Nursing Activities Score (NAS): adaptação transcultural e validação para a língua portuguesa

O estudo teve como objetivos adaptar para o português e avaliar as propriedades psicométricas do Nursing Activities Score (NAS), instrumento de medida de carga de trabalho de enfermagem em UTI. Após o processo de adaptação cultural, o NAS foi aplicado em uma amostra de 200 pacientes adultos internados em UTIs. A análise da consistência interna pelo coeficiente Alfa de Cronbach revelou que o NAS possui 23 medidas independentes que não comportam consolidação ou redução. A avaliação da confiabilidade interobservadores demonstrou alta concordância (99,8%) e índice Kappa médio de 0,99. A validade concorrente foi demonstrada pela correlação estatisticamente significativa entre o TISS-28 e o NAS (r=0,67; p<0,0001), assim como pela análise de regressão multivariada (R²=94,4%; p<0,0001). Na avaliação da validade convergente, a regressão multivariada mostrou associação estatisticamente significativa entre o NAS e o SAPS II, quando ajustada pela idade (R²=99,8%; p<0,0001). Pelos resultados obtidos, o NAS mostrou-se um instrumento confiável e válido para mensurar carga de trabalho de enfermagem em UTIs brasileiras.

Comunicación de riesgo y sistemas de información en la Web: cinco modelos

Las administracionespúblicas de los países avanzadosestán llevando a caboiniciativas para gestionar lainformación y la comunicaciónde riesgo y emergencias mediantesitios web concebidos ydiseñados para ello. Estos sitiosestán pensados para facilitarinformación a los ciudadanosen caso de emergencias, perotambién contienen informaciónútil para los expertos y las autoridades.En este trabajo, y ala luz de la legislación españolasobre emergencias, se comparanlos sitios de la administraciónautonómica catalana y delgobierno de España con lossitios de tres países de referencia:Estados Unidos, Francia yReino Unido. Al mismo tiempose propone una metodologíasimple para llevar a cabo unacomparación que permita extraerconclusiones y plantearrecomendaciones en un aspectode la gestión de la información que puede resultar clave para salvar bienes materiales y vidas humanas.

ASTRAL Score Predicts 5-Year Dependence and Mortality in Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: The ASTRAL score was externally validated showing remarkable consistency on 3-month outcome prognosis in patients with acute ischemic stroke. The present study aimed to evaluate ASTRAL score's prognostic accuracy to predict 5-year outcome. METHODS: All consecutive patients with acute ischemic stroke registered in the Athens Stroke Registry between January 1, 1998, and December 31, 2010, were included. Patients were excluded if admitted >24 hours after symptom onset or if any ASTRAL score component was missing. End points were 5-year unfavorable functional outcome, defined as modified Rankin Scale 3 to 6, and 5-year mortality. For each outcome, the area under the receiver operating characteristics curve was calculated; also, a multivariate Cox proportional hazards analysis was performed to investigate whether the ASTRAL score was an independent predictor of outcome. The Kaplan-Meier product limit method was used to estimate the probability of 5-year survival for each ASTRAL score quartile. RESULTS: The area under the receiver operating characteristics curve of the score to predict 5-year unfavorable functional outcome was 0.89, 95% confidence interval 0.88 to 0.91. In multivariate Cox proportional hazards analysis, the ASTRAL score was independently associated with 5-year unfavorable functional outcome (hazard ratio, 1.09; 95% confidence interval, 1.08-1.10). The area under the receiver operating characteristics curve for the ASTRAL score's discriminatory power to predict 5-year mortality was 0.81 (95% confidence interval, 0.78-0.83). In multivariate analysis, the ASTRAL score was independently associated with 5-year mortality (hazard ratio, 1.09, 95% confidence interval, 1.08-1.10). During the 5-year follow-up, the probability of survival was significantly lower with increasing ASTRAL score quartiles (log-rank test <0.001). CONCLUSIONS: The ASTRAL score reliably predicts 5-year functional outcome and mortality in patients with acute ischemic stroke.

Pédiatrie. 3. Le score de McIsaac: une aide à l'indication des tests de diagnostic rapide dans tes angines à streptocoques A [Pediatrics. Using the McIsaac score for the indication of rapid diagnostic testing in children with streptococcal pharyngitis].

The McIsaac scoring system is a tool designed to predict the probability of streptococcal pharyngitis in children aged 3 to 17 years with a sore throat. Although it does not allow the physician to make the diagnosis of streptococcal pharyngitis, it enables to identify those children with a sore throat in whom rapid antigen detection tests have a good predictive value.

The role of the New Trauma and Injury Severity Score (NTRISS) for survival prediction

The objective of this study was to verify if replacing the Injury Severity Score (ISS) by the New Injury Severity Score (NISS) in the original Trauma and Injury Severity Score (TRISS) form would improve the survival rate estimation. This retrospective study was performed in a level I trauma center during one year. ROC curve was used to identify the best indicator (TRISS or NTRISS) for survival probability prediction. Participants were 533 victims, with a mean age of 38±16 years. There was predominance of motor vehicle accidents (61.9%). External injuries were more frequent (63.0%), followed by head/neck injuries (55.5%). Survival rate was 76.9%. There is predominance of ISS scores ranging from 9-15 (40.0%), and NISS scores ranging from 16-24 (25.5%). Survival probability equal to or greater than 75.0% was obtained for 83.4% of the victims according to TRISS, and for 78.4% according to NTRISS. The new version (NTRISS) is better than TRISS for survival prediction in trauma patients.

