O CUIDADOR FAMILIAR FRENTE A CRIANÇA COM DIABETES MELLITUS TIPO 1: AÇÕES EDUCATIVAS.

The study aims to identify the benefits and contributions that health education provides to home caregivers of children with type 1 Diabetes Mellitus. This is an integrative literature review, carried out between June and August 2021, through the respective virtual platforms that provide selected collections of scientific journals, these were LILACS, IBECS, MEDLINE and BDENF, crossing with the Boolean operator AND, 53 studies were found, which after the eligibility process, remained 8 researches. Health education for caregivers of children with type 1 diabetes mellitus is of fundamental importance, with the aim of providing safe, humanized and effective care, with educational actions mainly aimed at adherence to pharmacological and non-pharmacological treatment and targeted actions to social and emotional aspects. It is concluded that it was possible to show through this study the need that caregivers have for continued health promotion at home.El estudio tiene como objetivo identificar los beneficios y aportes que la educación en salud brinda a los cuidadores domiciliarios de niños con Diabetes Mellitus tipo 1. Se trata de una revisión integradora de la literatura, realizada entre junio y agosto de 2021, a través de las respectivas plataformas virtuales que brindan colecciones seleccionadas de información científica. revistas, estas fueron LILACS, IBECS, MEDLINE y BDENF, cruzando con el operador booleano Y, se encontraron 53 estudios, que luego del proceso de elegibilidad quedaron 8 investigaciones. La educación para la salud de los cuidadores de niños con diabetes mellitus tipo 1 es de fundamental importancia, con el objetivo de brindar una atención segura, humanizada y eficaz, con acciones educativas orientadas principalmente a la adherencia al tratamiento farmacológico y no farmacológico y acciones focalizadas en los aspectos sociales y emocionales. . Se concluye que a través de este estudio se pudo evidenciar la necesidad que tienen los cuidadores de una promoción continua de la salud en el hogar.O estudo tem o objetivo de identificar os benefícios e contribuições que a educação em saúde proporciona a cuidadores domiciliares de crianças com Diabetes Mellitus tipo 1. Trata-se de uma revisão de literatura do tipo integrativa, realizado entre os meses de junho a agosto de 2021, através das respectivas plataformas virtuais que disponibilizam coleções selecionadas de periódicos científicos, foram estas LILACS, IBECS, MEDLINE e BDENF, cruzando com o operador booleano AND, foram encontrados 53 estudos, que após o processo de elegibilidade, restaram 8 pesquisas. A educação em saúde a cuidadores de crianças com diabetes mellitus tipo 1, é de fundamental importância, com o intuído de fornecer uma assistência segura, humanizada e efetiva, sendo as ações educativas voltadas principalmente para a adesão ao tratamento farmacológico e não farmacológico e ações direcionadas aos aspectos sociais e emocionais. Conclui-se que foi possível evidenciar através desse estudo a necessidade que os cuidadores possuem de uma promoção de saúde continua no domicilio.O estudo tem o objetivo de identificar os benefícios e contribuições que a educação em saúde proporciona a cuidadores domiciliares de crianças com Diabetes Mellitus tipo 1. Trata-se de uma revisão de literatura do tipo integrativa, realizado entre os meses de junho a agosto de 2021, através das respectivas plataformas virtuais que disponibilizam coleções selecionadas de periódicos científicos, foram estas LILACS, IBECS, MEDLINE e BDENF, cruzando com o operador booleano AND, foram encontrados 53 estudos, que após o processo de elegibilidade, restaram 8 pesquisas. A educação em saúde a cuidadores de crianças com diabetes mellitus tipo 1, é de fundamental importância, com o intuído de fornecer uma assistência segura, humanizada e efetiva, sendo as ações educativas voltadas principalmente para a adesão ao tratamento farmacológico e não farmacológico e ações direcionadas aos aspectos sociais e emocionais. Conclui-se que foi possível evidenciar através desse estudo a necessidade que os cuidadores possuem de uma promoção de saúde continua no domicilio

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Coccidioidomicose pulmonar e extrapulmonar: três casos em zona endêmica no interior do Ceará Pulmonary and extrapulmonary coccidioidomycosis: three cases in an endemic area in the state of Ceará, Brazil

A coccidioidomicose, uma doença fúngica adquirida através da inalação do agente Coccidioides sp. sob a forma de artroconídio, foi pela primeira vez descrita em 1894. Restringe-se principalmente a áreas de clima árido, solo alcalino e regiões de baixo índice pluviométrico. Não por acaso, a maioria dos casos descritos no Brasil ocorreu na região Nordeste. Relatam-se três casos de coccidioidomicose pulmonar ocorridos nos anos de 2005 e 2006, em zona endêmica no interior do Ceará. Todos eram homens imunocompetentes de idade adulta, adeptos à prática de caça a tatus (Dasypus novemcinctus) com queixas de tosse, febre, dispneia e dor pleurítica. Houve evoluções com comprometimento pulmonar e lesão cutânea foi observada em apenas um paciente. Todos apresentaram radiografia e TC de tórax com lesões características da coccidioidomicose. O diagnóstico foi confirmado através de teste sorológico. Todos evoluíram para cura após tratamento com antifúngico.Coccidioidomycosis, a fungal illness acquired by the inhalation of arthroconidia of Coccidioides sp., was first described in 1894. Coccidioidomycosis is mainly restricted to areas with arid climate, alkaline soil and low rainfall. Consequently, most of the reported cases in Brazil have occurred in the northeastern region. We report three cases of pulmonary coccidioidomycosis occurring between 2005 and 2006 in an endemic area in the state of Ceará, Brazil. The three patients were immunocompetent adult males, hunters of armadillos (Dasypus novemcinctus), with complaints of cough, fever, dyspnea and pleuritic pain. All three patients presented pulmonary involvement, and only one also presented cutaneous lesions. Chest X-rays and CT scans of the patients revealed characteristic coccidioidomycosis lesions. The diagnosis was confirmed by serological testing. All of the patients evolved to cure after antifungal treatment

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine