UNIDADES DE TERAPIA INTENSIVA ADULTO: FATORES PREDISPONENTES E BARREIRAS CONTRA ERROS DE MEDICAÇÃO

This article aimed to describe the main predisposing factors and preventive measures against medication errors in adult patients admitted to intensive care units. This is an integrative review of the literature carried out on materials indexed in the Virtual Health Library (VHL): Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), Database of Nursing data (BDENF), Index Medicus for the Western Pacific (WPRIM) and the Spanish Bibliographic Index in Health Sciences (IBECS). The Health Sciences Descriptors (DeCS) were used in conjunction with the Boolean operator AND and OR. After applying the eligibility criteria, 14 studies were selected to compose this review. It is concluded that among the main predisposing factors associated with medication errors in adult intensive care units are errors in prescribing, preparing, administering and transcribing medications. These errors were associated with a series of risk factors, such as lack of continuity in electronic prescription systems, work overload, lack of knowledge, rush, lack of attention, among others. Among the barrier measures identified included the implementation of computerized prescription systems, such as electronic prescriptions and bar code medication administration systems, the introduction of automated dispensing cabinets and the education and awareness of the healthcare team presented themselves as strategies that played a fundamental role in preventing medication errors.Este artículo tuvo como objetivo describir los principales factores predisponentes y medidas preventivas contra errores de medicación en pacientes adultos ingresados ​​en unidades de cuidados intensivos. Se trata de una revisión integradora de la literatura realizada sobre materiales indexados en la Biblioteca Virtual en Salud (BVS): Sistema de Análisis y Recuperación de Literatura Médica en Línea (MEDLINE), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Base de Datos de Datos de Enfermería ( BDENF), el Index Medicus para el Pacífico Occidental (WPRIM) y el Índice Bibliográfico Español en Ciencias de la Salud (IBECS). Se utilizaron los Descriptores de Ciencias de la Salud (DeCS) junto con el operador booleano AND y OR. Después de aplicar los criterios de elegibilidad, se seleccionaron 14 estudios para componer esta revisión. Se concluye que entre los principales factores predisponentes asociados a errores de medicación en unidades de cuidados intensivos de adultos se encuentran los errores en la prescripción, preparación, administración y transcripción de medicamentos. Estos errores se asociaron a una serie de factores de riesgo, como falta de continuidad en los sistemas de receta electrónica, sobrecarga de trabajo, desconocimiento, prisas, falta de atención, entre otros. Entre las medidas de barrera identificadas se encuentran la implementación de sistemas de prescripción computarizada, como la receta electrónica y los sistemas de administración de medicamentos con códigos de barras, la introducción de gabinetes de dispensación automatizados y la educación y sensibilización del equipo de salud se presentaron como estrategias que jugaron un papel fundamental en la prevención. errores de medicación.Este artigo teve por objetivo descrever os principais fatores de predisponentes e as medidas preventivas contra erros de medicação em pacientes adultos internados nas unidades de terapia intensiva. Trata-se de uma revisão integrativa da literatura realizada nos materiais indexados na Biblioteca Virtual em Saúde (BVS): Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS),  Base de dados de Enfermagem (BDENF),  Index Medicus para o Pacífico Ocidental (WPRIM) e o Índice Bibliográfico Español en Ciencias de la Salud (IBECS). Foram utilizados os Descritores em Ciências da Saúde (DeCS) em cruzamento com o operador booleano AND e OR. Após a aplicação dos critérios de elegibilidade foram selecionados 14 estudos para compor essa revisão. Conclui-se que a entre os principais fatores predisponentes associados a erros de medicação nas unidades de terapia intensiva adulto, erros na prescrição, preparo, administração e transcrição de medicamentos. Esses erros foram associados a uma série de fatores de risco, como a falta de continuidade nos sistemas de prescrição eletrônica, sobrecarga de trabalho, falta de conhecimento, pressa, falta de atenção, entre outros. Entre as medidas de barreiras identificadas incluíram a implementação de sistemas informatizados de prescrição, como prescrições eletrônicas e sistemas de administração de medicamentos com código de barras, introdução de armários de distribuição automatizados e a educação e sensibilização da equipe de saúde apresentaram-se como estratégias que desempenharam um papel fundamental na prevenção de erros de medicação. &nbsp

Bilateral Double-Pigtail Ureteral Stent Placement for Management of Ureteral Obstruction Secondary to Transitional Cell Carcinoma in a Dog

