Hipodermóclise: uma nova velha alternativa de administração subcutânea / Hypodermoclysis: a new old alternative of subcutaneous administration

A hipodermóclise é uma prática muito antiga, porém pouco utilizada na medicina moderna como alternativa para administração de fluidos pela via subcutânea.  O estudo tem como objetivo analisar na literatura científica as especificidades da hipodermóclise e os cuidados de enfermagem necessários para manter a qualidade de uso. Trata-se de uma revisão integrativa da literatura. A coleta de dados foi realizada através da Biblioteca Virtual em Saúde (BVS), utilizando os descritores: “hipodermóclise”, “cuidados de enfermagem”, “via de administração” e “infusão subcutânea”’ desenvolvidos por diversas áreas da saúde, publicados em língua portuguesa, no período de 2010 a 2020.  Foram selecionados 7 artigos e, a partir de sua análise, criados dois agrupamentos temáticos:  1. Especificidades da Hipodermóclise e 2. Cuidados de Enfermagem no uso da hipodermóclise. Observa-se que a hipodermóclise é uma técnica alternativa de infusão subcutânea, cuja eficácia e benefícios já é comprovada, principalmente, para indivíduos sem condições de ingestão por via oral, para os que não apresentam condições de acesso venoso e para aqueles mais debilitados como os que se encontram em cuidados paliativos e os idosos. Sendo assim, a análise dos artigos permitiu observar a importância do conhecimento desta técnica pelos enfermeiros a fim de prestar uma assistência adequada aos pacientes. Observa-se ainda, que no Brasil o tema ainda carece de estudos e publicações com relatos de experiências

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

GRUPO TERAPÊUTICO COM MULHERES IDOSAS EM SITUAÇÃO DE VULNERABILIDADE NO MUNICÍPIO DE IVOTI/RS

Universidade FEEVAL

GRUPO TERAPÊUTICO COM MULHERES IDOSAS EM SITUAÇÃO DE VULNERABILIDADE NO MUNICÍPIO DE IVOTI/RS

Universidade FEEVAL

Análise do desenvolvimento neuropsicomotor de crianças participantes de um programa mãe-bebê

