Brazilian University Hospital Research Articles

Caregivers' Mastery in Handling Gastrostomy at Home after Educational Intervention: Qualitative Descriptive Study.

Effective hospital discharge planning is crucial, particularly in educating caregivers on handling medical devices. This education helps manage the patient's signs and symptoms, prevents post-discharge complications, and reduces early readmissions. This study aimed to understand aspects involved in the acquisition of mastery by home caregivers, in handling care of a patient who just underwent gastrostomy, after educational intervention during hospitalization and telemonitoring upon return home. Qualitative descriptive study. It followed 15 caregivers of people with percutaneous endoscopic gastrostomy. The intervention took place between November 2022 and July 2023 in the neuromusculoskeletal unit of a Brazilian university hospital. The educational intervention had four stages. In stage 1, caregivers felt confused and uncertain about managing PEG. By stage 2, they expressed a desire to be capable of handling care, especially in the event of potential complications, and showed increased awareness and engagement. Stage 3 highlighted the effectiveness of hands-on training with feedback from professionals. In stage 4, during monitoring, several complications were noted, including granuloma formation in the stoma, tube obstruction, and accidental tube loss. However, caregivers demonstrated the ability to handle these situations, indicating the effectiveness of the training and telemonitoring interventions. Nursing professionals should consider various factors when training caregivers in a hospital setting, including providing adequate space, allocating sufficient time for educational interventions, offering both theoretical and practical demonstrations, ensuring effective communication, and taking into account the caregivers' context, as they play a direct role in acquiring a safe and effective skill set.

Recent cardiac rehabilitation and its impact on cardiopulmonary exercise test variables in Brazilian cardiac transplant recipients

Abstract Introduction Heart transplantation (HTx) is an option for restoring the functional capacity of individuals with end-stage heart failure (HF). Cardiac rehabilitation (CR) plays an important role in improving variables related to cardiopulmonary exercise testing (CPET) in post-HTx patients. Purpose To evaluate whether CR is effective in improving CPET variables in Brazilian patients post-recent HTx compared to a Control Group (CG). Methods Retrospective comparative study composed of two groups: CR group (CRG) and CG. These recent HTx patients (aged 14 to 73 years) initiated CR within 150 days and were recruited from an HTx outpatient clinic at a south Brazilian public university hospital between 2014 and 2023. CPET was performed at three different times: pre-HTx (Time 01), post-recent HTx (Time 02), and post-CR or post-follow-up for CG (Time 03). This study was approved by the Institutional Review Board (protocol No. 20180651). Statistical analysis used Generalized Estimating Equations with alpha ≤ 0.05, and the mean difference (MD) data were presented along with 95% confidence interval (CI). Results CRG (n=18) had a mean age of 47.3±15.6 years and CG (n=11) 48.6±12.5 years (P=0.81). The mean time to start CRG was 62.2±9.6 days (minimum: 21; maximum: 147). There was an interaction for the Group*Time factor for the following CPET variables: VO2peak (P=0.039); VEmax (P=0.009); VO2 on second ventilatory threshold (P<0.001); HR on VT2 (P=0.030) and T½ (P=0.002). The main results are summarized in Table 1. We highlight that there was a difference in the comparison between groups at Time 03 for the variable VO2peak: MD: 5.16 ± 1.95 (95% CI: 1.3 to 9.0; P = 0.008), favorable to CRG. Conclusion Early CR after very recent HTx significantly increase peak VO2peak, VEmax, T½ and VO2 and HR at the VT2 compared to the control group (CG).

Eighteen-year trends in the rates of intra-operative cardiac arrest and associated mortality at a public university hospital in Brazil.

