Morte como desafio afetivo para o profissional da saúde: ansiedade e sentimentos de quem lida com o paciente terminal com câncer

It is a Cross-sectional and multi-disciplinary study whose population selection was made by department of human resources (composed by a Manager, an Oncologist and a Psychologist) from the hospital where this research was realized. They also collaborated with important information about the work of that professionals in the hospital. We also counted on a Statistic who made study design calculating the sample and analyzing data. This research issued Evaluating health professionals anxiety levels who care for cancer terminally ill and their feelings about that work as well as identifying the factors which have influence on it. 100 health professionals from the Hospital which is a reference on cancer caring in Brazil situated in the city of Natal, state of Rio Grande do Norte, participated of this research. There was a sample loss of 21%. Data were collected through a questionnaire and State-Trait Anxiety Inventory (STAI). Results showed that 15% of the professionals have low State Anxiety levels, 70% Medium State Anxiety levels and 15% high State anxiety levels. The Number of Patients and Working in another Institution have interfered in the anxiety levels. Doctors and Nursing Assistants and Technicians have got the highest high State Anxiety percentage (25%). 73% of them declare to feel some sort of different behavior and/or feelings in caring for terminally ill. The most remarkable professionals feelings were Suffering and Sadness, and Terminally ill Children was the most difficult age group to care for. We conclude that work overload and having more than one job can interfere in professional stress levels and anxiety. Dealing with terminally ill, specially children one, can cause on the professionals psychological suffering. It s recommended the development of supporting and training strategies to reduce and/or to prevent Stress and Anxiety high levels

Transfusão de eritrócitos em crianças internadas em unidade de terapia intensiva pediátrica

JUSTIFICATIVA E OBJETIVOS: As indicações de transfusão de eritrócitos não estão bem estabelecidas em crianças gravemente enfermas. O objetivo deste estudo foi descrever a prática da transfusão de eritrócitos na UTI Pediátrica do Hospital de Clínicas da Universidade Estadual Paulista (HC-UNESP). MÉTODO: Estudo retrospectivo observacional realizado durante o ano de 2003. RESULTADOS: Setenta e cinco pacientes receberam transfusão, havendo registro de 105 indicações. Mais da metade dos pacientes (53,3%) tinha menos que um ano de idade. Taquipnéia (75,2%), palidez (65,7%) e hipotensão (51,4%) foram os registros mais freqüentemente observados antes da transfusão. Além disso, a gasometria evidenciou acidose metabólica (68,08%) e hipoxemia (63,8%). Dos 93 registros de valores de hemoglobina (Hb), 54 (58,1%) estavam entre 7 e 10 g/dL e dos 90 registros de hematócrito (Ht) observou-se que 66 (73,3%) apresentavam valores entre 21% e 30%. As principais indicações de transfusão foram anemia em 75 crianças (71,4%) e sangramento ativo em 26 (24,7%). O valor médio de Hb antes da transfusão foi de 7,82 ± 2,82 g/dL. Sete transfusões foram indicadas para pacientes com valores de Hb > 10 g/dL, crianças estas em pós-operatório imediato de intervenção cirúrgica cardíaca e casos de choque séptico. CONCLUSÕES: A transfusão de eritrócitos vem sendo utilizada criteriosamente, com indicações restritivas (Hb entre 7 e 10 g/dL). Nem sempre há anotação dos valores de Hb imediatamente antes da transfusão. A partir deste estudo, foi elaborado um protocolo de indicação de transfusão na unidade.

