Objective: The aim of this study was to compare sleep pattern, tiredness sensation and quality of life between different chronotypes in train drivers from a Brazilian transportation company. Subjects and Methods: Ninety-one train drivers, working a rotary work schedule including night shift, were divided into three groups according to their chronotype (morning types, intermediate or evening types) and were assessed for their sleep and quality of life, as characterized by a subjective questionnaire and the Psychomotor Vigilance Task (PVT), applied before and immediately after the night shift. The pattern of activity and rest was measured for 10 days by actigraphy, and the chronotype was determined through the Morningness-Eveningness Questionnaire. Results: Forty-one (45.1%) individuals were classified as morning type, 44 (48.4%) were classified as intermediate and 6 (6.6%) as evening type. The evening types had a tendency to remain awake for a longer period of time before the night shift (p = 0.05) and scored worse overall for quality of life compared to morning types (p = 0.11). There was no significant difference between the groups regarding variability in the PVT performance, even when covaried by the period of waking time before the test. There was no significant difference either in feelings of fatigue before and after starting the shift. Conclusion: Although the evening type number was small, evening type individuals scored worse relative to sleep and quality of life than morning type individuals.

This theoretical and reflexive study analyzed the risks related to the maintenance of patency of the Peripherally Inserted Central Catheter with the use of saline solution in comparison with saline-filled syringes, through the application of the Healthcare Failure Mode and Effect Analysis - HFMEA. The process was mapped, detailing the failure modes of each step. For the calculation of the Risk Priority Number, the severity and probability of the failure modes were analyzed. This analysis gave rise to the severity and probability matrix. Finally, actions to reduce the failure modes in the maintenance of patency were proposed, considering the use of saline-filled syringes in comparison to the use of saline ampoules. It was verified that the use of saline ampoules is associated with a greater risk, since it requires four stages more than saline-filled syringe does not, increasing the risk of contamination and the level of three different risks, which would result in additional hospital costs. The use of the saline-filled syringe would avoid risks that could negatively affect the patient’s health, the nursing professional and the health institution.

Objective: To assess the MEWS association with the clinical outcomes (CO) of patients admitted to an internal medicine ward (IMW) at a Brazilian university hospital (UH). Introduction:It is important to quickly identify patients with clinical deterioration, especially in wards. The health team must recognize and act before the situation becomes an adverse event. In Brazil, nurses' work to overcome performance myths and the application of standardized predictive scales for patients in wards is still limited.Design: An observational cohort study designed and developed by a registered nurse that followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.Methods: Data were collected from the IMW of a UH located in the city of São Paulo, Brazil (2017). An ROC curve was calculated to strengthen the use of a MEWS of < or ≥ 4 as a cutoff. CO of the two subgroups were compared.Results: Three hundred patients completed the study; their vital signs were recorded consecutively throughout hospitalization in the IMW. The highest MEWS value each day was considered for analysis. Scores < 4 were significantly associated with a higher probability of hospital discharge, a lower chance of transfer to the ICU, a lower total number of days of hospitalization, and a lower risk of death. Score ≥ 4 had worse CO (orotracheal intubation and cardiac monitoring), transfer to the ICU, and increased risk of death. Conclusion: Scores < 4 were associated with positive outcomes, while scores ≥ 4 were associated with negative outcomes. MEWS can help prioritize interventions, increase certainty in decision-making, and improve patient safety, especially in a teaching IMW with medical teams undergoing professional development, thereby ensuring the central role of the nursing team in Brazil. Relevance for clinical practice: MEWS aid nurses in identifying and managing patients, prioritizing interventions through assertive decision-making.

Objectives: to analyze the mean direct cost and peripheral venous access length outcomes using devices over needle with and without extension. Methods: quantitative, exploratory-descriptive research. Venous punctures and length of the devices were followed. The mean direct cost was calculated by multiplying the time (timed) spent by nursing professionals by the unit cost of labor, adding to the cost of materials. Results: the total mean direct cost of using devices “with extension” (US$ 9.37) was 2.9 times the cost of using devices “without extension” (US$ 4.50), US$ 7.71 and US$ 2.66, respectively. Totaling 96 hours of stay, the “device over needle with extension” showed a lower occurrence of accidental loss. Conclusions: the use of the “device over needle with extension”, despite its higher mean direct cost, was more effective in favoring adequate length of peripheral venous access.

