High-complexity Care Research Articles

The Regionalization Process for Universal Health Coverage in Brazil (2008-2015).

The objective of this article is to analyze the development of the public and private offer for the universalization of health services, specifically, for the progression of the public network. The time period examined is from 2008 to 2015, when there was considerable economic growth and expansion of private health insurance and an unprecedented historical period with economic growth and reduction of social inequality. Across 5570 municipalities, the multivariate analysis model was used to estimate the level of concentration and the imbalance (heterogeneity) of installed health capacity of the network of health care services. Public spending on investment and human resources showed positive variation in all regions and in almost all population strata. The offer by the Unified Health System (public) of primary health care increased by 8000 new establishments in all regions, especially in previously uncovered cities and cities that had shortages of public health services. Public universalization almost reached its maximum, with about 70% of municipalities. The only setback was the significant reduction of 50% in the number of private establishments in primary health care services. The data suggest a positive movement toward the universalization of health services in Brazil, with the concentration of high-complexity care and the heterogeneity of the installed capacity being points for improvement.

“Slow science” for 21st century healthcare: reinventing health service research that serves fast-paced, high-complexity care organisations

PurposeThe purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of “slow science” as a critical yardstick.Design/methodology/approachThe paper is structured in three parts. It first reviews the field of health services research and the approaches that dominate it. It then considers the healthcare research approaches whose principles and methodologies are more aligned with “slow science” before presenting a description of a “slow science” project in which the authors are currently engaged.FindingsCurrent approaches to health service research struggle to offer adequate resources for resolving frontline complexity, principally because they set more store by knowledge generalisation, disciplinary continuity and integrity and the consolidation of expertise, than by engaging with frontline complexity on its terms, negotiating issues with frontline staff and patients on their terms and framing findings and solutions in ways that key in to the in situ dynamics and complexities that define health service delivery.Originality/valueThere is a need to engage in a paradigm shift that engages health services as co-researchers, prioritising practical change and local involvement over knowledge production. Economics is a research field where the products are of natural appeal to powerful health service managers. A “slow science” approach adopted by the embedded Economist Program with its emphasis on pre-implementation, knowledge mobilisation and parallel site capacity development sets out how research can be flexibly produced to improve health services.

Perfil da qualidade de vida três meses ou mais após o término da radioterapia adjuvante utilizada para o tratamento do câncer de cabeça e pescoço em um Centro de Assistência de Alta Complexidade em Oncologia

The treatment of head and neck cancer (HNC) is multimodal and can generate different physical and psychological impairments. The aim of this study was to assess the quality of life profile of patients with HNC, in search of possible therapeutic targets that can be improved. This is a descriptive, cross-sectional, observational study, developed at a High Complexity Care Center in Oncology. Data were collected through anamnesis and the University of Washington quality of life questionnaire (UW-QOL). The sample consisted of 68 patients with head and neck cancer who underwent adjuvant radiotherapy for at least 90 days. There was a predominance of males (89%) and an involvement of the oropharynx (69%). In addition to radiation therapy, 53% of individuals also underwent surgery and 65% chemotherapy. Stomatognathic functions were the most affected, followed by negative implications related to activities of daily living and psychological aspects. According to the nature of the domains found in the UW-QOL Questionnaire, the low scores observed in the questions related to the activities of daily living and in the components of the psychological status assessment, it is pertinent to assume that the late complications imposed by both the pathophysiology of the HNC as well as the antineoplastic treatment should be approached by a multidisciplinary team aligned with the synergistic objective of rehabilitating stomatognathic functions, nutrition, and physical capacity. Although our data do not suggest emotional impairments, additional support from a psychologist could be considered in order to strengthen and motivate engagement in the rehabilitation of the complex clinical condition intrinsic to HNC.

