Rev Esc Enferm USP2014; 48(3):537-51 www.ee.usp.br/reeusp/ RESUMEN Objetivo: Identificar los factores de riesgo para la ocurrencia de caídas en pacientes adultos hospitalizados. Método: Revisión integradora de la literatura de artículos publicados entre los años 1989 al 2012 en las bases de datos LILACS, SciElO, MEDLINE y Web of Science. Resultados: La muestra final estuvo compuesta por setenta y un artículos. Entre los factores de riesgo de caídas indicados en esta revisión están los relacionados con el paciente (intrínsecos), con el ambiente hospitalario y con el proceso de trabajo de los profesionales de la salud, especialmente enfermería (extrínse-cos). Conclusión: La detección sistemática de factores de riesgo asociados a caídas fue identificada como un factor que contribuye a la reducción de este daño, favoreciendo de esta manera su no ocurrencia, la que a pesar de ser prevenible puede acarrear consecuencias graves, incluyendo la muerte. DESCRIPTORESAccidentes por caídas Pacientes interno Hospitalización Seguridad del paciente Atención de enfermeira Revisión RESUMOObjetivo: Identificar os fatores de risco para a ocorrência de quedas em pacientes adultos hospitalizados. Método: Revisão integrativa realizada nas bases de dados LILACS, SciELO, MEDLINE e Web of Science, abrangendo artigos publicados entre 1989 e 2012. Resultados: Setenta e um artigos compuseram a amostra final do estudo. Os fatores de risco para quedas apresentados nesta revisão foram relacionados ao paciente (intrínsecos), ao ambiente hospitalar e ao processo de trabalho dos profissionais da saúde, em especial à enfermagem (extrínsecos). Conclusão: A triagem sistemática de fatores de risco para queda foi identificada como fator contribuinte para a redução desse agravo, auxiliando a não ocorrência deste evento que, apesar de ser prevenível, pode determinar consequên-cias graves incluindo o óbito. DESCRITORES Acidentes por quedas Pacientes internados Hospitalização Segurança do paciente Cuidados de enfermagem Revisão ABSTRACTObjective: Identifying risk factors for the occurrence of falls in hospitalized adult patients. Method: Integrative review carried out in the databases of LILACS, SciELO, ME-DLINE and Web of Science, including articles published between 1989 and 2012. Results: Seventy-one articles were included in the final sample. Risk factors for falls presented in this review were related to patients (intrinsic), the hospital setting and the working process of health professionals, especially in nursing (extrinsic). Conclusion: The systematic screening of risk factors for falls was identified as a contributing factor to the reduction of this injury, helping the nonoccurrence of this event that, despite being preventable, can have serious consequences including death. DESCRIPTORS

The present study was aimed at verifying the occurrence, if any, of in vivo oxidative DNA damage in FA homozygotes, their parents and siblings. 8-Hydroxy-2'-deoxyguanosine (8-OHdG) was measured, by HPLC/EC, in DNA from circulating blood leucocytes from FA homozygotes and their relatives and compared with a group of paediatric and adult healthy subjects. The population studied consisted of: (i) 15 FA homozygotes; (ii) 24 FA heterozygotes; (iii) 11 siblings. The 8-OHdG level in FA homozygotes was significantly higher with respect to age-matched controls, with a mean level of 33.3 +/- 6.8 (mean +/- SE) and 3.9 +/- 0.26 8-OHdG/10(5) dG respectively. The FA parents (heterozygotes) also displayed higher 8-OHdG levels relative to controls. The release of hydroxyl (.OH) and .OH-like radicals from leucocytes was determined by luminol-dependent chemiluminescence (LDCL) in a subgroup of FA homo- and heterozygotes, showing a very large in vivo formation of non-superoxide radicals. Chromosomal instability was also measured in the FA population. When relating either 8-OHdG or LDCL levels to spontaneous or diepoxybutane-induced chromosomal instability (S-CI and DEB-CI respectively), a significant correlation was observed between the 8-OHdG, LDCL and S-CI data. Within families a positive association was found between 8-OHdG levels in homozygotes and their related heterozygotes, suggesting segregation of the genetic defect(s) underlying the abnormal oxidative metabolism. The present study provides evidence for an in vivo pro-oxidant state in FA, in terms of excess formation of .OH and .OH-like radicals, and of DNA hydroxyl adducts. This finding appears to be shared by homozygotes and, to a lesser extent, by heterozygotes.

