University Hospital In Southern Brazil Research Articles

Radiological Protection Management: software implementation in a hospital in south Brazil

The exacerbated increase in the use of ionizing radiation to obtain images, and the risks and standards that exist to preserve the health of those who use it, are not properly taken into account when carrying out radiodiagnostic examinations. The professionals who work in these environments play a decisive role in the performance of their numerous activities within radiodiagnostic services, bearing in mind that any dose of radiation is associated with a probability of biological effects occurring, no matter how low that dose may be. Thus, the aim of building a software program was to optimize the work of the multiprofessional and interdisciplinary team in radiodiagnostic services, in the management of radiological protection. This is a methodological and quasi-experimental study carried out in a university hospital in southern Brazil, intentionally chosen because it has a Radiological Protection Committee. This research design was adopted for the development of technological production, in this case software for managing radiological protection. The study was carried out in the radiological protection sector of the radiology department of a university hospital in southern Brazil. The results showed that the software, called SisPRad - Management System for Radiological Protection, is a tool that helps the service's multi-professional and interdisciplinary team in terms of managing radiological protection. Finally, it aims to ensure the safety of professionals working in the service and its users, as well as reducing repetition of activities at management level, and can be adapted for other institutions. The computer registration number 512019002125-8 was obtained from the National Institute of Industrial Property for the first version of the software and the registration number 512023003116-0 for its second version.

Staphylococcus aureus: changes in antimicrobial sensitivity profile and its relationship with SCCmec among clinical isolates

Background and Objectives: Staphylococcus aureus is a pathogen of great clinical relevance, especially those resistant to methicillin, called MRSA. Over the years, S. aureus antimicrobial resistance patterns have changed. Understanding such changes is essential to update protocols and propose efficient therapeutic approaches. This study aimed to characterize the temporal distribution of S. aureus antimicrobial resistance in patients admitted to the hospital as well as to assess its relationship with SCCmec typing. Methods: a total of 9,949 cultures of clinical materials were analyzed, between January 2000 and October 2019, from patients admitted to a university hospital in southern Brazil. All isolates had their identification and antimicrobial sensitivity profile analyzed using manual and automated techniques. Furthermore, 86 isolates were selected for mecA gene research and SCCmec typing using conventional and multiplex PCR techniques, respectively. Results: when assessing the temporal distribution of S. aureus over 20 years, it was possible to observe a drop in the proportion of MRSA compared to methicillin-sensitive S. aureus (MSSA). Between 2000 and 2002, the frequency of MRSA was 58.5%, whereas that of MSSA was 36.7%. However, from 2003 onwards, there was a reversal of these percentages. At the end of the analyzed period, 55.2% of infections were caused by MSSA, whereas 36.2% contained MRSA isolates. Furthermore, in the period analyzed, the highest prevalence was of SCCmectype II. Conclusion: these data suggest an epidemiological change in S. aureus from clinical materials, with a change in the prevalent type of SCCmec and changes in the antimicrobial sensitivity profile exhibited by the isolates. Such facts must be considered by the clinical staff with a focus on effective patient management, the choice of appropriate antimicrobial therapy so that effective infection control measures are implemented.

Heel skin microclimate control: Secondary analysis of a self-controlled randomized clinical trial

Objectivethis study was undertaken to evaluate the efficacy of multilayer polyurethane foam with silicone (MPF) compared to transparent polyurethane film (TPF) dressings in the control of heel skin microclimate (temperature and moisture) of hospitalized patients undergoing elective surgeries. Methodthe study took of a secondary analysis of a randomized self-controlled trial, involving patients undergoing elective surgical procedure of cardiac and gastrointestinal specialties in a university hospital in southern Brazil, from March 2019 to February 2020. Patients served as their own control, with their heels randomly allocated to either TPF (control) or MPF (intervention). Skin temperature was measured using a digital infrared thermometer; and moisture determined through capacitance, at the beginning and end of surgery. The study was registered in the Brazilian Registry of Clinical Trials: RBR-5GKNG5. Resultssignificant difference in the microclimate variables were observed when the groups (intervention and control) and the timepoint of measurement (beginning and end of surgery) were compared. When assessing temperature, an increase (+3.3 °C) was observed with TPF and a decrease (−7.4 °C) was recorded with MPF. Regarding skin moisture, an increase in moisture (+14.6 AU) was recorded with TPF and a slight decrease (−0.3 AU) with MPF. ConclusionsThe findings of this study suggest that MPF is more effective than TPF in controlling skin microclimate (temperature and moisture) in heels skin of hospitalized patients undergoing elective surgeries. However, this control should be better investigated in other studies.