Intervenção farmacêutica na antibioticoterapia do idoso: caminhos para a redução da ocorrência de problemas relacionados a medicamentos e promoção da farmacoeconomia

Objetivo: Avaliar estudos sobre intervenções farmacêuticas direcionadas à redução de Problemas Relacionados a Medicamentos em pacientes idosos, durante o uso de antibióticos, no contexto hospitalar. Métodos: Trata-se de uma Revisão Integrativa. Os estudos incluídos responderam a critérios previamente definidos, os quais adotaram participantes dos estudos como “idosos internados em unidades de média e/ou alta complexidade”; intervenções a serem investigadas como “intervenções farmacêuticas em nível hospitalar” e resultados a serem mensurados como “evidências clínicas, epidemiológicas, de acesso (output), humanísticas e/ou econômicas”. Os dados foram coletados em fontes secundárias, com um recorte temporal de 2015 a 2020, em que foram selecionados estudos relacionados ao acompanhamento/cuidado, em pacientes idosos, cujas características metodológicas foram de Ensaios Clínicos Controlados, Ensaios Clínicos Controlados Randomizados e Revisões Sistemáticas, obrigatoriamente nos níveis de atenção de média e alta complexidade. Resultados: Foram selecionados 7 estudos, e cada um apresentou um método de intervenção farmacêutica para a problemática apresentada. Considerações finais: A análise dos resultados sugeriu que existem evidências de que intervenções farmacêuticas podem reduzir os Problemas Relacionados a Medicamentos na antibioticoterapia em idosos hospitalizados; não sendo identificadas, porém, investigações robustas acerca dos efeitos dessas intervenções sobre a promoção da sustentabilidade econômica.

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.

O acesso de pessoas com doenças crônicas não transmissíveis à Rede de Atenção à Saúde em pequenos municípios

As doenças crônicas apresentam início gradual, com duração longa ou incerta e geralmente têm múltiplas causas, contemplando uma categoria vasta de agravos e exigindo reorganizações do sistema de saúde. A rede de atenção à saúde das pessoas com doenças crônicas busca promover a atenção integral e ampliação das ações de promoção à saúde e de prevenção do aparecimento de complicações. Este estudo objetivou analisar o acesso das pessoas com doenças crônicas não transmissíveis aos serviços de saúde, comparando a oferta de atendimentos e procedimentos em dois pequenos municípios da Região de Saúde 29, do Rio Grande do Sul (RS), com os parâmetros estabelecidos pela Portaria 1.631/2015. Trata-se de um estudo transversal e exploratório, com base em documentos das Secretarias Municipais de Saúde e entrevistas com gestores e informantes-chave de dois municípios do RS. Verificou-se que não há dificuldade de acesso aos serviços de saúde na atenção básica; porém, a oferta de assistência na média e alta complexidade é insuficiente, dificultando o acesso do usuário e induzindo sua participação financeira no custeio do diagnóstico e tratamento. Concluiu-se que é necessário ampliar a oferta de atendimentos de média e alta complexidade, no que se refere às doenças crônicas, cabendo aos três entes federativos estabelecer mecanismos de garantia de acesso a estes serviços, bem como uma regulação qualificada.

Perfil do câncer infantil em um estado da Amazônia Ocidental em 2018

OBJETIVO: Identificar o perfil do câncer infantil em um estado da Amazônia Ocidental em 2018. MATERIAIS E MÉTODO: Trata-se de um estudo transversal, exploratório e descritivo, realizado na unidade de assistência de alta complexidade de um hospital de grande porte do Acre. A população de estudo foi formada por 49 crianças de 0 a 10 anos com diagnóstico de câncer e atendidas no local de estudo no ano de 2018. RESULTADOS: Os dados apontam que a maioria das crianças (38,8%), encontrava-se na faixa etária entre 05 a 07 anos, do sexo masculino (57,0%), de cor/raça parda (34,7%), e a maior parte delas eram procedentes do município de Rio Branco (39,0%). Os tipos de cânceres mais frequentes foram leucemias (48,0%), seguido do câncer do sistema nervoso central (18,0%) e do sarcoma de partes moles (10,0%). Frente ao ano do diagnóstico prevaleceu o ano de 2018 com 19 casos e observa-se ainda que o número de ocorrências apresentou uma tendência de crescimento a partir do ano de 2015. Quanto ao desfecho dos casos, a maioria das crianças seguem em acompanhamento 40 (82,0%), sendo que 6 (12,0%) evoluíram para óbito e 1(2,0%), para cura. CONCLUSÃO: Observou-se que o câncer infantil é problema atual e crescente, predominado em crianças de 2 a 7 anos, do sexo masculino, de cor/raça parda. A leucemia e a quimioterapia representaram o tipo de câncer e o tratamento, respectivamente, mais frequentes. Recomendam-se estratégias que contemple o diagnóstico e tratamento precoce para o enfrentamento do problema.