Analgesia pós-operatória para crianças com menos de 1 ano: análise retrospectiva

JUSTIFICATIVA E OBJETIVOS: A dor pós-operatória continua sendo uma das principais complicações pós-operatórias e motivo de desconforto, principalmente em crianças. O objetivo deste estudo foi avaliar o uso de analgésicos desde o término da cirurgia até a alta da sala de recuperação pós-anestésica (SRPA), como medida terapêutica ou profilática, para crianças com menos de 1 ano de idade. MÉTODO: Utilizando o banco de dados do Departamento de Anestesiologia, foi realizada análise retrospectiva, envolvendo o período de janeiro de 2000 a abril de 2001, das anestesias de crianças menores que 1 ano de idade submetidas a procedimentos cirúrgicos diversos, avaliando aspectos relacionados à analgesia pós-operatória. RESULTADOS: No período do estudo, foram anestesiadas 402 crianças menores que 1 ano, sendo que 194 (48,2%) não receberam analgésicos e 208 (51,8%) receberam. Com relação ao uso ou não de analgésicos, foi observado o que se segue: Sem analgésicos: (1) Idade: até 1 mês, 68/99; entre 1 e 6 meses, 53/126; entre 6 meses e 1 ano, 73/177. (2) Peso: 6,7 ± 3,1 kg (3). Sexo: masculino, 106/240; feminino, 88/162. (4) Estado físico ASA: ASA I, 69/187; ASA II, 56/113; ASA III, 46/79; ASA IV, 23/23. (5) Anestesia peridural sacral: 3/4. (6) Tempo de anestesia: 106 ± 32 minutos. (7) Encaminhamento para unidade de terapia intensiva (UTI): 93/119. Uso de analgésicos: (1) Idade: até 1 mês, 31/99; entre 1 e 6 meses, 73/126; entre 6 meses e 1 ano, 104/177. (2) Peso: 9 ± 2,3 kg. (3) Sexo: masculino, 134/240; feminino, 74/162. (4) Estado físico ASA: ASA I, 118/187; ASA II, 57/113; ASA III, 33/79; ASA IV, 0/23. (5) Anestesia peridural sacral: 1/4. (6) Tempo de anestesia: 130 ± 38 minutos. (7) Encaminhamento para UTI: 26/119. Os fármacos empregados para promover analgesia foram: dipirona (60,6%), dipirona + tramadol (25,5%), dipirona + nalbufina (5,3%), tramadol (3,8%), nalbufina (3,8%), meperidina (0,5%) e fentanil (0,5%). CONCLUSÕES: Utilizar analgésicos em crianças desde o término da cirurgia até a alta da SRPA não foi habitual, principalmente nas crianças menores e mais graves e em procedimentos cirúrgicos mais rápidos. O uso de dipirona, isoladamente, ou a associação dipirona/tramadol, foram as drogas analgésicas mais freqüentemente empregadas.

Willingness of Brazilian dentists to treat an HIV-infected patient

A study of the willingness of 363 general dental practices in Brazil to accept a patient infected with human immunodeficiency virus for treatment of dental pain and the provision of routine dental care showed only 44% of dental practices to be willing to provide dental care. Willingness was influenced neither by financial factors nor the local prevalence of human immunodeficiency virus disease. © 1994.

Surgical and clinical management of a patient with Glanzmann thrombasthenia: A case report

A 6-year-old girl with Glanzmann thrombasthenia presented with caries and periapical lesions in the primary mandibular second molars and moderate gingivitis of the maxillary and mandibular anterior teeth. Dental extraction was recommended, and before every surgical intervention, the patient underwent platelet-concentrate transfusion to prevent hemorrhage. Epsilon aminocaproic acid was administered 6 hours before, and 48 hours after every dental procedure to prevent bleeding. In this case, treatment was effective in the prevention of hemorrhagic complications, during the required dental procedures.

HIV attitudes and practices among professors in a Brazilian dental school.

Although there is considerable published research on Acquired Immunodeficiency Syndrome (AIDS), individual biases persist because of lack of information regarding HIV virus transmission. As a result, both infected patients and health care professionals suffer. The objective of this study was to determine if there is prejudice among university professors at the School of Dentistry at Aracatuba's Sao Paulo State University (FOA-UNESP) concerning HIV-positive patients or HIV-positive health care professionals. Out of the seventy-seven professors who responded to the questionnaire, 62.3 percent (forty-eight) stated that they advise their students not to refuse to treat a patient with HIV. Although 96.2 percent (fifty-two) of the fifty-four professors who treat patients have reported that they treat patients who are HIV-positive, only 65.3 percent of them were aware of infection control precautions, and only 32.7 percent reported that they would treat an HIV-positive patient like any other patient. There is also prejudice regarding HIV-positive professionals because only 48.1 percent (thirty-seven) of the professors responded that they would be willing to be treated by an infected professional. It can be concluded that there is prejudice among some of the FOA-UNESP university professors regarding individuals who are HIV-positive.

A família do paciente em situação crônica de vida: a visão de enfermeiros de um hospital de ensino

This exploratory descriptive study, of qualitative nature had the purpose to study how the nurses from a hospital school see the family as care participants. Six nurses from clinics of chronically ill patients were interviewed. The data analysis allowed to infer that the nurses had only little knowledge of the family's thematic during graduation, making the relationship with the accompanying families very difficult. Daily care during hospitalization period is marked by easy moments when members are willing to participate in the process, and by difficulties when they attempt to break institutional rules. It was suggested that new nurses have theoretical foundation to attend the family in several scenarios of care. It was considered the need of investments in professional training, and that the advance of humanization of services implies in exchange and integration of knowledge among patients, family members, health professionals, support staff and managers beyond the science field.