Background: Transitional cell carcinoma (TCC) usually affects the trigone region of the bladder and proximal portion of the urethra. TCC in dogs is often complicated by local tumor invasion and obstruction of the urethra, ureters, or both. Urinary obstruction is the cause of death in approximately 60% of dogs with TCC. Radical surgeries are associated with morbidity and mortality rates. Stents have recently been evaluated for use in dogs with ureteral obstruction resulting from a variety of urinary tract tumors. This report aims to describe bilateral ureteral stent placement for treatment of malignant ureteral obstruction and long-term follow-up in a dog.Case: An 11‐year‐old female spayed Maltese with ureteral obstruction secondary to transitional cell carcinoma (TCC) in the bladder trigone. After palliative debulking procedure and diagnostic of TCC in bladder and NSAIDs treatment, recurrence has occurred causing ureteral obstruction and TCC had invaded the abdominal wall. Abdominal wall local tumor resection, trigone mass debulking and bilateral ureteral stent placement was made. A double-pigtail ureteral stent of appropriate length was advanced to bypass the ureteral obstruction. Stent sizes were 3.5 Fr in diameter and from 8 to 32 cm in length. The patient underwent surgical resection of the transitional cell carcinoma in the abdominal wall. The correct location of the bilateral ureteral pigtail stent was certified by abdominal radiography. Recovery was uneventful and the dog was discharged 2 days after surgery. Eleven months after stent placement, the dog developed lumbar vertebrae metastasis, without evidence of recurrent ureteral obstruction. The owners elected euthanasia 517 days after original presentation and 337 days after ureteral stent placement. Euthanasia was unrelated to the local tumor obstruction but was related to the bone metastasis.Discussion: Ureteral stent placement is feasible techniques for treatment of bladder TCC in dogs, with the objective of delaying the evolution of the disease and preventing ureteral obstruction. According to previous studies, although distant metastatic disease is worrisome, in the majority of dogs with bladder TCC, the primary location of the tumor is the most common cause of death. In patients with ureteral obstruction, early intervention preserves functional renal tissue. Thus, relief of obstruction should be recommended as soon as possible before irreversible renal damage occurs. The authors encourage aggressive and timely intervention, particularly when ureteral obstruction is bilateral. In the present report, 90 days postoperatively local recurrence causing ureteral obstruction was not evidenced on bladder ultrasound images and laboratory test follow-up. After this period, until 180 days after debulking surgery, tumor recurrence occurred, causing clinical signs and compromising renal function. Complications associated with stent placement included stent migration, recurrent ureteral obstruction, stranguria/pollakiuria, presumably due to irritation of the trigonal region from the distal stent; imperfect stent location; ureteral trauma during stent placement; and urinary tract infection. In the present report, the ureteral stents were placed for palliative treatment for malignant ureteral obstructions. Although urinary tract infection was recurrent, other complications associated with bilateral ureteral stent did not occur, such as accidental dislocation or stent obstruction by the tumor. The results obtained were satisfactory for urinary tract obstruction, allowing survival of 517 days. These findings may support long-term ureteral stenting in veterinary patients

Nutritional status of human T-lymphotropic virus 1 patients: a retrospective study

