Impacto na epidemiologia da sepse tardia após a mudança do protocolo de antimicrobianos em uma UTIN de um serviço universitário

Advances in neonatology resulted in reducing the mortality rate and the consequent increase in survival of newborn pre terms (PTN). On the other hand, there was also a considerable increase in the risk of developing health care-related infection (HAI) in its most invasive, especially for bloodstream. This situation is worrying, and prevent the occurrence of it is a challenge and becomes one of the priorities in the Neonatal Intensive Care Unit (NICU). Sepsis is the main cause of death in critical neonates and affects more than one million newborns each year, representing 40% of all deaths in neonates. The incidence of late sepsis can reach 50% in NICUs. Currently the major responsible for the occurrence of sepsis in developed countries is the coagulase negative Staphylococcus (CoNS), followed by S. aureus. The cases of HAIs caused by resistant isolates for major classes of antimicrobial agents have been increasingly frequent in the NICU. Therefore, vancomycin has to be prescribed more frequently, and, today, the first option in the treatment of bloodstream infections by resistant Staphylococcus. The objectives of this study were to assess the impact on late sepsis in epidemiology III NICU after the change of the use of antimicrobials protocol; check the frequency of multiresistant microorganisms; assess the number of neonates who came to death. This study was conducted in NICU Level III HC-UFU. three study groups were formed based on the use of the proposed late sepsis treatment protocol, with 216 belonging to the period A, 207 B and 209 to the C. The work was divided into three stages: Period A: data collected from neonates admitted to the unit between September 2010 to August 2011. was using treatment of late sepsis: with oxacillin and gentamicin, oxacillin and amikacin, oxacillin and cefotaxime. Period B: data were collected from March 2012 to February 2013. Data collection was started six months after protocol change. Due to the higher prevalence of CoNS, the initial protocol was changed to vancomycin and cefotaxime. Period C: data were collected from newborns inteerne in the unit from September 2013 to August 2014. Data collection was started six months after the protocol change, which occurred in March 2013. From the 632 neonates included in this study, 511 (80,8%) came from the gynecology and obstetrics department of the HC-UFU. The mean gestational age was 33 weeks and the prevailing sex was male (55,7%). Seventy-nine percent of the studied neonates were hospitalized at the NICU HC-UFU III because of complications related to the respiratory system. Suspicion of sepsis took to hospitalization in the unit of 1,9% of newborns. In general, the infection rate was 34,5%, and the most frequent infectious sepsis syndrome 81,2%. There was a tendency to reduce the number of neonates who died between periods A 11 and C (p = 0,053). From the 176 cases of late sepsis, 73 were clinical sepsis and 103 had laboratory confirmation, with greater representation of Gram positive bacteria, which corresponded to 67.2% of the isolates and CoNS the most frequent micro-organism (91,5%). There was a statistically significant difference in the reduction of isolation of Gram positive microorganisms between periods A and C (p = 0,0365) as well as in reducing multidrug-resistant CoNS (A and B period p = 0,0462 and A and C period, p = 0,158). This study concluded that: the CoNS was the main microorganism responsible for the occurrence of late sepsis in neonates in the NICU of HC-UFU; the main risk factors for the occurrence of late sepsis were: birth weight <1500 g, use of PICC and CUV, need for mechanical ventilation and parenteral nutrition, SNAPPE> 24 and length of stay more than seven days; the new empirical treatment protocol late sepsis, based on the use of vancomycin associated cefepime, it was effective, since promoted a reduction in insulation CoNS blood cultures between the pre and post implementation of the Protocol (A and C, respectively); just as there was a reduction in the number of newborns who evolved to death between periods A and C.

Contradições como força de mudança: o processo de formação continuada de professores do ensino médio enquanto potencializador da práxis transformadora à luz da teoria histórico-cultural

The intervention research proposed was based on the Cultural-Historical Theory based on the laws and logic of materialism historical-dialectical. Therefore, we tried to design a research process that involved all as responsible for the process. In the field of continuous teacher's training usually has been found dualistic relationship / paradoxical processes as a result of the adopted training models which are characterized by individualist human processes. The teacher training work sought to overcome this dualism, to promote the unveiling of the contradictions with regard to teaching models. As a hypothesis, we imagined that immersed in this process, teachers recognize such contradictions, and this recognition would make the contradictions become the driving force of change in teaching practice, realizing the teaching-learning-development triad as the basis of praxis. Aiming to develop a process of continuing education to bring results to the professional teachers development looking for answer the following research question: How and what the changes of teachers who participated in the Didactic-Formative Intervention process raised the quality of their teaching practices? In this context, the objective of the research was to develop a process of Didactic-Formative Intervention from the perspective of Cultural-Historical Theory with high school teachers in order to theorize about the changes in pedagogical practices of teachers and learn aspects that transform the essence teaching practice. The research involved two high school teachers of a public school in Uberlândia-MG. The training meetings took place at the school through a collective study group between the years 2013 and 2015. As procedures were used two interconnected aspects: classes observations, and a theoretical and methodological training, both for diagnosis and for the process evaluation, the second aspect has a formative dimension, and a didactic dimension (double meaning) to form didactically the teacher and to elaborate didactic procedures. The collected data were analyzed by observing the assumptions of the method, analysis by units and the processuality. As results teachers showed changes in their teaching practices regarding the organization of the pedagogical work and also centered their design educational actions based on learning and development of the students. The presence of continuous diagnosis during the classes, work with a systems of concepts and their conceptual links, problematization as a teaching method can be pointed as meaningful changes in their praxis. Regarding the training activities that emerged from the analysis of the compiled materials and analyzed throughout the process can be emphasized: forming a collective group of school teachers continuous training, diagnostics, development of practical activities, increase relationships among participants, the choice of scientific material used should have direct relation to the needs of the participants, promoting conditions that enable the emergence of contradictions between the pedagogical practice of teachers and teaching based on the perspective of the Cultural-Historical Theory. This research craved to develop and design a teachers' training processes that increase the quality of teachers life and ways of teaching in the Brazilian public school.