Quality of Care Transition for COVID-19 Patients in a University Hospital in Southern Brazil.

To assess the quality of care transition from hospital to home for COVID-19 patients. A cross-sectional study conducted at a University Hospital in Southern Brazil, involving 78 patients discharged after COVID-19 hospitalization. Data collection was performed via telephone using the Brazilian version of the Care Transitions Measure (CTM-15). Data were analyzed using descriptive and analytical statistics. The mean quality of care transition was 70.8 on a scale ranging from zero to 100, indicating moderate quality of care transition. The highest score was attributed to factor 1, "Preparation for self-management," and the lowest to factor 4, "Care Plan." It is important to enhance communication and support provided to patients during the transition process, especially regarding understanding prescribed medications and the development of clear care plans.

Outcomes and associated factors of open abdomen after urgent laparotomy at a University Hospital in Southern Brazil: a retrospective study.

The technique of open abdomen refers to a surgical procedure that intentionally involves leaving an opening in the abdominal wall. This study aimed to evaluate the clinical outcomes, mortality, and morbidity of patients undergoing open abdomen in a public hospital in Brazil and investigate associated risk factors associated with the outcome. Data from electronic medical records were collected from 2017 to 2022. The variables were used for descriptive analyses, association analysis, and survival analysis using the Kaplan-Meier curve. The sample included 104 patients, with 84 presenting with acute abdomen and 20 with trauma, having highly variable ages and comorbidities. Peritonitis and the need for early reoperation were the most common indication for the procedure, each accounting for 34%, and negative pressure wound therapy was the most commonly used technique. Fistula was the most frequent complication, with the majority forming in the early days after the surgery. The number of interventions and open abdomen time obtained statistical significance in comparison with the outcome. The overall mortality rate was 62,5%. Despite open abdomen being a technique that can have benefits in controlling intraabdominal contamination and preventing abdominal compartment syndrome, its implementation is associated with complications. The mortality and complication rates were high in this sample. The decision to use the technique should be individualized and based on several factors, including the indications and the patient's clinical status.

Comparação do nível de dependência de Enfermagem e dimensionamento entre unidades de internação clínica e cirúrgica

Abstract Objective to compare the level of dependence on nursing care and staffing between clinical and surgical inpatient units. Method This is a descriptive, retrospective study carried out in four inpatient units of a large university hospital in southern Brazil. A total of 7,486 patient classification records were included between January and October 2022. Descriptive statistical analysis, demand for nursing hours, staff projections, and the chi-square test were used. Results Intermediate care (40.2%) and semi-intensive care (40.8%) patients prevailed, with a difference between the units (p-value<0.001). There was a shortage of nurses in all the units. In one clinical unit, the projected number of nursing technicians/assistants was the same as the number available (n=46). In two units, there was a slight to moderate surplus of mid-level staff. The surgical inpatient unit with the best classification rate (92.3%) showed the greatest discrepancy between the prescribed and actual sizing. Conclusion and implications for practice the units were highly dependent on nursing care. When also considering occupancy rates and adherence to patient classification, it is plausible that one of the clinical units has the highest demand for care.

Lactation physiology video clip: health professionals` assessment in hospital care.

