Avaliação dos efeitos de diferentes manobras de fisioterapia respitatória no desfecho de pacientes ventilados mecanicamente

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A interface entre uma Unidade de internação infantil em Pronto Socorro de Hospital Universitário, com o Sistema de Saúde local e regional

Pós-graduação em Pediatria - FMB

A morte em situações de urgência e emergência: a dimensão cuidadora dos profissionais de enfermagem

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Avaliação e capacitação da equipe de enfermagem para o atendimento da parada cardiorrespiratória em uma unidade de terapia intensiva de um pronto socorro

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Comportamentos e situações de risco e de segurança para acidente com material biológico durante estágio curricular de enfermagem

Pós-graduação em Educação - FFC

Perfil epidemiológico de acidentes com material biológico entre estudantes de medicina em um pronto-socorro cirúrgico

OBJECTIVE: To evaluate the accidents with biological material among medical students interning in a trauma emergency room and identify key related situations, attributed causes and prevention. METHODS: we conducted a study with a quantitative approach. Data were collected through a questionnaire applied via internet, with closed, multiple-choice questions regarding accidents with biological material. The sample comprised 100 students. RESULTS: thirty-two had accidents with biological material. Higher-risk activities were local anesthesia (39.47%), suture (18.42%) and needle recapping (15.79%). The main routes of exposure to biological material were the eyes or mucosa, with 34%, and syringe needle puncture, with 45%. After contamination, only 52% reported the accident to the responsible department. CONCLUSION: The main causes of accidents and routes of exposure found may be attributed to several factors, such as lack of training and failure to use personal protective equipment. Educational and preventive actions are extremely important to reduce the incidence of accidents with biological materials and improve the conduct of post-exposure. It is important to understand the main causes attributed and situations related, so as general and effective measures can be applied.

Avaliação dos parâmetros gasométricos dos traumatizados durante o atendimento pré-hospitalar móvel

OBJECTIVE: To evaluate gasometric differences of severe trauma patients requiring intubation in prehospital care. METHODS: Patients requiring airway management were submitted to collection of arterial blood samples at the beginning of pre-hospital care and at arrival at the Emergency Room. We analyzed: Glasgow Coma Scale, respiratory rate, arterial pH, arterial partial pressure of CO2 (PaCO2), arterial partial pressure of O2 (PaO2), base excess (BE), hemoglobin O2 saturation (SpO2) and the relation of PaO2 and inspired O2 (PaO2/FiO2). RESULTS: There was statistical significance of the mean differences between the data collected at the site of the accident and at the entrance of the ER as for respiratory rate (p = 0.0181), Glasgow Coma Scale (p = 0.0084), PaO2 (p <0.0001) and SpO2 (p = 0.0018). CONCLUSION: tracheal intubation changes the parameters PaO2 and SpO2. There was no difference in metabolic parameters (pH, bicarbonate and base excess). In the analysis of blood gas parameters between survivors and non-survivors there was statistical difference between PaO2, hemoglobin oxygen saturation and base excess.

Orientações de alta: cartões padronizados ajudam na compreensão dos pacientes do pronto socorro?

OBJECTIVE: To determine whether the addition of discharge standard illustrated cards improves understanding of patients in the emergency room. METHODS: We conducted a prospective, randomized, interventional study with 228 patients discharged from the emergency department. All patients were interviewed and tested for the level of understanding of discharge instructions. Some of them received the intervention, with the standard cards, and another did not, constituting the control group. RESULTS: The average of followed discharge guidelines of the group that received the cards was higher than the control group, with statistical significance (p=0.009). When segregated by age, the group between 16 and 35 years of both sexes had the best average of followed guidelines, statistically, than the average of the control group (p=0.01). The difference between the mean orientations between the control group and the card for patients undergoing procedures was statistically significant (p=0.02); as for the stratification according to the number of procedures, the significance increases when that is equal to 1 (p=0.001) and decreased the more procedures were carried out. CONCLUSION: The introduction of discharge standard orientation cards was associated with improvement in the understanding of patients. Without replacing the verbal directions, which establishes dialogue and doctor-patient bonding, cards appear as auxiliary elements, facilitating understanding and care guidelines.

