Perspectiva dos Enfermeiros Brasileiros sobre o Impacto da Acreditação Hospitalar

This study aimed to identify the impact of hospital accreditation programs from the nurses' perspective. This quantitative, descriptive, exploratory study was performed in a private general hospital. This institution is accredited with Excellence (Level III, the highest) by the Brazilian National Accreditation Organization. Data collection was conducted using a Likert-type questionnaire consisting of seven scales related to: quality results; human resources utilization; strategic quality planning; quality management; use of data related to patient satisfaction; staff involvement; and benefits of accreditation. The results show that nurses perceived improvements as outcome of the accreditation process in the following areas: strategic quality planning; quality management; use of data related to patient satisfaction; and staff involvement with hospital quality. Inversely, the accreditation process have not result in developments in relation to the time given to nurses to plan for and test quality improvements, and also in relation to human resources utilization, especially concerning rewards and recognition strategies. We concluded that nurses have a key role in accomplishment of the accreditation process and therefore rewards and recognition strategies need to be better developed and implemented, and nurses need to be given adequate time for performing activities related to the accreditation process.El estudio tuvo como objetivo identificar el impacto de los programas de acreditación hospitalaria desde la perspectiva de las enfermeras. Este es un estudio cuantitativo, descriptivo, exploratorio, que tuvo lugar en hospital general privado acreditado con excelencia (Nivel III, el más alto) por la Organización Nacional de Acreditación. La recolección de datos se realizó mediante un cuestionario tipo Likert compuesto por siete escalas relacionadas con: la calidad de los resultados; El uso de los recursos humanos; la calidad de la planificación estratégica; Gestión de la Calidad; El uso de datos relacionados con la satisfacción del paciente; Participación del personal; Y los beneficios de la acreditación. Los resultados muestran que las enfermeras se dieron cuenta de las mejoras resultantes del proceso de acreditación en las siguientes áreas: planificación estratégica de la calidad; Gestión de la Calidad; Utilización de los datos relacionados con la satisfacción del paciente y la participación del personal con la calidad del hospital. Por el contrario, el proceso de acreditación no resultó en desarrollos en relación al tiempo dado a las enfermeras para preparar y probar mejoras de la calidad y también para el uso de los recursos humanos, especialmente en lo que se refiere a las recompensas y estrategias de reconocimiento. Llegamos a la conclusión de que las enfermeras tienen un papel clave en la consecución del proceso de acreditación y, por tanto, las recompensas y las estrategias de reconocimiento precisan ser mejor desarrolladas y puestas en práctica y las enfermeras necesitan tener tiempo suficiente para realizar actividades relacionadas con el proceso de acreditación.O estudo objetivou identificar o impacto dos programas de acreditação hospitalar do ponto de vista dos enfermeiros. Trata-se de um estudo quantitativo, descritivo, exploratório, realizado em hospital geral privado credenciado com Excelência (Nível III, o mais alto) pela Organização Nacional de Acreditação. A coleta de dados foi realizada por meio de um questionário de tipo Likert composto por sete escalas relacionadas a: Resultados de qualidade; Utilização de recursos humanos; Planejamento estratégico de qualidade; Gestão da Qualidade; Uso de dados relacionados à satisfação do paciente; Envolvimento do pessoal; E os benefícios da acreditação. Os resultados mostram que os enfermeiros perceberam melhorias como resultado do processo de acreditação nas seguintes àreas: Planejamento estratégico de qualidade; Gestão da Qualidade; uso de dados relacionados à satisfação do paciente e envolvimento do pessoal com qualidade hospitalar. Inversamente, o processo de acreditação não resultou em desenvolvimentos em relação ao tempo dado aos enfermeiros para planejar e testar melhorias de qualidade, e também em relação à utilização de recursos humanos, especialmente no que se refere a recompensas e estratégias de reconhecimento. Concluímos que os enfermeiros têm um papel fundamental na realização do processo de acreditação e, portanto, as recompensas e as estratégias de reconhecimento precisam ser melhor desenvolvidas e implementadas e os enfermeiros precisam ter tempo suficiente para realizar atividades relacionadas ao processo de acreditação

High heterogeneity in methods used for the laboratory confirmation of pertussis diagnosis among European countries, 2010 : integration of epidemiological and laboratory surveillance must include standardisation of methodologies and quality assurance

