Brazilian General Hospital Research Articles

Pediatric COVID-19: clinical and epidemiological data of 1303 cases in a general hospital in Brazil.

This study aimed to describe the clinical characteristics of the pediatric population with COVID-19 in an Emergency Department (ED) of a Brazilian general hospital. Epidemiological and clinical data of patients younger than 20 years old were collected from patients' medical records from February 2020 to July 2021. Most of the epidemiological data described pertains to hospitalized patients. We also reviewed coinfections, treatment, and outcomes and compared the first and second waves of COVID-19. We identified a total of 1303 episodes of SARS-CoV-2 infection. The median time from symptom onset to diagnosis was three days. Symptoms were present in 92.3% of the patients. The most common symptoms were fever (45.2%), nasal congestion/discharge (44.2%), and cough (39.4%). Chest radiography and tomography were performed in 7.7 and 3.3% of cases, with abnormal findings in 29.7 and 53.4%, respectively. Hospital admissions occurred in 3.5% of patients, mainly in the presence of comorbidities, in children under five years old and in those who presented to the ED during the first wave of COVID-19. Coinfection with a viral agent was identified in 20% of the 71 cases tested in this study, and a positive rapid test for Streptococcus pyogenes was found in 8% of the 174 cases tested, with no impact of these coinfections on hospitalization. We found that COVID-19 was a mild disease in most children in our study population, with most hospitalizations and readmissions occurring during the first wave of COVID-19.

Usefulness of serum sodium levels as a novel marker for predicting acute appendicitis severity: a retrospective cohort study

BackgroundEarly and accurate preoperative diagnosis of complicated appendicitis mandates the identification of new markers. The aim of this study is to determine whether preoperative serum sodium levels are useful for predicting the severity of acute appendicitis.MethodsWe retrospectively analyzed 475 patients who underwent emergency appendectomies between January 2018 and February 2023 in a general hospital in Brazil. The patients were divided into 2 groups: complicated (n = 254) and uncomplicated (n = 221). Hyponatremia was defined as serum sodium levels < 136 mEq/L. The primary outcome was to evaluate if hyponatremia is associated with complicated appendicitis.ResultsThe patients had a median age of 22 years, and the median serum sodium level was 137 mEq/L in patients with complicated appendicitis and 139 mEq/L in uncomplicated appendicitis (P < 0.001). The analysis of the receiver operating characteristic curve used as the best cutoff value of serum sodium of 136 mEq/L with a sensitivity of 45.7%, specificity of 86.4%, positive predictive value of 79.5%, and negative predictive value of 58.1% for the diagnosis of complicated AA. Of the 254 patients with complicated appendicitis, 84 (33.1%) had serum sodium levels below 136 mEq/L, while only 12 (5.4%) patients with uncomplicated appendicitis had values ​​below this cutoff. Patients with hyponatremia were 5 times more likely to develop complicated appendicitis. (odds ratio: 5.35; 95% confidence interval: 3.39–8.45)ConclusionsPreoperative serum sodium levels are a useful tool for predicting the severity of acute appendicitis. Due to its low cost and wide availability, it has become an extremely relevant marker.

Influence of the centralizing gastric cancer surgery on the health-related quality of life in Brazil.

The assessment of health-related quality of life (QoL) has improved the treatment of gastric cancer. Aiming to compare the influence of skilled surgeons in general hospitals versus specialized hospitals in cancer in Brazil, this study evaluated the relationship between quality of life and types of hospitals (general or cancer) in treating patients with gastric adenocarcinoma operated by surgeons with specific training in Surgical Oncology. This was a cross-sectional study involving 104 patients. Inferential analyses were used to compare two Brazilian general hospitals and a cancer center, evaluating scores of the SF-36 and FACT-Ga QoL questionnaires (Kruskal-Wallis test, Mann-Whitney test); gender, smoking, and Helicobacter pylori tests status (Pearson's Chi-Square test); ethnicity, alcoholism, location of the tumor in the stomach, Lauren's histological types, and type of surgery (Fisher's exact test), number of lymph nodes resected by Surgical Oncologists [Analysis of Variance (ANOVA) with a Fixed Factor], and comparative survival analysis (Log-Rank test). Patients treated at a cancer hospital had higher scores of the FACT-Ga (FACT-G total score, P=0.023; physical well-being, PWB, P=0.006; and functional well-being, FWB, P=0.011). The mean scores of the SF-36 questionnaire showed similar behavior but without reaching a significant difference. Patients operated by Surgical Oncologists at the cancer hospital had better scores in emotional well-being FACT-Ga domain (EWB, P=0.034 and P=0.047) compared to those operated by Surgical Oncologists in general hospitals. There was no significant difference in survival among the three hospitals (P=0.214). In this study, it was possible to suggest the relationship between QoL assessment scores with the centralization of care at specialized cancer hospital in the treatment of patients with gastric adenocarcinoma undergoing surgery with curative intent in Brazil.