Caracterização da demanda do pronto socorro do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP

The demand for health services can be understood as an application needs the user has. The inability to use the outpatient services and limited supply of these make it possible for users to browse sites that focus attention on a greater possibility of entry doors, in which first-aid centers and hospital emergency match this profile, distorting the flow of patients in the network through an inverse demand of the movement hierarchy. Added to this, the burden of care in these services results in overcrowding and poor quality of care. Evaluate the demand of the visits occurred in the Emergency Room of the Hospital of the Medical School of Botucatu / UNESP (PS - HC - FMB / UNESP) during June-July 2010. A transversal, descriptive and retrospective. For data collection sheet was used in the proposed Service unit and the data it was filled out the form with the necessary items for the search. Made an exploratory analysis and frequency distributions for categorical variables of the form. Females predominated (56%) and aged 61 years or older with 30%. 96.5% were owned by DRS VI, and 62.5% of Botucatu. The attendance by the physician on duty and corresponded to 57.7% among the 23 medical specialties, Gastric (7.0%), Cardiology (4.5%), Medical (4.4%), urology (4.2%) and Pulmonology (4.1%) were the ones that stood out. The medical procedures performed that stood out were X-ray (46.4%) and electrocardiogram (ECG) (42.3%) and in most specialty care occurred, only the daily consultation with the patient. It was possible to characterize, so the demand for PS - HC - FMB / UNESP for the period June- July 2010, The predominance of the elderly shows that come along with aging diseases and addictions, causing a greater need for health services. Moreover, this study showed that the high number of visits is related to both the daily demands that the tertiary hospital has the same transformation... (Complete abstract click electronic access below)

Gerenciamento dos resíduos de serviços de saúde do pronto socorro de um hospital escola na cidade de Botucatu

Health Care Waste (HCW) represents 1%, and it has presently gained a lot of importance. Adequate management is one of the great challenges to be faced by health care centers. It has gained distinction and been widely discussed by members of the sectors involved with sanitation, public health and environmental issues due to waste physical, chemical biological characteristics, which pose potential risk to the environment and public health. The present study aims at evaluating HCW internal management by following all its phases, determining indicators, classifying and quantifying, establishing production rates (kg /patient/day) for the sector and designing materials to disseminate appropriate HCW disposal in the Emergency Room of the UNESP University Hospital in the city of Botucatu according to the guidelines presently in force. : From June to October 2011, the waste flow was observed from its production to final disposal. Four weight measurements were performed on four consecutive days in the month of August by using a properly calibrated (in grams) digital scale at the times scheduled for collection of the produced waste. Hence, the daily and monthly amounts were estimated according to their classification. All the waste packaged in the bags in garbage cans in the Emergency Room for a 24-hour period was considered to be a sample. Separation was not adequately performed in that sector, and waste from Group A was mixed with that from Group D. The amount of infectious waste produced in the sector corresponded to 87.80 %, common waste to 10.93 % and recyclable waste to 1.27%. The mean daily HCW production was of 123.300 kg/day, and the total monthly production was of 3,822 kg/month, which was distributed as follows: Group A 3,355,750 kg/month; Group D 417,570 kg/month and recyclables 48,670 kg/month. The production rate corresponded to 0.47 kg/patient/day, thus showing... (Complete abstract click electronic access below)

Análise dos acidentes automobilísticos atendidos no Hospital das Clínicas no ano de 2010, Botucatu

