Nível de agudização, gravidade e intensidade do cuidado de adultos e idosos na admissão em Unidade de Terapia Intensiva

Objective: To characterize the level of acuity, severity and intensity of care of adults and older adults admitted to Intensive Care Units and to identify the predictors of severity with their respective predictive capacity according to the age group. Method: A retrospective cohort based on the analysis of medical records of individuals admitted to eight adult intensive care units in the city of São Paulo. The clinical characteristics at admission in relation to severity profile and intensity of care were analyzed through association and correlation tests. The predictors were identified by linear regression and the predictive capacity through the ROC curve. Results: Of the 781 cases (41.1% from older adults), 56.2% were males with a mean age of 54.1 ± 17.3 years. The burden of the disease, the organic dysfunction and the number of devices were the predictors associated with greater severity among adults and older adults, in which the organic dysfunction had the highest predictive capacity (80%) in both groups. Conclusion: Adults and older adults presented a similar profile of severity and intensity of care in admission to the Intensive Care Unit. Organic dysfunction was the factor with the best ability to predict severity in adults and older adults

Patient Safety in Intensive Care Units: patient safety, professional satisfaction and practice environment factors in the occurrence of adverse healthcare events

Introdução: Fatores estruturais das Unidades de Terapia Intensiva (UTI) relacionados aos pacientes, aos profissionais de enfermagem e ao ambiente das práticas podem associar-se à ocorrência de eventos adversos (EAs) comprometendo a segurança dos pacientes. Portanto, identificar esses fatores poderá contribuir para melhores práticas e redução de riscos desnecessários. Objetivo: Analisar as características dos pacientes (demográficas, clínicas, de internação e demanda de trabalho), dos profissionais (biossociais, burnout, satisfação profissional) e ambiente das práticas de enfermagem na ocorrência de EA moderados, graves e óbitos em UTI. Método: Estudo observacional, do tipo coorte histórico para análise das características dos pacientes e incidentes, realizado na UTI de um hospital privado, de nível terciário, em São Paulo, Brasil, de janeiro de 2013 a dezembro de 2014, seguido de estudo transversal com os profissionais de enfermagem, em janeiro de 2015. Dados demográficos e clínicos, incluindo Simplified Acute Physiology Simplified Score 3 (SAPS-3), Índice de Comorbidades de Charlson (ICC), Nursing Activities Score (NAS) e EAs foram obtidos dos prontuários eletrônicos e documentos digitais existentes na Unidade. Os EAs foram caracterizados segundo Classificação Internacional para Segurança do Paciente (CISP) da Organização Mundial da Saúde (OMS). A coleta de dados dos profissionais de enfermagem foi feita com a aplicação de um questionário sobre as características biossociais e de trabalho da equipe, juntamente com outros três instrumentos: Maslach Burnout Inventory (MBI), Index of Work Satisfaction (IWS) e Nursing Working Index-Revised (B-NWI-R), para o estudo do burnout, satisfação profissional e percepção sobre o ambiente das práticas, respectivamente. Para análise das variáveis de interesse, utilizaram-se os testes t Student, Mann Whitney e correlação de Spearman, além do modelo de regressão logística e linear múltipla. Considerou-se significativo valor p>0,05. Resultados: Das 5590 admissões no período, predominaram pacientes masculinos (52,43%), com média de idade de 67,63 anos e médias do ICC e do NAS de, respectivamente, 1,71 pontos e 56,41%. Os pacientes permaneceram na UTI, em média 3,79 dias. A probabilidade de óbito medida pelo RM SAPS 3 foi 16,90%, sendo a mortalidade observada de 8,39%. No período de dois anos, ocorreram 213 (55,20%) EAs de gravidade moderada/grave/óbito com maior frequência do tipo infecção associada à assistência (71,40%). Foram fatores dos pacientes associados à ocorrência de EA moderado, grave e óbito o tempo de permanência (p=0,00), RM SAPS-3 (p= 0,00) e NAS (p=0,01). Quanto aos profissionais de enfermagem a amostra foi composta por 36 enfermeiros e 33 técnicos de enfermagem. Observou-se que do total (69), 7 (10,10%) dos enfermeiros apresentaram burnout. Referente à satisfação profissional, 47,80% da equipe encontrava-se satisfeita, com média de 4,4 pontos (dp=0,62). O ambiente das práticas profissionais foi de 1,95 pontos (dp=0,46), indicando percepção de condições favoráveis para o trabalho. Os fatores dos profissionais associados ao burnout foram as horas de sono suficientes (p=0,04), que diminuem em 43% a chance de presença da síndrome. Sobre a satisfação profissional, também horas de sono