Intra-operative cardiac arrest is a rare but life-threatening event. Over the past two decades, various initiatives have improved the care of patients undergoing surgery at our quaternary teaching hospital in Brazil. We aimed to evaluate the epidemiology of intra-operative cardiac arrest and associated 30-day mortality over an 18-year period. A secondary aim was to identify associated risk factors. We conducted a retrospective observational study using data collected from 1 January 2005 to 31 December 2022. Factors associated with cardiac arrest and mortality were identified using multivariable logistic regression analysis. Among the 154,178 cases, the overall rates of intra-operative cardiac arrest (n = 297) and associated 30-day mortality (n = 248) were 19.3 (95%CI (16.6-21.9)) and 16.1 (95% CI 13.9-18.3) per 10,000 anaesthetics, respectively. These decreased over time (2005-2010 vs. 2017-2022) from 26.3 (95%CI 21.0-31.6) to 15.4 (95%CI 12.0-18.7) per 10,000 anaesthetics, and from 23.4 (95%CI 18.8-28.1) to 13.7 (95%CI 10.8-16.7) per 10,000 anaesthetics, respectively. Factors associated with intra-operative cardiac arrest included children aged < 1 year (adjusted OR (95%CI) 3.51 (1.87-6.57)); ASA physical status 3-5 (adjusted OR (95%CI) 13.85 (8.86-21.65)); emergency surgery (adjusted OR (95%CI) 10.06 (7.85-12.89)); general anaesthesia (adjusted OR (95%CI) 8.79 (4.60-19.64)); surgical procedure involving multiple specialities (adjusted OR (95%CI) 9.13 (4.24-19.64)); cardiac surgery (adjusted OR (95%CI) 7.69 (5.05-11.71)); vascular surgery (adjusted OR (95%CI) 6.21 (4.05-9.51)); and gastrointestinal surgery (adjusted OR (95%CI) 2.98 (1.91-4.65)). We have shown an important reduction in intra-operative cardiac arrest and associated 30-day mortality over an 18-year period. Identification of relative risk factors associated with intra-operative cardiac arrest can be used to improve the safety and quality of patient care, especially in a resource-limited setting.

8032 Clinical And Laboratory Characteristics Of Patients With Primary Hyperparathyroidism Followed At A Brazilian University Hospital

Abstract Disclosure: G. Koga: None. D. Amorim: None. L.M. dos Santos: None. D. Calixto: None. M. Ohe: None. J.G. Vieira: None. M. Lazaretti-Castro: None. Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by hypercalcemia due to hyperfunction of parathyroid glands. Its clinical presentation has been changing, becoming mostly asymptomatic. However, there are few data on developing countries.Objective: to describe clinical and biochemical features of primary hyperparathyroidism in a Brazilian population of a tertiary hospital. Methods: 259 individuals with PHPT are followed in a school-hospital in Sao Paulo in the last 2 years and this preliminary analysis included 161 of them. Clinical and laboratorial data were obtained by reviewing medical records. Data are presented as median [min-max] and statistical differences were considered if p&amp;lt;0.05. Results: 133 (82.6%) were women (3.7:1 female:male ratio) with a median age at diagnosis of 63 years [24-88]. There was higher prevalence of Caucasian (62.7%) then among Afro-descendants and Asians/indigenous: 35.4% and 1.9%, respectively. 99 (61.5%) patients were asymptomatic. Symptoms were observed in 38,5% (nephrolithiasis, fractures, bone pain, hypercalcemic crisis). Target organ involvement was evaluated: 48.4% had osteoporosis, and 47.2% kidney stones. At diagnosis, median total calcium (tCa) was 11.2 mg/dL [10.0-19.1], ionized calcium (iCa) 1.48 mmol/L [1.30-2.48], PTH 277.7 pg/mL [51.4-2374.0] and 25OHD 23.5 ng/mL [5.0-54.2]. Symptomatic patients were diagnosed younger (61 [24-83] vs 64 [31-88]; p=0.036), had higher tCa (11.4 [10.2-19.1] vs 11.2 [10-16]; p=0.049) and greater prevalence of 25OHD&amp;lt;20 ng/mL (50.0 vs 30.4%; p=0.03) than asymptomatic. Patients with severe hypercalcemia (&amp;gt;14 mg/dL) were diagnosed younger than those with non-severe hypercalcemia (52 [41-54] vs 63 [24-88] years; p=0.002). Patients with osteoporosis had older age at diagnosis compared to those without (64.0 [42-86] vs 61.5 [24-88]; p=0.018). Histological data were obtained from 94 individuals out of 104 submitted to surgery: 59.6% had single adenoma, 39.3% hyperplasia or multiple adenomas and 1.1% parathyroid carcinoma. Patients with single adenoma had higher levels of tCa and iCa than those with multiglandular disease (median of 11.4 [10.0-19.1] vs 10.9 [10.3-13.4]; p=0.042 and 1.52 [1.32-2.48] vs 1.43 [1.30-1.59]; p=0.02, respectively). Conclusion: Our preliminary data showed that most of the patients were Caucasian women presenting with asymptomatic disease. Compared with other countries, we still have a greater proportion of symptomatic presentations (38.5%) and multiglandular diseases (39.3%) than the reported in literature. Severe forms were diagnosed earlier, in younger patients and with a single adenoma, suggesting that they may have a different disease from the asymptomatic ones. These aspects demonstrate that there may be ethnic and environmental influences interfering with the presentation of this disease. Presentation: 6/2/2024

Staged Retrograde Intraoperative Enteroscopy: Description of the 5-Step Surgical Technique for the Diagnosis and Treatment of Small Bowel Bleeding.

