Pesquisa | SciELO

Abstract Objective: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). Methods: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. Outcome: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. Results: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92–2.31)/1.60 (1.27–2.02) for SGA; 0.90 (0.55–1.47)/1.05 (0.55–1.99) for LGA; 1.65 (1.08–2.51)/1.58 (1.28–1.96) for stunting; and 1.48 (1.02–2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. Conclusion: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes.

https://doi.org/10.1016/j.jped.2022.07.007

Implementation of a standardized handoff system (I-PASS) in a tertiary care pediatric hospital
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Soares, Deydson Rennan Alves

; Rodrigues, Dalma

; Carmona, Fabio

Revista Paulista de Pediatria

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2023, Volume 41 elocation e2022123

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

Abstract Objective: The handoff is the act of transferring information and responsibility among healthcare providers, and it is critical for the patient safety and the quality of service. The aim of this study was to evaluate the implementation of a standardized medical handoff system [I-PASS (Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver)] and assess the effect on the amount and quality of the information transmitted during medical handoffs in a pediatric ward. Methods: In a prospective intervention study, physicians (staff and residents) who work in 12- or 24-h shifts in the pediatric ward of a single tertiary care Brazilian hospital were eligible. Those who agreed to participate were trained in an online session (lecture plus simulation). Medical handoffs were recorded pre- and post-intervention (training) to compare the amount and quality of information transmitted in handoffs. Results: The handoff standardization significantly increased the number of relevant information delivered for 12 out of the 16 items assessed without increasing, in seconds, the handoff duration (45.9 vs. 48.0; p=0.349). The protocol training and the following discussion about communication resulted in greater focus and attention among participants during transfers, decreasing time spent with interruptions and communication unrelated to the patient (18 vs. 2.7%). Regarding the I-PASS elements, there was an increase in the number of action lists and contingency plans reported (31 vs. 81% and 16 vs. 73%, respectively; p<0.001 for both). Conclusion: Standardization brought greater efficiency and objectivity to handoffs. It increased the quantity and quality of the information transmitted while successfully drawing attention to the most important points.

RESUMO Objetivo: A passagem de plantão, ato de transferir informações e responsabilidade entre os médicos, é um dos elementos-chave para a qualidade do serviço prestado e a segurança do paciente. Este estudo objetivou avaliar a implantação de um sistema padronizado de passagem de plantão (Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver — I-PASS) e avaliar o efeito sobre a quantidade de informações transmitidas em passagens de plantão de uma enfermaria pediátrica. Métodos: Estudo prospectivo de intervenção da implementação de um sistema padronizado de passagem de plantão (I-PASS). Foram realizadas gravações das passagens de plantão em período pré- e pós-intervenção. O treinamento dos médicos que participam das escalas de plantão foi feito em módulo teórico-prático, com o auxílio de plataformas digitais. Resultados: A padronização da passagem de plantão resultou em aumento do número de informações relevantes, entregues em 12 dos 16 itens pesquisados, sem aumentar a duração em segundos da transferência (45,9 vs. 48,0; p=0,349). O treinamento do protocolo aliado à discussão sobre estratégias de comunicação implicou maior foco e atenção durante as passagens, reduzindo o tempo gasto com interrupções e comunicações que não se referiam ao paciente (18 vs. 2,7%). No que se refere aos elementos do I-PASS, houve acréscimo na citação de pendências (31 vs. 81%, p < 0,001) e plano de contingenciamento (16 vs. 73%, p < 0,001). Conclusão: A padronização da passagem de plantão trouxe maior eficiência ao processo no que se refere a número de informações transmitidas, objetividade na transferência e atenção aos pontos importantes.

https://doi.org/10.1590/1984-0462/2023/41/2022123

Why are pediatricians uncomfortable with prescribing emergency contraception for adolescents?
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Amorim, Renata Vieira

; Barbieri, Marco Antônio

; Bôtto-Menezes, Camila

; Carmona, Fábio

; Ferraro, Alexandre Archanjo

; Bettiol, Heloisa

Revista Paulista de Pediatria

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2023, Volume 41 elocation e2022060

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

Abstract Objective: Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas. Methods: A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions. Results: Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71–11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models. Conclusions: EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.