Meanings and dimensions of cancer by sick people - a structural analysis of social representations.

To describe the contents and structure of the social representation of cancer. A qualitative study based on the Theory of Social Representations, carried out in a High Complexity Care Unit in Oncology. Data collection included a socio-occupational and clinical characterization questionnaire and free evocations form from 100 cancer patients in chemotherapy treatment and in-depth interviews with 29 of them. The analysis was performed using EVOC software. One hundred (100) patients participated in the study. The social representation of cancer has the words normal, difficult disease, death and fear in its central nucleus. The apparent ambivalence between the continuity of life and its finitude as structuring meanings of this representation enables establishing an inferential hypothesis that relates normal disease to the possibility of treatment, control and cure of cancer, while the fear of death remains in the representational field linked to the disease, which has a difficult treatment to cope with. The social representations of cancer based on the presented interrelationships provide reflections which may contribute to increasing the individual and social care of patients with malignant neoplasm and their family in health services.

Seudoartrosis del escafoides: experiencia con injerto óseo vascularizado del primer metacarpiano. Serie de casos

BackgroundThe aim of study is to describe the clinical, functional, and radiological results in patients with pseudoarthrosis of scaphoid fractures who that underwent surgery using Bertelli's et al. technique. MethodsCase series of patients with nonunion of scaphoid fractures in a high complexity care center between 2005 and 2016, who underwent revision surgery with vascularized bone graft of the first metacarpal dorsal artery according to Bertelli's et al. technique. Data were collected from clinical records, and it waswere analyzed using descriptive summary measures. ResultsThe analysis included 11 patients with a mean age of 30,1 years (S.D: 9). 72,7% of the patients underwent conventional osteosynthesis as the initial approach. The revision surgery was performed with a median of 380 days (interquartile range: 194-470); there were no intraoperative complications. Post- surgery complications, such as graft necrosis, were reported in a one patient (9,1%), the need of for re-intervention in four patients and there were no infection related complications. Fracture union was seen in 72,7% patients in a mean of 7,6 months (S.D: 2,9) after the intervention. Half of the patient had a DASH score of 9 points or less. 54,5 reported pain as mild, 36,4% as moderate and without pain 9,1%. The median follow up period was 14 months and only one patient developed carpal arthritis. DiscussionThe advantage of this surgical technique is its reproducibility and versatility, thanks due to the constant and long vascular pedicle; this allows using dorsal or palmar approaches, as well as for the management of scaphoid nonunions of the proximal pole, waist, or distal pole. This study shows good clinical and functional results outcomes with a low rate of complications. Evidence LevelIV

Dinâmica da oferta de cuidados paliativos pediátricos: estudo de casos múltiplos

The objective was to analyze the dynamic involving the supply of palliative care for eligible children from the perspective of health professionals and families. A qualitative exploratory multiple case study was performed. This was a cross-section of data from a thesis that evaluated care for hospitalized children who were eligible for palliative care. The data were collected in a teaching hospital serving as the reference for high-complexity care in São Luís, Maranhão State, Brazil, from October 2016 to July 2017, interpreted with thematic analysis. The participants were 18 family members and 30 health professionals. Cases were nine children from one to eight years of age, five of whom were eligible for exclusive care and four for integrated care. Three categories emerged from the interviews: (1) a mistaken understanding of the concept of palliative care; (2) delivering the news; and (3) comprehensiveness and fragmentation in the context of palliative care. The mistaken understanding of pediatric palliative care interfered in the approach to the child and family and delayed the start of care. Feelings of insecurity, fear, resistance, and guilt were present among those involved in this care. The communication process and relations displayed weaknesses. The care involved both comprehensiveness and fragmentation. The care shows weaknesses and lack of knowledge and requires investments in training and preparing the health professionals, shared decisions, and receptiveness to the families. Palliative care mobilizes life-and-death cultural and religious values, and education in this direction proves to be a path full of challenges.