Sistema NAS: Nursing Activities Score em tecnologia móvel

Este estudo objetivou apresentar a estrutura informatizada que viabiliza a utilização do Nursing Activities Score (NAS) em tecnologia móvel. Trata-se de um projeto de desenvolvimento de produção tecnológica baseado na engenharia de software, fundamentada na teoria do ciclo de vida de desenvolvimento de sistema. O Sistema NAS foi construído em dois módulos: módulo de pesquisa, cujo acesso é realizado através de computador pessoal (PC) e módulo de coleta de dados, acessado por meio de dispositivo móvel (smartphone). O Sistema NAS foi construído de modo a permitir que outros formulários, além do instrumento NAS, sejam incluídos futuramente. Assim, entende-se que o desenvolvimento do Sistema NAS permitirá a aproximação entre os enfermeiros e a tecnologia móvel facilitando o acesso imediato aos dados do instrumento referentes aos pacientes, auxiliando na tomada de decisão e na adequação do quantitativo de pessoal de enfermagem para prestação da assistência.

Factores de riesgo y eventos cardiovasculares en inmigrantes latinoamericanos adultos en el Distrito Macarena, Sevilla, España: estudio piloto

Con la finalidad de estimar la prevalencia por autorreporte de factores de riesgo y eventos cardiovasculares en población latinoamericana inmigrante adulta del Distrito 2 (Macarena) de Sevilla, se realizó un estudio piloto de investigación descriptiva de corte transversal. Fue utilizado un cuestionario anónimo con autorreporte de factores de riesgo y eventos cardiovasculares. Resultados: participaron 34 personas, (18% de la muestra), media etaria: 31,8 años, residencia media: 6,5 años, mujeres: 52,9%. Prevalencias de factores de riesgo: 8,8% diabetes, 14,7% colesterol elevado y 23,5% hipertensión arterial. Prevalencia de eventos coronarios corresponde a 8,8%: angina de pecho, infarto de miocardio y accidente cerebrovascular: 2,9% para ambos. Se concluye en que la prevalencia de eventos cardiovasculares autorreportados supera la mencionada en la literatura, mereciendo este asunto la atención de los organismos sanitarios. Este dato debe ser tenido en cuenta por enfermería para elaborar planes de cuidados adaptados culturalmente al contexto de este colectivo inmigrante.

Carga de trabajo en tres grupos de pacientes de UCI Española según el Nursing Activities Score

Se objetivó valorizar la carga de trabajo al ingreso y al alta en tres grupos de pacientes (síndrome coronario agudo, insuficiencia respiratoria aguda y sepsis) en terapia intensiva. Estudio descriptivo, prospectivo, de 27 meses, incluyéndose 563 pacientes, valorando carga de trabajo según Nursing Activities Score. Existieron diferencias significativas en la carga de trabajo al ingreso y en el alta entre los grupos de pacientes, siendo superior en ambos momentos la de pacientes con insuficiencia respiratoria aguda y sepsis frente a pacientes coronarios. Durante los siete primeros días de estancia se mantuvo esta diferencia, desapareciendo a partir del octavo día, equilibrándose la carga de trabajo para los tres grupos. Para conseguir una adecuada dotación de personal es fundamental contar con instrumentos para medir las necesidades de cuidados y conocer la carga de trabajo de los distintos grupos de enfermos que ingresan con mayor frecuencia en las unidades de terapia intensiva.

Usage analysis of the Nursing Activities Score in two Spanish ICUS

The aim of this study was to analyze the discourse of health managers on aspects related to delay in tuberculosis diagnosis. This was a qualitative research study, conducted with 16 Family Health Unit managers. The empirical data were obtained through semi-structured interviews. The analysis was based on the theoretical framework of the French school of discourse analysis. According to the managers’ statements, the delay in tuberculosis diagnosis is related to patient and health service aspects. As for patient aspects, managers report fear, prejudice and lack of information as factors that may promote a delayed diagnosis. Regarding health service aspects, structural problems and lack of professional skills were reported. The discourse of managers should be considered to qualify tuberculosis control actions and to prevent delays in diagnosis.

Trabecular bone score: a noninvasive analytical method based upon the DXA image.