Background: Small bowel bleeding (SB) comprises 5%-10% of gastrointestinal (GI) bleeding cases. This article describes the staged retrograde intraoperative enteroscopy (SRIE) surgical technique for the etiological diagnosis and treatment of small bowel bleeding. Methods: SRIE was performed on patients with persistent SB at a quaternary university hospital in Brazil from 2020 to 2023. The technique is described in 5 steps, alongside visual aids, including images and a depicting a portion of the procedure. Patients presenting with confirmed coagulopathies, pregnancy, or unwillingness for surgery were excluded. Surgical procedures were performed after informed consent. Case Series: Four participants were submitted to SRIE, including 2 females (64 and 83 years old), and 2 males (46 and 57 years old). Three out of four (75%) of the patients received a confirmed diagnosis of GI bleeding, attributed to angioectasia, acquired von Willebrand disease, and vitamin K deficiency. SRIE was conducted via enterotomy, involving a subsequent insufflation-inspection-deflation of 10 to 10 cm segments of the small bowel (Steps 1 to 5). The procedure was successfully executed in all four patients without complications, allowing confirmation of the etiological diagnosis of SB or exclusion of anatomical causes of hemorrhage. Conclusions: SRIE is a valuable but invasive tool for assessing SB hemorrhage when conventional imaging falls short. When performed systematically and standardized, it allows accurate visualization of SB using a standard endoscope.

Prevalence and molecular characterization of carbapenem-resistant Enterobacterales in patients from a public referral hospital in a non-metropolitan region of Brazil during and post the SARS-CoV-2 pandemic.

Antimicrobial resistance (AMR) poses a global threat, with carbapenem-resistant Enterobacterales (CRE) representing a significant concern due to limited therapeutic options. This study investigated the prevalence of carbapenemase genes in CRE strains isolated from tracheal aspirates of patients at a Brazilian university hospital between January 2020 and August 2023. Bacterial identification was conducted using MALDI-TOF, while carbapenemase genes were detected by qPCR. Demographic and clinical data were collected, and univariate analysis was performed using the chi-square test (p < 0.05). Variables with p ≤ 0.10 were further investigated using the chi-square test for linear trend, along with stratified analysis. Out of 1,133 samples, 111 (9.79%) showed CRE growth, with 46 isolates included in the final sample, predominantly comprising Klebsiella pneumoniae (65.21%) and Serratia marcescens (19.57%). The blaKPC gene was prevalent (78.26%), while blaNDM was detected in 21.74% of cases. The identified population was predominantly male (67.39%), elderly (69.57%), white (56.52%), unmarried (63.04%), and had a low level of education (56.52%). Most patients (69.57%) were in the intensive care unit and remained hospitalized for more than 30 days (76.08%). There was a significant inverse trend between Klebsiella pneumoniae and age (p = 0.045), as well as a direct linear trend between blaNDM and the annual increase in COVID-19 cases in Brazil (p = 0.050). A high probability of finding non-Klebsiella pneumoniae bacteria was observed in patients with prolonged hospital stays, independent of COVID-19 (p = 0.006) and the type of resistance genes (p = 0.020). The persistent prevalence of CRE, especially with blaKPC, underscores the urgency of effective control measures.

Early Results of Fenestrated and Branched Endovascular Repair of Complex Aortic Aneurysms with a Custom-made National Device Available in the Brazilian Public Health System