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Lista de Abreviaturas/Siglas _________________________________________ Resumo ____________________________________________________________ 1. INTRODUÇÃO __________________________________________________ 1.1 Modified Early Warning Score _____________________________________ 2. OBJETIVOS ____________________________________________________ 3. MÉTODOS _____________________________________________________ 3.1 Delineamento da pesquisa ________________________________________ 3.2 Local do estudo __________________________________________________ 3.3 Amostra _________________________________________________________ 3.4 Critérios de elegibilidade _________________________________________ 3.5 Procedimento para coleta de dados _______________________________ 3.6 Análise estatística dos dados _____________________________________ 3.7 Aspectos éticos __________________________________________________ 4. RESULTADOS __________________________________________________ 4.1 Análise Descritiva Geral __________________________________________ 4.2 Característica dos pacientes com MEWS ≥ 4 comparado aos pacientes com MEWS <4 ______________________________________________________________ 4.3 MEWS ≥ 4 e condutas ____________________________________________ 4.4 MEWS Entrada e Saída ___________________________________________ 4.5 MEWS e pacientes que foram para UTI _____________________________ 4.6 MEWS ≥ 4: Comparação 24h e 48h antes ___________________________ 4.7 Estudo de caso __________________________________________________ 5. DISCUSSÃO ____________________________________________________ 5.1 Características dos pacientes internados na enfermaria de clínica médica 52 5.2 Tempo de internação _____________________________________________ 5.3 Manejo de pacientes críticos ______________________________________ 5.4 Escalas diversas e MEWS_________________________________________ 5.5 MEWS de entrada e MEWS de saída _______________________________ 5.6 Pontuação de MEWS≥4 e condutas ________________________________ 5.7 Enfermagem e MEWS_____________________________________________ 6. CONCLUSÃO ___________________________________________________ 6.1 Sugestões para trabalhos futuros _________________________________ 6.2 Limitações _______________________________________________________ ANEXO 1 -Caracterização da Amostra -Ficha de coleta ______________ ANEXO 2 -Modified Early Warning Score (MEWS) ____________________ 7. REFERÊNCIAS BIBLIOGRÁFICAS _______________________________ CRONOGRAMA _____________________________________________________ APENDICE -Revisão Integrativa _____________________________________ Resumo Saba A. Identificação da piora do quadro clínico do paciente internado na enfermaria [dissertação].

Oral poster abstracts (2) or to determine if it was affected with Fragile X, and declined in 4 males despite the increased risk. Amniocentesis was subsequently performed in the case with genital ambiguity because of other scan anomalies. Conclusions: Non-invasive prenatal diagnosis using ffDNA is a reliable way of determining fetal sex from 6 weeks gestation. Early NIPD in CAH can result in complete avoidance or early cessation of steroid treatment. Cases at increased risk of genital ambiguity or X-linked conditions, or with genital anomalies detected on scan should be offered NIPD as invasive testing can be avoided in nearly half of the cases. As molecular technology improves and methods of separating ffNA from the maternal DNA are refined, NIPD will become available for other conditions changing prenatal diagnosis significantly.

The aim of this study is to compare transperineal and endovaginal ultrasonography in the evaluation of the endometrium, assess for image quality and for a systematic difference in endometrial thickness measured by the two techniques. Methods: Transperineal and endovaginal ultrasonography evaluation of the endometrial thickness was performed on 58 women, in Dona Estefânia Hospital, between November 2005 and March 2007. Two physicians reviewed the images and rated the relative diagnostic value of the techniques for assessing the endometrial thickness. We identified two groups (G1-visualized; G2-not visualized). In G1 data were analyzed to determine if there is a correlation between the two approaches using the Spearman test, with a statistical significance of 5% (p < 0.05). In GI and G2 we concluded about the uterine position. Results: Fifty-eight women (average age 57.51) were divided in two groups (G1 n = 45; G2 n = 13). In G1 the Spearman test result was R = 0.933, which reveals a strong correlation between the two techniques. In this group 97.78% (44/45) of uterine position was anteversus or intermediary. In G2 the uterine positions were: anteversus 53.85% (7/13), intermediary 7.69% (1/13) and retroversus 38.46% (5/13). In the majority the transabdominal approach reveals worse quality images. Conclusions: Both transperineal and endovaginal ultrasonography can provide satisfactory images of the endometrium, but endovaginal images are frequently superior to transperineal images. With this study we can conclude that transperineal approach is correlated with endovaginal images for endometrial thickness evaluation, especially in anteversus and intermediary uterus. It had patient acceptance and tolerance, without the need for vaginal penetration, and could be a method of choice in virginal or in postmenopausal women with genital atrophy. This technique needs further study to validate its potential application.