Caracterización de los pacientes con hemorragia de vías digestivas altas no varicosa atendidos en el Hospital Universitario de la Samaritana, Cundinamarca

La hemorragia de vías digestivas altas (HVDA) es una emergencia frecuente. La etiología más común es la úlcera péptica. La restauración del volumen intravascular y la presión arterial son la prioridad del manejo. La endoscopia (EGD) debe realizarse luego de la reanimación inicial y lograda la estabilización hemodinámica, tratar la lesión subyacente mediante hemostasia. Se realiza un estudio en un hospital de referencia de tercer nivel, Cundinamarca, Colombia Materiales y métodos: Estudio descriptivo retrospectivo, datos obtenidos de la historia clínica electrónica de pacientes adultos que consultaron por urgencias en el Hospital Universitario de la Samaritana (HUS) por HVDA, diagnosticada por hematemesis, melenas, hematoquezia y/o anemia; a quienes se les realizó EGD durante abril del 2010 - abril del 2011. Resultados: Se atendieron 385 pacientes en el período de estudio, 100 fueron excluidos debido a hemorragia secundaria a várices esofágicas, historia incompleta y hemorragia digestiva baja, para un total de 285 pacientes analizados. El 69.1% eran mayores de 60 años. El 73.3% presentaba hipertensión arterial, el 55.1% reportaba ingesta de Anti-inflamatorios no esteroideos (AINES) y Aspirina (ASA). El 19.6% reportaba episodios de sangrado previos y 17.9% presentó inestabilidad hemodinámica. Sesenta y tres pacientes (22,1%) requirieron hemostasia endoscópica, treinta y dos (11.2%) presentaron resangrado. La mortalidad reportada fue del 13.1%, del cual 55.3% correspondía a hombres. Discusión: La mayoría de la población atendida en el HUS por HVDA son adultos mayores de 60 años. La úlcera péptica, continúa siendo el diagnóstico más frecuente asociado al uso de AINES y ASA.

Correlación entre saturación venosa, ruptura de anastomosis y formación de fístulas en pacientes con trauma abdominal en el Hospital Occidente de Kennedy

El manejo del trauma abdominal supone el reto de realizar una anastomosis o sutura intestinal en pacientes comprometidos hemodinámicamente. La decisión de cirugía de control de daños ante la presencia de acidosis, hipotermia y coagulopatía es evidente, sin embargo la situación no siempre es tan clara. En individuos con trauma se desarrollan cambios moleculares e inflamatorios por inadecuado balance entre aporte y demanda de oxígeno, que afectan el proceso de reparación de los tejidos con el riesgo de aparición de fístulas. Una forma rápida y práctica de detectar esta hipoperfusión es midiendo la saturación venosa de oxígeno (SVO2) y el Lactato Sérico. OBJETIVOS: Establecer correlación entre los valores de SVO2 transoperatorio y la aparición de fístulas intestinales en pacientes intervenidos por trauma abdominal. MATERIALES Y METODOS: Estudio de cohorte prospectivo que analiza diferentes variables en relación con la aparición de fistulas en pacientes con trauma abdominal que requieren suturas en el tracto gastrointestinal, haciendo énfasis en los niveles de SVO2. RESULTADOS: Los pacientes con falla anastomótica, presentaron un promedio de SVO2 más baja (60.0% ± 2.94%), versus los no fistulizados (69.89% ± 7.21%) (p =0.010). Todos los pacientes de la cohorte expuesta (SVO2<65%), presentaron dehiscencia de la anastomosis (RR =39.8, IC95%: 2.35,659.91, p<0.001, Test exacto de Fisher). El valor predictivo positivo de la saturación (<65%) fue de 57.14% (IC 95%: 13.34%, 100%) y el valor predictivo negativo fue de 100% (IC 95%:81.75%, 100%). La sensibilidad fue de 100% (IC 95%:87.50%, 100%) y especificidad de 91.89% (IC 95%: 81.75%, 100%). En el análisis bivariante determinó que el índice de trauma abdominal, el nivel de hemoglobina y el requerimiento de transfusión de glóbulos rojos, son factores de riesgo directamente relacionados con la falla de la anastomosis en pacientes con trauma abdominal CONCLUSIONES: - Hay una fuerte relación entre la falla en la reparación intestinal y SVO2 < 65%. - El pronóstico de una anastomosis intestinal está directamente relacionada con el estado hemodinámico y la perfusión tisular al momento de la intervención quirúrgica. - El nivel de SVO2 puede apoyar al cirujano en la decisión de realizar o no una reparación en víscera hueca al momento de intervención quirúrgica en un paciente con trauma abdominal.