Exploring Depressive and Anxiety Symptoms Among Employees from a General Hospital in Need of Mental Health Treatment: A Cross-sectional Study

ObjectiveThis study aimed to investigate the association between occupation and depressive/anxiety symptoms, and education levels, among professionals from a Brazilian General Hospital in need of mental health treatment. Design and settingThis is a cross-sectional study, involving professionals from a teaching hospital in São Paulo. MethodsSocio-demographic data were collected as well as two standardized scales for depression and anxiety symptoms. ResultsData from 506 employees seeking mental health assistance have been described: mean age was 34.6 years, 46.2% of them worked in the administrative sector, 35.0% were nursing assistants, 7.5% were nursing technicians, 6.7% were nurses, and 4.5% reported other occupations. According to the International Classification of Diseases-10th edition (ICD-10) criteria, the rates of diagnosis of depressive disorders and anxiety disorders were 60.9% and 37%, respectively. Nursing technicians and nursing assistants reported higher somatic cluster Beck Depression Inventory (BDI) scores (P=0.012) than other professionals of technical staff, but they were less inclined to receive a psychiatric diagnosis. ConclusionsOur study demonstrated prevalence rates higher than similar studies in university hospitals, fact that associated with difficulties of the studied population as seeing themselves as sick, and the social discrimination suffered by people with mental disorders can make this problem even worse.

“We weren’t used to seeing our colleagues hospitalized”: A clinical-qualitative study on reports from an intensivist clinical team at a Brazilian university public hospital

IntroductionThe care relationships of physicians and nurses with patients with Covid-19 had pointed to a scenario explorable from a psychological point of view due to the peculiarities of this pandemic. How do clinicians feel, when caring for their co-workers, in a context that was not so common to see colleagues occupy the patient’s place? What emotional experiences arise from this reality? The results of the present study sought to point out how to handle this caring relationship, in an exceptional context.ObjectivesTo interpret emotional meanings reported by physicians and nurses on their experiences of working at COVID-19 intensive care units during the height of the pandemic.MethodsClinical-qualitative design of Turato. Data collection with semi-directed interviews with open-ended questions in-depth applied to a sample of six professionals, closed by theoretical information saturation according to Fontanella, in a Brazilian university general hospital. Trigger question: “Talk about the psychological meanings of your experience in face of management of patients with COVID-19 at ICU”. Data treatment by the Seven Steps of the Clinical-Qualitative Content Analysis of Faria-Schützer. Theoretical framework from Medical Psychology using Balintian concepts.ResultsWe raised initially 4 categories. Three categories were presented preliminarily in this congress, version last year. In this opportunity, we show this special category of analysis that emerged during the deepened discussion of the final results: “The feeling of insecurity: from technique to affective dimension”.ConclusionsThe care relationships between the health professional and the patient hospitalized in the Covid-19 ICU pointed to peculiar transference and countertransference psychodynamic mechanisms between both. Before the pandemic, the care relationship seemed pragmatic and protocolar. During the pandemic, this relationship seemed “more subjective”, building a strongly emotional dimension, as health professionals also began to care for their colleagues in the profession. The egoic defense mechanisms, such as projective and introjective identification were reported as intense.Disclosure of InterestNone Declared

Evaluation of in-vitro susceptibility of ß-lactam-resistant Gram-negative bacilli to ceftazidime-avibactam and ceftolozane-tazobactam from clinical samples of a general hospital in southern Brazil.