Dental students' familiarity with the medical management of dental patients at Brazilian dental schools

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Saúde, meio ambiente e complexidade

Pós-graduação em Serviço Social - FCHS

Procalcitonina e interleicina-6 em crianças com diagnóstico de sepse e choque séptico

Sepse é causa comum de mortalidade e morbidade em unidades de tratamento intensivo, sendo atualmente entendida como a resposta sistêmica à infecção, resposta esta caracterizada por duas ou mais das seguintes manifestações: temperatura corporal > 38°C ou < 36°C; taquicardia; taquipnéia; e alteração da contagem de células brancas (leucocitose ou leucopenia) ou mais de 10% de formas imaturas. Entretanto, tem sido descrito que os elementos que caracterizam a resposta sistêmica são muito sensíveis, insuficientemente específicos e não levam em consideração o avanço do entendimento da fisiopatologia da doença. Além disso, a sepse tem fisiopatologia complexa, o que dificulta ainda mais o diagnóstico, principalmente em crianças. O diagnóstico rápido e a instituição de tratamento o mais cedo possível são imperativos nos pacientes sépticos. Consequentemente, vários marcadores laboratoriais têm sido estudados, sendo que dos vários mediadores envolvidos na sepse, procalcitonina (PCT) e interleucina-6 (IL-6) têm despertado interesse pela possibilidade de auxiliar no diagnóstico e no estabelecimento da gravidade de pacientes adultos com sepse ou choque séptico, sendo que a PCT já foi incluída entre os critérios diagnósticos de sepse nestes indivíduos. Em pediatria... (Resumo completo, clicar acesso eletrônico abaixo)

Opinião de familiares sobre a internação de crianças em uma Unidade de Terapia Intensiva Pediátrica

A Pediatric Intensive care Unit (PICU) is an environment where care is provided to seriously ill children. Hospitalization is regarded as an unpleasant experience that requires adaptation and routine change. To assess the opinion of relatives of children hospitalized at a PICU concerning tie breakage and/or separation between children and their families. It is a descriptive, cross-sectional, quantitative study. A structured interview was conducted with the families of hospitalized children from July to September, 2010. The data were statistically analyzed. RESULTS: Twenty relatives were interviewed, 80% of whom believed that children’s behavior changes when they are present in the unit, and 85% considered the visitation time established to be sufficient. All the respondents reported to be satisfied about the care provided. The feelings prevailing in 50% of the relatives were fear and hope. Change in the family’s union after hospitalization occurred in 85% of the families. The most fearful aspect concerning the ICU is the equipment (25%), and the most worrisome, as regards personal life, is the separation from other children (65%). Health care professionals must pay more attention to relatives by including them in their health care plan so that the health care team and the family, who are essential in children’s recovery, can interact in a congenial fashion. It is also necessary to improve the knowledge related to that subject so that the health care team and families can work together towards children’s recovery

Incidence of adverse events associated with percutaneous muscular biopsy among healthy and diseased subjects

The development of the percutaneous muscle biopsy technique is recognized as one of the most important scientific contributions in advancing our understanding of skeletal muscle physiology. However, a concern that this procedure may be associated with adverse events still exists. We reported the incidence of adverse outcomes associated with percutaneous muscle biopsy in healthy and diseased subjects. Medical records of 274 volunteers (496 muscle biopsies) were reviewed. This included 168 healthy subjects (330 muscle biopsies) as well as 106 chronically ill patients (166 muscle biopsies). This latter group encompassed patients with type II diabetes (n=28), osteoarthritis (n=39), inclusion body myositis (n=4), polymyositis (n=4), and chronic heart failure (n=31). The most common occurrences were pain (1.27%), erythema (1.27%), and ecchymosis (1.27%). Panic episode, bleeding, and edema were also reported (0.21%, 0.42%, and 0.84%, respectively), while infection, hematoma, inflammation, denervation, numbness, atrophy, and abnormal scarring were not verified. The percent of incidents did not differ between healthy and ill individuals. In conclusion, the incidence of complications associated with percutaneous muscle biopsy is scarce and of minor clinical relevance. Additionally, the rate of adverse events is comparable between healthy and chronically ill subjects.