RESUMO Objetivo: A contracepção de emergência (CE) é um método eficaz e seguro para prevenir gravidez não planejada após relação sexual desprotegida entre adolescentes, mas raramente prescrito por pediatras. Diante da escassez de dados sobre o desconforto com a prescrição de CE entre médicos no Brasil, o objetivo deste estudo foi identificar fatores associados a esse desconforto entre pediatras do estado do Amazonas. Métodos: Uma pesquisa do tipo e-survey coletou dados sociodemográficos, conhecimento, atitudes e desconforto com relação à prescrição de CE. Métodos de regressão logística multivariada e inteligência artificial, como árvore de decisão e random forest, foram usados para identificar fatores associados ao desconforto para a prescrição de CE. Resultados: Entre os 151 médicos que responderam à pesquisa, 53,0% sentiam-se desconfortáveis para prescrever CE e apenas 33,1% já a haviam prescrito. A inexperiência foi associada a esse desconforto (odds ratio — OR 4,47, intervalo de confiança — IC95% 1,71–11,66). A prescrição prévia de CE foi fator de proteção com relação ao desconforto nos três modelos. Conclusões: A CE ainda é pouco prescrita por pediatras. Apesar de sua segurança e eficácia, a inexperiência e conceitos equivocados foram associados ao desconforto para sua prescrição. Investigações sobre o assunto são importantes para subsidiar políticas públicas de saúde para a redução da gravidez não intencional na adolescência.

https://doi.org/10.1590/1984-0462/2023/41/2022060

Sanitary measures to contain COVID-19 spread decreased pediatric hospitalizations due to other respiratory infections in São Paulo, Brazil
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Altizani, Gabriela Marengone

; Balbão, Viviane da Mata Pasti

; Gaspar, Gilberto Gambero

; Aragon, Davi Casale

; Carmona, Fabio

Jornal de Pediatria

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Set 2022, Volume 98 Nº 5 Páginas 533 - 539

Resumo: En | Texto: En | PDF: En

Abstract Objective After the Covid-19 pandemics hit Brazil and sanitary measures were adopted to contain its dissemination, pediatric hospital admissions were apparently fewer than usual. The authors aimed to describe the time trends of public hospital admissions of children and adolescents due to respiratory infections (RIs) in São Paulo State, Brazil, before and after the adoption of sanitary measures to contain the dissemination of Covid-19. Methods Ecological, time-series study on the monthly average number of admissions per day of children and adolescents (< 16 years) admitted to public hospitals of São Paulo due to acute RIs between January 2008 and March 2021. Data from 2008 to 2019 were used to adjust the statistical model, while data from 2020 and 2021 were compared to the values predicted by the model. Results In 2020 and 2021, the number of hospital admissions was significantly lower than predicted by the time series. However, lethality was three times higher in these years, compared to the previous, and six times higher in patients with Covid-19, compared to those without the disease. Hospitalization costs in 2020 and 2021 were lower than in previous years. Conclusions These findings suggest that the sanitary measures adopted to contain the dissemination of Covid-19 also effectively reduce the transmission of other respiratory viruses. Policymakers and administrators can use this knowledge as a guide to planning preventative interventions that could decrease the number and severity of RIs and related hospital admissions in children and adolescents, decreasing the burden on the public health system.

https://doi.org/10.1016/j.jped.2022.01.005

Two years of the COVID-19 pandemic: an anesthesiology perspective
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Schmidt, André P.

; Módolo, Norma S.P.

; de Amorim, Célio G.

; Simões, Cláudia M.

; Kraychete, Durval C.

; Joaquim, Eduardo H.G.

; Lineburger, Eric B.

; Papa, Fábio V.

; Fernandes, Fátima C.

; Mendes, Florentino F.

; Guimarães, Gabriel M.N.

; Barros, Guilherme A.M.

; Silva-Jr, João M.

; Lima, Laís H. Navarro e

; Azi, Liana M.T.A.

; Carvalho, Lorena I.M.