suficientes (p=0,02) e média B-NWI-R (p=0,00) foram associados à satisfação. Horas de sono suficientes aumentaram em 0,25 pontos o ISP e cada ponto reduzido do B-NWI-R aumentaram em 0,01 a satisfação profissional. Idade (p=0,04) e horas de sono necessárias (p=0,01) foram os fatores associados à percepção do ambiente das práticas pelos profissionais. Os fatores de risco dos profissionais para a ocorrência de eventos adversos na UTI não foram possíveis pelo pequeno número de profissionais participantes no estudo Conclusões: Tempo de permanência (p=0,00), RM SAPS-3 (p= 0,00) e demanda de cuidados NAS (p=0,01) foram os fatores dos pacientes associados aos eventos adversos moderados, graves e óbitos na UTI. Dada a importância do tema, recomenda-se a continuidade da investigação dos fatores da equipe de enfermagem relacionados à ocorrência desses incidentes em amostras mais amplas para a obtenção de melhores evidências.Introduction: Structural factors of Intensive Care Units (ICUs) related to patients, nursing staff and the environment of the practices may be associated with the occurrence of adverse events (AEs), compromising patient safety. Therefore, to recognizing these factors beforehand may be of great contribution to the best practices and reduce unnecessary risks. Objective: To analyze the influence of the characteristics of the patients (demographic, clinical, hospitalization and workload), professionals (biosocial factors, burnout and professional satisfaction) and occurrence of AEs in the environment of nursing practices and ICU deaths. Method: Study was performed at the general ICU of a private tertiary-level hospital in São Paulo city, Brazil. Prospective cohort study was carried out from January 2013 to December 2014, Followed by a transversal study involving nursing professionals in January 2015. Demographic and clinical data, including Simplified Acute Physiology Simplified Score 3 (SAPS-3), Charlson Comorbidity Index (ICC), Nursing Activities Score (NAS) and EAs were obtained from electronic records and digital documents available in the Unit. AEs were categorized according to International Classification for Patient Safety (ICPS) from the World Health Organization. A cross-sectional approach was taken by the application of three instruments: Maslach Burnout Inventory (MBI), Index of Work Satisfaction (IWS) and Nursing Working Index (NWI) which enables for the analysis of the characteristics of nursing professionals, burnout, professional satisfaction and perception of the practice environment. Student\'s t test, Mann Whitney and Pearson / Spearman correlation and the logistic regression model were considered in the analysis of interest variables. A p value above 0.05 was considered significant. Results: 5590 admissions, male patients predominated (52.43%), average age of 67.63 years. Average ICC and NAS were, respectively, 1.71 points and 56.41%. Patients stayed in the ICU for 3.79 days, in average. Death probability, measured by SAPS 3, was 16.90% and the mortality observed was 8.39%. Within a two-year period, 213 (55.20%) AEs occurred in the moderate/severe/death range, with the higher frequency being stated as \"infection associated with healthcare\" (71.40%). Patients\' factors associated with the occurrence of moderate and severe AE were the length of stay (p = 0.00), SAPS 3 (p = 0.00) and NAS (p = 0.01). Nursing staff was composed of 36 nurses and 33 nursing technicians. It was observed that of the total (69), 7 (10.10%) of the nurses presented burnout. Concerning professional satisfaction, 47.80% of the team was satisfied, with an average of 4.4 points (SD = 0.62). The professional practice environment was 1.95 points (dp = 0.46), indicating the perception of favorable conditions for the work environment. Factor associated with burnout was sufficient hours of sleep (p = 0.04) that can be reduce by 43% the chance of the syndrome. Also enough sleep hours (p = 0.02) and mean NWI-R (p = 0.00) were associated with professional satisfaction. Sufficient hours of sleep increased ISP by 0.25t point, and each point decrease of NWI-R enhanced 0.01 professional satisfactions. Age (p = 0.04) and hours of sleep required (p = 0.01) were factors associated with the professionals\' perception of the environment. Risk factors of the professionals for the occurrence of AEs in the ICU were not possible associated due to the small number of professionals in the study. Conclusions: Length of stay (p = 0.00), RM SAPS 3 (p = 0.00) and workload of NAS (p = 0.01) were patients\' factors associated with moderate, severe and deaths in ICU. In spite of these results, it is recommended to continue the investigation of the factors of the nursing staff related occurrence of these variables using more robust samples of multicenter surveys to obtain better evidence