Physical long-term health problems and mental comorbidity: evidence from Vietnam

OBJECTIVE: The mental health of children living in low-income countries remains a neglected research area despite the high burden of disease. This study is one of the first that examines the effects of long-term physical health problems on child mental health disorders in a low-income country and investigates whether this association is modified by the socio-economic status of the child's family. METHODS: Community-based cross-sectional survey of 975 eight-year-old children from 20 sites in Vietnam. Long-term physical health problems were measured by a caregiver report and included conditions such as anaemia, congenital malformation, physical disability and skin problems. Child mental disorders were assessed using the strengths and difficulties questionnaire (SDQ). Generalised estimating equations models were fitted to explore the association between long-term physical health problems and child mental disorders. RESULTS: Vietnamese children who suffer from long-term physical health problems have odds 2:1 times greater than children without long-term physical health problems of having a mental disorder (95% CI 1.2 to 3.6, p = 0.006). No significant interaction with socio-economic status was found. CONCLUSIONS: This study showed a high burden of mental disorders among physically ill children, re-enforcing the idea that there is "no health without mental health". While this association needs to be explored longitudinally, children with long-term health problems may be a visible group for targeted mental-health interventions.

Risk, outcomes, and cost of emergency center visits in cancer patients

Cancer is a chronic disease that often necessitates recurrent hospitalizations, a costly pattern of medical care utilization. In chronically ill patients, most readmissions are for treatment of the same condition that caused the preceding hospitalization. There is concern that rather than reducing costs, earlier discharge may shift costs from the initial hospitalization to emergency center visits. ^ This is the first descriptive study to measure the incidence of emergency center visits (ECVs) after hospitalization at The University of M. D. Anderson Cancer Center (UTMDACC), to identify the risk factors for and outcomes of these ECVs, and to compare 30-day all-cause mortality and costs for episodes of care with and without ECVs. ^ We identified all hospitalizations at UTMDACC with admission dates from September 1, 1993 through August 31, 1997 which met inclusion criteria. Data were electronically obtained primarily from UTMDACC's institutional database. Demographic factors, clinical factors, duration of the index hospitalization, method of payment for care, and year of hospitalization study were variables determined for each hospitalization. ^ The overall incidence of ECVs was 18%. Forty-five percent of ECVs resulted in hospital readmission (8% of all hospitalizations). In 1% of ECVs the patient died in the emergency center, and for the remaining 54% of ECVs the patient was discharged home. Risk factors for ECVs were marital status, type of index hospitalization, cancer type, and duration of the index hospitalization. The overall 30-day all-cause mortality rate was 8.6% for hospitalizations with an ECV and 5.3% for those without an ECV. In all subgroups, the 30-day all-cause mortality rate was higher for groups with ECVs than for those without ECVs. The most important factor increasing cost was having an ECV. In all patient subgroups, the cost per episode of care with an ECV was at least 1.9 times the cost per episode without an ECV. ^ The higher costs and poorer outcomes of episodes of care with ECVs and hospital readmissions suggest that interventions to avoid these ECVs or mitigate their costs are needed. Further research is needed to improve understanding of the methodological issues involved in relation to health care issues for cancer patients. ^

Integrated care programmes for adults with chronic conditions: a meta-review.

OBJECTIVE To review systematic reviews and meta-analyses of integrated care programmes in chronically ill patients, with a focus on methodological quality, elements of integration assessed and effects reported. DESIGN Meta-review of systematic reviews and meta-analyses identified in Medline (1946-March 2012), Embase (1980-March 2012), CINHAL (1981-March 2012) and the Cochrane Library of Systematic Reviews (issue 1, 2012). MAIN OUTCOME MEASURES Methodological quality assessed by the 11-item Assessment of Multiple Systematic Reviews (AMSTAR) checklist; elements of integration assessed using a published list of 10 key principles of integration; effects on patient-centred outcomes, process quality, use of healthcare and costs. RESULTS Twenty-seven systematic reviews were identified; conditions included chronic heart failure (CHF; 12 reviews), diabetes mellitus (DM; seven reviews), chronic obstructive pulmonary disease (COPD; seven reviews) and asthma (five reviews). The median number of AMSTAR checklist items met was five: few reviewers searched for unpublished literature or described the primary studies and interventions in detail. Most reviews covered comprehensive services across the care continuum or standardization of care through inter-professional teams, but organizational culture, governance structure or financial management were rarely assessed. A majority of reviews found beneficial effects of integration, including reduced hospital admissions and re-admissions (in CHF and DM), improved adherence to treatment guidelines (DM, COPD and asthma) or quality of life (DM). Few reviews showed reductions in costs. CONCLUSIONS Systematic reviews of integrated care programmes were of mixed quality, assessed only some components of integration of care, and showed consistent benefits for some outcomes but not others.