; Stefani, Luciana C.

; Garcia, Luis V.

; Carmona, Maria José C.

; Salgado Filho, Marcello F.

; Nascimento Junior, Paulo do

; Alves, Rodrigo L.

; Carvalho, Vanessa H.

; Quintão, Vinicius C.

; Carmona, Maria José C.

Brazilian Journal of Anesthesiology

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Abr 2022, Volume 72 Nº 2 Páginas 165 - 168

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1016/j.bjane.2022.02.004

Evaluation of renal replacement therapy in children and adolescents in the state of Amazonas, Brazil
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Schramm, Ana Matilde Menezes Melik

; Facincani, Inalda

; Carmona, Fabio

Revista Paulista de Pediatria

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2022, Volume 40 elocation e2021057

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Objetivo Descrever as características de crianças e adolescentes com doença renal crônica (DRC) dialítica no estágio 5 submetidos à terapia renal substitutiva no Amazonas, Brasil, estimando a frequência de casos atuais e novos, e discorrer sobre a presença de anemia e distúrbios do metabolismo ósseo. Métodos Foram estudados 35 pacientes de 7 a 19 anos em hemodiálise ou diálise peritoneal (DP) de junho de 2018 a abril de 2019. As frequências de casos atuais e novos foram estimadas com base na população do Amazonas de 0 a 19 anos no mesmo período. Foram coletados dados sobre a doença de base da DRC, seu diagnóstico, a diálise e a análise bioquímica. Resultados As frequências de casos atuais e novos foram 24 e 15 pacientes por milhão de pessoas em idade compatível (pmpic), respectivamente. As causas da DRC foram síndrome nefrótica (22,8%), síndrome nefrítica (14,3%) e bexiga neurogênica (14,3%), com 48,6% de causa ignorada. Dez pacientes fizeram biópsia renal, sendo sete com glomeruloesclerose segmentar e focal. A maioria (80%) fazia hemodiálise, com Kt/V médio de 1,4, sendo o cateter venoso central de duplo lúmen o acesso vascular em 51,4% dos casos. Observou-se hipocalcemia em 82,8% dos pacientes, hiperfosfatemia em 57,2%, insuficiência ou deficiência de vitamina D em 60% e valores do paratormônio alterados em 48,6%. A hemoglobina encontrava-se baixa em 80%, com deficiência absoluta ou funcional de ferro em 28,6%. Conclusões Em crianças e adolescentes do Amazonas, Brasil, encontramos uma frequência de 24 pacientes com DRC dialítica e 16.3 pmpic por ano de novos casos. Os pacientes são, principalmente, adolescentes em hemodiálise, metade sem diagnóstico causal da DRC, com alta frequência de anemia e distúrbio do metabolismo ósseo.

Abstract Objective: To describe the characteristics of stage-5 chronic kidney disease (CKD) children and adolescents undergoing renal replacement therapy (RRT) in Amazonas, Brazil, estimating the frequencies of current and new cases, describing the presence of anemia and bone metabolism disorders. Methods: Thirty-five patients aged 7 to 19 years-old on hemodialysis (HD) or peritoneal dialysis (PD) were studied between June 2018 and April 2019. The frequencies of current and new cases were estimated based on the 0 to 19 years-old population of Amazonas, in the same period. Data were collected about the underlying cause and diagnosis of CKD, dialysis, and biochemical analysis. Results: The frequencies of current and new cases were 24 and 15 patients per million people of compatible age (pmpca), respectively. The causes of CKD were nephrotic syndrome (22.8%), nephritic syndrome (14.3%), and neurogenic bladder (14.3%); in 48.6%, the cause was unknown/not investigated. Ten patients underwent renal biopsy, seven with segmental and focal glomerulosclerosis. The majority (80%) were on HD, with an average kt/V of 1.4, and in 51.4% the vascular access was the double lumen catheter. Hypocalcemia was found in 82.8% of patients, hyperphosphatemia in 57.2%, vitamin D insufficiency or deficiency in 60%, and altered parathyroid hormone values in 48.6%. Hemoglobin was low in 80%, with absolute/functional iron deficiency in 28.6%. Conclusions: In children and adolescents of Amazonas, Brazil, we found 24 pmpca with stage-5 CKU currently in RRT and 16.3 pmpca per year of new cases requiring RRT. Most patients were adolescents on HD, half without a causal diagnosis of CKD, with a high frequency of anemia and bone metabolism disorder.

https://doi.org/10.1590/1984-0462/2022/40/2021057

Weight/length ratio references and newborn body composition estimation at birth from a Brazilian cohort
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Grandi, Carlos

; Rodrigues, Livia dos S.

