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.

Tratamento ambulatorial e hospitalar na monitorização glicêmica de gestantes diabéticas em uso de insulina

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Implantação de um serviço de farmacovigilância hospitalar e comparação dos algoritmos para análise de reação adversa a medicamento

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Tipos documentais e sua relação com o processo decisório de uma empresa hospitalar da região de Bauru/SP

Decisions are made constantly in organizational contexts; however, a wrong decision can bring undesirable consequences for organizations. In this sense, access to organic information becomes essential considering that decreases the uncertainties of managers in relation to decision making process. In this perspective, the identification of documental types from its production provides a consistent documental cycle, which will result in the recovery of information at the time requested by managers. Based on the above it was intended to verify what documental types recurrently used in the decision making process of a hospital company in the Bauru region, Sao Paulo State. For that, we applied the method 'Case Study' of Yin. We analyzed the information type that provided more security to the decision maker during the decision making. As a result, we elaborated a systematic documental organic types most used and most relevant to the decision-making process of the company, showing that when they are defined from the production of documents, the benefits for both the professional as archivist for the organization are significant.

Prevalência de infecção clamidiana em mulheres com diagnóstico de infertilidade primária e secundária atendidas no ambulatório de esterilidade do Hospital das Clínicas da Faculdade de Medicna de Botucatu, Unesp

A infertilidade está se tornando um problema emergente de saúde pública em muitos países do mundo e, para muitos autores, esse aumento parece coincidir com o crescente papel desempenhado pela Chlamydia trachomatis. A infecção por C. trachomatis é uma das principais causas de lesão tubária que pode levar a oclusão desta ou processos aderentes que comprometem o complexo tubo-ovariano. O objetivo deste trabalho foi avaliar a prevalência de cervicite por Chlamydia trachomatis em mulheres diagnosticadas com infertilidade primária ou secundária atendidas no Ambulatório de Esterilidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP. Foram incluídas no estudo 112 mulheres atendidas no período de julho de 2008 a junho de 2009, que concordaram em participar do estudo e que responderam ao questionário para caracterização sóciodemográfica e ginecológica, sendo 62 pacientes com infertilidade primária e 50 com infertilidade secundária. Durante o exame especular, foi coletada secreção cervical com cytobrush para pesquisa de C. trachomatis pela técnica de reação em cadeia da polimerase (PCR) e conteúdo vaginal por meio de swab para avaliação da flora vaginal pelo método de Gram. Em relação à caracterização das pacientes, 66,7% eram moradoras de municípios com menos de 100.000 habitantes, 63,4% relataram ter vínculo empregatício, 98,2% declararam união estável, 74,1% eram brancas e 14,3% fumantes. A mediana de idade das pacientes no momento da inclusão no estudo foi de 28 anos (14-44). A mediana de idade à menarca e ao início da atividade sexual foi de 12 anos (9-17) e 16 anos (11-38), respectivamente. A mediana do tempo de infertilidade foi de 4 anos (1-17). Ainda nesse estudo, 67,9% das pacientes relataram mais de três relações sexuais por semana, 25,0% relataram infecção do trato genital inferior anteriormente ao estudo, 23,2% relataram... (Resumo Completo, clicar acesso eletrônico abaixo)

Readequação acessível em edifício hospitalar em Ribeirão Branco/SP: (proposta de readequação espacial do Hospital Municipal Maria Rosa Cardoso)

Um dos problemas enfrentados pelas cidades brasileiras, e que atinge inclusive as de pequeno porte, refere-se à questão hospitalar. A falta de adequação de espaços e equipamentos tem causado grandes problemas à qualidade de vida da população. A melhoria das condições hospitalares nas cidades tem como consequência o aumento na qualidade de vida urbana; e esta, por sua vez está relacionada à adoção de medidas específicas a adequação hospitalar ás normas técnicas vigentes. O objetivo desse trabalho é realizar uma proposta projetual de requalificação espacial do Hospital Municipal de Ribeirão Branco (SP), incorporando uma visão sobre todos os aspectos necessários para o desenvolvimento correto de um programa hospitalar. Este trabalho de conclusão de curso visa dar condições confortáveis e autônomas de acesso a todos os usuários dessa unidade de saúde, além de melhor suas condições funcionais, em termos de programa hospitalar. Além disso, a proposta buscará inserir o Hospital num contexto tecnológico mais recente, para atualizar e potencializar a eficiência dos tratamentos

Infância, ludicidade e pedagogia hospitalar: encontros e desencontros nas práticas educativas

