Diagnósticos/resultados de enfermagem para parturientes e puérperas utilizando a Classificação Internacional para Prática de Enfermagem

http://dx.doi.org/10.5216/ree.v14i2.11211 O objetivo deste estudo foi desenvolver afirmativas de diagnósticos de enfermagem para parturientes e puérperas, utilizando o modelo dos setes eixos da Classificação Internacional para Prática de Enfermagem. Foram elaboradas 68 afirmativas de diagnóstico de enfermagem, as quais foram agrupadas de acordo com as necessidades humanas básicas de Horta. A formulação de diagnósticos de enfermagem expressa o julgamento clínico do enfermeiro acerca dos fenômenos pelos quais é responsável para atingir resultados de enfermagem, após realizar uma intervenção.  A utilização da linguagem padronizada para construção desses diagnósticos e resultados favorece a documentação de enfermagem, que por sua vez, contribui para evidenciar os conceitos importantes para prática profissional na atenção à saúde materna

Expression of TIGIT, PD-1 and HLA-DR/CD38 markers on CD8-T cells of children and adolescents infected with HIV and uninfected controls

Immune exhaustion and senescence are scarcely studied in HIV-pediatric patients. We studied the circulatory CD8 T cells activation/exhaustion and senescent phenotype of children and adolescents vertically infected with HIV or uninfected controls based on the expression of human leukocyte antigen (HLA-DR), CD38, T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif (ITIM) domain (TIGIT), programmed death 1 (PD-1) and CD57 by flow cytometry, during approximately one year. Eleven HIV-infected (HI) and nine HIV-uninfected (HU) children/adolescents who received two doses or one dose of meningococcal C conjugate vaccine (MenC), respectively, were involved in this study. Blood samples were collected before the immunization (T0), 1–2 months after the first dose (T1), and 1–2 months after the second dose (T2), which was administered approximately one year after the first one. HI patients not receiving combined antiretroviral therapy (cART) showed a higher frequency of CD8 T cells TIGIT+, PD-1+ or CD57+, as well as a higher frequency of CD8 T cells co-expressing CD38/HLA-DR/TIGIT or CD38/HLA-DR/PD-1 when compared to HI treated or HU individuals, at all times that they were assessed. CD8 T cells co-expressing CD38/DR/TIGIT were inversely correlated with the CD4/CD8 ratio but positively associated with viral load. The co-expression of CD38/DR/TIGIT or CD38/DR/PD-1 on CD8 T cells was also inversely associated with the CD4 T cells expressing co-stimulatory molecules CD127/CD28. The results showed a higher expression of exhaustion/senescence markers on CD8 T cells of untreated HI children/adolescents and its correlations with viral load

Segurança do paciente em cirurgia oncológica: experiência do Instituto do Câncer do Estado de São Paulo