Experience in the Surgical Management of Abdominal Compartment Syndrome in the Hospital Occidente de Kennedy

The abdominal compartment syndrome (ACS) is the result of various physiological alterations produced by an abnormal increase of the intra-abdominal pressure. Some of these patients will undergo a surgical procedure for its management. Methods: This is a retrospective case series of 28 patients with ACS who required surgical treatment at the Hospital Occidente de Kennedy between 1999 and 2003. We assessed retrospectively the behavior of McNelis’s equation for prediction of the development of the ACS. Results: The leading cause of ACS in our study was intraabadominal infection (n=6 21,4%). Time elapsed between diagnosis and surgical decompression was less than 4 hours in 75% (n=21) of the cases. The variables that improved significantly after the surgical decompression were CVP (T: 4,0 p: 0,0001), PIM (T: 2,7; p: 0,004), PIA (T1,8; p:0,034) and Urine Output (T:-2,4; p:0,02). The values of BUN, Creatinine and the cardiovascular instability did not show improvement. The ICU and hospital length of stay were 11 days (SD: 9) and 18 days (SD13) respectively. Global mortality was 67,9% (n=19) and mortality directly attributable to the syndrome was 30% (n=8). The behavior of the McNelis’s equation was erratic. Conclusions: The demographic characteristics as well as disease processes associated with ACS are consistent with the literature. The association between physiological variables and ACS is heterogeneous between patients. Mortality rates attributable to ACS in our institution are within the range described world-wide. The behavior of the McNelis’s equation seems to depend greatly upon fluid balance.

Exploratory Study on Occupational Health Exposure to Chemical Agents, in a Public Hospital in Valencia, Venezuela. Preliminar Assessment

Descriptive study that identified chemical agents (AQ) use and training on risk management and waste disposal techniques in a public Hospital in Valencia. A questionnaire was answered by 48 workers. Information obtained was: personal data, occupational history, AQ used; knowledge of risk management and waste disposal. There were 16 occupations from 12 “High Risk” areas. “Adult emergency” was the one with more workers (11 individuals), followed by “sterilization” and “clinical laboratory” (7 each) and oncology (5). The remained areas had less than 8.3% workers. The most used anesthetic agents were: Halothane, Enfluorane and Isofluorane 4.17% each and main antineoplastics used were: Doxorubicin 16.67% and Paclitaxel, 5-Fluoracil and Etoposide, 8.33% each. The most mentioned substances were: alcohol (70.8%) and Chlorine (64.6%). None of the answers regarding knowledge of AQ’ risk management and waste disposal was satisfactory. Statistical associations between training and several variables such as age, time in their job and being or not a professional, resulted non-significant. The correlation between training and the knowledge of AQ’s management was significant (p < 0.001). Participants showed that their knowledge about chemical occupational risk factors they are exposed to is still insufficient. Therefore, this theme should be included in graduate course curricula. These results provide important data and will serve as a pilot research for the follow up Phase II study that will include clinical aspects and environmental and biological monitoring.