The trabecular bone score (TBS) is a gray-level textural metric that can be extracted from the two-dimensional lumbar spine dual-energy X-ray absorptiometry (DXA) image. TBS is related to bone microarchitecture and provides skeletal information that is not captured from the standard bone mineral density (BMD) measurement. Based on experimental variograms of the projected DXA image, TBS has the potential to discern differences between DXA scans that show similar BMD measurements. An elevated TBS value correlates with better skeletal microstructure; a low TBS value correlates with weaker skeletal microstructure. Lumbar spine TBS has been evaluated in cross-sectional and longitudinal studies. The following conclusions are based upon publications reviewed in this article: 1) TBS gives lower values in postmenopausal women and in men with previous fragility fractures than their nonfractured counterparts; 2) TBS is complementary to data available by lumbar spine DXA measurements; 3) TBS results are lower in women who have sustained a fragility fracture but in whom DXA does not indicate osteoporosis or even osteopenia; 4) TBS predicts fracture risk as well as lumbar spine BMD measurements in postmenopausal women; 5) efficacious therapies for osteoporosis differ in the extent to which they influence the TBS; 6) TBS is associated with fracture risk in individuals with conditions related to reduced bone mass or bone quality. Based on these data, lumbar spine TBS holds promise as an emerging technology that could well become a valuable clinical tool in the diagnosis of osteoporosis and in fracture risk assessment.

Padrão de intervenções de enfermagem realizadas em vítimas de trauma segundo o Nursing Activities Score

RESUMO Objetivo Identificar o padrão de intervenções de enfermagem realizadas em vítimas de trauma nas primeiras 24 horas de internação na Unidade de Terapia Intensiva (UTI). Método Estudo prospectivo, realizado na UTI de um hospital em São Paulo, Brasil. O instrumento Nursing Activities Score (NAS) foi utilizado para identificar as intervenções de enfermagem. Resultados A casuística foi composta por 200 pacientes, a maioria homens, com idade média de 40,7 anos, vítimas de acidentes de transporte. A média do NAS foi de 71,3% e o padrão de intervenções de enfermagem identificado incluiu as atividades de monitorização e controles; investigações laboratoriais; medicação, exceto drogas vasoativas; procedimentos de higiene; cuidados com drenos; mobilização e posicionamento; suporte e cuidado aos familiares e pacientes; tarefas administrativas e gerenciais; suporte respiratório; cuidado com vias aéreas artificiais; e tratamento para melhora da função pulmonar. Nas intervenções de monitorização e mobilização, houve a necessidade de cuidados além do normalmente requerido por pacientes de UTI. Conclusão Os resultados desta pesquisa trazem importantes contribuições para o planejamento de ações que visem a capacitação e o dimensionamento da equipe de enfermagem na unidade crítica.

TBS (trabecular bone score) and diabetes-related fracture risk.

CONTEXT: Type 2 diabetes is associated with increased fracture risk but paradoxically greater bone mineral density (BMD). Trabecular bone score (TBS) is derived from the texture of the spine dual x-ray absorptiometry (DXA) image and is related to bone microarchitecture and fracture risk, providing information independent of BMD. OBJECTIVE: This study evaluated the ability of lumbar spine TBS to account for increased fracture risk in diabetes. DESIGN AND SETTING: We performed a retrospective cohort study using BMD results from a large clinical registry for the province of Manitoba, Canada. Patients: We included 29,407 women 50 years old and older with baseline DXA examinations, among whom 2356 had diagnosed diabetes. MAIN OUTCOME MEASURES: Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Health service records were assessed for incident nontraumatic major osteoporotic fractures (mean follow-up 4.7 years). RESULTS: Diabetes was associated with higher BMD at all sites but lower lumbar spine TBS in unadjusted and adjusted models (all P < .001). The adjusted odds ratio (aOR) for a measurement in the lowest vs the highest tertile was less than 1 for BMD (all P < .001) but was increased for lumbar spine TBS [aOR 2.61, 95% confidence interval (CI) 2.30-2.97]. Major osteoporotic fractures were identified in 175 women (7.4%) with and 1493 (5.5%) without diabetes (P < .001). Lumbar spine TBS was a BMD-independent predictor of fracture and predicted fractures in those with diabetes (adjusted hazard ratio 1.27, 95% CI 1.10-1.46) and without diabetes (hazard ratio 1.31, 95% CI 1.24-1.38). The effect of diabetes on fracture was reduced when lumbar spine TBS was added to a prediction model but was paradoxically increased from adding BMD measurements. CONCLUSIONS: Lumbar spine TBS predicts osteoporotic fractures in those with diabetes, and captures a larger portion of the diabetes-associated fracture risk than BMD.

Riesgo de fractura asociado a los estadios previos al diagnóstico de la diabetes tipo 2: estudio de caso-control anidado (cohorte DIAFOS)

El objetivo es comparar la prevalencia de fractura en casos incidentes de diabetes y en controles apareados. Estudio casos-control que incluye todos los pacientes diabéticos tipo 2 diagnosticados entre 2006-2011 y dos controles sin diabetes. Se identificaron fracturas y enfermedad cardiovascular prevalentes, calculando prevalencias de fracturas osteoporóticas, mayores y de cadera, y de enfermedad cardiovascular. Se identificaron 58931 diabéticos y 117862 controles. Los diabéticos presentaban mayor prevalencia de accidente cerebro-vascular y de cardiopatía isquémica. Las prevalencias de fracturas osteoporóticas, de cadera y mayores fue similar en ambos grupos. En conclusión el riesgo de fractura es similar al de los controles no diabéticos.