A preocupação com a segurança do paciente em centro cirúrgico (CC) tem sido crescente, devido à elevada frequência de erros e eventos adversos, que muitas vezes poderiam ser prevenidos. A Joint Commission on Accreditation of Healthcare Organizations (JCAHO) propôs o Protocolo Universal (PU) para a prevenção do lado, procedimento e paciente errado. No Brasil foram poucas as instituições que o implantaram, sendo necessária a divulgação e avaliação da sua efetividade. O objetivo foi relatar a experiência do Instituto do Câncer do Estado de São Paulo (ICESP) na implantação do PU-JCAHO. O protocolo inclui três etapas: verificação pré-operatória, marcação do sitio cirúrgico (lateralidade) e TIME OUT. O CC do ICESP está em funcionamento desde novembro de 2008. O PU-JCAHO é aplicado integralmente a todas as cirurgias. Até junho de 2009 foram realizadas 1019 cirurgias, sem registro de erro ou evento adverso. A implantação do PU-JCAHO é simples, sendo ferramenta útil para prevenir erros e eventos adversos em CC.La preocupación por la seguridad del paciente en centro quirúrgico (CC, siglas en portugués) ha sido creciente, debido a la elevada frecuencia de errores y eventos adversos que muchas veces podrían ser prevenidos. La Joint Commission on Accreditation of Healthcare Organizations (JCAHO) propuso el Protocolo Universal (PU) para la prevención de sitio, procedimiento o paciente equivocados. En Brasil, pocas instituciones lo implantaron, haciéndose necesaria la divulgación y evaluación de su efectividad. El objetivo del trabajo fue relatar la experiencia del Instituto del Cáncer del Estado de São Paulo (ICESP) en la implantación del PU-JCAHO. El protocolo incluye tres etapas: verificación preoperatoria, marcación del sitio quirúrgico (lateralidad) y TIME OUT. El CC del ICESP está en funcionamiento desde noviembre de 2008. El PU-JCAHO es aplicado integralmente en todas las cirugías. Hasta junio de 2009 fueron efectuados 1019 procedimientos quirúrgicos, sin registro de error o evento adverso. La implantación del PU-JCAHO es simple, y es una herramienta útil para prevenir errores y eventos adversos en el quirófano.Patient safety concerns in surgery are increasing. The frequency of surgery-related adverse events and errors is high, and most could be avoided. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) proposed the Universal Protocol (UP-JCAHO) for preventing wrong site, wrong procedure, and wrong person surgery. In Brazil, very few health-care institutions have adopted this Protocol. Thus, there is a need to improve its dissemination and assess its effectiveness. The aim of the present study was to report the experiences of the Sao Paulo State Cancer Institute (ICESP, acronym in Portuguese) in implementing the UP-JCAHO. The Protocol comprises three steps: pre-operative verification process, marking the operative site and Time out immediately before starting the procedure. The ICESP surgical center (SC) has been functioning since November 2008. The UP-JCAHO is applied to all surgeries. A total 1019 surgeries were performed up to June 2009. No errors or adverse events were registered. The implementation of the UP-JCAHO is simple. It can be a useful tool to prevent error and adverse events in SC

PERFIL DEL CLIENTE ATENDIDO POR EL ENFERMERO EN LA ESTRATEGIA ACOGIMIENTO MADRE BEBÉ

This quantitative study of the descriptive-exploratory type aimed to identify socio-demographic and healthcharacteristics of mothers and babies attended by nurses in the Mother-and-Baby Embracement Strategy in a primary healthcare unit in the city of Rio de Janeiro. The data was collected from 26 hospital records which had the Guide for Motherand-Baby Embracement Consultation Activities protocol, in 2011. The data was analyzed using the Epi-infor 3.5.2 software.The results show that 61.3% of the women were in the age range 20 to 30 years old; 46.2% had had a normal birth; 7.7%had changes in the surgical scar and 11.5% had changes in their breasts. In relation to the new-borns, 50% were between 2and 7 days old; the majority (96.2%) were being exclusively breast-fed, and 23.1% presented jaundice. It is concluded thatknowledge of the profile of the clientele attended in the Mother-and-Baby Embracement, by the nurse, constitutes importantsupport for carrying out health promotion measures which aim to reduce maternal and infant morbidity and mortality.Trata-se de um estudo quantitativo do tipo descritivo-exploratório que objetivou identificar características sociodemográficas e de saúde de mães e bebês atendidos pelo enfermeiro na Estratégia Acolhimento Mãe-Bebê, em uma unidade básica de saúde do Município do Rio de Janeiro. Os dados foram coletados em 26 prontuários que possuíam o protocolo Roteiro de Atividades da Consulta do Acolhimento Mãe-Bebê, em 2011. A análise dados foi feita com o uso do software Epi-Info 3.5.2. Os resultados mostram que 61,3% das mulheres estavam na faixa etária entre 20 a 30 anos; 46,2% haviam realizado parto normal; 7,7% apresentavam alteração na cicatriz cirúrgica e 11,5% alteração nas mamas. Com relação aos recém-nascidos, 50% possuíam de 2 a 7 dias de vida; a maioria (96,2%) encontrava-se em aleitamento materno exclusivo e 23,1% apresentavam icterícia. Conclui-se que o conhecimento do perfil da clientela atendida no Acolhimento Mãe-Bebê, pelo enfermeiro, constitui importante subsídio para o desenvolvimento de medidas de promoção à saúde que visem redução da morbidade e da mortalidade materno-infantil.Este es un estudio cuantitativo del tipo descriptivo exploratorio que tuvo el objetivo de identificarcaracterísticas sociodemográficas y de salud de madres y bebés atendidos por el enfermero en la Estrategia AcogimientoMadre Bebé, en una unidad básica de salud del Municipio de Rio de Janeiro. Los datos fueron obtenidos en 26 prontuariosque poseían el protocolo Guion de Actividades de la Consulta del Acogimiento Madre Bebé, en 2011. El análisis de datosfue hecho con el uso del software Epi-Info 3.5.2. Los resultados muestran que 61,3% de las mujeres estaban en la franjaetaria entre 20 y 30 años; 46,2% habían realizado parto normal; 7,7% presentaban alteración en la cicatriz quirúrgica y11,5% alteración en las mamas. Acerca de los recién nacidos, 50% poseían de 2 a 7 días de vida; la mayoría (96,2%) estabaen amamantamiento materno exclusivo y 23,1% presentaban ictericia. Se concluye que el conocimiento del perfil de laclientela atendida en el Acogimiento Madre Bebé, por el enfermero constituye importante subsidio para el desarrollo demedidas de promoción a la salud para la reducción de la mortalidad materno infantil