To evaluate the usability of a lactation physiology video clips by healthcare professionals and to identify barriers and facilitators for this usage in hospitals. Cross-sectional study juxtaposed with the Knowledge Translation Model. The video clip was evaluated with the System Usability Scale self-applied to 63 health professionals from a university hospital in southern Brazil, from April to September 2022. Spearman's correlation test was used. The usability of the video clip obtained the best imaginable classification with a positive association with longer training time (p=0.038) and motivation for using it (p=0.035). The facilitators went to have institutional capacity building; physical space and moments of guidance for breastfeeding; brevity of the video clip with easy and playful information. Barriers were overcrowding and turnover, limited audiovisual equipment and internet equipment. The excellence of the usability of the video clip in the hospital highlights the potential for its application in continuing education with professionals and in health education with users. It is concluded that the longer the training time and the motivation for using technologies in daily care, the better professionals evaluate usability.

Prolonged hospitalization and 1-year mortality are associated with sarcopenia and malnutrition in older patients with type 2 diabetes: a prospective cohort study

AimTo assess the relationship of the presence of sarcopenia and malnutrition with unfavorable clinical outcomes: prolonged length of hospital stay (LOS), readmission, and one-year mortality in older patients with type 2 diabetes (T2D). MethodsWere included 319 patients with ≥60 years of age with T2D hospitalized at a university hospital in Southern Brazil. Sarcopenia was diagnosed according to handgrip strength (HGS), calf circumference (CC), and the timed up and go (TUG) walking test, and malnutrition according to the subjective global assessment (SGA) and the mini nutritional assessment long form (MNA-LF). Multivariate analyses, adjusted for confounders, were performed to assess the association of sarcopenia and malnutrition with clinical outcomes. One-year survival was compared using Kaplan-Meier analysis. ResultsThe association between sarcopenia and malnutrition increased by 2.42 times (95%CI 1.35–4.36) the probability of LOS ≥14 days and by 2.01 times (95%CI 1.09–3.72) the risk of one-year mortality. Older patients with malnutrition and sarcopenia have a higher risk of one-year mortality (log-rank p<0.05) compared with well-nourished patients without sarcopenia. ConclusionIn older patients with type 2 diabetes, those with sarcopenia, and malnutrition have higher odds of prolonged hospitalization and risk of mortality within one year after hospital discharge.

Daily work variability in falls prevention of hospitalized patients: nursing team’s perception

BackgroundThe identification of safety incidents and establishment of systematic methodologies in health services to reduce risks and provide quality care was implemented by The World Health Organization. These safety incidents allowed the visualization of a vast panorama, ranging from preventable incidents to adverse events with catastrophic outcomes. In this scenario, the issue of fall(s) is inserted, which, despite being a preventable event, can lead to several consequences for the patient, family, and the healthcare system, being the second cause of death by accidental injury worldwide, this study aims to identify the variability inherent in the daily work in fall prevention, the strategies used by professionals to deal with it and the opportunities for improvement of the management of work-as-imagined.MethodA mixed method approach was conducted, through process modeling and semi-structured interviews. The study was conducted in a public university hospital in southern Brazil. Study steps: modeling of the prescribed work, identification of falls, modeling of the daily work, and reflections on the gap between work-as-done and work-as-imagined. Medical records, management reports, notification records, protocols, and care procedures were consulted for modeling the work process, and semi-structured interviews were conducted with 21 Nursing professionals. The study was conducted between March 2019 and December 2020.ResultsFrom July 2018 to July 2019, 447 falls occurred, 2.7% with moderate to severe injury. The variability occurred in the orientation of the companion and the assurance of the accompanied patient's de-ambulation. The professionals identified individual strategies to prevent falls, the importance of multi-professional work, learning with the work team, and the colleague’s expertise, as well as suggesting improvements in the physical environment.ConclusionThis study addressed the need for fall prevention in the hospital setting as one of the main adverse events that affect patients. Identifying the variability inherent to the work allows professionals to identify opportunities for improvement, understand the risks to which patients are subjected, and develop the perception of fall risk as a way to reduce the gap between work-as-imagined and work-as-done.