Submitted by Janaína Nascimento ([email protected]) on 2019-11-07T12:36:42Z No. of bitstreams: 1 ve_Bacelo_Adriana_etal_INI_2019.pdf: 308698 bytes, checksum: 8992ac97d665f1835bddb94631a577d8 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-11-07T13:49:06Z (GMT) No. of bitstreams: 1 ve_Bacelo_Adriana_etal_INI_2019.pdf: 308698 bytes, checksum: 8992ac97d665f1835bddb94631a577d8 (MD5)Made available in DSpace on 2019-11-07T13:49:07Z (GMT). No. of bitstreams: 1 ve_Bacelo_Adriana_etal_INI_2019.pdf: 308698 bytes, checksum: 8992ac97d665f1835bddb94631a577d8 (MD5) Previous issue date: 2019Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Serviço de Nutrição. Rio de Janeiro, RJ, Brasil.State University of Rio de Janeiro. Nutrition Institute. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Plataforma de Pesquisa Clínica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Serviço de Nutrição. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Serviço de Nutrição. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Serviço de Nutrição. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Serviço de Nutrição. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Serviço de Nutrição. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Serviço de Nutrição. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Serviço de Nutrição. Rio de Janeiro, RJ, Brasil.Background & aims: The nutritional status of people with human T-lymphotropic virus (HTLV-1) infection has been poorly described because it involves a neglected disease. The few studies that have been conducted mostly involve people with neurologic consequences and the possible clinical evolutions of the disease. The aim of this study was to describe the nutritional status of patients with HTLV-1, including those with associated myelopathy/tropical spastic paraparesis, and to evaluate food security in these patients. Methods: A retrospective observational study was conducted in people with HTLV-1 admitted to a referral hospital. We collected data from 17 medical records, including anthropometric data (i.e., body mass index, mid-upper arm circumference, triceps skinfold, and mid-arm muscle circumference), laboratory test results (i.e., haemoglobin, haematocrit, albumin, globulin, iron fixation capacity, and iron), the Subjective Global Assessment (SGA) method, and food security (Brazilian Food Insecurity Scale) data. The data were analysed using the R-project software. To evaluate possible associations between the outcomes and predictors (age at hospitalisation, food security, presence of children <18 years of age living in the household, income, schooling, ANSG, BMI, difference between ideal weight and hospitalisation, TSF, MUAC ICU days, hospitalisation outcome, rehospitalisation in the first year after discharge, interval between readmissions, death, associated conditions, constipation upon admission), we used KruskaleWallis, ManneWhitney, Fisher's exact, chi-square tests with continuity correction, and Spearman's correlation coefficient. Hypothesis tests were considered statistically significant when p ≤ 0.05. Results: The mean age of the patients was 57 (52-60) years. The patients were predominantly women (59%) and had an income lower than the local minimum wage with at least 6 years of schooling (52.3%). Only 18.2% of patients were eutrophic according to their BMI and 23.5% of patients were malnourished based on the SGA method. Patients predominantly had food security (64.7%) and good intestinal functions (64.7%) during their hospital stay. Conclusion: Despite having a limited number of patients in this study, HTLV-1 patients admitted to hospital are at high risk of malnutrition based on the scores from the SGA method

Endoscopic approach for a laryngeal neoplasm in a dog

Laryngeal and tracheal tumors are rare in pets; some piece of information on their disease behavior, therapy and evolution are limited. Neoplasms in this area are a diagnostic challenge. In many cases, they can be biopsied and excised using endoscopic instruments, but there is no report of this in canines. The goal of this study is to report a successful case of a laryngeal neoplasm removal through endoscopy. A head and neck radiogram revealed a mass in the laryngeal lumen protruding into the trachea. The patient then underwent an endoscopy to confirm the radiographic diagnosis and to surgically remove the tumor. The histopathological diagnosis was poorly differentiated carcinoma. The most appropriate treatment for laryngeal tumors is the resection of the submucosa or a partial laryngectomy however, partial and total laryngectomies are associated with many postoperative complications. In contrast, the endoscopic approach allows for highly magnified visualization of the lesion in situ, which facilitates the surgical removal of the mass through videosurgery. With little manipulation of the affected area, the chances of postoperative complications are reduced, leading to a more rapid recovery.Tumores de laringe e traqueia são raros em animais de estimação e as informações sobre o comportamento, terapia e evolução destas neoplasias são limitadas. Neoplasias nesta área são desafios diagnósticos. Em muitos casos, pode ser feita a biópsia e excisão da massa utilizando instrumentos endoscópicos, mas não existe relato deste tipo de procedimento em caninos. O objetivo deste estudo foi relatar um caso de sucesso da remoção endoscópica de um tumor de laringe. A radiografia da região cervical revelou uma massa na luz da laringe invadindo a traqueia. O paciente foi então submetido a uma endoscopia para confirmar o diagnóstico radiográfico e remover cirurgicamente o tumor. O diagnóstico histopatológico foi de carcinoma pouco diferenciado. O tratamento mais adequado para os tumores da laringe é a ressecção da submucosa ou uma laringectomia parcial, no entanto, estas estão associadas a muitas complicações pós-operatórias. Em contraste, a abordagem endoscópica permite a visualização da lesão in situ, o que facilita a remoção cirúrgica da massa através de videocirurgia. Com pouca manipulação da área afetada, as chances de complicações pós-operatórias são reduzidas, levando a uma recuperação mais rápida.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Ano IX, número 19

Espaço e Economia: Revista Brasileira de Geografia Econômica, além dos artigos em fluxo contínuo, inclui nesta edição o Dossiê Oeste Metropolitano do Rio de Janeiro, organizado pelos professores Marcio Rufino Silva, Denise de Alcantara, Leandro Dias de Oliveira e André Santos da Rocha (PPGGEO e PPGDT-UFRRJ)

ATLANTIC ANTS: a data set of ants in Atlantic Forests of South America

International audienc