Comparative effectiveness and safety of monoclonal antibodies for mCRC

Introduction: Biological medicines are increasingly used in combination with chemotherapy for patients with metastatic colorectal cancer (mCRC), resulting in increased progression-free survival (PFS). However, concerns remain over the extent of their effect on overall survival (OS) given the high costs of these monoclonal antibodies (MoAbs) (bevacizumab, cetuximab and panitumumab) and their safety. Published studies suggest no major differences in effectiveness and safety between the MoAbs; however, differences in costs with cetuximab more expensive than bevacizumab by 127% in Brazil and more expensive than panitumumab by 112%, with panitumumab more expensive than bevacizumab by 6%. Since there is rising litigation in Brazil in order to access these 3 MoAbs as they are not currently reimbursed, we wanted to compare their effectiveness and safety associated with chemotherapy or chemotherapy alone in patients with mCRC to provide future guidance to the judiciary and the healthcare system. Method: A systematic review and meta-analysis based on cohort studies published in databases up to November 2017. Effectiveness measures include PFS, post-progression survival (PPS), RECIST (Response Evaluation Criteria In Solid Tumors), response rates, metastasectomy rates, OS and safety. We also evaluated the methodological quality of the studies. Results: Overall, 21 observational cohort studies were included in the review. There were statistically significant and clinically relevant benefits in patients treated with bevacizumab versus those not treated with bevacizumab (no bevacizumab arm) mainly around PFS, PPS, metastasectomy rates and OS, but not for disease control rates. However, bevacizumab increased toxicities and there were concerns with the heterogeneity of the studies. Conclusion: The results suggested an advantage in favour of bevacizumab for a number of outcome measures and costs in patients with mCRC. However, this advantage may be only clinically modest for bevacizumab. This though has to be weighed against the serious adverse events associated with bevacizumab, especially severe hypertension and gastrointestinal perforation

The budget impact of monoclonal antibodies used to treat metastatic colorectal cancer in Minas Gerais, Brazil

Introduction: Biological medicines have increased the cost of cancer treatments, which also raises concerns about sustainability. In Brazil, three monoclonal antibodies (mAbs)—bevacizumab, cetuximab, and panitumumab—are indicated for the treatment of metastatic colorectal cancer (mCRC) but not currently funded by the Unified Health System (SUS). However, successful litigation has led to funding in some cases. Objective: Our objective was to evaluate the budgetary impact of including the mAbs bevacizumab, cetuximab, and panitumumab in standard chemotherapy for the treatment of mCRC within the SUS of Minas Gerais (MG), Brazil. Method: A budget impact analysis of incorporating mAbs as first-line treatment of mCRC in MG was explored. The perspective taken was that of the Brazilian SUS, and a 5-year time horizon was applied. Data were collected from lawsuits undertaken between January 2009 and December 2016, and the model was populated with data from national databases and published sources. Costs are expressed in $US. Results: In total, 351 lawsuits resulted in funding for first-line treatment with mAbs for mCRC. The three alternative scenarios analyzed resulted in cost increases of 348–395$US103,360,980 compared with the reference scenario over a 5-year time horizon, and bevacizumab and cetuximab had budgetary impacts of $US111,334,890 and 113,772,870, respectively. The use of the anti-epidermal growth factor receptor (EGFR) mAbs (cetuximab and panitumumab) is restricted to the approximately 41$US106 million. Conclusion: These results highlight the appreciable costs for incorporating bevacizumab, cetuximab, and panitumumab into the SUS. Appreciable discounts are likely to be necessary before incorporation of these mAbs is approved