Factores asociados a la infección para Clostridium difficile en un hospital universitario de Bogotá

Introducción La infección por Clostridium difficile, es una de las causas más frecuentes de diarrea nosocomial con una alta morbimortalidad, con un aumento exponencial en su incidencia, en Estados Unidos se duplicó, de 261 casos x 100.000 en 1993 pasó a 546 x 100.000 en 2003 2, y en Canadá se encontraron datos similares con un aumento de 4.5 veces, en 1991 de 35.6 casos x 100.000 a 156.3 casos por 100.000 en 2004 3 . Se han descrito varios factores asociados Materiales y Métodos Se trata de un estudio descriptivo de tipo serie de casos en el que se evaluaron pacientes con diagnóstico de infección por C. Difficile y los factores asociados en un Hospital Universitario entre febrero de 2010 hasta septiembre de 2011 Resultados Se recolectaron 31 pacientes la edad promedio fue de 58 años con un rango entre 18 y 93 años, de los cuales 19 (61%) fueron mujeres y 12 (39%) hombres. El factor asociado a la infección por C. Difficile más frecuentemente encontrado fue el uso de inhibidores de bomba de protones con 54.84% (n=17) .No se encontraron pacientes VIH positivos o con diagnóstico de enfermedad inflamatoria intestinal. Ningún paciente presentó complicaciones asociadas a la infección ni mortalidad alguna. Conclusión El factor asociado que más se presentó fue el uso de antimicrobianos en los quince dias previos al inicio del cuadro en el 74% de los pacientes lo que coincide con lo presentado en la literatura mundial.

Herniorrafia inguinal por laparoscopia, experiencia en hospital universitario mayor de febrero 2013 a febrero 2014

Los defectos herniarios inguinales son una condición con alta prevalencia en nuestra población. En los últimos años la introducción de la cirugía laparoscopia para la corrección de esta patología ha tomado fuerza gradualmente. El propósito del presente trabajo es describir la experiencia en el uso de esta técnica quirúrgica en una institución hospitalaria. Materiales y métodos: estudio descriptivo de corte trasversal en el cual se revisaron las historias clínica de cada uno de los sujetos llevados a herniorrafia inguinal laparoscópica, donde se evaluaron las características pre y postoperatorias de los casos, así como las complicaciones derivadas del procedimiento. Resultados: Se evaluaron un total de 250 pacientes para un total de 334 Herniorrafias. El promedio de edad fue 58,3 años. La relación hombre mujer fue 3,7: 1. Del total de procedimientos 168 correspondieron a defectos bilaterales. 32 pacientes tenían antecedentes de herniorrafia previa. Se presentaron un total de tres complicaciones. El promedio general de tiempo quirúrgico fue de 69,3 minutos. El seguimiento post operatorio evidencio al dolor inguinal agudo como el principal proceso patológico derivado. El promedio de tiempo de incapacidad en total fue 8,3 días. Se encontró reproducción de la hernia comprobado por ecografía en 10 pacientes. No se produjo ninguna mortalidad en los pacientes del estudio. Conclusiones: La corrección laparoscopia se ha convertido en una alternativa segura y eficiente en el tratamiento definitivo de los defectos herniarios inguinales y debe ser tenida en cuenta en el momento de seleccionar la vía de acceso.

Trauma craneoencefálico severo en la UCIP del Hospital de la Misericordia, 2010-2013

El Trauma Craneoencefálico (TCE) infantil constituye un motivo frecuente de consulta en Urgencias y supone la primera causa de muerte en niños, llegando a ser hasta del 50% en trauma severo. En Colombia se conocen cifras de TCE por algunos estudios descriptivos, pero no existen reportes en Bogotá ni específicamente en TCE severo. Objetivo: Caracterizar el trauma craneoencefálico severo pediátrico en la Unidad de Cuidado intensivo del Hospital de la Misericordia entre los años 2010 y 2013. Materiales y métodos: Un estudio descriptivo retrospectivo fue realizado en el Hospital de la Misericordia mediante revisión de las historias clínicas de los pacientes que ingresaron a la Unidad de Cuidado Intensivo pediátrico con diagnóstico de trauma craneoencefálico severo entre el año 2010 al 2013. Resultados: Se incluyeron 63 pacientes (71,4% hombres) con una edad mediana de 4 años (RIQ 2-8). La mayoría de los traumas fueron originados por caída o accidente de tránsito (79,4%). La principal lesión fue fractura de cráneo (79%). Casi la mitad de los pacientes sufrieron algún tipo de secuela neurológica al egreso (47,1%). La mayoría de los pacientes que murieron (19%) sufrieron choque hipovolémico (83,3%) y presentaron trauma asociado (66,7%). Conclusión: Las características y epidemiología del trauma craneoencefálico en nuestra población muestran claras similitudes con lo reportados en otras series de la literatura mundial y de Colombia, excepto por la mortalidad, que se esperaba más alta al estudiar solo pacientes con TCE severo.