BackgroundMulticenter studies conducted in developed countries demonstrated that custom-made devices are safe, effective, and durable for treating complex abdominal aneurysms. However, the situation in developing countries, such as Brazil, is different. Funding and time to have the endoprosthesis delivered are the major concerns. In order to overcome these conditions, high-volume Brazilian university hospitals started gaining experience with a custom-made device produced in the country. ObjectiveThe present study aimed to describe the practice of two tertiary centers and report the early results of fenestrated and branched endovascular repair of complex aortic aneurysms with a custom-made national device available in the Brazilian public health system. MethodsRetrospective analysis of all consecutive patients that underwent F/BEVAR of complex aortic aneurysms using custom-made manufactured endoprosthesis in two tertiary centers from January 2020 to July 2022. ResultsThirteen cases were included (10 male, mean age 69 ± 9 years). 70 % were complex abdominal aneurysms, and 30% were type II, III and IV thoracoabdominal aneurysms (mean aneurysm diameter 69.2 ± 8.12 mm). F/BEVAR included 33 visceral arteries. The Apolo® device was used in all cases. Technical success was achieved in 12 out of 13 patients (92.3%). Thirty-day major adverse events included one death (7.7%), five acute renal failure (38.4%), two spinal cord ischemia (15.4%). The one-year survival rate was 92.3%. ConclusionFenestrated and branched endovascular repair of complex aortic aneurysms with the custom-made Apolo® device has proven safe and effective in high-volume tertiary centers in the Brazilian public health system. Considering the complexity of the cases, the early patency of vessels and low initial mortality support this device continuation and expansion to treat complex aortic aneurysms in a developing country.

Quality of care transitions from hospital to home for COVID-19 patients discharged from Brazilian university hospitals

PurposeTo analyze the quality of transitional care for patients with COVID-19 at discharge from Brazilian university hospitals.Design/methodology/approachA cross-sectional descriptive study was carried out in five Brazilian university hospitals between April and December 2021. The sample consisted of 527 participants. Data collection consisted of a sociodemographic questionnaire and the Care Transitions Measure (CTM-15), a care transition assessment instrument, which was translated and validated in Portuguese.FindingsMost participants were patients (n = 369; 70.0%), with primary school completion (n = 218; 43.4%), multiracial (n = 218; 43.5%) and with an income of up to two minimum wages (n = 182; 42.8%). Dimension 1 – management preparation – obtained the highest score (71.2 points, SD = 16.5), while Dimension 4 – care plan – obtained the lowest score (62.2 points, SD = 23.4). Among the participating hospitals, there was a difference in the overall mean with results ranging from 67.0 to 72.9 points.Originality/valueA satisfactory quality of care transition was found, considering the context of a pandemic. The main weaknesses in the care transitions were related to the care planning after hospital discharge.

Assessment of erythrocyte alloimmunization among patients treated at a Brazilian university hospital

IntroductionAlloimmunization and transfusion reactions underscore the crucial role of precise immunohematological techniques to enhance safety in transfusion. This study aims to determine the frequency of alloimmunization in patients treated at a Brazilian university hospital, investigate demographic, clinical, and epidemiological characteristics of patients with positive irregular antibody screening, as well as to assess the frequency of erythrocyte antigens and anti-erythrocyte antibodies in the population. Materials and methodsThis retrospective observational study included all irregular antibody-positive patients treated at the transfusion service of Hospital de Clínicas of the Federal University of Uberlandia between January 2019 and December 2020. ResultsOf the 201 irregular antibody-positive patients, alloimmunization was more common in women (64.2%) than in men (35.8%). Blood groups A (39.8%) and O (38.8%), and Rh positive samples (69.1%) predominated, and about half (48.2%) of the patients were transfused for preoperative procedures. The most frequently found clinically significant alloantibodies were anti-D (27.2%), anti-E (15.0%), and anti-Kell (11.5%). Of the patients, 30.6% had multiple antibody associations, with anti-D and anti-C being the most common combination. Erythrocyte immunophenotyping was performed for 76 patients with the most frequent antigens detected being e (100%), c (86.8%), and C (40.8%). Among the 14 pregnant women evaluated, most were multiparous, 85.7% had anti-D as the most prevalent antibody, and had the A-negative blood type (33.3%). ConclusionAlloantibody screening and identification associated with erythrocyte immunophenotyping are necessary for a better understanding of the alloimmunized population, ensuring greater safety and efficacy of transfusion therapy in the hospital setting.

Relationship between antimicrobial use and the highest number of multidrug-resistant-Pseudomonas aeruginosa: a 10-year study.

Multi-drug-resistant (MDR) Pseudomonas aeruginosa is a dangerous pathogen causing nosocomial infection, particularly in low- and middle-income countries like Brazil. This retrospective study at a Brazilian university hospital examined the relationship between antimicrobial use and MDR-P. aeruginosa. Data was collected from 358 patients with non-repetitive P. aeruginosa infections from 2009 to 2019. Antibiotic use was measured in grams and expressed as defined daily dose (DDD) per 1000 patient-days for meropenem, imipenem, polymyxin, and tigecycline. Extensively drug-resistant (XDR) P. aeruginosa occurred in 36.1%, and MDR in 32.6% of cases. Risk factors for XDR infection were hospitalization prior to infection (OR = 0.9901), intensive care unit (ICU) admission (OR = 0.4766), previous antibiotic use (OR = 1.4417), and use of cefepime (OR = 0.3883). Over the ten-year period, utilization of the monitored antibiotics increased, and there was a positive correlation between the rise in MDR-P. aeruginosa and the consumption of ceftriaxone, imipenem, meropenem, and polymyxin B. The 30-day mortality rate was 40.0% for all patients and 41.0% for those infected with XDR-P. aeruginosa. This study highlights the negative impact of the indiscriminate use of antimicrobials, which has led to a significant increase in multidrug-resistant P. aeruginosa strains in hospitals.