; Aragon, Davi C.

; Carmona, Fabio

; Cardoso, Viviane C.

Jornal de Pediatria

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Dez 2021, Volume 97 Nº 6 Páginas 610 - 616

Resumo: En | Texto: En | PDF: En

Abstract Objectives: The objective was to calculate weight/length (W/L) ratio values and percentiles by sex and gestational age (GA) to estimate fat mass (FM), fat-free mass (FFM) and body fat percentage (BF%) as well as to compare these indices in preterm, small (SGA), and large (LGA) for GA, stunted and wasted infants from a Brazilian cohort of newborns, comparing with the INTERGROWTH-21st. Methods: Secondary, cross-sectional analysis of data obtained of 7427 live-born infants from the BRISA Cohort Study in the city of Ribeirão Preto, SP, Brazil in 2010. For body composition estimation, W/L ratio was used in multiple regression models. The 3rd, 50th, and 97th percentiles for W/L ratio and body composition measures (FM, FFM, and BF%) were calculated using fractional polynomial regression models. Results: Average W/L ratio was 6.50 kg/m (SD 0.87), while for FM, BF%, and FFM the corresponding values were 359.64 g (145.76), 10.90% (3.05) and 2798.84 g (414.84), respectively. SGA (< 3rd percentile), and wasted infants showed the lowest W/L ratios and measures of body composition. The 3rd, 50th, and 97th percentiles charts of W/L, FM, BF%, and FFM by GA and sex are presented. Conclusions: W/L ratio values of the RP-BRISA Cohort are higher than IG-21st. SGA (< 3rd) and wasted infants showed the lowest W/L ratio and measures of body composition. The body composition references presented here could be used to refine the nutritional assessment of Brazilian newborns and to facilitate comparisons across populations.

https://doi.org/10.1016/j.jped.2020.12.004 1 downloads

Central Venous Oxygen Saturation/Lactate Ratio and Prediction of Major Adverse Events After Pediatric Heart Surgery
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Rocha, Victória Helena Stelzer

; Manso, Paulo Henrique

; Carmona, Fabio

Brazilian Journal of Cardiovascular Surgery

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Dez 2021, Volume 36 Nº 6 Páginas 736 - 742

Resumo: En | Texto: En | PDF: En

Abstract Introduction: Major adverse events (MAE) are unexpected but undesirably frequent after pediatric congenital heart surgery and contribute to poorer outcomes. The aim of this study was to test the predictive value of a ratio between central venous oxygen saturation and arterial lactate (ScvO2/lactate) for MAE after pediatric congenital heart surgery in a Brazilian university hospital. Methods: We conducted a retrospective observational study in a tertiary care university hospital, including 194 infants and children submitted to surgery for congenital heart disease. The predictive value of ScvO2, lactate, and ScvO2/lactate ratio were assessed by the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The incidence of MAE was 16% — cardiac arrest/death, unplanned reoperation, and low cardiac output syndrome were the most common events. Overall, ScvO2/lactate ratio discriminated patients with and without MAE very well (AUC 0.842), performing better than either variable alone, with sensitivity of 48%, specificity of 94%, PPV of 60%, and NPV of 91%. Conclusion: A ScvO2/lactate ratio > 5 can accurately identify patients at low risk of MAE after pediatric congenital heart surgery, with very good specificity and NPV, but poor sensitivity and PPV.

https://doi.org/10.21470/1678-9741-2020-0521

DETERMINANTES MACROECONÓMICOS DE LA VALORACIÓN DE ACCIONES: CASO ALIANZA DEL PACÍFICO
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Chávez-Muñoz, Nelson Manolo