High Prevalence of Panton-valentine Leukocidin-encoding Genes in Methicillin-resistant Staphylococcus aureus Isolated from Inpatients with Invasive Infections at a University Hospital in Southern Brazil.

Staphylococcus aureus is a major cause of a wide diversity of infections in humans, and the expression of Panton-Valentine Leukocidin (PVL) has been associated with severe clinical syndromes. The present study aimed to investigate the prevalence of PVL-encoding genes in S. aureus isolated from clinical samples of inpatients with invasive infections in a teaching hospital in Southern Brazil. Furthermore, phenotypic and genotypic characteristics of bacterial isolates were analyzed. A total of 98 S. aureus isolates recovered from different body sites were characterized according to their antimicrobial susceptibility profile, methicillin-resistance and SCCmec typing, genetic relatedness and occurrence of virulence-encoding genes, such as icaA, lukS-PV/lukF-PV, and tst. Sixty-eight (69.4%) isolates were classified as methicillin-resistant, and among them, four (5.9%) did not harbor the mecA gene. The mecA-harboring methicillin-resistant S. aureus (MRSA) isolates were grouped into SCCmec types I (6.3%), II (64.1%), III (6.3%), IV (15.6%), V (4.7%), and VI (1.6%). One isolate (1.6%) was classified as non-typeable (NT). Seventy isolates (71.4%) were classified as multidrug-resistant. The overall prevalence of virulence-encoding genes was as follows: icaA, 99.0%; tst, 27.5%; and lukS-PV/lukF-PV, 50.0%. The presence of tst gene was significantly higher (p < 0.001) in methicillin-susceptible S. aureus (MSSA) compared to MRSA isolates. The present study reports a high prevalence of multidrug-resistant S. aureus harboring lukS-PV/lukF-PV and tst genes in invasive infections. The continuous monitoring of the antimicrobial susceptibility profile and virulence of S. aureus is an important measure for the control of infections caused by this bacterium.

Levels of Anxiety and Stress Experienced by Nurses in Inpatient Units

Objective: To assess state-trait anxiety levels and their correlation with occupational stress and socio-biographical and occupational factors in nursing professionals. Materials and Methods: This quantitative, cross-sectional, analytical study was conducted in the inpatient units of a university hospital in southern Brazil, with the participation of 162 nursing professionals. For data collection, socio-biographical and occupational forms, the Stress-Symptom Scale, the Workplace Stress Scale, and the State-Trait Anxiety Inventory were used. The data were analyzed based on descriptive and inferential statistics. Results: Nursing professionals have moderate levels of state-trait anxiety. There is a positive correlation between state-trait anxiety scores, stress scores, and stress dimensions (rho = 0.811, p &lt; 0.001). “Trait” anxiety is associated with years of experience in nursing (PR 0.97) and psychic-mental health follow-up (PR 1.97). “State” anxiety is associated with sex (PR 0.54), education (PR 2.26), and hours of sleep (PR 0.92). Conclusions: “State” anxiety is associated with sex, age, higher education level, and psychic-mental health follow-up; however, years of experience in nursing and hours of sleep were found to be protective factors.

DIÁLOGO SOBRE DOAÇÃO DE ÓRGÃOS E TECIDOS: GAMIFICATION NA EDUCAÇÃO PERMANENTE EM SAÚDE

ABSTRACT Objective: to systematize the teaching-service partnership experience in the creation and application of a virtual game on organ and tissue donation as a proposal for permanent education in health. Method: systematization of an experience, conducted through documentary analysis, involving the process to create and apply an educational gamification practice by Nursing students, professors and professionals who developed the strategy and applied it at a university hospital in southern Brazil in September 2020. Results: given the health context imposed by COVID-19, the virtual game consisting of 20 questions about the organ and tissue donation process for transplants, as a strategy for ongoing health education, inspired engagement and motivation among the professionals, who showed limited knowledge about the theme and evaluated the strategy as positive. Conclusion: a potential path to be replicated in different contexts and scenarios was made evident, stimulating and encouraging the care and education processes.