Point prevalence and risk factors for pressure ulcers in hospitalized adult patients: a cross-sectional study.

To estimate the point prevalence of and risk factors associated with the development of pressure ulcers at a university hospital in Brazil. This study was conducted on 196 participants using a structured questionnaire, physical examination of the skin, and the Braden scale. The Mann-Whitney U, χ2, or Fisher's exact tests were used to compare the participants and the associations of variables with pressure ulcers. A modified multivariate Poisson regression model was built considering the presence of pressure injuries and the independent variables. The point prevalence of pressure ulcers was 10.71% and was significantly associated with less than 12 years of schooling (p=0.0213), use of antihypertensive drugs during hospital stay (p=0.0259), diagnosis of systemic hypertension (p=0.0035), and diabetes mellitus. Lower scores on the Braden scale (p=0.0001) were positively associated with the presence of pressure ulcers. Furthermore, cardiovascular disease (p=0.0267) and diaper use (p=0.0001) were associated with the presence of pressure ulcers. Moreover, they were also associated with prolonged hospital stay, advanced age, less than 12 years of schooling, use of antihypertensive drugs, hypertension, diabetes, and lower Braden scale scores. Health professionals should be aware of the risk factors associated with pressure ulcers, evaluate patient skin daily, and offer prevention. Our findings support the need to allocate resources for the prevention and treatment of pressure injuries.

Analysis of Hospital Safety and Risk of Falls in the Elderly: A Cross-Sectional Study in Brazil.

This study analyzed hospital safety and the risk of falls in elderly people in a university hospital in Brazil. The Morse Falls Scale was used to stratify the risk of falls in 45 hospitalized elderly individuals, and two checklists were used to analyze the hospital environment. The analysis was based on the Chi-square test and multiple regression. The moderate risk of falls was predominant (51.1%). The variable age group (p-value = 0.024) showed statistical evidence of association with the risk of falls. However, the multiple regression analysis showed no difference between the age groups and the risk situation for falls. The hospital wards showed an adequate arrangement of furniture, but some aspects had inadequacies, such as objects in the corridors, non-functional bells in some beds, inadequacy of the toilet bowls in terms of the recommended height, and an absence of non-slip flooring and the support bar in some bathrooms. In conclusion, the moderate risk of falls among the elderly and the adequacy of the hospital environment to technical standards were evident with the exception of failures in the emergency communication system and sanitary installation.

Prevalence of Cryptococcal Antigenemia and Lateral Flow Assay Accuracy in Severely Immunosuppressed AIDS Patients.

This study aimed to estimate the prevalence of cryptococcal antigenemia detected by lateral flow assay (LFA) in AIDS patients and its accuracy in the diagnosis of cryptococcosis. Conducted at a university hospital in Brazil from March 2015 to July 2017, it included AIDS patients over 18 years old with a CD4+ count ≤ 200 cells/mm3. Cryptococcal antigen (CrAg) detection using LFA and latex agglutination (LA), along with blood and urine cultures, were performed. The reference standard was the identification of Cryptococcus spp. in clinical specimens through microbiological or histopathological examination. Among 230 patients, the prevalence of CrAg detected by LFA (CrAg LFA) was 13.0%. Factors associated with cryptococcal antigenemia included fever, vomiting, seizures, and a lack of antiretroviral therapy. The sensitivity and specificity of CrAg LFA were 83.9% and 98.0%, respectively. The positive predictive value (PPV) was 86.7%, the negative predictive value (NPV) was 97.5%, and overall accuracy was 96.1%. Cross-reactions were observed in patients with histoplasmosis and paracoccidioidmycosis, but not with aspergillosis or positive rheumatoid factor. The study concludes that the LFA is a useful tool for detecting cryptococcal antigenemia in severely immunocompromised AIDS patients due to its high NPV, specificity, and PPV.