; Ríos-Hernández, Héctor Fabio

; Carmona-Muñoz, Diana Milena

Dimensión Empresarial

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Mar 2020, Volume 18 Nº 1 Páginas 129 - 146

Resumo: Es En Pt | Texto: Es En Pt | PDF: Es | PDF: En | PDF: Pt

Resumen Este documento tiene como objetivo identificar los determinantes macroeconómicos que influyen en los retornos de las carteras en los mercados financieros de los países que hacen parte de la Alianza del Pacífico, para los años 2009 a 2015. Se pretende establecer si la teoría de fijación de precios de arbitraje (APT) de Ross (1976), se aplica a los portafolios de los mercados bursátiles de la Alianza. Las carteras se construyeron a partir de la metodología propuesta por Fama & French (1996). El estudio concluye en términos empíricos que el modelo APT no aplica a los mercados financieros de la Alianza del Pacífico. Palabras Clave: Teoría de fijación de precios de arbitraje (APT), factores macroeconómicos, bolsas de valoresLa economía mundial se vio afectada por la crisis financiera que resultó de un período de excesivos endeudamientos y préstamos. El propósito de la investigación fue comprender el proceso de toma de decisiones de crédito y los requisitos de información de los bancos. Se realizó una encuesta a veintidós establecimientos de crédito brasileños y los resultados muestran que la importancia percibida y la frecuencia del uso de los recursos, como las cuentas auditadas, los registros internos de los banqueros y la experiencia previa en préstamos fueron similares. La garantía fue un tema importante para las pequeñas empresas debido al problema de información asimétrica.

Abstract This document has as main objective to identify the macroeconomic determinants that influence the returns of the portfolios in the financial markets of the countries that are part of the Pacific Alliance, for the years between 2009 and 2015. Thus, it is intended to establish if the arbitration pricing theory (APT) postulated by Ross (1976), applies to the portfolios of the Alliance’s stock markets. The portfolios were constructed based on the methodology proposed by Fama and French (1996). The study concludes in empirical terms that the APT model does not apply to the financial markets of the Pacific Alliance countries.

Resumo Este documento tem como objetivo principal identificar os determinantes macroeconômicos que influenciam o retorno das carteiras nos mercados financeiros dos países que fazem parte da Aliança do Pacífico, para os anos entre 2009 e 2015. Assim, pretende-se estabelecer se a teoria de preços de arbitragem (APT) postulada por Ross (1976), se aplica às carteiras dos mercados de ações da Aliança. As carteiras foram construídas com base na metodologia proposta por Fama e French (1996). O estudo conclui em termos empíricos que o modelo APT não se aplica aos mercados financeiros dos países da Aliança do Pacífico.

https://doi.org/10.15665/dem.v18i(1).2066 555 downloads

10.

Ulcer pressure prevention and opportunity for innovation during the COVID-19 crisis
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Nani, Fernando Souza

; Stéfani, Kelly Cristina

; Busnardo, Fabio de Freitas

; Monteiro, Gustavo Gomes Ribeiro

; Santos, Maria Gabriela Guimarães Ribeiro dos

; John, Vanderley Moacyr

; Gouvêa, Douglas

; Carmona, Maria José C.

Clinics

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2020, Volume 75 elocation e2292

Resumo: En | Texto: En | PDF: En

https://doi.org/10.6061/clinics/2020/e2292 919 downloads

11.

TYROSINEMIA TYPE III: A CASE REPORT OF SIBLINGS AND LITERATURE REVIEW
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Barroso, Fábio

; Correia, Joana

; Bandeira, Anabela

; Carmona, Carla

; Vilarinho, Laura

; Almeida, Manuela

; Rocha, Júlio César

; Martins, Esmeralda

Revista Paulista de Pediatria

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2020, Volume 38 elocation e2018158

