Comparison of initial loading doses of 5 mg and 10 mg for warfarin therapy

CONTEXTO:A melhor dose para o início do tratamento anticoagulante com varfarina vem sendo debatida nos últimos dez anos. Em nosso meio, não observamos nenhum estudo comparativo quanto a estas características.OBJETIVO:Comparar segurança e eficácia de dois esquemas de dosagem inicial de varfarina para tratamento anticoagulante.MÉTODOS:Foram estudados prospectivamente 110 pacientes de ambos os sexos, consecutivos, com indicação de anticoagulação por tromboembolismo venoso ou arterial. Durante os três primeiros dias de tratamento, estes pacientes receberam doses adequadas de heparina (RT - razão dos tempos - alvo entre 1,5 e 2,5) e 5 mg de varfarina, cuja dose foi reajustada a partir do quarto dia pelo Razão Normatizada Internacional - RNI (alvo entre 2 e 3). Esse grupo foi comparado com série histórica de 110 pacientes que receberam 10 mg nos dois primeiros dias, 5 mg a partir do terceiro dia, com ajuste posterior de dose baseado no RNI. Os desfechos foram: recorrência do tromboembolismo, sangramentos e tempo para alcançar níveis terapêuticos.RESULTADOS:A eficácia, a segurança e o tempo de internação foram similares entre os grupos. O grupo que recebeu 10 mg atingiu níveis terapêuticos mais precocemente (média de 4,5 dias × 5,8 dias), sendo as doses na alta menores e os níveis terapêuticos mais adequados na primeira visita de retorno.CONCLUSÃO:O esquema de dosagem de 10 mg proporcionou menor tempo para alcançar nível terapêutico, com menores doses de varfarina na alta e RNI mais adequado no retorno.

Terapia nutricional perioperatória em pacientes submetidos à hepatectomia devido carcinoma hepatocelular (CHC): revisão sistem[atica de ensaios clínicos randonizados

Pós-graduação em Bases Gerais da Cirurgia - FMB

Análise dos atendimentos do SAMU 192: componente móvel da Rede de Atenção às Urgências e Emergências

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Eventos adversos em terapia medicamentosa em Unidade de Terapia Intensiva - UTI

Due to the complexity and instability of clinical conditions of ICU patients, the drug therapy applied in this type of environment requires a combination of several prescribed drugs, which is a favorable condition for drug interaction, toxic synergism and possible iatrogenia. In the possible universe of ICU occurrences, this study aimed at identifying and evaluating the incidence of adverse events in drug therapy at the Intensive Care Therapy Service (SETI) in wards I and II. It is a cross-sectional, descriptive, prospective and quantitative study conducted from August to September, 2011 in the Intensive Care Service of the Botucatu School of Medicine University Hospital - UNESP. The population consisted of fifteen clinical nurses, including those in the Improvement and Volunteer Internship Programs, who contributed to the investigation after signing an informed consent form and according to approval by the Research Ethics Committee number 10711/CE - FMB. The data were entered on a form and analyzed. Results showed that, on average, 8.9% of events/day occurred, and the highest frequency was observed on August 04, 2011. 63% and 22% were respectively observed in the morning and afternoon shifts, and 15% in the night shift. 48% of these were due to administration time errors, followed by drug prescription and dispensation errors, with percentages of 22% and 18%, respectively. Antibiotics showed the highest frequency of adverse events - 18%, which was followed by 13% for anticoagulant, 11% for antiemetic and 10% for antiulcerative drugs. As regards the occurrence of adverse events related to hospitalization time, the highest frequency occurred in patients who were hospitalized for 10 days. Concerning the ratio between reported events and the number of items in the prescription, the highest frequency of events was related to prescriptions with 20 items... (Complete abstract click electronic access below)