The aim of this study is to investigate the significance of educational practices aimed at children in non formal education, in this case, specifically, the hospital context. The chosen methodology is part of an investigation conducted in two phases. In the first phase was carried out a theoretical stage, scientifically based studies guided by an historical-cultural and Sociology of Childhood, enabling placement on the particularities of children, the playfulness and the positioning of Pedagogy in the hospital. After this theoretical study was performed the second phase, with the completion of an empirical study with a research and intervention in a hospital playroom, in a public hospital considered a regional center in the northwestern city of São Paulo. The methodological procedures adopted for this empirical study were participant observation, interviews, action research and a questionnaire. Participant observation and action research are conducted within the brinquetodeca in five meetings with about 15 children, interviews were conducted with three family members and the questionnaire was applied to a healthcare professional. Among the results we can mention the following findings: a confirmation of the necessity of work in the hospital directing playful adaptations for the preservation and development of children's learning, and recent publications are scarce about the Hospital Education and underscore the need for the professional practice of education in non-school, the educational activities carried out reveals the possibilities of offering the child the continuation of their educational activities involving the playful and educational, the international and national literature on educational practices in the hospital allow to check ...(Complete abstract click electronic access below)

Satisfação dos Usuários do Ambulatório Geral do Hospital das Clínicas de Botucatu

The searches for a health service it’s a part of a process, searches for a qualified evaluation can arise the perception, in form of irritating factors taking for an alert state. The personal expectation, it makes influence in its perceptions, too. The objective was to evaluate the satisfaction degree of the users of “Seção Técnica de Ambulatório Geral do Hospital das Clínicas de Botucatu”. The work is about a quantitative and transversal study, with calculated sample of 366 users, chosen randomly and invited to participate through a questionnaire. The population was compounded by a majority of women (64,5%), between 50 to 59 years old and average degree of education (38,3%). 25 specialties were cited. The evaluate about comfort, cleaning, reception, waiting time, medical attention and nursing vary between “very good” and “good”. Obtained significant “regular” assessment, the comfort in the waiting rooms (24%), silence (25%) and cleaning bathroom (63%). Others negative evaluation was the reception about the waiting time (26%), waiting time between arrival and the consultation (34%), waiting time between the request and consultation (27%). 30,6% report to know the place for complaints and 79,4% of these pointed to the ombudsman. 62% consider their problems solved, 84,4% would indicate the hospital, 57,4% would consider the hospital better than imagined. 42,62% used the opened area for thanking, critical for staff, suggestion infrastructure improvements, cleaning and waiting time. The biggest complaint was the staff turnover in the treatment. There was disharmony between the objective and subjective questions, but, all of them must be considered to propose improvements. The satisfaction evaluation makes the service more effective, bringing credibility to the health service and the patients adhere better to the treatment

Proposta de um dispositivo para ajuste automático da altura de uma cama hospitalar

This paper proposes a mechanical device to adapt a simple model of hospital bed used in the Emergency Department at Santa Casa of Guaratinguetá, allowing the bed’s height adjustment with electromechanical drive. This adaptation aims to introduce improvements in the routine work of nurses and reduce ergonomic problems stemming from repetitive strain during the transfer of patients to stretchers and wheelchairs, as well as providing more comfort to the bedridden patient. The device is mainly composed of: an electric induction motor used to drive the engine, a steel spindle with square thread, which allows axial displacement of the bed, a transmission system with pulleys and belt, which transmits power supplied by the motor to the spindle. The mechanism allows the height of the bed is regulated between 400 and 800 mm. The estimated implementation cost of this proposal is lower than the acquisition cost of a commercial hospital bed with the same features, which confirms the feasibility of the proposed solution

Proposta de um dispositivo para adaptação em uma cama hospitalar para ajuste de altura

In hospitals, health professionals may face different situations and problems. By following them, it is remarkable that one of the difficulties is related to the support provided by the facilities to carry out their work. This also affects the quality of treatment offered to patients. One of the points of improvement that could be studied is hospital beds. The Fawler's simplest hospital bed type, used in most Brazilian public hospitals, is designed with an ergonomic average height that offers a default position for analysis and treatment of patients. There is no possibility of adjusting the height of those beds, and hence there is a limitation in this regard since that height is fixed, but the physical structures of the workers and patients may vary widely and there may be a conflict when there are people too large or small involved in this process. Beyond that, studies by experts show that beds with height adjustment decreases the muscular effort and improve the movement quality of the spine of nursing staff, reducing the force on certain vertebrae and also the ergonomic risk. Of course, patient comfort is also affected accordingly. As the beds made with height adjustment are very expensive, this study aims to design a device to adapt the not adjustable beds. The project must be viable from an economic and mechanic standpoint, being able to adapt both old and new simplest Fawler hospital bed models, since their dimensions are similar. The final result shows that it is possible to adapt such beds using the designed concept at a viable cost. Furthermore, this concept could be applied in other bed types or objects that have hollow feet

Uso de rastreadores de eventos adversos a medicamentos para farmacovigilância no âmbito hospitalar