The spread of carbapenemase- and extended-spectrum β-lactamase (ESBL)-producing gram-negative bacilli (GNB) represent a global public health threat that limits therapeutic options for hospitalized patients. This study aimed to evaluate the in-vitro susceptibility of β-lactam-resistant GNB to ceftazidime-avibactam (C/A) and ceftolozane-tazobactam (C/T), and investigate the molecular determinants of resistance. Overall, 101 clinical isolates of Enterobacterales and Pseudomonas aeruginosa collected from a general hospital in Brazil were analyzed. Susceptibility to the antimicrobial agents was evaluated using an automated method, and the minimum inhibitory concentrations (MIC50/90) of C/A and C/T were determined using Etest®. The β-lactamase-encoding genes were investigated using polymerase chain reaction. High susceptibility to C/A and C/T was observed among ESBL-producing Enterobacterales (100% and 97.3% for CLSI and 83.8% for BRCAST, respectively) and carbapenem-resistant P. aeruginosa (92.3% and 87.2%, respectively). Carbapenemase-producing Klebsiella pneumoniae exhibited high resistance to C/T (80%- CLSI or 100%- BRCAST) but high susceptibility to C/A (93.4%). All carbapenem-resistant K. pneumoniae isolates were susceptible to C/A, whereas only one isolate was susceptible to C/T. Both antimicrobials were inactive against metallo-β-lactamase-producing K. pneumoniae isolates. Resistance genes were concomitantly identified in 44 (44.9%) isolates, with bla CTX-M and bla SHV being the most common. C/A and C/T were active against microorganisms with β-lactam-resistant phenotypes, except when resistance was mediated by metallo-β-lactamases. Most C/A- and C/T-resistant isolates concomitantly carried two or more β-lactamase-encoding genes (62.5% and 77.4%, respectively).

Implantação e implementação de serviços em cuidados paliativos

Abstract Since expanding palliative care services within general hospitals in Brazil involves confronting obstacles and establishing strategies to enable their implementation in the health system, this study sought to identify the process around establishing and implementing palliative care services in Brazilian general hospitals. An integrative literature review of four articles identified the following steps for establishing and implementing palliative care services: protocol development, humanized care, multidisciplinarity, and education. As for the obstacles, the analysis highlighted the lack of training and education in palliative care, difficulty in reaching consensus on palliative practices, communication, drug supply, and government support. In conclusion, public policy development is essential to guarantee the implementation of palliative care in hospitals.

FACE INFECTION AFFECTED BY PSEUDOMONAS AERUGINOSA: AN UNUSUAL CASE REPORT

<i>Pseudomonas aeruginosa</i> is a gram-negative bacterium that can be part of normal skin microbiota and is the cause of a variety of human infections. This study reports a case of suppurative face infection by <i>Pseudomonas aeruginosa</i>. A 56-year-old female patient with diabetes mellitus and arterial hypertension attended the outpatient clinic of the Clériston Andrade General Hospital in Brazil, with an abscess in the zygomatic and peri-orbital region. Complementary culture and antibiogram exams highlighted the presence of <i>Pseudomonas aeruginosa</i> bacteria in the purulent exudate, sensitive to medications of the carbapenem and quinolone classes meropenem and ciprofloxacin, respectively. The patient underwent debridement and drainage of edema, as well as specific antibiotic therapy by the beta-lactam meropenem and remained in follow-up for 3 months. It was possible to obtain success in treatment of the case with the steps instituted, which corroborates the importance of using complementary exams to define a diagnosis.

The difficult symbolic construction of physicians’ and nurses’ experiences working in COVID-19 intensive care units: A qualitative study on reports at a university public hospital in Southeastern Brazil