Factors associated with depression during pregnancy in women receiving high- and low-risk prenatal care: a predictive model.

Depression during pregnancy can put strain on pregnant women's interpersonal relationships, the formation of emotional bonds with the fetus, and the adaptation to the new routine and social role post-pregnancy. Some studies have associated socioeconomic factors, emotional factors, interpersonal relationships, perceived social support, gestational risk, and the occurrence of certain diseases during pregnancy with higher risk of depression. This study aimed to investigate the prevalence of depression during pregnancy and associated factors in low- and high-risk prenatal patients at a Brazilian university hospital. This study presents a retrospective and prospective cross-sectional design. A total of 684 prenatal psychological analysis records from a Brazilian tertiary university service were retrospectively evaluated to assess depression through the PRIME-MD questionnaire between 2002-2017. Between 2017 and 2018, 76 patients treated at the same service were prospectively evaluated with the aforementioned instrument. Medical records were accessed to obtain labor and birth data. Multivariate analyses assessed the association between sociodemographic, gestational or obstetric, and health variables and the presence of depression during pregnancy. A total of 760 pregnant women were included in the study, with a depression prevalence of 20.66% (n = 157). At the time of assessment, 48 (21.05%) women from the low-risk pregnancy group and 109 (20.49%) from the high-risk pregnancy group were depressed. The mean age was 30.01 ± 6.55 years in the group with depression and 29.81 ± 6.50 years in the group without depression. In the univariate analysis, there was an association of risk for depression with absence of paid work, absence of a partner, low family income and diagnosis of epilepsy, being a protective factor the presence of diabetes during pregnancy. However, in the multivariate analysis, a lower family income, not having a partner at the time of the assessment, and the prevalence of epilepsy were independently associated with an increased risk of depression during pregnancy. This study showed that 1 in 5 women had depression during pregnancy, with no association with obstetric risk, but those women living in unfavorable economic conditions, without a partner, and having epilepsy were at increased risk of depression.

[Artículo traducido] Predicción de reacciones adversas a medicamentos en pacientes geriátricos ingresados en unidades de cuidados intensivos

IntroductionIntensive Care Units (ICUs) pose challenges in managing critically-ill patients with polypharmacy, potentially leading to Adverse Drug Reactions (ADRs), particularly in the elderly. ObjectiveTo evaluate whether the severity and clinical prognosis scores used in ICUs correlate with the prediction of ADRs in aged patients admitted to an ICU. MethodsA cohort study was conducted in a Brazilian University Hospital ICU. APACHE II and SAPS 3 assessed clinical prognosis, while GerontoNet ADR Risk Score and BADRI evaluated ADR risk at ICU admission. Severity of the patients' clinical conditions was evaluated daily based on the SOFA score. Adverse Drug Reaction (ADR) screening was performed daily through the identification of ADR triggers. Results1295 triggers were identified (median 30 per patient, IQR = 28), with 15 suspected ADRs. No correlation was observed between patient severity and ADRs at admission (p=0.26), during hospitalization (p=0.91), or at follow-up (p=0.77). There was also no association between death and ADRs (p=0.28) or worse prognosis and ADRs (p>0.05). Higher BADRI scores correlated with more ADRs (p=0.001). ConclusionsThe data suggest that employing the severity and clinical prognosis scores used in Intensive Care Units is not sufficient to direct active pharmacovigilance efforts, which are therefore indicated for critically ill patients.

The Bed Bridge Test: a new functional test for hospital inpatients – a feasibility and measurement study

Purpose To develop and assess the Bed Bridge Test’s (BBT) feasibility, safety, and clinimetric properties and evaluate functional capacity in hospitalised patients. Materials and methods This feasibility and measurement study examined four BBT versions, including the timed-limited at 30 and 60 s and repetition-limited at 5 and 10 times, in hospitalised patients in a university hospital in Brazil. Ninety-two functionally stable patients with respiratory, gastrointestinal, or post-surgical conditions participated. Participants completed the BBT versions in a random order. BBT concurrent criterion validity was evaluated using the Short Physical Performance Battery (SPPB), Sit-to-Stand (STS) test, and Functional Status Score (FSS). Results The participants were 51 ± 17 years old, 60% female, and 66% with clinical conditions. All participants completed the BBT versions without adverse events. Test–retest reliability was good–excellent (intraclass correlation coefficient >0.87) for all BBT versions, with acceptable agreement parameters and minimal detectable changes. The time-limited versions of the BBT might be affected by a ceiling effect. Floor effects were minimal for all BBT versions. BBT showed moderate associations with SPPB and STS and weak associations with FSS. Conclusions The BBT is feasible and has promising measurement properties.