Level of acuity, severity and intensity of care of adults and older adults admitted to the Intensive Care Unit

ABSTRACT Objective: To characterize the level of acuity, severity and intensity of care of adults and older adults admitted to Intensive Care Units and to identify the predictors of severity with their respective predictive capacity according to the age group. Method: A retrospective cohort based on the analysis of medical records of individuals admitted to eight adult intensive care units in the city of São Paulo. The clinical characteristics at admission in relation to severity profile and intensity of care were analyzed through association and correlation tests. The predictors were identified by linear regression and the predictive capacity through the ROC curve. Results: Of the 781 cases (41.1% from older adults), 56.2% were males with a mean age of 54.1 ± 17.3 years. The burden of the disease, the organic dysfunction and the number of devices were the predictors associated with greater severity among adults and older adults, in which the organic dysfunction had the highest predictive capacity (80%) in both groups. Conclusion: Adults and older adults presented a similar profile of severity and intensity of care in admission to the Intensive Care Unit. Organic dysfunction was the factor with the best ability to predict severity in adults and older adults

J/ψJ/\psi production and nuclear effects in p-Pb collisions at SNN\sqrt{S_{NN}} = 5.02 TeV

Inclusive J/$\psi$ production has been studied with the ALICE detector in p-Pb collisions at $\sqrt{s_{NN}}$ = 5.02 TeV at the CERN LHC, in the rapidity domains 2.03 < y$_{cms}$ < 3.53 and −4.46 < y$_{cms}$ < −2.96, down to zero transverse momentum. The J/$\psi$ measurement is performed in the Muon Spectrometer through the $\mu^+\mu^−$ decay mode. In this Letter, the J/$\psi$ production cross section and the nuclear modification factor R$_{pPb}$ for the rapidities under study are presented. While at forward rapidity a suppression of the J/$\psi$ yield with respect to binary-scaled pp collisions is observed, in the backward region no suppression is present. The ratio of the forward and backward yields is also shown differentially in rapidity and transverse momentum. Theoretical predictions based on nuclear shadowing, as well as on models including, in addition, a contribution from partonic energy loss, are in fair agreement with the experimental results.Inclusive J/$\psi$ production has been studied with the ALICE detector in p-Pb collisions at the nucleon-nucleon center of mass energy $\sqrt{s_{\rm NN}}$ = 5.02 TeV at the CERN LHC. The measurement is performed in the center of mass rapidity domains $2.03<y_{\rm cms}<3.53$ and $-4.46<y_{\rm cms}<-2.96$, down to zero transverse momentum, studying the $\mu^+\mu^-$ decay mode. In this paper, the J/$\psi$ production cross section and the nuclear modification factor $R_{\rm pPb}$ for the rapidities under study are presented. While at forward rapidity, corresponding to the proton direction, a suppression of the J/$\psi$ yield with respect to binary-scaled pp collisions is observed, in the backward region no suppression is present. The ratio of the forward and backward yields is also measured differentially in rapidity and transverse momentum. Theoretical predictions based on nuclear shadowing, as well as on models including, in addition, a contribution from partonic energy loss, are in fair agreement with the experimental results

Energy Dependence of the Transverse Momentum Distributions of Charged Particles in pp Collisions Measured by ALICE

Differential cross sections of charged particles in inelastic pp collisions as a function of p_T have been measured at $\sqrt{s}$ = 0.9, 2.76 and 7 TeV at the LHC. The $p_T$ spectra are compared to NLO-pQCD calculations. Though the differential cross section for an individual $\sqrt{s}$ cannot be described by NLO-pQCD, the relative increase of cross section with sqrt(s) is in agreement with NLO-pQCD. Based on these measurements and observations, procedures are discussed to construct pp reference spectra at $\sqrt{s}$ = 2.76 and 5.02 TeV up to $p_T$ = 50 GeV/c as required for the calculation of the nuclear modification factor in nucleus-nucleus and proton-nucleus collisions

Long-range angular correlations of π, K and p in p–Pb collisions at sNN\sqrt{s_{NN}} = 5.02 TeV