a multicenter study

(1) Background: The Commercial Kit SIRE Nitratase® PlastLabor, is a drug susceptibility test kit used to detect Mycobacterium tuberculosis resistance to first-line TB treatment drugs. The present study aimed at evaluating its performance in a multicenter study. (2) Methods: To determine its accuracy, the proportion methods in Lowenstein Jensen medium or the BACTECTMMGITTM960 system was used as a gold standard. (3) Results: The study revealed that the respective accuracies of the kit with 190 M. tuberculosis clinical isolates, using the proportion methods in Lowenstein Jensen medium or BACTECTMMGITTM960 system as a gold standard, were 93.9% and 94.6%, 96.9% and 94.6%, 98.0% and 97.8%, and 98.0% and 98.9%, for streptomycin, isoniazid, rifampicin, and ethambutol, respectively. (4) Conclusion: Thus, the kit can rapidly screen resistance to streptomycin, isoniazid, rifampicin, and ethambutol. Additionally, it does not require sophisticated equipment; hence, it can be easily used in the laboratories of low and middle income countries.publishersversionpublishe

Estudo farmacoeconômico por análise de minimização de custos dos equivalentes terapêuticos em um hospital privado de Belo Horizonte/MG, Brasil.

Programa de Pós-Graduação em Ciências Farmacêuticas. CIPHARMA, Escola de Farmácia, Universidade Federal de Ouro Preto.Estudos farmacoeconômicos dão suporte aos profissionais de saúde na seleção de medicamentos de uso hospitalar e têm importância para a tomada de decisões no processo de aquisição. Foi utilizada a Análise de Minimização de Custos (AMC) para demonstrar que a adoção de equivalentes terapêuticos (ET) promove significativa redução dos custos de medicamentos incluídos no formulário farmacoterapêutico de um hospital privado de alta complexidade. A pesquisa foi realizada em duas etapas: 1) Estudo dos ET considerados pelo hospital como alternativas terapêuticas; 2) AMC dos ET que possuem estudos comparativos de equivalência terapêutica. Dentre as especialidades farmacêuticas apontadas como equivalentes, 55,7% possuíam estudos científicos comprobatórios de equivalência. As diferenças de custos de aquisição mensal para estes ET representam uma redução potencial de 34,25%. Este estudo baseado em AMC com a seleção de Alternativas terapêuticas menos onerosos gera uma economia nos gastos com fármacos e pode levar a uma maior segurança na utilização dos mesmos quando realizado Análise de Minimização de Custos (AMC).Cost-minimization analysis (CMA) is a tool used in pharmacoeconomics and is applied when comparing multiple drugs of equal efficacy and tolerability. The purpose of CMA is to support health care professionals in the drug selection stage and it is essential for making decisions in the procurement process. This study aimed to perform CMA to evaluate the efficiency of drug standardization procedure and verify the reduction of the monthly cost of therapeutic equivalents (TE) included in pharmacotherapeutic list of a high complexity private hospital. The survey was conducted in two stages: 1) Verification of therapeutic equivalence adopted by the hospital; 2) CMA study of the medicines that have scientific proof of TE. Corroborative scientific studies of TE were found for 55,7% of drugs considered as such by the hospital. Differences in monthly acquisition costs represent a reduction of 34,25% when the cheaper TE was selected. This study points to drugs costs economy and greater safety of medicines use when performed CMA

Mercurial exposure of residents of Santarém and Oriximiná cities (Pará, Brazil) through fish consumption