As a result of the 20th-century industrial development, and particularly after World War II, cars have become an important consumer good, and this has led to a large number of circulating vehicles. To this day, the number of cars has increased exponentially worldwide, which results in a high number of traffic accidents (TAs) every day. TAs are responsible for 1.2 million deaths worldwide each year, and in Brazil, they are considered to be a public health problem, considering that its traffic is regarded as one of the worst and most dangerous in the world. In addition to temporary or permanent physical disabilities that bring great harm to individuals, accidents also cause psychological disorders, such as the post-traumatic stress disorder. Hence, considering the importance of TAs in the country and their outcomes, this study aimed at investigating the epidemiological aspects of car accidents occurring in 2010 who were assisted in the emergency room of a university hospital in São Paulo state. By means of records made by the nursing team and medical records analysis, it was possible to extract a stratified sample of 88 cases involving adults and eight cases involving children. The sample was analyzed by the SAS software for Windows, version 9.2. As regards the accidents involving adults, there was a predominance of males (67%), with an approximate 2:1 ratio in relation to females. The victims’ most frequent age range was 20-29 years (39%), and they were mostly single (56%). The month showing the largest number of occurrences was July, with 17%, and the weekday was Sunday, with 25%. Showing 32%, the time period when most accidents occurred was from 06:00 o’clock p.m. to 11:59 p.m. As regards vehicles types involved, motorcycles were in first place, with 47% of cases, and the most common accident type was crashing between vehicles, with 43%... (Complete abstract click electronic access below)

The mean corpuscular volume and hydroxyurea in brazilian patients with sickle cell anemia: a surrogate marker of compliance

The suppression of erythropoiesis by Hydroxyurea (HU) therapy is associated with increase in mean corpuscular volume, in addition to the increase in Hb F. Monitoring the mean corpuscular volume values and the presence of macrocytosis are effective tools of adherence to the treatment with HU in patients with sickle cell anemia. The aim of this study is to monitor the mean corpuscular volume values after starting treatment with HU to determine if macrocytosis can be used as a surrogate marker of compliance with therapy. We conducted a prospective cohort study over one year with measurements of blood counts and mean corpuscular volume after starting therapy with HU in 95 patients with sickle cell anemia who were regularly followed in our ambulatory outpatient unit. In one-year of successful use of HU the mean value of the mean corpuscular volume increased significantly. The Andersen and Gill model demonstrated that the increase of one unit of MCV implies a 5% reduction in the risk of visiting the emergency room. Monitoring mean corpuscular volume values after prescribing HU alerts the provider of noncompliance in order to counsel the patient in question for better adherence to the use of HU that could improve the quality of care and to reduce morbidity and the frequency of acute pain crises and associated healthcare costs.

Relação entre poluição do ar e internações hospitalares por doenças respiratórias e cardiovascular em uma cidade do interior do Estado de São Paulo

Pós-graduação em Fisioterapia - FCT

As interfaces da convivência da família em uma unidade de pronto socorro

The aim was to describe the positive and negative aspects in a family communication at an emergency care unit. This is a descriptive research with a qualitative approach. The sample consisted of 20 family members / caregivers of patients admitted to the emergency room of a university hospital. Data collection was carried out through semi-structured interviews applied during the period of May-June 2011. Data analysis was performed using the methodological framework of the Collective Subject Discourse which resulted in four themes: Lack of information compromising the family/health professional ties; The ideal model of information provided by the professional regarding the condition of the hospitalized relative; Assessment of information provided about hospital routines; and The role of the relative/companion. Therefore, for the patient and his family, communication is presented as a tool on the care given with the function of transmitting safety, respect and guidance. However when it is incomplete, it becomes a potential form of stress and dissatisfaction.

Enfermagem cuidando de paciente adulto e família no processo de morte em sala de emergência

The purpose of the study was to understand the experience of nursing professionals on the care provided to adult patients and relatives who experience the dying process in an emergency room. Statements of 12 nursing professionals, being 8 technicians and 4 registered nurses of the emergency room of a high-complexity university hospital were analyzed. Data was collected by means of semi-structured interviews and evaluated according to Bardin’s content analysis. As a result, the theme entitled the relative’s mourning process emerged with two categories: alterity as an opening and suffering as a limit. when subjectivity, which was revealed under the principle of alterity, permeated the subjects’ actions, the nursing practices were targeted at the patients and their relative’s needs, but suffering as a limit imposed distancing by the professionals during care provision, even when it was perceived as necessary.