Angular correlations between unidentified charged trigger particles and various species of charged associated particles (unidentified particles, pions, kaons, protons and antiprotons) are measured by the ALICE detector in p-Pb collisions at a nucleon--nucleon centre-of-mass energy of 5.02 TeV in the transverse-momentum range 0.3 < $p_T$ < 4 GeV/c. The correlations expressed as associated yield per trigger particle are obtained in the pseudorapidity range |$\eta_{lab}$| < 0.8. Fourier coefficients are extracted from the long-range correlations projected onto the azimuthal angle difference and studied as a function of $p_T$ and in intervals of event multiplicity. In high-multiplicity events, the second-order coefficient for protons, $v_2^p$, is observed to be smaller than that for pions, $v_2^\pi$, up to about $p_T$ = 2 GeV/c. To reduce correlations due to jets, the per-trigger yield measured in low-multiplicity events is subtracted from that in high-multiplicity events. A two-ridge structure is obtained for all particle species. The Fourier decomposition of this structure shows that the second-order coefficients for pions and kaons are similar. The $v_2^p$ is found to be smaller at low $p_T$ and larger at higher $p_T$ than $v_2^\pi$, with a crossing occurring at about 2 GeV. This is qualitatively similar to the elliptic-flow pattern observed in heavy-ion collisions. A mass ordering effect at low transverse momenta is consistent with expectations from hydrodynamic model calculations assuming a collectively expanding system.Angular correlations between unidentified charged trigger particles and various species of charged associated particles (unidentified particles, pions, kaons, protons and antiprotons) are measured by the ALICE detector in p-Pb collisions at a nucleon-nucleon centre-of-mass energy of 5.02 TeV in the transverse-momentum range $0.3 < p_{\rm T} < 4$ GeV/$c$. The correlations expressed as associated yield per trigger particle are obtained in the pseudorapidity range $|\eta_{\rm lab}|<0.8$. Fourier coefficients are extracted from the long-range correlations projected onto the azimuthal angle difference and studied as a function of $p_{\rm T}$ and in intervals of event multiplicity. In high-multiplicity events, the second-order coefficient for protons, $v_2^p$, is observed to be smaller than that for pions, $v_2^\pi$, up to about $p_{\rm T} = 2$ GeV/$c$. To reduce correlations due to jets, the per-trigger yield measured in low-multiplicity events is subtracted from that in high-multiplicity events. A two-ridge structure is obtained for all particle species. The Fourier decomposition of this structure shows that the second-order coefficients for pions and kaons are similar. The $v_2^p$ is found to be smaller at low $p_{\rm T}$ and larger at higher $p_{\rm T}$ than $v_2^pi$, with a crossing occurring at about 2 GeV. This is qualitatively similar to the elliptic-flow pattern observed in heavy-ion collisions. A mass ordering effect at low transverse momenta is consistent with expectations from hydrodynamic model calculations assuming a collectively expanding system.Angular correlations between unidentified charged trigger particles and various species of charged associated particles (unidentified particles, pions, kaons, protons and antiprotons) are measured by the ALICE detector in p–Pb collisions at a nucleon–nucleon centre-of-mass energy of 5.02 TeV in the transverse-momentum range 0.3<pT<4 GeV/c . The correlations expressed as associated yield per trigger particle are obtained in the pseudorapidity range |ηlab|<0.8 . Fourier coefficients are extracted from the long-range correlations projected onto the azimuthal angle difference and studied as a function of pT and in intervals of event multiplicity. In high-multiplicity events, the second-order coefficient for protons, v2p , is observed to be smaller than that for pions, v2π , up to about pT=2 GeV/c . To reduce correlations due to jets, the per-trigger yield measured in low-multiplicity events is subtracted from that in high-multiplicity events. A two-ridge structure is obtained for all particle species. The Fourier decomposition of this structure shows that the second-order coefficients for pions and kaons are similar. The v2p is found to be smaller at low pT and larger at higher pT than v2π , with a crossing occurring at about 2 GeV/c . This is qualitatively similar to the elliptic-flow pattern observed in heavy-ion collisions. A mass ordering effect at low transverse momenta is consistent with expectations from hydrodynamic model calculations assuming a collectively expanding system

Multiplicity dependence of the average transverse momentum in pp, p-Pb, and Pb-Pb collisions at the LHC

The average transverse momentum versus the charged-particle multiplicity $N_{ch}$ was measured in p-Pb collisions at a collision energy per nucleon-nucleon pair $\sqrt{s_{NN}}$ = 5.02 TeV and in pp collisions at collision energies of $\sqrt{s}$ = 0.9, 2.76, and 7 Tev in the kinematic range 0.15 with $N_{ch}$ is observed, which is much stronger than that measured in Pb-Pb collisions. For pp collisions, this could be attributed, within a model of hadronizing strings, to multiple-parton interactions and to a final-state color reconnection mechanism. The data in p-Pb and Pb-Pb collisions cannot be described by an incoherent superposition of nucleon-nucleon collisions and pose a challenge to most of the event generators