A INTENSIFICAÇÃO DO TRABALHO NA PERSPECTIVA DE TRABALHADORES DE ENFERMAGEM

ABSTRACT Objective: to understand the factors that intensify work from the perspective of nursing professionals working in medical and surgical clinical units. Method: this is a descriptive, exploratory study, with a qualitative approach, carried out with 18 nursing professionals working at a university hospital in southern Brazil. Data production took place between April and June 2021 through semi-structured interviews. Data processing occurred through textual analysis, with the aid of IRaMuTeQ software, with the results being subjected to content analysis. The project followed the recommendations for research involving human beings, approved by the Research Ethics Committee. Results: based on similarity analysis and Descending Hierarchical Classification, data were organized into seven classes: I - Weaknesses in physical structure and lack of materials and/or equipment; II - Complexity of patients’ clinical condition; III - Weaknesses in training, qualification and number of professionals; IV - Work rhythms and demands; V - Work process organization; VI - Weaknesses in management; and VII - Lack of interprofessional collaboration. Conclusion: work intensification is present in study participants’ daily lives, being related to the lack of materials and equipment, severity of patients’ clinical condition, weaknesses in professional training and qualification, intensified pace and increase in work demands, weaknesses in management, and lack of interprofessional collaboration.

IMPLEMENTAÇÃO DA METODOLOGIA LEAN NA EMERGÊNCIA DE UM HOSPITAL UNIVERSITÁRIO: GESTÃO E DESENVOLVIMENTO SUSTENTÁVEL

ABSTRACT Objective: to describe the implementation of the Lean Methodology in an emergency department and its contribution to sustainable and quality management. Method: this is a methodological study carried out between October 2018 and January 2022 in the adult emergency department of a public university hospital in southern Brazil, analyzing the results before and after the implementation of the Lean Methodology. The study followed the model and standards adopted by the Standards for Quality Improvement Reporting Excellence 2.0 (SQUIRE) for the description of improvement cycle standards. Results: with the implementation of this methodology, actions were developed, such as innovations in work routines, both care and management, changes in patient reception with risk classification, construction of units for patient care and allocation, daily interdisciplinary meetings (huddle), full contingency plan, hospital discharge routines, external transfers, changes in the communication process with users and professionals, among other actions. Conclusion: the use of the Lean Methodology has resulted in a reduction in occupancy, which has helped to optimize health resources and ensure quality care and management practices. This reduction is believed to be proof of sustainable management in health services and contributes to reducing socio-economic inequalities.

Common mental disorders, depression, and anxiety in high-risk pregnant women from a university hospital in southern Brazil

Common mental disorders, depression, and anxiety in high-risk pregnant women from a university hospital in southern Brazil

Transição do cuidado à mulher no período puerperal na alta hospitalar

Abstract Objective to describe nurses’ activities in transition of care for puerperal women from hospital care to other services in the health care network. Method exploratory-descriptive research, developed in the rooming-in of a federal university hospital in southern Brazil. Data were collected remotely, between November and December 2020, through a semi-structured questionnaire via the SurveyMonkey electronic platform with five nurses and four resident nurses. Analysis followed Bardin’s content structure with the support of Qualitative Data Analysis Miner software. Results the activities carried out by nurses in transition of care for puerperal women included discharge guidelines and educational actions for puerperal women. Elements such as lack of communication between rooming-in professionals and other services in the Health Care Network and nurses’ workload were considered barriers to transition of care to puerperal women. Conclusion and implications for practice although nurses undertake efforts in transition of care to puerperal women through guidance and education for discharge, it is essential to outline management strategies in order to implement a set of systematized actions to ensure continuity of care for puerperal women.

