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IMPACTO-MR: um estudo brasileiro de plataforma nacional para avaliar infecções e multirresistência em unidades de terapia intensiva
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Tomazini, Bruno M
; Nassar Jr, Antonio Paulo
; Lisboa, Thiago Costa
; Azevedo, Luciano César Pontes de
; Veiga, Viviane Cordeiro
; Catarino, Daniela Ghidetti Mangas
; Fogazzi, Debora Vacaro
; Arns, Beatriz
; Piastrelli, Filipe Teixeira
; Dietrich, Camila
; Negrelli, Karina Leal
; Jesuíno, Isabella de Andrade
; Reis, Luiz Fernando Lima
; Mattos, Renata Rodrigues de
; Pinheiro, Carla Cristina Gomes
; Luz, Mariane Nascimento
; Spadoni, Clayse Carla da Silva
; Moro, Elisângela Emilene
; Bueno, Flávia Regina
; Sampaio, Camila Santana Justo Cintra
; Silva, Débora Patrício
; Baldassare, Franca Pellison
; Silva, Ana Cecilia Alcantara
; Veiga, Thabata
; Barbante, Leticia
; Lambauer, Marianne
; Campos, Viviane Bezerra
; Santos, Elton
; Santos, Renato Hideo Nakawaga
; Laranjeiras, Ligia Nasi
; Valeis, Nanci
; Santucci, Eliana
; Miranda, Tamiris Abait
; Patrocínio, Ana Cristina Lagoeiro do
; Carvalho, Andréa de
; Sousa, Eduvirgens Maria Couto de
; Sousa, Ancelmo Honorato Ferraz de
; Malheiro, Daniel Tavares
; Bezerra, Isabella Lott
; Rodrigues, Mirian Batista
; Malicia, Julliana Chicuta
; Silva, Sabrina Souza da
; Gimenes, Bruna dos Passos
; Sesin, Guilhermo Prates
; Zavascki, Alexandre Prehn
; Sganzerla, Daniel
; Medeiros, Gregory Saraiva
; Santos, Rosa da Rosa Minho dos
; Silva, Fernanda Kelly Romeiro
; Cheno, Maysa Yukari
; Abrahão, Carolinne Ferreira
; Oliveira Junior, Haliton Alves de
; Rocha, Leonardo Lima
; Nunes Neto, Pedro Aniceto
; Pereira, Valéria Chagas
; Paciência, Luis Eduardo Miranda
; Bueno, Elaine Silva
; Caser, Eliana Bernadete
; Ribeiro, Larissa Zuqui
; Fernandes, Caio Cesar Ferreira
; Garcia, Juliana Mazzei
; Silva, Vanildes de Fátima Fernandes
; Santos, Alisson Junior dos
; Machado, Flávia Ribeiro
; Souza, Maria Aparecida de
; Ferronato, Bianca Ramos
; Urbano, Hugo Corrêa de Andrade
; Moreira, Danielle Conceição Aparecida
; Souza-Dantas, Vicente Cés de
; Duarte, Diego Meireles
; Coelho, Juliana
; Figueiredo, Rodrigo Cruvinel
; Foreque, Fernanda
; Romano, Thiago Gomes
; Cubos, Daniel
; Spirale, Vladimir Miguel
; Nogueira, Roberta Schiavon
; Maia, Israel Silva
; Zandonai, Cassio Luis
; Lovato, Wilson José
; Cerantola, Rodrigo Barbosa
; Toledo, Tatiana Gozzi Pancev
; Tomba, Pablo Oscar
; Almeida, Joyce Ramos de
; Sanches, Luciana Coelho
; Pierini, Leticia
; Cunha, Mariana
; Sousa, Michelle Tereza
; Azevedo, Bruna
; Dal-Pizzol, Felipe
; Damasio, Danusa de Castro
; Bainy, Marina Peres
; Beduhn, Dagoberta Alves Vieira
; Jatobá, Joana D’Arc Vila Nova
; Moura, Maria Tereza Farias de
; Rego, Leila Rezegue de Moraes
; Silva, Adria Vanessa da
; Oliveira, Luana Pontes
; Sodré Filho, Eliene Sá
; Santos, Silvana Soares dos
; Neves, Itallo de Lima
; Leão, Vanessa Cristina de Aquino
; Paes, João Lucidio Lobato
; Silva, Marielle Cristina Mendes
; Oliveira, Cláudio Dornas de
; Santiago, Raquel Caldeira Brant
; Paranhos, Jorge Luiz da Rocha
; Wiermann, Iany Grinezia da Silva
; Pedroso, Durval Ferreira Fonseca
; Sawada, Priscilla Yoshiko
; Prestes, Rejane Martins
; Nascimento, Glícia Cardoso
; Grion, Cintia Magalhães Carvalho
; Carrilho, Claudia Maria Dantas de Maio
; Dantas, Roberta Lacerda Almeida de Miranda
; Silva, Eliane Pereira
; Silva, Antônio Carlos da
; Oliveira, Sheila Mara Bezerra de
; Golin, Nicole Alberti
; Tregnago, Rogerio
; Lima, Valéria Paes
; Silva, Kamilla Grasielle Nunes da
; Boschi, Emerson
; Buffon, Viviane
; Machado, André Sant’Ana
; Capeletti, Leticia