IntroductionHumanistic studies that explore symbolic aspects of the experience of working on the COVID-19 frontline are necessary. Do these professionals have psychic time to symbolize such acute experiences? We expect these preliminary findings of this research provide subsidies for discussing psychological management in groups with these professionals.ObjectivesTo interpret emotional meanings reported by physicians and nurses on their experiences of working at COVID-19 intensive care units.MethodsClinical-qualitative design. Data collection with semi-directed interviews with open-ended questions in-depth applied to a sample of six professionals, closed by theoretical information saturation, in a Brazilian university general hospital. Trigger question: “Talk about psychological meanings of your experience in face of management of patients with COVID-19 at ICU”. Data treatment by the Seven Steps of the Clinical-Qualitative Content Analysis. Theoretical framework of Medical Psychology using Balintian concepts.ResultsWe raised 3 categories. (1) Psychic time and absence of symbolization in face of the pandemic; (2) Denial as a defense or psychosocial adaptation mechanisms; (3) Tensions and family support: triggers of ambivalent emotional experiences.ConclusionsRaw experience of COVID-19 pandemic did not allow for realization of symbolization. Psychological defenses are manifested, either to maintain balance or to deny the existence of dangers related to mental health. Presence of families and health team confirm that the feeling of loneliness is avoided. Anxieties related to the fear of contamination are recurrent. There is dual relationship regarding the emotional experiences of health professionals, but the data point to importance of looking at how these individuals perceive and experience the pandemic.DisclosureNo significant relationships.

Clinical experience regarding the diagnostic value of segment-by-segment coronary computed tomography angiography in comparison with that of invasive coronary angiography.

ObjectiveTo compare the degree of coronary stenosis (≥ 50% luminal narrowing) determined by coronary computed tomography angiography (CCTA) with that determined by invasive coronary angiography (ICA), using segment-by-segment analysis.Materials and MethodsThis was a retrospective study of the records of patients who underwent CCTA and ICA between January 2014 and June 2018 at a general hospital in Brazil. Receiver operating characteristic curve analysis was applied, and the areas under the curve were used in order to assess the overall accuracy of the methods.ResultsThe degree of coronary stenosis was evaluated in a total of 844 arterial segments. The diagnostic performance of CCTA was good, with a sensitivity of 82.3%, a specificity of 96.4%, and a negative predictive value of 97.7% (95% CI: 96.5-98.5). In the segment-by-segment analysis, CCTA had excellent accuracy for the left main coronary artery and for other segments.ConclusionIn clinical practice at general hospitals, CCTA appears to have diagnostic performance comparable to that of ICA.

Outbreak caused by the SARS-CoV-2 Omicron variant in the psychiatric ward of a general hospital in Brazil.

ABSTRACTBackground: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant was detected in the psychiatric ward of a general hospital in Brasília, Brazil. Methods: We report the investigation, clinical outcomes, viral sequencing, and control measures applied to outbreak containment. Results: The overall attack rate was 95% (23/24) in a period of 13 days. Among the cases, 78% (18/23) were vaccinated and 17% (4/23) required intensive care. The Omicron variant was isolated from the 19 sequenced samples. Conclusions: The findings highlight the potential harm that highly transmissible variants may generate among hospitalized populations, particularly those with comorbidities.

Spatial reorganization of the Brazilian Unified National Health System's inpatient care supply.

The joint provision of efficient and equitable healthcare service delivery is a critical factor in improving social welfare. However, healthcare services pose a particular challenge when balancing healthcare provider efficiency and equity. Typically characterized by economies of scale and scope, inpatient care involves a wide variety of medical care that usually demands a broad range of health professional expertise and technological complexity to ensure health care quality. This study analyzes the current spatial organization of the Brazilian general hospitals and their respective flow of patients to identify the possible benefits of closing inefficient hospitals. We studied how inpatient care referrals may be reallocated without increasing access inequities following the potential closure of inefficient public hospitals. We used data from the Brazilian Hospital Information System of the Brazilian Unified National Health System (SIH/SUS) and the Brazilian National Register of Health Establishments (CNES). The smallest and least efficient hospitals were selected as units for potential closure, conditioned on an optimization criterion that minimizes patient travel distances to the nearest efficient hospital. Our results show that there is room for hospital resource reorganization in Brazil without compromising health care access equity.