International audienceA survey of the mercurial exposure of residents of Santarém and Oriximiná showed a differential mercurial impregnation between men and women. At the level of both cities, the mean hair mercury concentrations were 1.5 ± 0.5 (90th and 95th percentiles: 2.8 and 4.3) and 2.52 ± 0.09 μg g Hg/g (90th and 95th percentiles: 4.7 and 8.1) for women and men, respectively. The mercurial contamination appeared significantly closely linked to the daily amount of consumed fish. Carnivore species pescada branca (Plagioscion squamosissimus) and apapá (Pellona castelnaeana) and non-carnivore species pacú (Mylossoma duriventre) and aracú (Schizodon fasciatus) were consumed by 22, 19, 55 and 25 % of people, respectively, and the mean mercury concentrations within fish flesh were 1.44 ± 0.11, 1.66 ± 0.19, 0.48 ± 0.09 and 0.49 ± 0.06 μg/g dry weight, respectively. Men aged above 35 were significantly more contaminated than those below. The mean hair concentrations of men were 5.20 ± 1.25 and 1.50 ± 0.22 μg/g, for those aged above 35 and below, respectively. The probability for women of childbearing age from both cities to present a hair mercury concentration above 1 μg Hg/g (corresponding to the US Environmental Protection Agency reference dose) was equal to 0.30 (95 % confidence interval of 0.24-0.36). The probability of hair mercury concentration to be above the lowest observable adverse effect level (LOAEL) (0.3 μg Hg/g) was equal to 0.79 (95 % confidence interval: 0.73-0.86)

Segurança do paciente em cirurgia oncológica: experiência do Instituto do Câncer do Estado de São Paulo Seguridad del paciente en cirugía oncológica: experiencia del Instituto del Cáncer del Estado de São Paulo Patient safety in oncology surgery: experience of the São Paulo State Cancer Institute

A preocupação com a segurança do paciente em centro cirúrgico (CC) tem sido crescente, devido à elevada frequência de erros e eventos adversos, que muitas vezes poderiam ser prevenidos. A Joint Commission on Accreditation of Healthcare Organizations (JCAHO) propôs o Protocolo Universal (PU) para a prevenção do lado, procedimento e paciente errado. No Brasil foram poucas as instituições que o implantaram, sendo necessária a divulgação e avaliação da sua efetividade. O objetivo foi relatar a experiência do Instituto do Câncer do Estado de São Paulo (ICESP) na implantação do PU-JCAHO. O protocolo inclui três etapas: verificação pré-operatória, marcação do sitio cirúrgico (lateralidade) e TIME OUT. O CC do ICESP está em funcionamento desde novembro de 2008. O PU-JCAHO é aplicado integralmente a todas as cirurgias. Até junho de 2009 foram realizadas 1019 cirurgias, sem registro de erro ou evento adverso. A implantação do PU-JCAHO é simples, sendo ferramenta útil para prevenir erros e eventos adversos em CC.<br>La preocupación por la seguridad del paciente en centro quirúrgico (CC, siglas en portugués) ha sido creciente, debido a la elevada frecuencia de errores y eventos adversos que muchas veces podrían ser prevenidos. La Joint Commission on Accreditation of Healthcare Organizations (JCAHO) propuso el Protocolo Universal (PU) para la prevención de sitio, procedimiento o paciente equivocados. En Brasil, pocas instituciones lo implantaron, haciéndose necesaria la divulgación y evaluación de su efectividad. El objetivo del trabajo fue relatar la experiencia del Instituto del Cáncer del Estado de São Paulo (ICESP) en la implantación del PU-JCAHO. El protocolo incluye tres etapas: verificación preoperatoria, marcación del sitio quirúrgico (lateralidad) y TIME OUT. El CC del ICESP está en funcionamiento desde noviembre de 2008. El PU-JCAHO es aplicado integralmente en todas las cirugías. Hasta junio de 2009 fueron efectuados 1019 procedimientos quirúrgicos, sin registro de error o evento adverso. La implantación del PU-JCAHO es simple, y es una herramienta útil para prevenir errores y eventos adversos en el quirófano.<br>Patient safety concerns in surgery are increasing. The frequency of surgery-related adverse events and errors is high, and most could be avoided. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) proposed the Universal Protocol (UP-JCAHO) for preventing wrong site, wrong procedure, and wrong person surgery. In Brazil, very few health-care institutions have adopted this Protocol. Thus, there is a need to improve its dissemination and assess its effectiveness. The aim of the present study was to report the experiences of the Sao Paulo State Cancer Institute (ICESP, acronym in Portuguese) in implementing the UP-JCAHO. The Protocol comprises three steps: pre-operative verification process, marking the operative site and Time out immediately before starting the procedure. The ICESP surgical center (SC) has been functioning since November 2008. The UP-JCAHO is applied to all surgeries. A total 1019 surgeries were performed up to June 2009. No errors or adverse events were registered. The implementation of the UP-JCAHO is simple. It can be a useful tool to prevent error and adverse events in SC