; Foernges, Rafael Botelho
; Carvalho, Andréia Schubert de
; Oliveira Junior, Lúcio Couto de
; Oliveira, Daniela Cunha de
; Silva, Everton Macêdo
; Ribeiro, Julival
; Pereira, Francielle Constantino
; Salgado, Fernanda Borges
; Deutschendorf, Caroline
; Silva, Cristofer Farias da
; Gobatto, Andre Luiz Nunes
; Oliveira, Carolaine Bomfim de
; Dracoulakis, Marianna Deway Andrade
; Alvaia, Natália Oliveira Santos
; Souza, Roberta Machado de
; Araújo, Larissa Liz Cardoso de
; Melo, Rodrigo Morel Vieira de
; Passos, Luiz Carlos Santana
; Vidal, Claudia Fernanda de Lacerda
; Rodrigues, Fernanda Lopes de Albuquerque
; Kurtz, Pedro
; Shinotsuka, Cássia Righy
; Tavares, Maria Brandão
; Santana, Igor das Virgens
; Gavinho, Luciana Macedo da Silva
; Nascimento, Alaís Brito
; Pereira, Adriano J
; Cavalcanti, Alexandre Biasi
.
Revista Brasileira de Terapia Intensiva
- Métricas do periódico
ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.
RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.
2.
Hospitalization, mortality and public healthcare expenditure in Brazil during the COVID-19 crisis: vulnerabilities in the spotlight
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Nascimento, Israel Júnior Borges do
; Oliveira, Ana Luíza Matos de
; Diniz, Paulo Henrique Costa
; Leite, Maria de Fatima
; Oliveira, Graziella Lage
.
ABSTRACT BACKGROUND: Multiple opinion-based communications have highlighted the actions of the Brazilian government during the pandemic. Nevertheless, none have appraised public data to identify factors associated with worsening of the healthcare system. OBJECTIVE: To analyze and collate data from public health and treasury information systems in order to understand the escalating process of weakening of Brazilian healthcare and welfare since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. DESIGN AND SETTING: Secondary data study conducted using multiple public databases administered by the Brazilian federal government. METHODS: We processed information from multiple national databases and appraised health and economic-related data. RESULTS: Based on our analyses, there were substantial reductions in inpatient hospital admissions and in the numbers of patients seeking primary care services, along with a decrease in immunization coverage. Moreover, we observed a considerable decline in government transfers to hospital services (reduction of 82.0%) and a diminution of public outlays in several healthcare-related subfunctions (“hospital and outpatient care”, “primary care”, “prophylactic and therapeutic support” and “epidemiological surveillance”). We observed an increase in the overall mortality rate over the period analyzed, especially regarding all group-based diseases. Notably, there were remarkable differences among geographic, racial, gender and other parameters, thus revealing the impact of vulnerabilities on COVID-19 outcomes. CONCLUSION: This assessment of documentation of public expenditure and the shrinkage of investment in sensitive areas of the healthcare system in Brazil emphasized areas that still require collective attention in order to guarantee national welfare.
3.
Pre-hospital Care for Suspected Stroke Patients, Cared for by Mobile Emergency Care Units in Northern Minas Gerais
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Gusmão, Lorenn Lages
; Nascimento, Israel Junior Borges do
; Rocha, Gabriel Almeida Silqueira
; Oliveira, João Antonio de Queiroz
; Machado, Geisiane Sousa Braga
; Antunes, Izabella de Oliveira
; Sant’anna, Romeu Vale
; Fernandes, Breno Franco Silveira
; Correia, Ubiratam Lopes
; Ribeiro, Antonio Luiz Pinho
; Marcolino, Milena S.
.
