite inhibited biofilm development, showing the potential of these carbon materials as coatings for UCs. (c) 2023 by the authors

A multi-agent platform for hospital interoperability

The interoperability among the Health Information Systems is a natural demand nowadays. The Agency for Integration, Diffusion and Archive of Medical Information (AIDA) is a Multi-Agent System (MAS) specifically developed to guarantee interoperability in health organizations. This paper presents the Biomedical Multi-agent Platform for Interoperability (BMaPI) integrated in AIDA and it is used by all hospital services which communicates with AIDA, one of the examples is the Intensive Care Unit. The BMaPI main objective is to facilitate the communication among the agents of a MAS. It also assists the interaction between humans and agents through an interface that allows the administrators to create new agents easily and to monitor their activities in real time. Due to the BMaPI characteristics it is possible ensure the continuous work of the AIDA agents associated to INTCare system. The BMaPI was installed in Centro Hospitalar do Porto successfully, increasing the functionality and overall usability of AIDA platform.(undefined

Potencialidades y limitaciones del desempeño de las enfermeras en el Centro Parto Normal

Objective: To know the potentialities and limitations of the nurse’s performance in the Center for Normal Birth (CPN). Method: Qualitative approach, exploratory-descriptive type, carried out in 2018, with six nurses working in public intra-hospital CPN in the metropolitan region of Fortaleza, Ceará, Brazil. The collection of information occurred through individual interview, with analysis from the assumptions of the sociology of professions, focusing on the themes: knowledge and autonomy; credentialism; division of labor; labor market and value chart. Result: The nurse’s performance in the Center for Normal Birth (CPN)enhances good practices for childbirth and birth, as well as increases the importance and visibility of this professional in maternal and child care. Clinical care and management emerge as the focus of the nurse’s action in the CPN. However, even with the induction of the State to this action, there is still the need for recognition of the competencies and autonomy of the nurse in obstetric care by other professionals. Conclusion and implications for practice: There are challenges that need to be overcome such as the expansion of autonomy and respect for the accreditation of the nurse to work in the CPN and the harmonization between the management of the work process and management of clinical care by this professional.Objetivo: Conhecer as potencialidades e limitações da atuação do enfermeiro no Centro de Parto Normal (CPN). Método: abordagem qualitativa, do tipo exploratório e descritivo, realizado em 2018, com seis enfermeiras atuantes em CPN intrahospitalar público na região metropolitana de Fortaleza, Ceará, Brasil. A coleta das informações ocorreu por meio de entrevista individual, com análise a partir dos pressupostos da sociologia das profissões, com foco nos temas: conhecimento e autonomia; credencialismo; divisão do trabalho; mercado de trabalho e quadro de valores. Resultado: A atuação do enfermeiro no CPN potencializa as boas práticas para o parto e nascimento, bem como amplia a importância e visibilidade deste profissional no cuidado materno-infantil. O cuidado clínico e a gestão emergem como foco da ação do enfermeiro no CPN. No entanto, mesmo com a indução do Estado para essa atuação, ainda há a necessidade de reconhecimento das competências e autonomia do enfermeiro no cuidado obstétrico por outros profissionais. Conclusão e implicações para a prática: Há desafios que precisam ser superados como a ampliação da autonomia e do respeito ao credenciamento do enfermeiro para atuação no CPN e a harmonização entre a gestão do processo de trabalho e gestão do cuidado clínico por este profissional.Objetivo: Conocer las potencialidades y limitaciones del desempeño de la enfermera en el Centro de Parto Normal (CPN). Método: Enfoque cualitativo, del tipo exploratorio-descriptivo, realizado en 2018, con seis enfermeras que trabajan en el CPN intrahospitalario público en la región metropolitana de Fortaleza, Ceará, Brasil. La recopilación de información se realizó mediante una entrevista individual, con análisis basado en los supuestos de la sociología de las profesiones, centrándose en los temas: conocimiento y autonomía; credencialismo; división del trabajo; mercado de trabajo y tabla de valores. Resultado: El desempeño de la enfermera en la CPN mejora las buenas prácticas para el parto y el nacimiento, así como aumenta la importancia y la visibilidad de este profesional en el cuidado de la madre y el niño. El cuidado clínico y la gestión surgen como el foco de la acción de la enfermera en la CPN. Sin embargo, incluso con la inducción del Estado a esta acción, sigue siendo necesario que otros profesionales reconozcan las aptitudes y la autonomía de la enfermera en la atención obstétrica por otros profesionales. Conclusión e implicaciones para la práctica: Hay desafíos que deben superarse, como el aumento de la autonomía y el respeto de la acreditación de las enfermeras para trabajar en la CPN y la armonización de la gestión del proceso de trabajo y la gestión de la atención clínica por parte de este profesional.info:eu-repo/semantics/publishedVersio