A atividade física na saúde mental: uma revisão de literatura

Ao longo da história, a doença mental passou por diversos períodos de críticas relações com a própria humanidade, exposta à vulnerabilidade dos mitos e pré-concepções que motivaram a perseguição e segregação daqueles seres humanos qualificados como “insanos”. No Brasil, as primeiras intervenções específicas de atendimento à doença mental só ocorreram a partir da segunda metade do século 19. Atualmente a doença mental representa um dos maiores gastos da rede do SUS (Sistema Único de Saúde) (Ministério da Saúde do Brasil, 1999). Nas últimas décadas, a fim de diminuir o tempo de internação e o gasto com medicamentos, um conjunto de iniciativas surgiu como forma de transformar a compreensão cultural e a relação da sociedade com as pessoas que apresentam transtornos mentais. Dentre as novas propostas humanizadoras de atendimento, a educação física e, particularmente, o exercício, vieram mostrar sua contribuição nessa área. Para Silva (1995), a atividade física acarreta uma complexa rede de reações bioenergéticas no organismo e essas acabam por melhorar o rendimento físico e mental dos pacientes nas atividades de vida diária. Tendo em vista a relevância da intervenção através da atividade física no campo da doença mental, o objetivo deste trabalho foi analisar resultados dos estudos que demonstraram os benefícios da atividade física para indivíduos com transtornos psiquiátricos, considerando os aspectos fisiológicos e emocionais dos mesmos, através de revisão da literatura científica. Para isso, foi feito um levantamento nas principais bases de dados através do cruzamento de palavras chaves, tais como “saúde mental e atividade física”, “doença mental e atividade física”, “esquizofrenia e atividade física”, “transtorno psiquiátrico e atividade física”, “transtorno bipolar e atividade física”. Os resultados dos estudos revelaram que a atividade física possui...

Depressão e apoio social percebido por mães de crianças hospitalizadas

This study was performed as a requirement of the final course in Nursing. The study is cross-cutting, in order to identify associations between socioeconomic factors, education, child hospitalization in the ICU or not, degree of depression and level of social support (material, affective, emotional, informational and positive social interaction) and how to identify subgroups of mother - child vulnerable. Constitute themselves as subjects, mothers of children 0 to 17 years, 11 months and 29 days in hospital after the second day of hospitalization in the pediatric unit of a State Hospital Interior Paulista. Data collection was initiated after obtaining the assent of the Research Ethics Committee, as well as signing the consent form. We used the following instruments to collect data: the data form for socioeconomic and hospitalization; Beck Depression Inventory and Medical Outcomes Study (MOS). We obtained the result that there is a strong association between availability and social support and income per capita and the degree of depression, but did not find an association between time and hospital stay and whether the child was admitted to the ICU or not. We conclude that it is necessary to establish treatment services from the patient’s family, plus an appropriate social service support to meet this big demand for mothers who need support

Desperdício de dieta enteral em UTI: análise de modo de falhas e efeitos de danos ao paciente grave

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization

Introduction: The frequency of surgical procedures has increased steadily in recent decades, including the myocardial revascularization.Objectives: To demonstrate the importance of physiotherapy in the preoperative period of cardiac surgery in relation to the reduction of hospital stay, changes in lung volumes and respiratory muscle strength.Methods: We conducted a prospective study with patients undergoing myocardial revascularization, the Hospital das Clinicas da Universidade Estadual Paulista (UNESP)/Botucatu - SP. We evaluated 70 patients of both genders, aged between 40 and 75 years, subdivided into two groups: group I - 35 patients of both genders, who received a written protocol guidance, breathing exercises and respiratory muscle training in the preoperative period and group II - 35 patients of both genders, who received only orientation of the ward on the day of surgery. This study was approved by the Ethics Committee of UNESP /Botucatu - SP.Results: Maximal inspiratory pressure in third postoperative day and fifth postoperative day and significant difference between groups, being better for the intervention group. Expiratory pressure was significant in fifth postoperative day in the intervention group compared to controls. The difference of length of hospital stay in the postoperative was found between the groups with shorter hospital stay in the group receiving preoperative therapy.Conclusion: Physical therapy plays an important role in the preoperative period, so that individuals in the intervention group more readily restored the parameters evaluated before surgery, in addition, there was a decrease in the time of the postoperative hospital stay. Thus, it is thought the cost-effectiveness of a program of preoperative physiotherapy.