International Journal of Cardiovascular Sciences
- Métricas do periódico
Abstract Background Stroke management require rapid identification, assessment, and transport of patients to qualified health care centers. However, there is little description in the literature on the multiple challenges associated with the pre-hospital transport of suspected stroke patients. Objective To characterize the pre-hospital care provided to suspected stroke patients by the Brazilian Emergency Medical Service (SAMU in Portuguese), by means of a descriptive case study. Methods This is a descriptive study of a series of cases. Data from the SAMU regarding the responses to emergency calls from suspected stroke patients were collected. Independent reviewers confirmed the diagnostic hypothesis and all discordances were assessed using kappa statistics. Clinical data and transport times were described as frequency and proportion or central tendency and dispersion measures. Normality of continuous variable distribution was assessed using the Kolmogorov-Smirnov test. The Mann-Whitney U test was used for comparison of medians, with a 5% significance level. Results During the studied period, 556 suspected stroke patients were treated. The kappa index was 0.82 (95% CI 0.737 to 0.919) CI. In 74.7% of the cases, the symptom onset time was not recorded. The median time elapsed between the call for emergency services and the ambulance arrival was 18 minutes, and the median transport time was 38 minutes. A total of 34% of the patients were taken to referral hospitals for stroke. Conclusion This study revealed a low level of knowledge regarding the need to determine the exact time of symptom onset of suspected stroke patients. Also, the study showed the low rate of patients taken to referral hospitals. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)
https://doi.org/10.36660/ijcs.20190199
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4.
Clinical characteristics and outcomes among Brazilian patients with severe acute respiratory syndrome coronavirus 2 infection: an observational retrospective study
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Nascimento, Israel Júnior Borges do
; Pinto, Luiz Ricardo
; Fernandes, Valéria Alves
; Romero, Israel Molina
; Oliveira, João Antonio de Queiroz
; Marcolino, Milena Soriano
; Leite, Maria Fátima
.
ABSTRACT BACKGROUND: Since February 2020, data on the clinical features of patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and their clinical evolution have been gathered and intensively discussed, especially in countries with dramatic dissemination of this disease. OBJECTIVE: To assess the clinical features of Brazilian patients with SARS-CoV-2 and analyze its local epidemiological features. DESIGN AND SETTING: Observational retrospective study conducted using data from an official electronic platform for recording confirmed SARS-CoV-2 cases. METHODS: We extracted data from patients based in the state of Pernambuco who were registered on the platform of the Center for Strategic Health Surveillance Information, between February 26 and May 25, 2020. Clinical signs/symptoms, case evolution over time, distribution of confirmed, recovered and fatal cases and relationship between age group and gender were assessed. RESULTS: We included 28,854 patients who were positive for SARS-CoV-2 (56.13% females), of median age 44.18 years. SARS-CoV-2 infection was most frequent among adults aged 30-39 years. Among cases that progressed to death, the most frequent age range was 70-79 years. Overall, the mortality rate in the cohort was 8.06%; recovery rate, 30.7%; and hospital admission rate (up to the end of follow-up), 17.3%. The average length of time between symptom onset and death was 10.3 days. The most commonly reported symptoms were coughing (42.39%), fever (38.03%) and dyspnea/respiratory distress with oxygen saturation < 95% (30.98%). CONCLUSION: Coughing, fever and dyspnea/respiratory distress with oxygen saturation < 95% were the commonest symptoms. The case-fatality rate was 8.06% and the hospitalization rate, 17.3%.
https://doi.org/10.1590/1516-3180.2020.00365.r1.08092020
1016 downloads
5.
Use of smartphone-based instant messaging services in medical practice: a cross-sectional study
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Nascimento, Israel Junior Borges do
; Oliveira, João Antonio de Queiroz
; Wolff, Iago Souza
; Ribeiro, Laura Defensor
; Silva, Maíra Viana Rego Souza e
; Cardoso, Clareci Silva
; Mars, Maurice
; Ribeiro, Antonio Luiz
; Marcolino, Milena Soriano
.
ABSTRACT BACKGROUND: Instant messaging services (IMS) are widely used in medical practice. OBJECTIVE: To evaluate perceptions regarding use and usability of IMS within clinical practice and assess users’ knowledge of the ethical and legal context involved in using IMS within medical practice. DESIGN AND SETTING: Cross-sectional study conducted in different hospitals and medical institutions in Minas Gerais, Brazil. METHODS: Medical students, medical residents, primary care physicians and specialist doctors answered an online questionnaire regarding epidemiological data, graduation level and use of IMS for medical communication. Responses were collected over a five-month period and data were assessed using the IBM-SPSS software. RESULTS: 484 people answered the questionnaire: 97.0% declared that they were using IMS for medical-related purposes; 42.0%, to elucidate medical concerns every week; 75.0%, to share imaging or laboratory tests and patients’ medical records; and 90.5%, to participate in clinical case-study private groups. Moreover, only 37.0% declared that they had knowledge of the legislative aspects of use of smartphones within clinical practice. Differences in the frequency of discussion of medical concerns within the daily routine between student/residents and general practitioners/specialists, and in the frequency of image-sharing and patient-guiding/assistance between students and medical doctors, were observed. CONCLUSIONS: Our results provide reliable proof that medical doctors and students use IMS, as a tool for clinical case discussions, interactions between healthcare providers and patients, or dissemination of knowledge and information. Nonetheless, because of limitations to the ethical and legal regulations, evidence-based discussions between authorities, academics and medical institutions are needed in order to fully achieve positive outcomes from such platforms.
https://doi.org/10.1590/1516-3180.2020.0010.r1.28032020
1040 downloads
6.
