RESUMO
O aborto legal e a violência sexual são temas importantes para a saúde das mulheres no país. Porém, o acesso e a qualidade dos serviços prestados a estas demandas estão aquém do ideal. Lançada em 2011, a Rede Cegonha tem entre suas ações vinculadas o ApiceON Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia , projeto que congrega cerca de cem hospitais com atividade de ensino no país e se volta a qualificação da atenção, gestão e ensino, considerando-os componentes indissociáveis. Em Belo Horizonte, o projeto conta em com o Hospital Risoleta Tolentino Neves (HRTN) como um destes serviços. OBJETIVO: Demarcar os movimentos e ações disparadas, planejadas e/ou implementadas por um coletivo de trabalho de uma maternidade participante do projeto ApiceON na humanização do cuidado às mulheres em situação de violência sexual e abortamento, considerando seu desenho de acompanhamento avaliativo. MÉTODOS: Pesquisa qualitativa, do tipo estudo de caso, recorte de um estudo maior intitulado "Avaliação para a qualificação da atenção obstétrica e neonatal em hospitais com atividades de ensino". Foi escolhido como unidade de análise o grupo estratégico local (GEL-HRTN). Participaram deste estudo 10 trabalhadores que integravam o GEL de forma ativa no período da pesquisa. A coleta de dados ocorreu entre out./2019 e jan./2020, por meio de análise documental, observação participante e entrevista. A análise dos dados ocorreu mediante a metodologia do acompanhamento avaliativo transversal proposta pelo Projeto. RESULTADOS: O GEL realizou movimentos e ações que proporcionaram a construção do serviço de atendimento à vítima de violência sexual, assim como possibilitou o reconhecimento do trabalho coletivo como importante ferramenta para a mudança. Porém, observase que ações de gestão e formação ainda apontam como incipientes. CONCLUSÕES: Reconhece-se que este coletivo avançou nos aspectos relativos ao componente atenção. Contudo, apresentou dificuldades próprias de uma instância colegiada, em especial aquelas referentes à gestão e participação dos estudantes. Novos estudos devem ser conduzidos a fim de elucidar questões não esclarecidas neste trabalho.
Legal abortion and sexual violence are important issues for the health of women in the country. However, the access and quality of services provided to these demands are less than ideal. Launched in 2011, the Cegonha Network has among its related actions ApiceON Improvement and Innovation in Care and Education in Obstetrics and Neonatology , a project that brings together about one hundred hospitals with teaching activity in the country, aimed at qualifying care, management and teaching, considering them inseparable components. The project in Belo Horizonte has the Hospital Risoleta Tolentino Neves (HRTN) as one of these services. OBJECTIVE: To demarcated the movements and actions triggered, planned and / or implemented by a working group from a maternity hospital participating in the ApiceON project in the humanization of care for women in situations of sexual violence and abortion, considering its evaluative follow-up design METHODS: Qualitative research , of the case study type, part of a larger study entitled "Evaluation for the qualification of obstetric and neonatal care in hospitals with teaching activities." As a unit of analysis, the local strategic group (GEL-HRTN) was chosen. They participated in this study 10 workers who actively integrated the GEL during the research period. The data collection took place between Oct / 2019 and Jan / 2020, through document analysis, participant observation and interview. The data analysis took place using the evaluation monitoring methodology transversal proposal proposed by the Project RESULTS: GEL made arrangements, and movements provided the construction of the service to victims of sexual violence, as well as making it possible to recognize collective work as an important tool for change. However, it is observed that management and training actions still point out as incipient. CONCLUSIONS: It is recognized that this group has advanced in the aspects related to the attention component, however, it presented difficulties specific to a collegiate body, especially those related to the management and participation of students. New studies should be conducted in order to elucidate issues not revealed in this work.