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: A tirosinemia tipo III (TT III) é a forma mais rara das tirosinemias e o espectro clínico desta entidade não está totalmente esclarecido. O envolvimento neurológico é variável, incluindo o atraso cognitivo ou transtorno do déficit de atenção com hiperatividade (TDAH). Descrevemos o caso de dois irmãos que foram diagnosticados com TT III em idades diferentes. Descrição dos casos: O caso índice foi diagnosticado no contexto do rastreio endócrino-metabólico neonatal, tendo iniciado imediatamente dieta hipoproteica, com redução consistente dos níveis de tirosina. Por volta dos três anos, foi detectado um comportamento hiperativo, tendo iniciado dois anos depois tratamento para o TDAH. Aos sete anos, apresenta leve melhora de comportamento e da atenção e avaliação cognitiva levemente inferior ou pouco abaixo quando comparado a crianças da mesma faixa etária, apesar de manter níveis aceitáveis de tirosina. A sua irmã, com história de TDAH desde os cinco anos, foi diagnosticada de TT III aos oito anos no contexto do rastreio de familiares. Apesar de iniciar tratamento dietético, nenhum efeito foi notado em termos de comportamento e a doente apresenta leve atraso cognitivo. Comentários: Este é o primeiro caso clínico descrito de irmãos com TT III que iniciaram terapêutica dietética com dieta hipoproteica em diferentes fases da vida, com melhor avaliação em termos neurológicos e comportamentais no doente que iniciou tratamento mais precocemente.

ABSTRACT Objective: Tyrosinemia type III (HT III) is the rarest form of tyrosinemia, and the full clinical spectrum of this disorder is still unknown. The neurological involvement varies, including intellectual impairment and attention deficit disorder with hyperactivity (ADHD). We report the case of two siblings diagnosed with HT III at different ages. Case description: The index case was diagnosed by newborn screening for endocrine and metabolic disorders, starting a low-protein diet immediately, with a consistent decrease in tyrosine levels. By the age of three, the child displayed a hyperactive behavior, starting treatment for ADHD two years later. At seven years of age, he shows a slight improvement in terms of behavior and attention span and has a cognitive performance slightly lower than his peers, despite maintaining acceptable tyrosine levels. His sister, who had a history of ADHD since age five, was diagnosed with HT III after family screening at the age of eight. Despite initiating a dietetic treatment, her behavior did not improve, and she has a mild intellectual impairment. Comments: This is the first case report describing siblings with HT III who underwent nutritional treatment with a low-protein diet in different phases of life, with a better neurological and behavioral evaluation in the patient who started treatment earlier.

https://doi.org/10.1590/1984-0462/2020/38/2018158 2380 downloads

12.

A multidisciplinary approach to prevent and treat pressure sores in proned COVID-19 patients at a quaternary university hospital
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Busnardo, Fabio de Freitas

; Monteiro, Gustavo Gomes

; Mendes, Rogério Rafael da Silva

; Abbas, Laielly

; Pagotto, Vitor Figueiredo

; Camargo, Cristina

; Carmona, Maria José Carvalho

; Gemperli, Rolf

Clinics

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2020, Volume 75 elocation e2196

Resumo: En | Texto: En | PDF: En

https://doi.org/10.6061/clinics/2020/e2196 841 downloads

13.

Surgery is unlikely to be enough for a patient to stop smoking 24 h prior to hospital admission
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Marinho, Igor Maia

; Carmona, Maria José C.

; Benseñor, Fábio Ely Martins

; Hertel, Julia Mintz

; Moraes, Marcos Fernando Breda de

; Santos, Paulo Caleb Junior Lima

; Vane, Matheus Fachini

; Issa, Jaqueline Scholz

Revista Brasileira de Anestesiologia

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Ago 2018, Volume 68 Nº 4 Páginas 344 - 350