Comparative study of two laboratory techniques for the detection of HLA-B27 in patients with axial spondyloarthritis: a cross-sectional analysis

BackgroundThe diagnostic and prognostic relevance of Human Leukocyte Antigen B-27 (HLA-B27) in Axial Spondyloarthritis (AxSpA) is undeniable, with 70% of Ankylosing Spondylitis (AS) patients carrying the B27 gene, contrasted with a mere 4.35% in the general population. Flow cytometry (FC) and Polymerase Chain Reaction (PCR) have emerged as the predominant techniques for routine HLA-B27 typing. While various studies have compared these methods, none have catered to the unique characteristics of the Brazilian demographic. Therefore, this research aims to compare FC and PCR in a Brazilian cohort diagnosed with AxSpA.MethodsAn analytical cross-sectional study was undertaken involving 62 AxSpA outpatients from a Brazilian University Hospital. Both FC and PCR-SSP assays were utilized to ascertain HLA-B27 typing. The outcomes (either confirming or refuting the allele’s presence) underwent rigorous scrutiny. Agreement between the methodologies was assessed using the kappa statistic. A p-value of < 0.05 was deemed statistically significant.ResultsOf the participants, 90.3% (n = 56) were HLA-B27 positive according to FC, while 79% (n = 49) were identified as positive using the PCR method. FC exhibited a sensitivity rate of 98% paired with a specificity of 38.5%. The Positive Predictive Value for FC stood at 85.7%, and the Negative Predictive Value was 83.5%. Consequently, the overall accuracy of the FC method was gauged at 85.5%. A kappa coefficient of κ = 0.454 was derived.ConclusionsFC demonstrated noteworthy sensitivity and satisfactory accuracy in HLA-B27 detection, albeit with a reduced specificity when contrasted with PCR-SSP. Nevertheless, given its cost-effectiveness and streamlined operation relative to PCR, FC remains a pragmatic option for preliminary screening in clinical practice, especially in low-income regions. To optimize resource allocation, we advocate for a refined algorithm that initiates by assessing the relevance of HLA-B27 typing based on Choosing Wisely recommendations. It then leans on FC, and, if results are negative yet clinical suspicion persists, advances to PCR. This approach aims to balance diagnostic accuracy and financial prudence, particularly in regions contending with escalating medical costs.

Performance measurement of Brazilian federal university hospitals: an overview of the public health care services through principal component analysis

PurposeThis paper aimed to contextualize the process of public hospital providing services, based on the measurement of the performance of Federal University Hospitals (HUFs) of Brazil, using the technique of multivariate statistics of principal component analysis.Design/methodology/approachThis research presented a descriptive and quantitative character, as well as exploratory purpose and followed the inductive logic, being empirically structured in two stages, that is, the application of principal component analysis (PCA) in four healthcare performance dimensions; subsequently, the full reapplication of principal component analysis in the most highly correlated variables, in module, with the first three main components (PC1, PC2 and PC3).FindingsFrom the principal component analysis, considering mainly component I, with twice the explanatory power of the second (PC2) and third components (PC3), it was possible to evidence the efficient or inefficient behavior of the HUFs evaluated through the production of medical residency, by specialty area. Finally, it was observed that the formation of two groups composed of seven and eight hospitals, that is, Groups II and IV shows that these groups reflect similarities with respect to the scores and importance of the variables for both hospitals’ groups.Research limitations/implicationsAmong the main limitations it was observed that there was incomplete data for some HUFs, which made it impossible to search for information to explain and better contextualize certain aspects. More specifically, a limited number of hospitals with complete information were dealt with for 60% of SIMEC/REHUF performance indicators.Practical implicationsThe use of PCA multivariate technique was of great contribution to the contextualization of the performance and productivity of homogeneous and autonomous units represented by the hospitals. It was possible to generate a large quantity of information in order to contribute with assumptions to complement the decision-making processes in these organizations.Social implicationsDevelopment of public policies with emphasis on hospitals linked to teaching centers represented by university hospitals. This also involved the projection of improvements in the reach of the efficiency of the services of assistance to the public health, from the qualified formation of professionals, both to academy, as to clinical practice.Originality/valueThe originality of this paper for the scenarios of the Brazilian public health sector and academic area involved the application of a consolidated performance analysis technique, that is, PCA, obtaining a rich work in relation to the extensive exploitation of techniques to support decision-making processes. In addition, the sequence and the way in which the content, formed by object of study and techniques, has been organized, generates a particular scenario for the measurement of performance in hospital organizations.