Despite extensive childhood immunisation, pertussis remains one of the world's leading causes of vaccinepreventable deaths. The current methods used for laboratory diagnosis of pertussis include bacterial culture, polymerase chain reaction (PCR) and enzymelinked immunosorbent assay (ELISA) serology. We conducted a questionnaire survey to identify variations in the laboratory methods and protocols used among participating countries included in the European surveillance network for vaccine-preventable diseases (EUVAC.NET). In February 2010, we performed the survey using a web-based questionnaire and sent it to the country experts of 25 European Union countries, and two European Economic Area (EEA) countries, Norway and Iceland. The questionnaire consisted of 37 questions which covered both general information on surveillance methods and detailed laboratory methods used. A descriptive analysis was performed. Questionnaires were answered by all 27 contacted countries. Nineteen countries had pertussis reference laboratories at the national level; their functions varied from performing diagnosis to providing technical advice for routine microbiology laboratories. Culture, PCR and serology were used in 17, 18 and 20 countries, respectively. For PCR, nine laboratories used insertion sequence IS481 as the target gene, which is present in multiple copies in the Bordetella pertussis genome and thus has a greater sensitivity over single copy targets, but has been proved not to be specific for B. pertussis. Antibodies directed against pertussis toxin (PT) are specific for B. pertussis infections. For ELISA serology, only 13 countries' laboratories used purified PT as coating antigen and 10 included World Health Organization (WHO) or Food and Drug Administration (FDA) reference sera in their tests. This present survey shows that methods used for laboratory confirmation of pertussis differ widely among European countries and that there is a great heterogeneity of the reference laboratories and functions. To evaluate the effects of different pertussis immunisation programmes in Europe, standardisation and harmonisation of the laboratory methods are needed.peer-reviewe

Aspectos inerentes à saúde mental do enfermeiro no combate a Pandemia da COVID-19

O presente estudo tem a finalidade de identificar as situações que comprometem a saúde mental e física dos profissionais de enfermagem, durante a pandemia; bem como demonstrar as razões que contribuem com o desenvolvimento de enfermidades físicas e mentais durante a pandemia. Metodologia: trata-se de uma revisão sistemática da literatura. foram utilizadas as seguintes bases de dados: Scientific Eletronic Library Online (SciELO), Biblioteca Virtual em Saúde (BVS), e Google Scholar, por meio de descritores: Saúde Mental; Pandemia; Covid-19; Ansiedade; Depressão; Enfermagem e Saúde. Após realizar o cruzamento dos descritores e incluindo os critérios de inclusão, finalizou-se com a seleção de 11 artigos relacionados a esse tema Resultados: Nas literaturas analisadas evidenciou-se uma alta taxa de adoecimento mental e físico e infelizmente número de morbimortalidades entre enfermeiros, técnicos e auxiliares de enfermagem, incluídos temas relacionados a depressão, ansiedade, medo, número de casos de contaminação dentro do contexto enfermagem, insalubridade, sobrecarga de trabalho

Associations between sex, body mass index and the individual microglial response in Alzheimer's disease

Background and objectives18-kDa translocator protein position-emission-tomography (TSPO-PET) imaging emerged for in vivo assessment of neuroinflammation in Alzheimer's disease (AD) research. Sex and obesity effects on TSPO-PET binding have been reported for cognitively normal humans (CN), but such effects have not yet been systematically evaluated in patients with AD. Thus, we aimed to investigate the impact of sex and obesity on the relationship between beta-amyloid-accumulation and microglial activation in AD.Methods49 patients with AD (29 females, all A beta-positive) and 15 A beta-negative CN (8 female) underwent TSPO-PET ([18F]GE-180) and beta-amyloid-PET ([18F]flutemetamol) imaging. In 24 patients with AD (14 females), tau-PET ([18F]PI-2620) was additionally available. The brain was parcellated into 218 cortical regions and standardized-uptake-value-ratios (SUVr, cerebellar reference) were calculated. Per region and tracer, the regional increase of PET SUVr (z-score) was calculated for AD against CN. The regression derived linear effect of regional A beta-PET on TSPO-PET was used to determine the A beta-plaque-dependent microglial response (slope) and the A beta-plaque-independent microglial response (intercept) at the individual patient level. All read-outs were compared between sexes and tested for a moderation effect of sex on associations with body mass index (BMI).ResultsIn AD, females showed higher mean cortical TSPO-PET z-scores (0.91 +/- 0.49;males 0.30 +/- 0.75;p = 0.002), while A beta-PET z-scores were similar. The A beta-plaque-independent microglial response was stronger in females with AD (+ 0.37 +/- 0.38;males with AD - 0.33 +/- 0.87;p = 0.006), pronounced at the prodromal stage. On the contrary, the A beta-plaque-dependent microglial response was not different between sexes. The A beta-plaque-independent microglial response was significantly associated with tau-PET in females (Braak-II regions: r = 0.757, p = 0.003), but not in males. BMI and the A beta-plaque-independent microglial response were significantly associated in females (r = 0.44, p = 0.018) but not in males (BMI*sex interaction: F(3,52) = 3.077, p = 0.005).ConclusionWhile microglia response to fibrillar A beta is similar between sexes, women with AD show a stronger A beta-plaque-independent microglia response. This sex difference in A beta-independent microglial activation may be associated with tau accumulation. BMI is positively associated with the A beta-plaque-independent microglia response in females with AD but not in males, indicating that sex and obesity need to be considered when studying neuroinflammation in AD

Individual regional associations between Aβ-, tau- and neurodegeneration (ATN) with microglial activation in patients with primary and secondary tauopathies