Factors contributing to fecal incontinence in older people and outcome of routine management in home, hospital and nursing home settings

Objective: Fecal loading, cognitive impairment, loose stools, functional disability, comorbidity and anorectal incontinence are recognized as factors contributing to loss of fecal continence in older adults. The objective of this project was to assess the relative distribution of these factors in a variety of settings along with the outcome of usual management. Methods: One hundred and twenty adults aged 65 years and over with fecal incontinence recruited by convenience sampling from four different settings were studied. They were either living at home or in a nursing home or receiving care on an acute or rehabilitation elderly care ward. A structured questionnaire was used to elicit which factors associated with fecal incontinence were present from subjects who had given written informed consent or for whom assent for inclusion in the study had been obtained. Results: Fecal loading (Homes 6 [20%]; Acute care wards 17 [57%]; Rehabilitation wards 19 [63%]; Nursing homes 21 [70%]) and functional disability (Homes 5 [17%]; Acute care wards 25 [83%]; Rehabilitation wards 25 [83%]; Nursing homes 20 [67%]) were significantly more prevalent in the hospital and nursing home settings than in those living at home (P < 0.01). Loose stools were more prevalent in the hospital setting than in the other settings (Homes 11 [37%]; Acute care wards 20 [67%]; Rehabilitation wards 17 [57%]; Nursing homes 6 [20%]) (P < 0.01). Cognitive impairment was significantly more common in the nursing home than in the other settings (Nursing homes 26 [87%], Homes 5 [17%], Acute care wards 13 [43%], Rehabilitation wards 14 [47%]) (P < 0.01). Loose stools were the most prevalent factor present at baseline in 13 of the 19 (68%) subjects whose fecal incontinence had resolved at 3 months. Conclusion: The distribution of the factors contributing to fecal incontinence in older people living at home differs from those cared for in nursing home and hospital wards settings. These differences need to be borne in mind when assessing people in different settings. Management appears to result in a cure for those who are not significantly disabled with loose stools as a cause for their fecal incontinence, but this would need to be confirmed by further research.

Change management in practice: an ethnographic study of changes to contract requirements on a hospital project

Changes to client requirements are inevitable during construction. Industry discourse is concerned with minimizing and controlling changes. However, accounts of practices involved in making changes are rare. In response to calls for more research into working practices, an ethnographic study of a live hospital project was undertaken to explore how changes are made. A vignette of a meeting exploring the investigation of changes illustrates the issues. This represents an example from the ethnographic fieldwork, which produced many observations. There was a strong emphasis on using change management procedures contained within the contract to investigate changes, even when it was known that the change was not required. For the practitioners, this was a way of demonstrating best practice, transparent and accountable decision-making regarding changes. Hence, concerns for following procedures sometimes overshadowed considerations about whether or not a change was required to improve the functionality of the building. However, the procedures acted as boundary objects between the communities of practice involved on the project by coordinating the work of managing changes. Insights suggest how contract procedures facilitate and impede the making of changes, which can inform policy guidance and contract drafting.