Graphene-Based Coating to Mitigate Biofilm Development in Marine Environments

Due to its several economic and ecological consequences, biofouling is a widely recognized concern in the marine sector. The search for non-biocide-release antifouling coatings has been on the rise, with carbon-nanocoated surfaces showing promising activity. This work aimed to study the impact of pristine graphene nanoplatelets (GNP) on biofilm development through the representative marine bacteria Cobetia marina and to investigate the antibacterial mechanisms of action of this material. For this purpose, a flow cytometric analysis was performed and a GNP/polydimethylsiloxane (PDMS) surface containing 5 wt% GNP (G5/PDMS) was produced, characterized, and assessed regarding its biofilm mitigation potential over 42 days in controlled hydrodynamic conditions that mimic marine environments. Flow cytometry revealed membrane damage, greater metabolic activity, and endogenous reactive oxygen species (ROS) production by C. marina when exposed to GNP 5% (w/v) for 24 h. In addition, C. marina biofilms formed on G5/PDMS showed consistently lower cell count and thickness (up to 43% reductions) than PDMS. Biofilm architecture analysis indicated that mature biofilms developed on the graphene-based surface had fewer empty spaces (34% reduction) and reduced biovolume (25% reduction) compared to PDMS. Overall, the GNP-based surface inhibited C. marina biofilm development, showing promising potential as a marine antifouling coating

Interoperability in health care

With the advancement of technology, patient information has been being computerized in order to facilitate the work of healthcare professionals and improve the quality of healthcare delivery. However, there are many heterogeneous information systems that need to communicate, sharing information and making it available when and where it is needed. To respond to this requirement the Agency for Integration, Diffusion, and Archiving of medical information (AIDA) was created, a multi-agent and service-based platform that ensures interoperability among healthcare information systems. In order to improve the performance of the platform, beyond the SWOT analysis performed, a system to prevent failures that may occur in the platform database and also in machines where the agents are executed was created. The system has been implemented in the Centro Hospitalar do Porto (one of the major Portuguese hospitals), and it is now possible to define critical workload periods of AIDA, improving high availability and load balancing. This is explored in this chapter.(undefined

Schistosoma mansoni rSm29 Antigen Induces a Regulatory Phenotype on Dendritic Cells and Lymphocytes From Patients With Cutaneous Leishmaniasis

The immune response induced by Schistosma mansoni antigens is able to prevent immune-mediated diseases. Conversely, the inflammatory response in cutaneous leishmaniasis (CL), although responsible for controlling the infection, is also associated with the pathogenesis of disease. The aim of this study was to evaluate the potential of the S. mansoni Sm29 antigen to change certain aspects of the profiles of monocyte derived dendritic cells (MoDCs) and lymphocytes from subjects with CL in vitro. Expression of surface molecules and intracellular cytokines in the MoDCs and lymphocytes as well as the proliferation of Leishmania braziliensis were evaluated by flow cytometry. Levels of cytokines were evaluated in culture supernatants by ELISA. It was observed that stimulation by rSm29 increased the frequency of expression of CD83, CD80, CD86, and IL-10R in MoDCs compared to non-stimulated cultures. Additionally rSm29 decreased the frequency CD4+ and CD8+ T cells expressing CD28 and increased the frequency of CD4+CD25hi and CD4+CTLA-4+ T lymphocytes. Addition of rSm29 to cultures increased IL-10 levels and decreased levels of IL-12p40 and IFN-γ, while not altering TNF levels compared to non-stimulated cultures. This study showed that rSm29 induced a regulatory profile in MoDCs and lymphocytes and thereby regulated the exaggerated inflammation observed in CL. Considering that there are few therapeutic options for leishmaniasis, the use of rSm29 may be an alternative to current treatment and may be an important strategy to reduce the healing time of lesions in patients with CL

Assessing genetic structure in common but ecologically distinct carnivores: the stone marten and red fox

The identification of populations and spatial genetic patterns is important for ecological and conservation research, and spatially explicit individual-based methods have been recognised as powerful tools in this context. Mammalian carnivores are intrinsically vulnerable to habitat fragmentation but not much is known about the genetic consequences of fragmentation in common species. Stone martens (Martes foina) and red foxes (Vulpes vulpes) share a widespread Palearctic distribution and are considered habitat generalists, but in the Iberian Peninsula stone martens tend to occur in higher quality habitats. We compared their genetic structure in Portugal to see if they are consistent with their differences in ecological plasticity, and also to illustrate an approach to explicitly delineate the spatial boundaries of consistently identified genetic units. We analysed microsatellite data using spatial Bayesian clustering methods (implemented in the software BAPS, GENELAND and TESS), a progressive partitioning approach and a multivariate technique (Spatial Principal Components Analysis-sPCA). Three consensus Bayesian clusters were identified for the stone marten. No consensus was achieved for the red fox, but one cluster was the most probable clustering solution. Progressive partitioning and sPCA suggested additional clusters in the stone marten but they were not consistent among methods and were geographically incoherent. The contrasting results between the two species are consistent with the literature reporting stricter ecological requirements of the stone marten in the Iberian Peninsula. The observed genetic structure in the stone marten may have been influenced by landscape features, particularly rivers, and fragmentation. We suggest that an approach based on a consensus clustering solution of multiple different algorithms may provide an objective and effective means to delineate potential boundaries of inferred subpopulations. sPCA and progressive partitioning offer further verification of possible population structure and may be useful for revealing cryptic spatial genetic patterns worth further investigation