Contexto psicossocial de mulheres mastectomizadas

OBJETIVO: Conhecer os aspectos psicossociais de mulheres mastectomizadas. MÉTODO: Trata-se de estudo de abordagem qualitativa, realizado com 12 mulheres mastectomizadas e acompanhadas em uma unidade de assistência de alta complexidade de tratamento de câncer do Acre. RESULTADOS: Os resultados apontam que a maioria das mulheres eram casadas 5 (42%), com idade entre 50 a 55 anos 7 (58%), com nível médio completo 4 (33%) e renda familiar entre 1 a 2 salários mínimos 8 (67%). Os achados foram agrupados em quatro categorias: O enfrentamento da mastectomia, as dificuldades enfrentadas pela mulher após a cirurgia, a interferência da mastectomia nos seus relacionamentos e a relação da mesma com a sua autoimagem e autoestima. Conforme os relatos, para algumas mulheres a vivência frente a mastectomia foi tranquila, no entanto para outras foi um processo que gerou sentimentos de tristeza e medo do novo. Houve repercussões negativas, relacionamentos familiares afetados, incapacidade no funcionamento social e alteração na imagem corporal. Para elas, o apoio familiar foi fundamental para o enfrentamento da nova realidade. CONCLUSÃO: Realizar o procedimento afeta a vida emocional das mulheres, sendo assim, torna-se indispensável que elas recebam um adequado suporte psicológico principalmente por parte da família e dos profissionais de saúde.

Health system financing paradigm in the state of São Paulo: a regional analysis.

ABSTRACTOBJECTIVE To analyze the allocation of financial resources in the Brazilian Unified Health System (SUS) in the state of São Paulo by level of care, health region, source of funds and level of government.METHODS This is an exploratory study based on 2014 data extracted from the Public Health Budget Database, presented in absolute terms, relative terms and per capita .RESULTS In 2014, R$52.1 bi were spent on public health, 58.0% having corresponded to the expenditures of the municipalities and 42.0% to those of the state government. Regional per capita spending varied from R$561.75 to R$824.85. As for the per capita spending on primary health care, which represented 37.5% of the municipalities’ total expenditure, the lowest value was found in the city of São Paulo and the highest, in Araçatuba. Campinas had the highest per capita expenditure on medium and high complexity care, while Presidente Prudente had the lowest. The highest regional percentage of the current net revenue spent on health was verified in Registro, and the lowest, in the city of São Paulo.CONCLUSIONS The paradigm of the health sector’s financing in São Paulo revealed that the expenditure on primary health care, level elected by health policy as strategic because it depends on coordination and integral health care in the attention networks, was not considered a priority in relation to the expenditure with the medium and high complexity, exposing the iniquities in the state’s regions.

PNS260 DISTRIBUTION OF HEALTH CARE COST BY COMPLEXITY LEVELS IN THE LAST YEAR OF LIFE IN PEOPLE IN A PALLIATIVE CARE PROGRAM FROM A PRIVATE HEALTH INSURANCE COMPANY IN COLOMBIA

INTRODUCTION: A private company in Latin America with a vision to create a sustainable healthcare system that achieve better solutions and deliver enhanced healthcare value, built a Palliative care program focused on health management, coordinated care and community projects with patients and families with life-threatening diseases. to determine the changes in costs and level of complexity of medical services to treat terminal diseases among members of a Palliative Care program. retrospective cohort of 284 patients who died between August 2017 and July 2018 were analyzed. Patients who qualified for palliative care intervention according to McNamara criteria were identified. Costs per activity and level of complexity of medical attention in the last three months of life were calculated comparing subjects enrolled in a palliative care program to those receiving usual care. approximately 68% (193 patients) of deceased patients were eligible for Palliative Care; of whom 85 were admitted to the program (44% of program coverage). Median survival was 31 days. The median cost of patients with usual care was USD$ 19,131, which was 64% higher than the median cost of those in palliative care program (USD$ 11,654). In the last three months of life, medical attention complexity had differences between patients with usual care and those enrolled: high complexity decreased from 73.4% to 36.6%; medium complexity from 12.6% to 6.2%; low complexity increased from 11.4% to 20.3% and home care from 2.6% to 36.9%. after one year of implementation of a Palliative care intervention, the median cost of care was reduced and there were changes in distribution of the medical attention complexity, with decreases in high and medium complexity care but increase in lower complexity care. These changes support the sustainability of healthcare, delivering enhanced healthcare value and achieving better solutions for particular situations.

