Early mobilization in ischemic stroke : a pilot randomized trial of safety and feasibility in a public hospital in Brazil

Abstract Background: The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. Methods: The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. Results: Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant differences in functional independence, disability, or ADL (mBI ≥ 85) were observed between the groups at the 3-month follow-up. Conclusions: This pilot trial conducted at a public hospital in Brazil suggests that early mobilization after acute ischemic stroke is safe and feasible. Despite some challenges and limitations, early mobilization was successfully implemented, even in the setting of a large, complex ED, and without complications. Patients from the IG were mobilized much earlier than controls receiving the standard care provided in most Brazilian hospitals

AÇÕES DE CONTROLE E PREVENÇÃO DE INFECÇÕES EM UNIDADE DE TERAPIA INTENSIVA ADULTO

Palliative care in oncology uses a humanistic and integrated approach to treat patients who have no chance of recovery, reducing symptoms and improving quality of life. Therefore, the objective of this work was to evaluate the importance of palliative care in promoting biopsychosocial well-being in advanced malignant tumors. Participants had inoperable malignant neoplasia and received palliative care at home. Data were collected using a recoded form. Observing sociodemographics and the types of palliative care provided were identified in the medical records. Patients were divided into two groups: one with clinical symptoms under control and the other without, to determine whether the treatment contributed to symptom control.Objetivo: examinar as evidências científicas dos fatores que interferem no tratamento e na prevenção de infecções hospitalares no contexto do trabalho do enfermeiro em unidades de terapia intensiva adulto. Método: Trata-se de uma revisão integrada da literatura baseada nas bases de dados da Biblioteca Virtual em Saúde; Biblioteca eletrônica científica on-line e banco de dados de enfermagem. Resultados: Os estudos mostraram que a adesão às precauções padrão, o controle da corrente sanguínea e das infecções respiratórias são fatores importantes no controle e prevenção de infecções nesses ambientes. Conclusão: confirmou-se a importância do trabalho da equipe de enfermagem, e a formação contínua desses especialistas é essencial para a prevenção e controle de infecções em terapia intensiva

Treatment of ischemic stroke with r-tPA: implementation challenges in a tertiary hospital in Brazil

Purpose: This paper presents the initial experience with thrombolysis for acute ischaemic stroke at Hospital de Base do Distrito Federal (HBDF), Brazil, and the difficulties associated with the implementation of this treatment. Method: A retrospective study was performed using the medical records of all patients with acute stroke who were treated with intravenous alteplase in our department, between May 2011 and April 2012. Results: The thrombolytic therapy was administered to 32 patients. The mean time between the ictus and the start of stroke therapy start was 195 (60-270) minutes. Sixteen patients demonstrated a significant clinical improvement (decrease in National Institute Health Stroke Scale [NIHSS] score≥4 points in 24 hours); 6 patients were discharged with an NIHSS score of 0 and 2 demonstrated haemorrhagic transformation. Conclusions: The results of our study are similar to those reported in the literature, although we have been dealing with difficulties, such as the lack of a stroke unit

Early mobilization in ischemic stroke : a pilot randomized trial of safety and feasibility in a public hospital in Brazil

Abstract Background: The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. Methods: The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. Results: Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant differences in functional independence, disability, or ADL (mBI ≥ 85) were observed between the groups at the 3-month follow-up. Conclusions: This pilot trial conducted at a public hospital in Brazil suggests that early mobilization after acute ischemic stroke is safe and feasible. Despite some challenges and limitations, early mobilization was successfully implemented, even in the setting of a large, complex ED, and without complications. Patients from the IG were mobilized much earlier than controls receiving the standard care provided in most Brazilian hospitals

Contribuições à nova agenda urbana: O relatório do concidades para a Conferência Habitat III

Every 20 years, the United Nations Organization (UN) promotes the Conference on Housing and Sustainable Urban Development (Habitat) to discuss the problems of housing and urban development and to sign international commitments that favor the existence and production of settlements Human resources. In preparation for the third edition of Habitat, the UN proposed the production of national reports from Member States to guide negotiations on the new global urban agenda. At the invitation of the National Council of Cities (ConCidades), Ipea was responsible for drafting the Brazilian Report for Habitat III. In this context, the following text discusses the main themes incorporated in this process of discussion / construction of the New Brazilian Urban Agenda

Reperfusion therapy for acute ischemic stroke: where are we in 2023?

Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil

III Livro de Resultados de Pesquisa do GRAED PUCPR: trabalhos científicos em análise econômica do direito

Trata-se de obra coletiva composta por trabalhos científicos de membros e parceiros do GRAED PUCPR, que se apresenta como mecanismo de promoção de pesquisas científicas na área de Análise Econômica do Direito. Para tanto, são consolidados comunicados científicos apresentados no III Encontro de Pesquisa do GRAED PUCPR, resultados do Programa Institucional de Bolsas de Iniciação Científica (PIBIC) realizados por membros do grupo e artigos científicos avaliados por pares e cujas pesquisas relacionam-se com os projetos do grupo