Assuntos
Humanos , Feminino , Violência contra a Mulher , Aborto , Humanização da Assistência , Hospitais de Ensino/tendências , Delitos Sexuais/legislação & jurisprudência , Assistência Perinatal , Pesquisa Qualitativa , NeonatologiaRESUMO
Background Adverse drug reactions (ADRs) occur frequently during hospital stays and are an important public health problem, particularly in the care of the older. Objectives This study aimed to determine the prevalence of ADRs among older inpatients and the factors associated with their occurrence. Setting Brazilian teaching hospital. Methods This was a cross-sectional study with older inpatients in the internal medicine ward of a teaching hospital. The dependent variable was the occurrence of an ADR during hospitalization. The independent variables were gender, age, length of hospitalization, number of health problems, medications, and potentially inappropriate medications for the older. Logistic regression was performed to analyze the association between an ADR and the independent variables. Main outcome measure Factors associated with ADR in older inpatients. Results Among the 237 inpatients investigated, 50 (21.1%) developed at least one ADR. The total number of ADRs observed was 62 and the most frequent were acute kidney injury, hypotension, and cutaneous adverse reactions A multivariate analysis demonstrated a positive and independent association between the occurrence of an ADR and the presence of heart failure [odds ratio (OR) 2.4; 95% confidence interval (CI) 1.2-4.6], and with hospitalization time exceeding 12 days (OR 2.3; 95% CI 1.2-4.4). Conclusions The study showed a high prevalence of ADRs among the older and a positive association with hospitalization time and heart failure. Understanding the factors associated with the occurrence of ADRs among older inpatients provides elements for improving the safety of care and optimization of pharmacotherapy.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Hospitalização/tendências , Hospitais de Ensino/tendências , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoAssuntos
Serviço Hospitalar de Emergência/tendências , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Hospitais de Ensino/tendências , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/terapia , Humanos , Masculino , México , Pessoa de Meia-Idade , Volume SistólicoRESUMO
The need for surgical care in Haiti remains vast despite the enormous relief efforts after the earthquake in 2010. As the poorest country in the Western hemisphere, Haiti lacks the necessary infrastructure to provide surgical care to its inhabitants. In light of this, a multidisciplinary approach led by Partners In Health and Dartmouth-Hitchcock Medical Center is improving the access to surgical care and offering treatment of a broad spectrum of pathology. This article discusses how postearthquake Haiti partnerships involving academic institutions can alleviate the surgical burden of disease and, in the process, serve as a profound educational experience for the academic community. The lessons learned from Haiti prove applicable in other resource-constrained settings and invaluable for the next generation of surgeons.
Assuntos
Países em Desenvolvimento , Desastres , Terremotos , Acessibilidade aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/tendências , Previsões , Haiti , Acessibilidade aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Hospitais de Ensino/organização & administração , Hospitais de Ensino/tendências , Humanos , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/tendências , Ferimentos e Lesões/cirurgiaRESUMO
BACKGROUND: Penetrating traumas, including gunshot and stab wounds, are the major causes of cardiac trauma. Our aim was to describe and compare the variables between patients with penetrating cardiac trauma in the past 20 y in a university hospital, identifying risk factors for morbidity and death. METHODS: Review of trauma registry data followed by descriptive statistical analysis comparing the periods 1990-1999 (group 1, 54 cases) and 2000-2009 (group 2, 39 cases). Clinical data at hospital admission, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS) were recorded. RESULTS: The incidences of penetrating cardiac injuries were steady within the period of study in the chosen metropolitan area. The two groups were similar regarding age, mechanism of trauma (gunshot × stab), and ISS. Group 1 showed lower systolic blood pressure at admission (mean 87 versus 109 mm Hg), lower GCS (12.9 versus 14.1), lower RTS (6.4 versus 7.3), higher incidence of grade IV-V cardiac lesions (74% versus 48.7%), and were less likely to survive (0.83 versus 0.93). The major risk factor for death was gunshot wound (13 times higher than stab wound), systolic blood pressure < 90 mm Hg, GCS < 8, RTS < 7.84, associated injuries, grade IV-V injury, and ISS > 25. We observed a tendency in mortality reduction from 20.3% to 10.3% within the period of observation. CONCLUSIONS: Several associated factors for mortality and morbidity were identified. In the last decade, patients were admitted in better physiological condition, perhaps reflecting an improvement on prehospital treatment. We observed a trend toward a lower mortality rate.
Assuntos
Traumatismos Cardíacos/epidemiologia , Traumatismos Cardíacos/mortalidade , Hospitais de Ensino/tendências , Hospitais Universitários/tendências , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/mortalidade , Adulto , Brasil , Serviços Médicos de Emergência/tendências , Feminino , Traumatismos Cardíacos/terapia , Humanos , Incidência , Masculino , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/mortalidade , Ferimentos por Arma de Fogo/terapia , Ferimentos Penetrantes/terapia , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/mortalidade , Ferimentos Perfurantes/terapiaRESUMO
BACKGROUND: A decrease in hemoglobin concentration [Hb] with no apparent cause is frequently observed in critically ill patients. Scarce information is available about this situation in general ward-admitted patients (GWAP). OBJECTIVES: To describe [Hb] variation with no obvious cause in GWAP, and to estimate the prevalence and predictors of patients with [Hb] decreases > or =1.5 g/dL. DESIGN, SETTING AND PATIENTS: Prospective, observational study in internal medicine GWAP, carried out at two teaching hospitals in Buenos Aires, Argentina. Patients with a history of, or admitted for diseases associated with decreases in [Hb], as well as those with length of stay less than three days, were excluded. MEASUREMENTS: Upon hospitalization, complete personal and clinical data were recorded. Furthermore, Katz index, APACHE II acute physiology score (APS) and Charlson score were calculated. [Hb] and hematocrit (HCT) were also assessed during hospitalization. RESULTS: A total of 338 patients were evaluated, 131 were included. A mean [Hb] decrease of 0.71 g/dL was observed between admission and discharge (P < 0.001; 95% CI, 0.47-0.97). Forty-five percent of the included patients had decreases in [Hb] > or = 1.5 g/dL. This was associated with a higher APS, a higher [Hb] at admission, and a discharge diagnosis of infectious or gastrointestinal disease. No bleeding episodes were observed. CONCLUSIONS: An [Hb] decrease was frequently observed during GWAP hospitalization with no evident blood loss. Even though this decrease has multiple causes, the severity of the acute illness seems to play a major role.