Process automation in a clinical laboratory of a Brazilian general hospital: co-creating value within the supply chain

Process automation in a clinical laboratory of a Brazilian general hospital: co-creating value within the supply chain

The impact of monitoring software on antimicrobial management in a pediatric intensive care unit

Antimicrobial stewardship programs are necessary practices to combat resistance in hospital infections. However, studies frequently cite the scarcity of technological resources as an obstacle to the comprehensive development of ASPs. The aim of the study was to assess the impact of monitoring software on reducing antibiotic consumption and reducing resistance in a pediatric intensive care unit. We conducted an analytical longitudinal study during the period January 1, 2007, to December 31, 2018, in the pediatric intensive care unit of a high-complexity tertiary general hospital in Brazil. In the period after the implementation of software, we observed decreases in total antimicrobial consumption (P=.037). Regarding Enterobacterales, we observed a decrease in the proportion of antimicrobial resistance of first and second-generation cephalosporin classes (P=.041) and third and fourth-generation cephalosporins (P=.028). There was a decrease in the proportion of resistance of nonfermenting gram-negative bacilli to aminoglycoside scans (P=.016). We also observed evidence of a decrease in the proportion of resistance of Staphylococcus aureus agents to oxacillin (P < .001). The monitoring software reduced the total consumption of antimicrobials and decreased the proportion of resistance, therefore demonstrating its importance in controlling the development of multidrug-resistant bacteria.

Distresses reported by physicians and nurses toward peculiarities of patients with head and neck cancer at a university general hospital in Brazil: A qualitative study

IntroductionContextualization: health professionals’ anguish towards the patient with head and neck cancer (HNC) permeates clinical issues: the location of the tumour, if advanced diagnosis, the psychosocial features of the patient. The perception, coming from patients as undesirable, refers to the conflict of how to deal with one’s own anguishes.ObjectivesAIM: To explore and interpret how anguish experienced by physicians and nurses are mobilized regarding to the clinical and psychosocial peculiarities of patients with HNC.MethodsStrategies: Clinical-qualitative design; semi-directed interview with open-ended questions in depth. Trigger question: “Tell me about the management of the patient with …”. Ten interviewees (06 nurses and 04 resident doctors) from a university oncology outpatient. Intentional sample. Clinical-Qualitative Content Analysis with psychodynamic concepts. Findings validated by peers at the Laboratory of Clinical-Qualitative Research at the University of Campinas, Brazil.ResultsTopics: the treatment of the speeches resulted in three emerging categories: (1) Cancer is literally on the face: self-perception of peculiarities; (2) An appalling illness: dealing with the ‘deteriorated’; (3) To naturalize without trivializing: handling with their own anguish.ConclusionsFinal considerations: The anguish of health professionals who deals with the HNC patient consists of the feelings, which are not exposed, because they are not organized and neither understood as natural feelings. It is up to them to seek neutrality to minimize the anguish present in the conflict of not manifesting thoughts considered inadequate by the patient, avoiding moral judgments and conflicts. Balint groups are recommended to attend emotional demands of health professionals.

COVID-19 highlights negligence with psychiatry patients in Brazilian general hospitals: a call for action

COVID-19 highlights negligence with psychiatry patients in Brazilian general hospitals: a call for action

Abstract 288: Rapid Response Team Implementation Associated with Reductions in In-hospital Mortality Rate and Hospitalization Costs: A Retrospective Analysis

Introduction: Early recognition of clinical deterioration in inpatient subjects seems to be one of the main factors associated with prevention of in-hospital severe adverse events occurrence. Previous studies failed to demonstrate that the implementation of a rapid response team (RRT) could reduce in-hospital mortality rate. Hypothesis: Could a RRT implementation reduces in-hospital mortality and/or hospitalizations costs in a private general hospital in Brazil? Methods: This is a retrospective cohort built from data of electronic medical database of consecutive adult inpatients admitted to general wards who had to be transferred to an ICU after an acute clinical deterioration between May 1st, 2012 and June 30th, 2016. Subjects were divided into two groups as follows: group 1 (G1) with those admitted to ICU before RRT implementation on June 1st, 2014 and group 2 (G2) with the ones admitted to ICU after the implementation. All patients in G2 received care by the RRT before ICU admittance. In cases in which a patient had more than one hospital admission, only the first admittance was used for analyses. Results: Patients data are shown in table 1.Outcome data are shown in table 2. Conclusions: From these data, it is possible to infer that this RRT implementation at this hospital was associated with improvement in clinical outcomes of inpatients who needed an ICU admittance after an acute clinical deterioration, as well as a significant reduction of their hospitalization costs. These data reinforce the hypotheses that MERIT study was underpowered. Further multicenter randomized trials, with appropriate statistical power, shall be proposed to address these questions.

Profile of general hospitals in the Unified Health System.