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Aim:To develop and validate a predictive model for falls in hospitalized adult clinical and surgical patients, assessing intrinsic (i.e. patient-related) and extrinsic factors (i.e. care process-related). Background:To identify factors predictive of falls and enable appropriate management of fall risk it is necessary to understand patient and environmental factors, along with care delivery processes. Design:A matched case-control study. Methods:This study was conducted in the medical and surgical wards of a Brazilian teaching hospital. The sample included 536 patients, with data collected in 2013- Data analysis included descriptive statistics and conditional logistic regression.Cases of patients aged 18 years or older who fell while hospitalized were included.One patient who did not fall during hospitalization, matched by sex, ward and admission date, was selected as a control for each included case. Results: The SAK Fall Scale (Severo-Almeida-Kuchenbecker) was developed and validated. The scale includes seven variables: disorientation/confusion, frequent urination, walking limitations, lack of caregiver, postoperative status, previous falls and number of medications administered within 72 hr prior to the fall. This scale showed acceptable predictive accuracy. Conclusions: The newly developed SAK Fall Scale includes five intrinsic and two extrinsic variables and differs from other predictive scales for falls. The findings of this study are broad and the scale, which is easy to apply, can be used worldwide by nurses in health services. In advanced practice, the testing of a new model for fall risk contributes to preventive interventions and thus has an impact on patient safety. K E Y W O R D S adult, advanced practice, falls, nurses, patient safety, risk management *Member of the Study Group on Adult and Elderly Care -GEPECADI -CNPq.• The study gives data for a new prediction model that should be used to predict fall risk.• The findings should be used to support the care and safety of hospitalized clinical and surgical patients. 564 | SEVERO ET AL.

Aims and Objective To identify clinical indicators of septic shock in critical care patients. Background The identification of clinical indicators of septic shock is relevant to avoid clinical deterioration of patients with sepsis. However, the recognition of these factors, especially by the nursing team, is still deficient and reinforces the need for studies that investigate the subject in different realities such as that of Brazil. Design The study had a cross‐sectional design based on STROBE guidelines (see Appendix S1). Methods A sample of 392 patients with sepsis or septic shock was admitted to the Intensive Care Unit of a Brazilian university hospital. Data were collected from medical records of the Intrahospital Sepsis Combat Program referring to patients admitted between January 2018–January 2019. Sociodemographic and clinical data were collected, as well as information on the time from diagnosis of sepsis or septic shock to initiation of antibiotic therapy, length of stay, and discharge or death outcomes. Data were statically analysed. Results Out of the total sample, 190 (49%) patients were admitted with septic shock. Clinical indicators of septic shock were hypotension, mechanical ventilation, lactate levels between 2.0–3.9 or >4, hypothermia <36°C, radiotherapy‐associated chemotherapy, Sequential Organ Failure Assessment score >3 and admittance through the emergency unit. Among patients with septic shock, 85 (44.7%) were discharged and 105 (55.2%) died in the intensive care unit. Conclusions Patients with septic shock presented hyperlactataemia and greater organic dysfunction as clinical indicators when compared to patients with sepsis. Mechanical ventilation, chemotherapy and radiotherapy increased the risk of developing septic shock. Relevance to clinical practice Our results can support the nursing team by providing the main clinical indicators of septic shock and contributing to the interprofessional team in the prevention of septic shock.

Background Handgrip strength (HGS) is a potential method to approximate perioperative risk in cardiothoracic surgery patients and correlates well with European System for Cardiac Operative Risk Evaluation (EuroSCORE) values. This study aimed to characterize the functional capacity in preoperative cardiac surgery patients through HGS. Methods This cross‐sectional study investigated patients aged 18 years or older. The collected data included surgical risk (EuroSCORE), body mass index (BMI), body composition (electrical bioimpedance), and HGS. Results The mean age of the 278 participants was 62.1 ± 11.2 years, of whom 61.5% were male, 43.2% were overweight, and 26.3% were obese. The main types of surgery were myocardial revascularization (50%) and valve replacement (40.6%). HGS values differed between genders in all age groups (P < 0.05) and were approximately 40% lower than reference values for healthy individuals. The values differed with respect to operative risk (P = 0.003) and had a moderate positive correlation with fat‐free mass (rs = 0.435, P < 0.001), a moderate negative correlation with fat mass (rs = −0.447, P < 0.001), and weak negative correlations with age (rs = −0.270, P < 0.01) and EuroSCORE (rs = −0.316, P < 0.01). Conclusions The HGS values of preoperative elective cardiac surgery patients were below reference values for healthy individuals, were lower in male patients, were positively correlated with fat‐free mass, and were negatively correlated with fat mass, age, and operative risk. Its preoperative use in these patients is an attractive complementary method of risk assessment in clinical practice.

Resumo OBJETIVO Descrever a implantação de um indicador de qualidade assistencial associado ao diagnóstico de enfermagem de pacientes com alto risco de sangramento, com base nos resultados alarmantes de tempo de protombina (TP), tempo de tromboplastina parcialmente ativada (TTPa) e plaquetas. MÉTODOS Relato de experiência retrospectivo de ações multidisciplinares desenvolvidas em um hospital universitário. As etapas do estudo envolveram reuniões de equipes, busca de estratégias de comunicação efetiva e criação de um novo indicador de qualidade assistencial. RESULTADOS O indicador foi denominado “Conformidade do Diagnóstico de Enfermagem Risco de Sangramento”, monitorado mensalmente desde junho de 2016. A ficha técnica contempla as características e atributos do indicador. Com base nas suas análises são estabelecidos planos de ações para sua qualificação. CONCLUSÃO A implantação do indicador de qualidade assistencial associado ao diagnóstico de enfermagem aprimorou o processo de comunicação, monitoramento e cuidado de enfermagem a pacientes com risco de sangramento.

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