Assuntos
Índices de Eritrócitos/fisiologia , Hemoglobinas , Hospitalização/tendências , Medicina Interna/tendências , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estado Terminal/epidemiologia , Contagem de Eritrócitos/tendências , Feminino , Hemoglobinas/metabolismo , Hospitais de Ensino/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Adulto JovemRESUMO
Introdução: Relatos das prevalências de interações medicamentosas em hospitais brasileiros são escassos. Objetivos: Descrever a prevalência de interações medicamentosas potenciais entre os fármacos prescritos nas enfermarias clínicas e cirúrgicas de um hospital-escola. secundariamente, descrever as características dessas interações e relacionar a sua ocorrência com o número de medicamentos prescritos e a idade dos pacientes. Pacientes e Métodos: Os dados foram coletados durante uma semana de out/2007, de 2a a 6a feira, a partir da última ficha de prescrição encontrada nos prontuários, envolvendo 128 fichas de prescrição com 10,5±4,1 fármacos. Os pacientes tinham 58,6±16,9 anos e 51,2% eram homens. A doença cardiovascular foi a enfermidade principal (23,4%) e a comorbidade (42,5%) mais frequentemente encontrada. A análise das interações foi feita através de consulta a um sistema interativo (Micromedex®). Resultados: 485 interações foram encontradas, estando presentes em 79,7% (IC95%: 72,6-86,8) das fichas de prescrição (média 3,8). A interação mais frequente foi captopril/dipirona (9,7%), seguida por dipirona/furosemida (4,5%), e os fármacos mais envolvidos foram dipirona (29,3%) e captopril (21,2%). A maioria das interações tinha mecanismo farmacodinâmico (65,5%), gravidade moderada (55,5%), começo tardio (61,3%) e bom embasamento científico (71,1%). A prevalência de interações esteve associada fortemente com o número de fármacos prescritos (r=0,65, p<0,001) e fracamente com a idade do paciente.
Introduction: Reports of the prevalence of drug interactions in Brazilian hospitals are scarce. Aims: To describe the prevalence of potential drug interactions among the medical drugs prescribed in the clinical and surgical units of a teaching hospital. Secondarily, to describe the characteristics of drug interactions and relate their occurrence to the number of prescribed medications and patient age. Patients and Methods: The data were collected from Monday to Friday of a week in Oct 2007, starting from the last prescription form found in the medical charts, and involved 128 prescription forms with 10.5±4.1 drugs. The patients mean age was 58.6±16.9 years and 51.2% were males. Cardiovascular disease was the main disease (23.4%) and the most frequently found comorbidity (42.5%). The analysis of interactions was done through consultation with an interactive system (Micromedex®). Results: 485 cases of drug interactions were found, being present in 79.7% (CI95%: 72.686.8) of the prescription forms (mean 3.8). The most frequent interaction was captopril/dipyrone (9.7%), followed by ipyrone/furosemide (4,5%), and the most frequently involved drugs were dipyrone (29.3%) and captopril (21.2%). Most of the interactions had a pharmacodynamic mechanism (65.5%), moderate severity (55.5%), late onset (61.3%), and a good scientific basis (71.1%). The prevalence of interactions was strongly associated with the number of drugs prescribed (r=0.65, p<0.001) and weakly associated with patient age.
Assuntos
Humanos , Masculino , Feminino , Captopril/administração & dosagem , Captopril , Captopril/efeitos adversos , Dipirona/administração & dosagem , Dipirona , Dipirona/efeitos adversos , Dipirona/farmacologia , Prescrições de Medicamentos , Prevalência , Prescrição Homeopática , Hospitais de Ensino/organização & administração , Hospitais de Ensino , Hospitais de Ensino/tendênciasRESUMO
This article is intended to describe to clinicians what the Department of Education in Health Sciences means to pre graduation teaching of bioethics, through its historical development,its educational objectives and its contents. There is yet no consensus among different Schools about the methods used to teach the discipline and its purpose, so discussion provokesreflection and alternative decisions. The concept and significance of the hidden curriculum, derived from the afore explicit terminology with polisemic interpretation, adds to the debateas it produces new entrances to the pool of meanings, varying from knowledge and culture increments to deliberated and malicious imposition of information. It seems mandatory to all the clinical tutors to assume direct responsibility in students ethics problems analysis, as part of their general competences and reflecting the usual clinical exposure to these situations and the importance that knowing to handle these events has in the medical setting.