ABSTRACTOBJECTIVE To characterize the organization of Brazilian general hospitals that provide services to the Unified Health System using indicators that describe the main dimensions of hospital care.METHODS A 2015 cross-sectional observational study, comprising the range of general hospitals that serve the Unified Health System. We constructed the hospital indicators from two national administrative databases: the National Registry of Health Facilities and the Hospital Information System of the Unified Health System. The indicators include the main dimensions associated with hospital care: public-private mix, production, production factors, performance, quality, case-mix and geographic coverage. Latent class analysis of indicators with bootstrapping was used to identify hospital profiles.RESULTS We identified three profiles, with hospital size being the variable with the highest degree of belonging. Small hospitals show low occupancy rates (21.36%) and high participation of hospitalizations that could have been solved with outpatient care, besides attending only medium complexity cases. They receive few non-residents, indicating that they are mainly dedicated to the local population. Medium-sized hospitals are more similar to small-sized ones: about 100% of the visits are of medium complexity, low occupancy rate (45.81%), high rate of hospitalizations for primary care sensitive conditions (17.10%) and relative importance in the healthcare provision of non-residents (26%). Large hospitals provide high complexity care, have an average occupancy rate of 64.73% and show greater geographical coverage.CONCLUSIONS The indicators point to three hospital profiles, characterized mainly by the production scale. Small hospitals show low performance, suggesting the need to reorganize hospital care provision, especially at the municipal level. The set of proposed indicators includes the main dimensions of hospital care, providing a tool that can help to plan and continuously monitor the hospital network of the Unified Health System.

Pediatric bacterial meningitis and meningococcal disease profile in a Brazilian General Hospital

ObjectiveTo evaluate the clinical and epidemiological profile of bacterial meningitis and meningococcal disease in pediatric patients admitted to a Brazilian Secondary Public Hospital. MethodsA descriptive observational study was conducted. Microbiologically proven bacterial meningitis or meningococcal disease diagnosed from 2008 to 2018 were included. ResultsA total of 90 patients were diagnosed with proven bacterial meningitis. There were 64 confirmed cases of meningococcal disease. The prevalence was higher in boys (n = 38), median age 30 months (1–185). The main clinical manifestations were: meningococcal meningitis (n = 27), meningococcemia without meningitis (n = 14), association of meningococcemia with meningitis (n = 13), and fever without a known source in infants (n = 7).Admissions to intensive care unit were necessary for 45 patients. Three deaths were notified. Serogroup C was the most prevalent (n = 32) followed by serogroup B (n = 12).Pneumococcal meningitis was identified in 21 cases; out of the total, 10 were younger than two years. The identified serotypes were: 18C, 6B, 15A, 28, 7F, 12F, 15C, 19A and 14. Pneumococcal conjugate 10-valent vaccine covered four of the nine identified serotypes.Haemophilus influenzae meningitis serotype IIa was identified in three patients, median age 4 months (4–7). All of them needed intensive care. No deaths were notified. ConclusionMorbidity and mortality rates from bacterial meningitis and meningococcal disease remain high, requiring hospitalization and leading to sequelae. Our study observed a reduced incidence of bacterial disease over the last decade, possibly reflecting the impact of vaccination.

Patient safety climate in a Brazilian general hospital.

To measure patient safety climate and the associated factors from the perspective of the multiprofessional team. This was an analytical cross-sectional study, developed in a medium-sized hospital in the Southern region of Brazil. The Safety Attitudes Questionnaire (SAQ) was used as the data collection tool and applied to 199 workers of the multiprofessional and support team between November 2017 and February 2018. Data analysis was descriptive and analytical. A positive score was considered when ≥75. The overall SAQ score was positive (75.1). The domain Satisfaction at Work was the one with the highest score (88.7), while Stress Perception showed the worst score (59.1). It was observed that professionals without a College/University degree better evaluated the domains Satisfaction at Work, Management Perception and Working Conditions, whereas the ones with a College/University degree had better stress perception. Medical doctors showed better Stress Perception when compared to the other health professionals. There is a positive safety climate in health organizations from the perspective of the multiprofessional team. However, the domains Safety Climate, Working Conditions and Stress Perception constitute areas that need improvement in terms of patient safety in the institution.