A sistematização da gestão baseada em atividades (ABM) - Activity Based Management - para aplicação na área hospitalar : caso Centro de Terapia Intensiva de um hospital universitário público

Esta pesquisa tem por base a aplicação da Gestão Baseada em Atividades ABM - Activity Based Management -, em um Centro de Terapia Intensiva (CTI) de um hospital universitário público. Tem corno objetivo aperfeiçoar a prática gerencial do CTI, estabelecendo relações de causa e efeito no uso dos recursos (humanos, tecnológicos, materiais), permitindo efetuar mudanças para sua melhor utilização, maximizando beneficios a toda organização. O enfoque metodológico foi a pesquisa qualitativa e quantitativa, sendo que o Centro de Terapia Intensiva foi o foco de análise na implementação do ABM. As etapas envolvidas na condução deste trabalho foram a exploratória e a dos seminários, orientadas pela técnica de Thiollent (2000). O trabalho propõe urna sistemática de aplicação do ABM em CTI. A partir de sua aplicação no caso específico - CTI de um hospital público de Porto Alegre - discute os principais benefícios e limitações, bem corno as informações gerenciais proporcionadas. De acordo com análise do conteúdo e os resultados obtidos, pôde-se alicerçar o conhecimento teórico e prático do modelo de gestão proposto, estabelecendo urna nova dimensão na gestão de recursos na área hospitalar, com mais eficiência, assegurando a captura de todo potencial de melhoria identificado.

Influence of Implant Drill Materials on Wear, Deformation, and Roughness After Repeated Drilling and Sterilization

Purpose:The aim of this study was to evaluate deformation, roughness, and mass loss of stainless steel, diamond-like carbon (DLC)-coated and zirconia drills after multiple osteotomies with sterilization procedures.Materials and Methods:Drilling procedures were performed using stainless steel (G1), DLC-coated (G2), and zirconia (G3) drills. All groups were divided in subgroups 1, 2, 3, 4, and 5, corresponded to drills used 0, 10, 20, 30, and 40 times, respectively.Results:No significant differences in mass and roughness were detected among all groups and subgroups. In SEM images, all groups revealed signs of wear while coating delamination was detected in G2. Drills from G1 displayed more irregular surface, whereas cutting edges were more regular in G3.Conclusion:Zirconia drills presented more regular surfaces whereas stainless steel drills revealed more severe signs of wear. Further studies must be performed to evaluate the putative influence of these findings in heat generation.

Gerenciamento dos resíduos de serviços de saúde da Unidade de Terapia Intensiva do Pronto Socorro do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP

Health care waste (HCW) is the type of waste that results from activities performed in health care services during care provision to humans or animals. Presently, according to RDC 306/04, issued in 2004 by Anvisa, and Resolution no. 358/05, by CONAMA, waste groups have the following classification: Group A (biological waste), Group B (chemical waste), Group C (waste containing radionucleotides), Group D (common waste) and Group E (piercing and cutting waste). In Brazil, 149 tons of wastes are collected every day, and HCW corresponds to approximately 1% to 3 % of that total. An efficient way to adequately manage HCW is through the Health Care Waste Management Plan (HCWMP), and it is possible to reduce the risk posed by certain materials in addition to ensuring disposal in an ecologically correct and economical fashion. According to the Pan-American Health Organization (PAHO), the management process enables health care establishments to adequately manage waste. Hence, there is greater control and reduction in the health risks caused by infectious or special waste, in addition to facilitated recycling, treatment, storage, transport and final disposal of solid hospital waste in an environmentally safe fashion. To evaluate the management of HCW of Groups A and D from the Intensive Care Unit of the University Emergency Hospital - FMB - UNESP in the city of Botucatu according to the guidelines presently in force. The waste flow was followed up, and during four random days in the month of September 2011, waste was quantified by estimating daily and monthly values, according to its classification. : In 2011, the University hospital has produced an average of 57,676.8 kg/month of biological and common waste. By adding Groups A and D, during the four days, approximately 209.8 Kg of waste (202.2 Kg of Group A and 7.6 Kg of Group D) were produced in the establishment under study, which... (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)

Integrated pest management programme in hospital environment

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)