& beta;-amyloid (A & beta;) and tau aggregation as well as neuronal injury and atrophy (ATN) are the major hallmarks of Alzheimer's disease (AD), and biomarkers for these hallmarks have been linked to neuroinflammation. However, the detailed regional associations of these biomarkers with microglial activation in individual patients remain to be elucidated. We investigated a cohort of 55 patients with AD and primary tauopathies and 10 healthy controls that underwent TSPO-, A & beta;-, tau-, and perfusion-surrogate-PET, as well as structural MRI. Z-score deviations for 246 brain regions were calculated and biomarker contributions of A & beta;(A), tau (T), perfusion (N1), and gray matter atrophy (N2) to microglial activation (TSPO, I) were calculated for each individual subject. Individual ATN-related microglial activation was correlated with clinical performance and CSF soluble TREM2 (sTREM2) concentrations. In typical and atypical AD, regional tau was stronger and more frequently associated with microglial activation when compared to regional A & beta;(AD: & beta;(T) = 0.412 & PLUSMN;0.196 vs. & beta;(A) = 0.142 & PLUSMN;0.123, p < 0.001;AD-CBS: & beta;(T) = 0.385 & PLUSMN;0.176 vs. & beta;(A) = 0.131 & PLUSMN;0.186, p = 0.031). The strong association between regional tau and microglia reproduced well in primary tauopathies (& beta;(T) = 0.418 & PLUSMN;0.154). Stronger individual associations between tau and microglial activation were associated with poorer clinical performance. In patients with 4RT, sTREM2 levels showed a positive association with tau-related microglial activation. Tau pathology has strong regional associations with microglial activation in primary and secondary tauopathies. Tau and A & beta;related microglial response indices may serve as a two-dimensional in vivo assessment of neuroinflammation in neurodegenerative diseases

Individual regional associations between Aβ-, tau- and neurodegeneration (ATN) with microglial activation in patients with primary and secondary tauopathies.

β-amyloid (Aβ) and tau aggregation as well as neuronal injury and atrophy (ATN) are the major hallmarks of Alzheimer's disease (AD), and biomarkers for these hallmarks have been linked to neuroinflammation. However, the detailed regional associations of these biomarkers with microglial activation in individual patients remain to be elucidated. We investigated a cohort of 55 patients with AD and primary tauopathies and 10 healthy controls that underwent TSPO-, Aβ-, tau-, and perfusion-surrogate-PET, as well as structural MRI. Z-score deviations for 246 brain regions were calculated and biomarker contributions of Aβ (A), tau (T), perfusion (N1), and gray matter atrophy (N2) to microglial activation (TSPO, I) were calculated for each individual subject. Individual ATN-related microglial activation was correlated with clinical performance and CSF soluble TREM2 (sTREM2) concentrations. In typical and atypical AD, regional tau was stronger and more frequently associated with microglial activation when compared to regional Aβ (AD: βT = 0.412 ± 0.196 vs. βA = 0.142 ± 0.123, p < 0.001; AD-CBS: βT = 0.385 ± 0.176 vs. βA = 0.131 ± 0.186, p = 0.031). The strong association between regional tau and microglia reproduced well in primary tauopathies (βT = 0.418 ± 0.154). Stronger individual associations between tau and microglial activation were associated with poorer clinical performance. In patients with 4RT, sTREM2 levels showed a positive association with tau-related microglial activation. Tau pathology has strong regional associations with microglial activation in primary and secondary tauopathies. Tau and Aβ related microglial response indices may serve as a two-dimensional in vivo assessment of neuroinflammation in neurodegenerative diseases

The extinct Sicilian wolf shows a complex history of isolation and admixture with ancient dogs

The Sicilian wolf remained isolated in Sicily from the end of the Pleistocene until its extermination in the 1930s–1960s. Given its long-term isolation on the island and distinctive morphology, the genetic origin of the Sicilian wolf remains debated. We sequenced four nuclear genomes and five mitogenomes from the seven existing museum specimens to investigate the Sicilian wolf ancestry, relationships with extant and extinct wolves and dogs, and diversity. Our results show that the Sicilian wolf is most closely related to the Italian wolf but carries ancestry from a lineage related to European Eneolithic and Bronze Age dogs. The average nucleotide diversity of the Sicilian wolf was half of the Italian wolf, with 37–50% of its genome contained in runs of homozygosity. Overall, we show that, by the time it went extinct, the Sicilian wolf had high inbreeding and low-genetic diversity, consistent with a population in an insular environmen

Article The extinct Sicilian wolf shows a complex history of isolation and admixture with ancient dogs

The Sicilian wolf remained isolated in Sicily from the end of the Pleistocene until its extermination in the 1930s-1960s. Given its long-term isolation on the island and distinctive morphology, the genetic origin of the Sicilian wolf remains debated. We sequenced four nuclear genomes and five mitogenomes from the seven existing museum specimens to investigate the Sicilian wolf ancestry, rela-tionships with extant and extinct wolves and dogs, and diversity. Our results show that the Sicilian wolf is most closely related to the Italian wolf but carries ancestry from a lineage related to European Eneolithic and Bronze Age dogs. The average nucleotide diversity of the Sicilian wolf was half of the Italian wolf, with 37-50% of its genome contained in runs of homozygosity. Overall, we show that, by the time it went extinct, the Sicilian wolf had high inbreeding and low-genetic diversity, consistent with a population in an insular environment