Bleeding hepatocellular adenoma: historical series and outcomes.

hepatocellular adenoma - AHC - is a rare benign neoplasm of the liver more prevalent in women at reproductive age and its main complication is hemorrhage. In the literature, case series addressing this complication are limited. between 2010 and 2022, 12 cases of bleeding AHC were attended in a high-complexity university hospital in southern Brazil, whose medical records were retrospectively evaluated. all patients were female, with a mean age of 32 years and a BMI of 33kg/m2. The use of oral contraceptives was identified in half of the sample and also half of the patients had a single lesion. The mean diameter of the largest lesion was 9.60cm and the largest lesion was responsible for bleeding in all cases. The presence of hemoperitoneum was documented in 33% of the patients and their age was significantly higher than the patients who did not have hemoperitoneum - 38 vs 30 years, respectively. Surgical resection of the bleeding lesion was performed in 50% of the patients and the median number of days between bleeding and resection was 27 days. In only one case, embolization was used. The relation between ingrowth of the lesions and the time, in months, was not obtained in this study. it is concluded that the bleeding AHC of the present series shows epidemiological agreement with the literature and may suggest that older patients trend to have hemoperitoneum more frequently, a fact that should be investigated in further studies.

Family motivations and expectations in the care for psychoactive substance users.

To understand the motivations and expectations of family members for the care of users of psychoactive substances. This is a qualitative study using Alfred Schutz's phenomenological sociology framework. Data was collected through semi-structured interviews with family members of substance users treated in the inpatient and outpatient clinic of a university hospital in southern Brazil. Data was interpreted through comprehensive phenomenological analysis. Five categories of motivation were identified: for fear and insecurity with the situation; for obligation; due to the relationship of love and connection; to stop suffering; to promote independent living. The motivations of the family members aim to avoid the helplessness of the substance user and to achieve positive changes in the construction of a life without the use of substances, projecting a self-sufficient future for the user.

Sociodemographic profile, diagnoses and nursing care in post-COVID-19 patients in a Brazilian university hospital.

to analyze the sociodemographic profile, diagnoses and nursing care of post-COVID-19 patients admitted to a university hospital in southern Brazil. a retrospective cohort study. The sample consisted of 1,467 medical records, from January 2020 to January 2021. from the analyzed medical records, the most prevalent profiles, respectively, included: males (52.9%); white (81.1%); with Impaired Physiological Balance Syndrome* Nursing Diagnosis (77.3%); nursing care implementing aerosol precautions (94.5%); implementing droplet precautions (93.4%); checking vital signs (91.9%); applying standard disinfectant to equipment and surfaces (89.6%). the analysis of the sociodemographic profile, diagnoses and nursing care of patients in this study may contribute to implementing the Nursing Process in the coronavirus pandemic context.

Healthcare of pregnant women with diabetes during the COVID-19 pandemic: a Southern Brazilian cross-sectional panel data.

To evaluate the indirect effects of the COVID-19 pandemic on the care of women with pregnancies complicated by gestational or pre-existing diabetes, and their maternal-fetal outcomes. A cross-sectional panel data conducted in a University Hospital in Southern Brazil. Maternal-fetal outcomes and predictors of care from 235 pregnant women with type 1, type 2, or gestational diabetes were evaluated. Two time periods were compared: six months preceding the pandemic, in 2019, and the COVID-19 period from September 2020 to March 2021. Comparisons were performed using analysis of variance, Mann-Whitney U, Fisher's exact and T-tests. Risks were calculated using the Poisson regression with robust estimates. Maternal age was lower (32.1±6.8 vs. 34.4±6.6, p=0.009) and rates of depression/anxiety were higher (16.5 vs. 7.4%, p=0.046) in the group evaluated during the COVID-19. Neonatal hypoglycemia (RR 4.04; 95% CI 1.37-11.98, p=0.012), and SGA rates (RR 4.29; 95% CI 1.93-9.54, p<0.001) were higher in the group assessed before the pandemic. Despite economic, social and structural impacts of the pandemic, parameters of maternal care were similar; diabetes control improved, and neonatal hypoglycemia and SGA rates were lower among pregnant women with diabetes during the pandemic.