Saúde Mental de Alunos de Medicina Submetidos à Aprendizagem Baseada em Problemas: Revisão Sistemática da Literatura
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Silva, Carlos Emanoel Chaves da
; Nascimento, Alef Oliveira do
; Nascimento, Israel Junior Borges do
; Couto, Mayra Hermínia Simões Hamad Farias do
; Souza Filho, Luiz Euclides Coelho de
; Cunha, Katiane da Costa
.
Resumo: Introdução: O curso de Medicina possui fatores potencialmente estressantes que podem gerar adoecimento psíquico nos alunos. Métodos curriculares alternativos ao sistema tradicional, como aAprendizagem Baseada em Problemas (ABP), podem ter impacto na saúde mentaldos discentes. O objetivo deste estudo foirealizar uma revisão sistemática de estudos que avaliaram a saúde mental de estudantes de Medicina submetidos ao método ABP. Método: Realizou-se uma busca de alta sensibilidade nas principais bases de dados científicas associadas àsaúde mental (CochraneLibrary, Medline via PubMed, Portal Regional da Biblioteca Virtual em Saúde(BVS), Eric e Embase) com inserção até 22 de setembro de 2019. Os descritos indexados e os termos de identificação foram definidos por especialistas e avaliados pelo grupo de tecnologia da informação da Universidade Estadual do Pará.Os critérios de inclusão para os estudos obtidos por meioda busca foram: artigos apresentados na íntegra, escritos em qualquer língua, publicados no período de 1998 a 2018, com foco na saúde mental de alunos do curso de Medicina submetidos ao método ABP. Excluíram-se os trabalhos que não avaliaram a saúde mental, os artigos em que a amostra não foi submetida à metodologia de ensino ABP e aqueles de revisão literária. Após a seleção, os artigos foram avaliados duplamente por revisores independentes quanto ao risco de viés e à qualidade de evidência mediante a ferramenta Robins-I. Resultados: Identificaram-se 1.261 estudos, dos quais se excluíram 1.251 conforme orientaçãodoprotocolo Prisma, restando dezartigos ao final, os quais foram sintetizados de forma descritiva. Em geral, os estudos têm mostrado que o método de ABP, em comparação com o método tradicional, promove melhor desempenho acadêmico, bem como estimula atividades práticas, fato que gera certo grau de satisfação. Conclusão: Os discentes de Medicina submetidos ao método ABP são associados a resultados adequados de aprendizado e desempenho médico-científico. Entretanto,metodologias científicas mais assertivas, baseadas em critérios metodológicos mais rigorosos,são necessárias para elucidar de forma mais abrangente os benefícios e danos dessa metodologia pedagógica.
Abstract: Introduction: Medical students are subjected to potentially stressful factors that can lead to psychological illness. Alternatives to traditional training methods, such as Problem-Based Learning (PBL), can impact on students’ mental health. The aim of this study was to carry out a systematic review of studies that evaluate the mental health of medical students submitted to the Problem-Based Learning (PBL) method. Method: A highly sensitive search was carried out in the main scientific databases associated with mental health (Cochrane Library, MEDLINE via PUBMED, Regional Health Portal (VHL), Eric and EMBASE) with inclusion up to September 22, 2019. Indexed descriptions and identification terms were defined by specialists and evaluated by the information technology group of the StateUniversity of Pará. The inclusion criteria for the study search were: articles presented in full, written in any language, published in the period from 1998 to 2018, focusing on the mental health of medical students submitted to the PBLmethod. Articles that did not assess mental health, articles in which the sample was not submitted to PBL, andreview articleswere excluded. After selection, the articles were assessed twice by independent reviewers for risk of bias and quality of evidence using the ROBINS-I tool. Results: 1261 studies were identified, of which 1251 were excluded following the PRISMA protocol, leaving a final sample of ten articles, which were descriptively summarized.In general, studies have shown that PBL, compared to traditional teaching methods, promotes better academic performance, as well as stimulating practical activities, a fact that generates a certain degree of satisfaction. Conclusion: Medical students submitted to the PBL method are more likely to be associated with better learning outcomes and medical-scientific performance. However, better study designs, based on rigorous systematic methodologies are required in order to elucidate the benefits and harms of this educational methodology.
https://doi.org/10.1590/1981-5271v44.4-20200052
1738 downloads
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