Budgetary Impact of Oral Rehabilitation With Complete Dentures: An Economical Evaluation From São Paulo State, Brazil

ObjectiveTo develop a budgetary impact analysis regarding the possibility of offering complete upper and lower dentures to an eligible population of elderly people (above 65 years) in the São Paulo state, Brazil. MethodsThe proportion of eligible population was calculated by assessing the prevalence of edentulous (upper and lower arch) and by defining the eligible group (public health system users). The budgetary impact analysis was designed under the following scenario: 5-year time horizon (2018-2022), prospect of municipal expenses with prostheses, and additional progressive incorporation of technology (upper and lower dentures) at an annual rate of 10%, 15%, 20%, 25%, and 30%. Sensibility analysis was performed in 3 different situations (reference, more pessimistic, and more optimistic) based on the calculation of spending through assessed demand and epidemiological demand. ResultsThe municipal cost for each denture, already discounted the value transferred by the union for this procedure, was R$50.97. The incremental impact on the budget measured by the epidemiological demand relative to assessed demand was approximately R$59 141 510 over 5 years, meaning an impact of 0.08% (0.01% more optimistic; 0.13% more pessimistic) of the “medium and high complexity care” budget and 0.09% (0.03%-0.14%) of the primary care budget. ConclusionThe budgetary impact of increasing the oral rehabilitation with complete dentures for elderly population in the São Paulo state is low relative to the expenses with primary or specialized care budgets. In addition, incorporation of denture rehabilitation would be feasible, according to the financial availability and priorities of each municipality.

Ocorrência de Escherichia coli e Klebsiella spp produtoras de ESBL em Hospital Universitário, na cidade de Manaus - AM

Justificativa e Objetivos:Bactérias produtoras de betalactamase de espectro ampliado (ESBL) são crescentes, sobretudo, pelo uso 
 rotineiro de antibióticos. Causam principalmente, infecções urinárias e de feridas operatórias e, caracterizam-se pela resistência às cefa-losporinas de terceira geração, aztreonam e associação de cefalosporinas com ácido clavulânico. Este estudo teve como objetivo conhecer 
 a frequência de Escherichia coli ESBL e Klebsiella spp.ESBL através da análise fenotípica. Métodos:Teste de sensibilidade in vitro por 
 aproximação de discos (CLSI), de bactérias isoladas de meios biológicos dos pacientes atendidos no HUGV entre 2017 e 2018. Resultados: 
 34,66% eram Escherichia coli ESBL e 46,80% Klebsiella spp.ESBL, totalizando 39,34% de amostras ESBL. Dos meios biológicos predomina-ram ESBL na: urina (56,25%) e feridas cirúrgicas (22,91%). Clínicas com maior ocorrência de ESBL: médica e cirúrgica. Conclusão: Os índices 
 de ESBL no HUGV estão próximos ou até mais altos do que em algumas regiões do país. Consoante a literatura revisada, predomina a 
 Escherichia coli nos isolados e há mais Klebisella spp. ESBL do queEscherichia coliESBL. 
 Descritores:Fenótipo. Escherichia coli. Klebsiella. ESBL. Infecção Hospitalar

Compliance with standard precautions by nursing professionals in high complexity care

Abstract Objective: To evaluate the compliance with Standard Precautions by nursing professionals from high complexity units. Methods: Quantitative, descriptive and cross-sectional study, carried out in a Brazilian public hospital between January and March 2017. Data collection was performed through the application of an instrument with demographic and professional variables and the Brazilian version of Compliance with Standard Precautions Scale (CSPS-PB). Data were analyzed using descriptive and inferential statistics with IBM SPSS® software. Results: A total of 148 professionals participated. The rate of compliance with SP was 65.0%. There was a statistically significant difference only in relation to the professional category (p<0.001). Conclusion and implications for practice: Compliance with SP by nursing professionals was lower than expected and there was association of compliance with SP mean scores only for professional category. These results may contribute to direct strategies to encourage adherence to SP, improving the safety of professionals and patients.

The resilience process in family caregivers of people with malignant neoplasia

ABSTRACT Objective: To unveil the resilience process in family caregivers of people with malignant neoplasia. Method: Descriptive and qualitative research performed between September and November of 2017 in a Brazilian Unit of High Complexity Care in Oncology. Individual interviews and four focus groups were conducted with 29 family caregivers. Socio-constructivist methodology was used under Vygotsky's perspective, the theoretical framework of the construction of the resilience processes, besides the hybrid model of thematic analysis. Results: Three thematic categories emerged: "feelings revealed through colors"; "practice of care and communication in the process of resilience" and "faith and hope in the process of resilience". The family caregivers organized themselves to provide support to their family member with malignant neoplasia and they faced, in a more consolidated way, the overwhelming transformations imposed by the disease. Conclusion and implications for practice: The guidelines made by health professionals were paramount in the process of family caregivers' resilience, in addition to emotional support and spirituality. The communication with health professionals is essential in the coping of family caregivers when dealing with problems or conflicts, since there is better conduction in the process of illness of the loved one, when there is greater knowledge and understanding of the disease.

Gastos Públicos e Produtividade nos Serviços de Saúde de Média e Alta Complexidade nos Estados Brasileiros

Objective: Verify to what extent the volume of public expenditures in health has influence the efficiency and productivity gains of medium and high-complexity services in the Brazilian States. Method: Based on Data Envelopment Analysis (DEA) and Malmquist’s Productivity Index, a theoretical-empirical study was developed with a quantitative approach, using the Brazilian states that disclosed information in Datasus between 2008 and 2015 as analysis units. Results: The main findings evidenced that the states with the mean highest resource volume could not be considered the most efficient, indicating that there may exist a negative relationship between the growth of public expenditures and the efficiency in the services offered. In addition, in the states that increased their spending in health between 2009 and 2015, the productivity was not directly proportional to the resource volume used. Contributions: The research offers empirical elements that evidence the need to seek better outcomes for the health system, in the context of medium and high-complexity care, based on the efficiency and productivity gains offered, in principle without liberating new resources for the sector.

Epidemiological study on calcaneus fractures in a tertiary hospital

ObjectiveTo analyze the epidemiology and characteristics of patients with calcaneus fractures. MethodsThis is a retrospective revision of patients with calcaneus fractures hospitalized in the Institute of Orthopedics and Traumatology of this institution between 2006 and 2010. Data such as age, gender, laterality, trauma mechanism, type of fracture, associated injuries, compound fractures, and time from injury to surgery were analyzed. ResultsThe analysis of 52 patients showed that men were more commonly affected than women, at a ratio of 5.5:1. Bilateral fractures were observed in ten cases, resulting in a total of 62 calcaneus fractures. A fall from a height was the most frequent trauma mechanism (75%), followed by motorcycle accidents (11.5%) and automobile accidents (9.6%). The most frequent fractures were intra-articular, with 47 cases. Compound fractures were observed in 15 patients (28.9%). Non-surgical management was adopted for 11 patients while 41 patients underwent surgery. The mean time between trauma and the definitive treatment was 7.8 days (range: 0–21 days), and 58.5% of cases were treated within seven days. ConclusionPatients with calcaneus fractures, most commonly young men, were admitted to a high complexity care hospital, victims of a fall from a height with associated injuries. The great severity of these fractures is characterized by the high prevalence of bilateral (19.2%) and compound fractures (28.9%) in this population group.

The impact of the hospitalization process on the caregiver of a chronic critical patient hospitalized in a Semi-Intensive Care Unit

Abstract Objective: To understand the impact of the hospitalization process on the family companion of critical patients admitted to a Semi-Intensive Care Unit (SICU). Method: Exploratory research with a qualitative approach, conducted in the months of April to July of 2016 through a semi-structured interview applied to relatives who were accompanying patients hospitalized in an SICU of a high complexity care hospital in Fortaleza. The interviews were submitted to content analysis. Results: Three themes emerged through the perception of the family members, which reveal the companion's functioning during the hospitalization period: emotional, familiar and behavioural. Conclusion: The companion experiences an intense process of suffering and emotional fragility, causing changes in the family organization. The companion, being a caregiver, is subjected to high levels of stress, having to use coping skills, with; spirituality and social media among the most evident. The companion is an integral care unit for the hospitalized patient and a key piece in the humanization process of health.