Analysis of clinical outcomes in older individuals who received pharmaceutical care and posthospital discharge follow-up.

Previous evidence underscores the need to assess potential clinical outcomes resulting from pharmaceutical care interventions and to monitor patient's progress to evaluate their clinical evolution, which is crucial for bolstering the relevance of implementing pharmaceutical care in healthcare services. To conduct an in-depth analysis of pharmaceutical care practices in a geriatric ward and monitor the clinical outcomes of older people served. This interventionist study was conducted in the geriatrics ward of a Brazilian university hospital. The research intervention occurred between January and May 2022, with a follow-up conducted for up to 90 days after patients' hospital discharge. Older patients in the geriatrics ward received pharmaceutical care, including medication reconciliation, medication review,and pharmacotherapeutic follow-up, aimed at identifying and resolving drug-related problems (DRPs). The clinical relevance of DRPs and pharmaceutical recommendations was evaluated. Additionally, analyses were conducted on mortality and rehospitalization outcomes in older patients at 30, 60,and 90 days following initial hospital discharge. Of the patients evaluated, a significant 88.3% exhibited at least one DRP (with an average of 2.6 ± 1.9 DRPs per patient), with the majority classified as need/indication problems (38.9%). The acceptance rate of pharmaceutical recommendations was 80.9%, with the majority categorized as very significant relevance (60.4%). DRPs were predominantly of serious clinical relevance (50.9%). In patients whose clinical indicators could be monitored, 95.5% showed some clinical response (in vital signs, laboratory testsand/or clinical status evolution) potentially related to resolved DRPs. Association analysis revealed that a higher number of medications in use before hospitalization correlated with a greater identification of DRPs during hospitalization (p = 0.03). At hospital discharge, 23.6% of patients were no longer using polypharmacy. In total, 16 patients (26.7%) died during the study period. Among patients who did not die during hospitalization (n = 54), 20 patients (37%) experienced rehospitalizations within 90 days following discharge. This study facilitated the consolidation of pharmaceutical care implementation in a geriatric ward. We conducted identification, evaluation,and proposed evidence-based solutions, as well as monitored cases for outcome analysis. It is anticipated that this methodology will inspire future research and the implementation of pharmaceutical care-related services.

Impact of SARS-CoV-2 Pandemic on Ocular Tissue Donation in a Teaching Hospital

Objectives: To analyze the impact of the severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic on ocular tissue donations, assessing lost opportunities for potential donors due to the suspension of collections and changes in eligibility criteria, as well as hospital eligibility rates of donors and causes of non-donation. Methods: Data from patients who died in cardiopulmonary arrest in a Brazilian university hospital in 2020 were analyzed. The number of donations made, the number of deaths potentially eligible for donation, and the causes of non-donation were compared during the three periods of 2020: period 1, pre-pandemic ( January 1 to March 18, 2020), period 2, with suspension of donations in cardiorespiratory arrest (March 19 to September 19, 2020), and period 3, of collections with epidemiological screening for SARS-CoV-2 and reduction of the age range of donors less than 65 years old (September 20 to December 31 2020). Results: There were 710 circulatory deaths in 2020. The hospital eligibility rate was 5.7% among 140 deaths in the pre-pandemic period 1, 11.9% among 395 patients during the suspension of uptake in pandemic period 2, and 3.4% among 175 patients during age group restrictions and coronavirus disease 2019 (COVID-19) screening (p:0.004). Forty-seven patients who died in period 2 represented a loss of donation opportunities due to the suspension of collections, and 13 (7.6%) of the 175 patients in period 3 were ineligible due to the reduction in age group. Due to pandemic restrictions, eighty-one percent of the 75 eligible patients without clinical contraindications had limited tissue donation offers. Only one patient was considered ineligible for donation due to clinical-epidemiological screening for SARS-CoV-2. Serious infections were the leading cause of non-donation in 50.7, 48.1, and 47.4% of deaths in the three periods (p:0.615). Conclusion: The SARS-CoV-2 pandemic significantly affected the procurement of ocular tissues for transplants due to the restrictive measures implemented for safety reasons, leading to the loss of donation opportunities for 81% of families. Age restrictions significantly reduced potential donor eligibility rates. Serious infections were the leading cause of non-donation of ocular tissue, but it did not increase significantly in this study during the pandemic, in the period studied.