Fatores maternos associados à realização de cesárea eletiva e resultado perinatal segundo tipo de parto: estudo populacional desenvolvido em município de médio porte do interior paulista

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliações farmacoeconômicas em vigilância de medicamentos

The study aimed to identify pharmacoeconomic studies in pharmacovigilance and to observe the economic outcomes in post-marketing surveillance. Therefore, a bibliographic survey was performed in databases Lilacs, PubMed/ Bireme. The search strategy was done by using scientific health descriptors [ "adverse drug reaction reporting systems " OR " medication errors " OR "product surveillance, postmarketing" OR " sentinel surveillance" ] AND [ " cost-benefit analysis" OR "cost efficiency analysis " OR " costs and cost analysis " OR " hospital costs " OR " cost-effectiveness " OR " cost-effectiveness evaluation " OR " drug costs " ]. Manuscripts published in the last 10 years were selected. We chose 13 articles, of which 12 corresponded to cost-benefit analysis and only one to cost-effectiveness assessment. In only one study there was no economy, all the other ones generated savings, ranging from 13.7 to 30% in spending valued service. Surveillance actions were: continuing education; active search through tracking devices and / or implementation of round; teamwork and multidisciplinary deployment; computerized security services management, enabling traceability of information and alerts. The results of the proposed actions have led to the prevention of adverse drug reactions, to decline of risks to the patient, to the reduction of inappropriate prescriptions, as well as the length of hospital stay spending valued service. Surveillance actions were: continuing education; active search through tracking devices and / or implementation of round; teamwork and multidisciplinary deployment; computerized security services management, enabling traceability of information and alerts. The results of the proposed actions have led to the prevention of adverse drug reactions, to decline of risks to the patient, to the reduction of inappropriate prescriptions, as well as the length of hospital stay

Infecção do trato urinário adquirida em ambiente hospitalar em idosos

Introduction: Hospital-acquired urinary tract infection (HAUTI) is an important cause of morbidity in the elderly population. Objective: Evaluate the occurrence of HAUTI and risk factors associated with it. Method: This is a prospective study of a sample of 332 elderly people, interned in a university hospital. Criteria for defining infection were established by the Center for Diseases and Prevention Control. Statistical analysis of data used calculation of frequencies, odds ratio and logistic regression. The rate of hospital infection was 23.6%. The prevalent topographies of infection were respiratory infections (27.6%), urinary tract infections (26.4%) and surgical wound infections (23.6%, with 21, 20 and 19 episodes, respectively. The HAUTI incidence density associated with urinary catheterization was 24.2 infections by 1,000 catheter-days. The length of hospital stay of patients without nosocomial infection was 6.9 days and with HAUTI was increased in 10.4 (p<0.05).The rate of mortality of patients with HAUTI was 20%. Pathogens were isolated in 75% of episodes of HAUTI and the prevalent were: Escherichia coli (33%) and Pseudomonas aeruginosa (20%). Risk factors found for HAUTI were urinary catheterization implementation (odds ratio (OR) = 43.1; 95% confidence interval (95 CI%) = 3.9 – 311.1), hospitalization with community infection (OR= 21.9; 95% CI = 4.9 – 97.9); vascular diseases (OR=14; 95% CI = 2 – 98); diabetes mellitus (OR= 5.5; 95% CI = 1.4 – 21) and urinary catheterization by more than three days (OR=3.7; 95% CI = 1 – 13.8). Conclusions: HAUTI presented elevated incidence and it increased the length of hospital stay.

Cuidados paliativos para pacientes em estado terminal em Unidades de Terapia Intensiva: revisão sistemática e metanálise

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação dos protocolos de diagnóstico e de controle da hiperglicemia materna: impacto na prevalência de Diabetes Melito Gestacional (DMG) e de Hiperglicemia Gestacional Leve (HGL) e nos resultados perinatais

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Correlação entre os resultados pré-operatórios de testes cardiopulmonares e a evolução pós-operatória em cirurgia bariátrica

Pós-graduação em Bases Gerais da Cirurgia - FMB

Avaliação do comportamento da mecânica respiratória e dos testes de exercício cardiopulmonar no pré e pós-operatório de pacientes submetidos à toracotomia para tratamento de doenças malignas e benignas, sua relação com as complicações pós-operatórias e com a qualidade de vida

Pós-graduação em Bases Gerais da Cirurgia - FMB