Eventos adversos a medicamentos (EAM) ainda são uma das principais limitações nos serviços de cuidados com a saúde, causando risco aos pacientes, além de grande impacto econômico. Assim, fazem-se necessários métodos de identificação de eventos adversos mais eficazes que a tradicional notificação espontânea, a qual revela apenas 5% do total de eventos. A utilização de critérios rastreadores (ou trigger tools), elaborados pelo Institute for Healthcare Improvement, tem se mostrado como a alternativa mais válida e eficiente para a triagem dos EAM. Com o objetivo principal de identificar os principais eventos adversos e medicamentos envolvidos, uma seleção de três critérios rastreadores foi utilizada, a saber: INR (razão normalizada internacional) > 6, WBC (contagem de leucócitos) < 3000/mm³ ou registros de episódios de sedação excessiva, letargia ou queda. Informações sobre os rastreadores foram coletadas e analisadas a partir dos prontuários de pacientes internados no Hospital Estadual Américo Brasiliense internados, de novembro de 2011 a janeiro de 2012 e maio a julho de 2012, a fim de se confirmar a ocorrência de evento adverso. Foram analisados prontuários referentes a 3318 hospitalizações, nas quais foram detectados 69 eventos adversos, 49 dos quais foram causados por apenas quatro das 12 classes de medicamentos envolvidos em algum EAM: anticoagulantes orais, relacionados ao rastreador INR>6 (eficácia = 0,75), sedativos e antipsicóticos, relacionados ao rastreador de sedação excessiva, letargia ou queda (eficácia = 0,52), e antivirais, relacionados ao rastreador WBC<3000 (eficácia = 0,48). Quando os rastreadores eram acionados e não estavam relacionados a EAM, os fatores de confusão mais recorrentes foram: torpor secundário ao quadro clínico, acidentes não relacionados ao medicamento e pacientes propositalmente em regime de sedação. Apesar de valores-limite menos radicais poderem aumentar a ...

A banalização da prescrição de psicofármacos em um ambulatório de saúde mental

The development of modern psychiatric medications coupled with the wide range currently gained by preventive emphasis in mental health changed the practices of psychiatry, which is no longer focused on treating insanity but is also dedicated to treat any psychiatric suffering through the prescription of psychopharmacos. This study discusses the current process in which medication has been generalized, and presents the results of an exploratory study aimed to examine the patients' medical files, the trajectory of users since they enter the service to the prescription of psychiatric medication in the scope of a Mental Health Outpatient Clinic, in a town in the west of the São Paulo state, Brazil. Results revealed that most (65%) users already arrive at the service with previous prescription of psychiatric medications, and nearly all (99%) of them receive prescriptions of psychiatric medication once forwarded to psychiatric consultations.

História clínica e alimentar de crianças atendidas em ambulatório de gastroenterologia pediátrica (GEP) com constipação intestinal crônica funcional (CICF) e suas possíveis complicações

In order to better understand the natural history of chronic functional constipation, a questionnaire was applied to 163 children and infants, before beginning standardized treatment. Median age (range) at start was 3 mo(0-108 mo) but age at arrival at the Pediatric Gastroenterology Unit was 53 mo(2-146 mo). In 62.4% of the cases symptoms began before or up to 3 mo after cow's milk introduction and rarely around (-/+ 6 mo) toilet training. Possible complications appeared progressively, often at preschool or school age or as the first noticeable manifestation: recurrent abdominal pain (61.1%), fecal soiling (45.4%), fecal blood (35%), enuresis (23.3%), vomiting (19%), urinary infection (17.9%), urinary retention (8.6%). Abdominal distension was rarely detected on physical examination and was usually discrete. In conclusion, children attended in Botucatu begin their constipation at an early age, frequently associated with weaning,and important complications may ensue along years. This evolution should be avoided by prevention and early treatment of constipation.

The importance of retesting the hearing screening as an indicator of the real early hearing disorder

Early diagnosis of hearing loss minimizes its impact on child development. We studied factors that influence the effectiveness of screening programs. To investigate the relationship between gender, weight at birth, gestational age, risk factors for hearing loss, venue for newborn hearing screening and pass and fail results in the retest. Prospective cohort study was carried out in a tertiary referral hospital. The screening was performed in 565 newborns through transient evoked otoacoustic emissions in three admission units before hospital discharge and retest in the outpatient clinic. Gender, weight at birth, gestational age, presence of risk indicators for hearing loss and venue for newborn hearing screening were considered. Full-term infants comprised 86% of the cases, preterm 14%, and risk factors for hearing loss were identified in 11%. Considering the 165 newborns retested, only the venue for screening, Intermediate Care Unit, was related to fail result in the retest. Gender, weight at birth, gestational age and presence of risk factors for hearing loss were not related to pass and/or fail results in the retest. The screening performed in intermediate care units increases the chance of continued fail result in the Transient Otoacoustic Evoked Emissions test.

Avaliação da eficácia do tratamento da cessação do tabagismo iniciado durante internação hospitalar em pacientes com doença cardiológica ou respiratória agudizada

Pós-graduação em Fisiopatologia em Clínica Médica - FMB