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Introdução A necessidade de cirurgia pode ser um fator decisivo para a cessação do tabagismo em longo prazo. Por outro lado, situações que precipitam o estresse podem precipitar a recaída do tabagismo. Decidimos avaliar o impacto de uma cirurgia no esforço do paciente para deixar de fumar durante pelo menos 24 horas antes da internação hospitalar e a possível recaída nas últimas 24 horas anteriores à internação em ex-fumantes. Métodos Fumantes, ex-fumantes e não fumantes adultos, quer de clínica pré-anestésica ou recentemente internados para cirurgias eletivas programadas que ficariam, no máximo, seis horas dentro das unidades hospitalares, foram incluídos no estudo. Os pacientes responderam um questionário na enfermaria ou na entrada da sala de operação (Grupo Internação) ou no início da primeira consulta pré-anestesia (Grupo Clínico) e fizeram mensurações dos níveis de CO. Resultados No total, 241 pacientes foram incluídos: 52 ex-fumantes, 109 que nunca fumaram e 80 não fumantes. Os fumantes apresentaram níveis mais elevados de monóxido de carbono expirado que os não fumantes e ex-fumantes (9,97 ± 6,50 vs. 2,26 ± 1,65 vs. 2,98 ± 2,69;p = 0,02). Entre os fumantes, o Grupo Clínico apresentou níveis de CO não estatisticamente diferentes daqueles do Grupo Internação (10,93 ± 7,5 vs. 8,65 ± 4,56; p = 0,21). Os ex-fumantes não apresentaram diferenças significativas entre os grupos Clínico e Internação para os níveis de monóxido de carbono (2,9 ± 2,3 vs. 2,82 ± 2,15; p = 0,45). Conclusão É improvável que uma condição médica, como uma cirurgia, sem assistência adequada seja suficiente para que um paciente pare de fumar, pelo menos, 24 horas antes da internação. A proximidade de uma cirurgia não foi associada à recaída do tabagismo nas 24 horas anteriores ao procedimento.

Abstract Introduction The need for surgery can be a decisive factor for long-term smoking cessation. On the other hand, situations that precipitate stress could precipitate smoking relapse. The authors decided to study the impact of a surgery on the patient's effort to cease smoking for, at least, 24 h before hospital admission and possible relapse on the last 24 h before hospital admission for ex-smokers. Methods Smoker, ex-smokers and non-smokers adults, either from pre-anesthetic clinic or recently hospital admitted for scheduled elective surgeries that were, at most, 6 h inside the hospital buildings were included in the study. The patients answered a questionnaire at the ward or at the entrance of the operating room (Admitted group) or at the beginning of the first pre-anesthetic consultation (Clinic group) and performed CO measurements. Results 241 patients were included, being 52 ex-smokers and 109 never smokers and 80 non-smokers. Smokers had higher levels of expired carbon monoxide than non-smokers and ex-smokers (9.97 ± 6.50 vs. 2.26 ± 1.65 vs. 2.98 ± 2.69; p = 0.02). Among the smokers, the Clinic group had CO levels not statistically different of those on the Admitted group (10.93 ± 7.5 vs. 8.65 ± 4.56; p = 0.21). The ex-smokers presented with no significant differences for the carbon monoxide levels between the Clinic and Admitted groups (2.9 ± 2.3 vs. 2.82 ± 2.15; p = 0.45). Conclusion A medical condition, such as a surgery, without proper assistance is unlikely to be enough for a patient to stop smoking for, at least, 24 h prior to admission. The proximity of a surgery was not associated with smoking relapse 24 h before the procedure.

https://doi.org/10.1016/j.bjane.2017.12.004 1511 downloads

14.

Disseminating health evidence summaries to increase evidence use in health care
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Galvao, Maria Cristiane Barbosa

; Carmona, Fabio

; Grand, Roland

; Pluye, Pierre

; Ricarte, Ivan Luiz Marques

Revista de Saúde Pública

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2018, Volume 52 elocation 57

Resumo: En | Texto: En | PDF: En

ABSTRACT OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.

https://doi.org/10.11606/s1518-8787.2018052000418 1103 downloads

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Disseminating health evidence summaries to increase evidence use in health care
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Galvao, Maria Cristiane Barbosa

; Carmona, Fabio

; Grand, Roland

; Pluye, Pierre

; Ricarte, Ivan Luiz Marques

Revista de Saúde Pública

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2018, Volume 52 elocation 57

Resumo: En | Texto: En | PDF: En

https://doi.org/10.11606/s1518-8787.2018052000418 77 downloads

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