Objective: To analyze the neuropsychomotor development of children participating in a Mother-baby Program. Methods: A cross-sectional study was carried out with 52 children between 6 and 12 months of age, from the Mother-baby Program, an extension project carried out in a deprived community of Novo Hamburgo, Rio Grande do Sul, Brazil, in 2017. The children were selected from the records and to evaluate child development, the Denver II Development Screening Test was applied in the children's home by trained professionals during the period from March to November 2017. Results: The sample consisted of infants born at term (38.52 ± 1.83 weeks), weighing more than 2500g (94.23%; n = 49), who received exclusive breastfeeding (57.70%; n = 30). As to neuropsychomotor development, 30.8% (n = 16) of the children presented suspicious global development, with the most affected domains being language (13.5%; n = 7) and gross motor (11.5%; n = 6). The independent variables that showed an association with suspected delay in neuropsychomotor development were exclusive breastfeeding (p = 0.03), number of children (p = 0.01) and marital status (p = 0.04). Conclusion: The majority of the children (69.2%, n = 36) participants in the Mother-baby Program presented adequate neuropsychomotor development compatible with their age group. However, 30% (n = 16) of the children who had neurodevelopment considered suspect had the language and the motor gross as the most affected domains.Objetivo: Analizar el desarrollo neuropsicomotor de niños participantes de un Programa Madre-bebé. Métodos: Estudio transversal realizado con 52 niños entre los 6 y 12 meses de edad de un Programa Madre-bebé que es un proyecto de extensión realizado en una comunidad que está falta de condiciones socio-económicas de Novo Hamburgo, Rio Grande de Sur, Brasil, en 2017. Se ha elegido los niños a partir de los historiales clínicos y se ha aplicado la Prueba de Tamizaje del Desarrollo de Denver II para la evaluación del desarrollo infantil en los domicilios de los niños por profesionales entrenados en el periodo entre marzo y noviembre de 2017. Resultados: La muestra ha sido de niños nacidos a término (38,52±1,83 semanas), con más de 2500g de peso (94,23%; n=49) y que han recibido amamantamiento materno exclusivo (57,70%; n=30). Respecto el desarrollo neuropsicomotor el 30,8% (n=16) de los niños presentan el desarrollo global sospechoso con los dominios de lenguaje (13,5%; n=7) y motor grueso (11,5%; n=6) más afectados. Las variables independientes que señalaron asociación sospechosa para el retraso del desarrollo neuropsicomotor fueron el amamantamiento materno exclusivo (p=0,03), el número de hijos (p=0,01) y la situación conyugal (p=0,04). Conclusión: La mayoría de los niños (69,2%, n=36) participantes del Programa Madre-bebé presentaron un desarrollo neuropsicomotor adecuado y compatible con su franja de edad. Sin embargo, el 30% (n=16) de los niños que presentaron un desarrollo neurológico sospechoso tuvieron los dominios de lenguaje y motor grueso más afectados.Objetivo: Analisar o desenvolvimento neuropsicomotor de crianças participantes de um Programa Mãe-bebê. Métodos: Estudo transversal, realizado com 52 crianças entre 6 e 12 meses de idade, procedentes do Programa Mãe-bebê, um projeto de extensão realizado em uma comunidade carente de Novo Hamburgo, Rio Grande do Sul, Brasil, em 2017. A partir dos prontuários, selecionaram-se as crianças e, para a avaliação do desenvolvimento infantil, utilizou-se o Teste de Triagem de Desenvolvimento de Denver II, aplicado no domicílio das crianças, por profissionais treinados, no período de março a novembro de 2017. Resultados: A amostra compôs-se de crianças nascidas a termo (38,52±1,83 semanas), com peso acima de 2500g (94,23%; n=49), que receberam aleitamento materno exclusivo (57,70%; n=30). Quanto ao desenvolvimento neuropsicomotor, 30,8% (n=16) das crianças apresentam desenvolvimento global suspeito, sendo que os domínios mais afetados foram a linguagem (13,5%; n=7) e o motor grosso (11,5%; n=6). As variáveis independentes que mostraram associação com suspeita de atraso no desenvolvimento neuropsicomotor foram o aleitamento materno exclusivo (p=0,03), o número de filhos (p=0,01) e a situação conjugal (p=0,04). Conclusão: A maioria das crianças (69,2%, n=36) participantes do Programa Mãe-bebê apresentaram um desenvolvimento neuropsicomotor adequado e compatível com sua faixa etária. No entanto, 30% (n=16) das crianças que apresentaram um neurodesenvolvimento considerado suspeito tiveram a linguagem e o motor grosso como os domínios mais afetados

Violence against elderly: An integrative review

This study aimed to conduct an integrative review of scientific knowledge produced in Brazil between 2013 and 2017, emphasizing the descriptors violence and the elderly. The scientific productions were selected in the SciELO database with crossings of the descriptors used in the title of the articles, available online in full form, with the period limitation from 2014 to 2018, in Brazil collections and Portuguese language. The search in the database generated 26 articles, and ten of them were chosen for the final analysis after applying the inclusion and exclusion criteria. The present integrative review showed that the central violence suffered was psychological, along with physical violence, with the elderly being the main victims. The findings related to violence against the elderly and associated factors reveal a scenario that is most prevalent in the home, an environment where the belief of a welcoming, loving and protective nature of external violence is deposited. In contrast, the intrafamilial relationship emerges concomitantly as a generator of conflicts that expose the elderly to the risk of violence of a character veiled, caused by the constituents themselves, which requires high vigilance and notification. Violence is a social challenge. We must prioritize research, work, and discuss the abuse of older people in political circles and understand the best way to prevent and help implement the necessary measures

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt