High Complexity University Hospital Research Articles

Quality indicators applied in a nursing continuing education program of a high complexity university hospital from Brazil: III - training indicator

Quality indicators applied in a nursing continuing education program of a high complexity university hospital from Brazil: III - training indicator

Quality indicators applied in a nursing continuing education program of a high complexity university hospital from Brazil: IV – training indicator versus sizing and workload

Quality indicators applied in a nursing continuing education program of a high complexity university hospital from Brazil: IV – training indicator versus sizing and workload

Quality indicators applied in a nursing continuing education program of a high complexity university hospital from Brazil:I- attendance indicators

Quality indicators applied in a nursing continuing education program of a high complexity university hospital from Brazil:I- attendance indicators

Quality indicators applied in a nursing continuing education program of a high complexity university hospital from Brazil: II - satisfaction indicators

Quality indicators applied in a nursing continuing education program of a high complexity university hospital from Brazil: II - satisfaction indicators

Factors associated with compliance to AHA/ACC performance measures in a myocardial infarction system of care in Brazil.

To evaluate compliance with American Heart Association/American College of Cardiology (AHA/ACC) performance measures for adults with acute myocardial infarction (AMI) and to investigate the factors associated with compliance, in an AMI System of Care in Brazil. Observational longitudinal study. A high-complexity University Hospital, part of the AMI System of Care implemented in Belo Horizonte, Brazil, in 2010. Of note, 1129 patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) admitted to a single center over 36 months (between 2011 and 2014). Compliance with 13 pre-specified AHA/ACC AMI performance measures was evaluated for patients with AMI, observing exclusion criteria and appropriate numerators and denominators. Median compliance was calculated and variables independently associated with compliance rates were evaluated. Median age was 60 (51/68) years, 67.7% male, 69.8% presented with STEMI and hospital mortality was 8.7%. Median compliance with performance measures was 83% (75/88). Among patients with STEMI, 56% received reperfusion therapy. Overall, 67.3% of patients complied with ≥80% of quality measures. Factors independently associated with better compliance were later date of presentation (semester), likely reflecting ongoing training (OR = 1.19, 95% CI: 1.10-1.28, P < 0.001), male gender (OR = 1.33, 95% CI: 1.00-1.76, P < 0.046), Killip I/II on admission (OR = 1.95, 95% CI: 1.36-2.80, P < 0.001) and diagnosis of NSTEMI (OR = 5.0, 95% CI: 3.51-7.11, P < 0.001). Compliance with AHA/ACC AMI performance measures remains below target in Brazil, but the time trends observed suggest improvement. Continuing education, reduction of system delays and prioritizing high-risk groups are needed to optimize AMI systems of care and improve patient outcomes.

No enterocutaneous fistula development in a cohort of 695 patients after incisional hernia repair using intraperitoneal uncoated polyproylene mesh.

To determine the incidence of enterocutaneous fistulas (ECFs) developed after elective incisional hernia (IH) repair using intraperitoneal uncoated polypropylene (PPE) mesh. This is a retrospective descriptive study of a prospective cohort of patients undergoing elective IH repair using intraperitoneal uncoated PPE mesh at the Department of General Surgery of a high complexity University Hospital. Between January 1992 and December 2013, 695 IH repairs were performed using intraperitoneal uncoated PPE mesh. The omentum was placed between the mesh and bowel in 507 patients (73%). In 188 patients (27%) it was not possible to place the omentum between the mesh and bowel; therefore, in 69 patients (9.92%) the PPE mesh was placed over the bowel, whereas in 119 patients (17.12%) a Vicryl® mesh was placed between the bowel and PPE mesh. Six hundred and seventy-eight (97.5%) IH repairs were open whereas 17 (2.5%) were laparoscopic. Postoperative complications consisted of seroma (5.9%), hematoma (4.3%), wound infection (4.8%), and mesh infection (4.0%). Recurrence of IH occurred in 52 patients (7.4%) after a mean follow-up of 59months. Four (0.5%) patients required additional surgery due to intestinal occlusion. Neither acute nor chronic ECFs were encountered during follow-up in 695 patients. Based on these results, the placement of intraperitoneal uncoated PPE mesh for elective IH repair might be a safe procedure that is not associated with ECF formation.

Use of Smartphones in Telemedicine: Comparative Study Between Standard and Teledermatological Evaluation of High-Complex Care Hospital Inpatients.

It is estimated that there are around 7 billion mobile phone subscriptions worldwide. Considering the availability and convenience, it appears to be a suitable device for store-and-forward (SF) consultations. Although teledermatology has been suggested as an effective way of reducing costs and providing otherwise inaccessible expert evaluation, most studies have relied on high cost and high technological means. We conducted a study with inpatients that required dermatological evaluation in a high-complexity university hospital, accessing the correlation between traditional face-to-face evaluation and SF teledermatology, with data and pictures collected by medical students using smartphone cameras and then sent to consultants by e-mail. For 2 months, we evaluated 100 patients and, as a result, the total agreement between both consultation modalities was 54%, the partial agreement was 27%, and the disagreement was 19%. This study points out that SF teledermatology with the use of mobile phone is comparable to traditional face-to-face evaluation. Furthermore, most of the disagreements were probably related to the inexperience of the medical residents. Our study suggests that a smartphone-based teledermatology inpatient consultation model could be a reasonable option for hospitals lacking dermatological services. Also, it may be as or more effective than face-to-face consultations, if performed by a more experienced dermatologist. When feasible, photographing training should be performed.

Induction of hospital indebtedness due to medicine purchases under monopoly conditions: the case of imatinib mesylate

Medicine expenditures consume a large share of the health budget, so knowledge on the use of these funds is essential for decision-making in public health and improvement of pharmaceutical care. This study analyzed the indebtedness of a high-complexity university hospital due to increased spending on imatinib mesylate. The descriptive study was based on analysis of documents and records in the Hospital Information System (SIH) from 2002 to 2010. Starting with inclusion of the medicine in the budget, the study mapped strategies by the pharmaceutical industry and government, as well as government responses to reduce the product's price. The systematization and publication of information stored in files and electronic databases can help monitor the results of programs funded by the Brazilian Ministry of Health.

Enfermagem cuidando de paciente adulto e família no processo de morte em sala de emergência

The purpose of the study was to understand the experience of nursing professionals on the care provided to adult patients and relatives who experience the dying process in an emergency room. Statements of 12 nursing professionals, being 8 technicians and 4 registered nurses of the emergency room of a high-complexity university hospital were analyzed. Data was collected by means of semi-structured interviews and evaluated according to Bardin’s content analysis. As a result, the theme entitled the relative’s mourning process emerged with two categories: alterity as an opening and suffering as a limit. when subjectivity, which was revealed under the principle of alterity, permeated the subjects’ actions, the nursing practices were targeted at the patients and their relative’s needs, but suffering as a limit imposed distancing by the professionals during care provision, even when it was perceived as necessary

Immune status and risk perception of acquisition of vaccine preventable diseases among health care workers

Risk perception of acquiring vaccine preventable diseases and the immune status of 187 health care workers (HCW) from a high-complexity university hospital in São Paulo, Brazil, were assessed. The vaccine preventable diseases more cited as at risk for acquisition were hepatitis B (94.1%), influenza (92.5%), meningococcal disease (90.3%), tuberculosis (85.0%), and varicella (72.7%). Previous disease or vaccination reported by HCW were hepatitis B (82.4%), tetanus (87.7%), diphtheria (81.8%), measles (86.6%), mumps (85.6%), rubella (85.0%), varicella (82.9%), and influenza (35.8%). One third of HCW reported previous percutaneous or mucosal occupational accidents, and 83.6% had notified the event to the Hospital Infection Control Committee. Despite good risk perception of acquiring vaccine preventable diseases, only 35.8% of individuals were fully immunized. Efforts should be made to increase influenza vaccination coverage among all professionals and to reduce the number of nonreported accidents, especially among physicians.