MANEJO DE PACIENTES INSTÁVEIS NA CLÍNICA MÉDICA

Patient instability in medical clinics is a significant challenge, influenced by chronic diseases, an aging population, and comorbidities. This condition increases vulnerability to complications and abrupt changes in health status. Additionally, lack of treatment adherence and variability in medication responses exacerbate the problem. Psychological impacts, such as anxiety and depression, further aggravate the situation, making treatment cooperation difficult. Effective strategies include continuous monitoring, multidisciplinary teams, and psychological support, aiming to minimize instability and improve clinical outcomes.  A instabilidade de pacientes na clínica médica é um desafio significativo, influenciado por doenças crônicas, envelhecimento populacional e comorbidades. Essa condição aumenta a vulnerabilidade a complicações e mudanças abruptas no estado de saúde. Além disso, a falta de adesão ao tratamento e a variabilidade nas respostas aos medicamentos exacerbam o problema. O impacto psicológico, como ansiedade e depressão, também agrava a situação, dificultando a cooperação com o tratamento. Estratégias eficazes incluem monitoramento contínuo, equipes multidisciplinares e suporte psicológico, visando minimizar a instabilidade e melhorar os resultados clínicos

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN