Critical Care 2017, 21(Suppl 1):P349 Introduction Imbalance in cellular energetics has been suggested to be an important mechanism for organ failure in sepsis and septic shock. We hypothesized that such energy imbalance would either be caused by metabolic changes leading to decreased energy production or by increased energy consumption. Thus, we set out to investigate if mitochondrial dysfunction or decreased energy consumption alters cellular metabolism in muscle tissue in experimental sepsis. Methods We submitted anesthetized piglets to sepsis (n = 12) or placebo (n = 4) and monitored them for 3 hours. Plasma lactate and markers of organ failure were measured hourly, as was muscle metabolism by microdialysis. Energy consumption was intervened locally by infusing ouabain through one microdialysis catheter to block major energy expenditure of the cells, by inhibiting the major energy consuming enzyme, N+/K + -ATPase. Similarly, energy production was blocked infusing sodium cyanide (NaCN), in a different region, to block the cytochrome oxidase in muscle tissue mitochondria. Results All animals submitted to sepsis fulfilled sepsis criteria as defined in Sepsis-3, whereas no animals in the placebo group did. Muscle glucose decreased during sepsis independently of N+/K + -ATPase or cytochrome oxidase blockade. Muscle lactate did not increase during sepsis in naïve metabolism. However, during cytochrome oxidase blockade, there was an increase in muscle lactate that was further accentuated during sepsis. Muscle pyruvate did not decrease during sepsis in naïve metabolism. During cytochrome oxidase blockade, there was a decrease in muscle pyruvate, independently of sepsis. Lactate to pyruvate ratio increased during sepsis and was further accentuated during cytochrome oxidase blockade. Muscle glycerol increased during sepsis and decreased slightly without sepsis regardless of N+/K + -ATPase or cytochrome oxidase blocking. There were no significant changes in muscle glutamate or urea during sepsis in absence/presence of N+/K + -ATPase or cytochrome oxidase blockade. ConclusionsThese results indicate increased metabolism of energy substrates in muscle tissue in experimental sepsis. Our results do not indicate presence of energy depletion or mitochondrial dysfunction in muscle and should similar physiologic situation be present in other tissues, other mechanisms of organ failure must be considered. , and long-term follow up has shown increased fracture risk [2]. It is unclear if these changes are a consequence of acute critical illness, or reduced activity afterwards. Bone health assessment during critical illness is challenging, and direct bone strength measurement is not possible. We used a rodent sepsis model to test the hypothesis that critical illness causes early reduction in bone strength and changes in bone architecture. Methods 20 Sprague-Dawley rats (350 ± 15.8g) were anesthetised and randomised to receive cecal ligation and puncture (CLP) (50% cecum length, 18G needle single pass through anterior and posterior wa...

The risk of health professionals exposed to different incidents associated with care, can cause damage to their health and that of their families, depending on the culture and institutional actions. The present study aims to: Propose a reflection on safety in professional practice, facing Covid-19, in the context of hospital care, considering Brazilian standards. It is a reflection article on health and safety measures for workers working in institutions for assistance, regulated by the Regulatory Norms of the Ministry of Labor and Employment of Brazil. The results are presented in two categories: 1. Exposure by health professionals and preventive measures to Covid-19; recommendations for the use of Personal Protective Equipment (PPE), as well as policies that mitigate exposure to these professionals to infection, must be prepared. 2. Identification and management of the worker's exposure risk; categorize the risk of each health professional after exposure to a patient with Covid 19 and proceed with the management of the professionals. 3. Worker safety and working conditions in Brazil; the pandemic exacerbated the condition of unhealthy work that health professionals experience on a daily basis and, as a consequence, aggravates exposure to other occupational risks, due to the precariousness of material necessary for the attention of users, and the work overload. Given the current scenario, it is necessary to carry out actions based on protocols and standards, aiming at the health of the population and professionals.

the diffusion by press of emergency nurses graduations magnified their apparition in public spaces, occasion on which the institutional rite was strategically used to transmit to the society the urgency of the new profession, in order to support the political causes in vigor in the country.

Objective: to analyze in the scientific literature the managerial strategies of nurses in stimulating active fatherhood in prenatal care in primary care. Method: this is an integrative review, with a 7-year time frame, in which the descriptors were used: Primary Care, Paternity, prenatal care, health services administration, whose languages were English and Portuguese. Studies from all countries were included for a sample. The searches were carried out in the databases: Medline, Lilacs, Bdenf through the Virtual Health Library (VHL) and Cinahl. Results: 2840 articles were found, of which were selected according to criteria 48. After analyzing the studies, it was observed that the practice of using: formal and informal invitations, lectures, electronic materials, pamphlets, competitions, prizes and training to encourage active parenting in prenatal care. Conclusion: there was a lack of management strategies designed specifically by nurses to establish greater adherence to active parenting, the existence of different programs with the multiprofessional team are still insufficient for adherence to prenatal care. Being of paramount importance to encourage the development of more inclusive actions.

Objective: To propose reflections on the challenges of managers and health professionals in relation to the Coronavirus pandemic in Primary Care. Method: This is a reflective study of the evidence and documentation available on the coronavirus pandemic in primary care. Research was carried out on databases and websites of regulatory agencies. The text was organized into two themes: management and structural challenges in primary health care against coronavirus; Challenges to protect and value health professionals during the coronavirus pandemic. Results and Discussion: When faced with challenges, aspects such as quality assurance of outpatient care, given the scarcity of technology, the adequate structural quality so that professionals can act, including their safety, with the adequate supply of materials and training through education in the face of the new scenario become essential. Another challenge is in the context of current management, which in a way shakes the action of primary care, due to the deficit of professionals, which negatively impacts the current confrontation scenario. Conclusion: the study's reflection refers to chronic factors in the management process, the deficit of professionals, the structural quality, as well as the supply of materials as factors that hinder the care process for users, corroborated by the population's vulnerability, are challenges in this chaotic and exhausting scenario.

RESUMO Objetivo: analisar os reflexos do processo do planejamento na assistência prestada em duas unidades da atenção básica de saúde. Método: trata-se de um estudo qualitativo, descritivo, tipo pesquisa de campo, tendo, como cenários, uma Unidade Básica de Saúde e uma Policlínica. Coletaram-se os dados em 2017, utilizando-se, como instrumento, um roteiro de entrevista semiestruturado, com quatro enfermeiros. Apresentaram-se os resultados por meio da Análise de Conteúdo. Resultados: evidenciou-se a categoria “Os reflexos do processo do planejamento na assistência prestada na atenção básica em saúde”.  Conclusão: demonstrou-se o conhecimento, por parte dos enfermeiros, sobre o planejamento ao analisar os discursos, refletindo a preocupação do envolvimento de todos para alcançar as metas institucionais. Possibilitou-se, ao ser empregado pelos enfermeiros, refletir sobre a importância da sua utilização para otimizar os serviços de Enfermagem e das instituições onde estes profissionais estão inseridos, porém, a existência de fragilidades, tais como a falta de recursos humanos, materiais, além da falta de reconhecimento de seu trabalho, dificultam, algumas vezes, o alcance dos objetivos. Descritores: Enfermeiros; Planejamento; Serviços de Saúde; Atenção Primária em Saúde; Administração e Organização; Instalações de Saúde.ABSTRACT Objective: to analyze the effects of the planning process in the assistance provided in two basic health care units. Method: this is a qualitative study, descriptive, field-research type, whose scenarios were a Basic Health Unit and a Polyclinic. Data were collected in 2017, using as instrument a semistructured interviews with four nurses. The results were presented by means of content analysis. Results: the category “Consequences of the planning process in the assistance provided in primary health care” emerged. Conclusion: the nurses demonstrated knowledge about planning when analyzing their speeches, reflecting the concern about the involvement of everyone to achieve the institutional goals. When used by nurses, it allowed reflecting on the importance of its use to optimize the nursing services and institutions where these professionals are inserted, however, the existence of weaknesses, such as the lack of human, material resources, in addition to the lack of recognition of their work, sometimes hinder achieving the objectives.Descriptors: Nurses; Planning; Health Services; Primary Health Care; Administration and Organization; Health Facilities.RESUMEN Objetivo: analizar los efectos del proceso de planificación en la asistencia que se presta en dos unidades de atención básica de la salud. Método: se trata de un estudio cualitativo, descriptivo, del tipo investigación de campo, teniendo como escenarios una unidad básica de salud y un policlínico. Los datos fueron recolectados en el 2017, usando como instrumento una entrevista semiestructurada con cuatro enfermeras. Los resultados fueron presentados por medio de análisis de contenido. Resultados: se evidenció la categoría “Reflexiones del proceso de planificación en la asistencia prestada en la atención primaria de la salud”. Conclusión: Se demostró el conocimiento, por parte de enfermeras, acerca de la planificación cuando se analizaron los discursos, reflejando la preocupación de la participación de todos para lograr los objetivos institucionales. Se utilizado por las enfermeras, reflexiona sobre la importancia de su uso para optimizar los servicios de enfermería e instituciones donde estos profesionales se insertan, sin embargo, la existencia de deficiencias, como la falta de recursos humanos, materiales, además de la falta de reconocimiento de su trabajo, hacen difícil, a veces, lograr los objetivos. Descriptores: Enfermeros; Planificación; Servicios de Salud; Atención Primaria de Salud; Administración y Organización; Instalaciones de Salud.

RESUMO Objetivos: avaliar a adesão às boas práticas de manutenção do cateter venoso central pela equipe de enfermagem durante a pandemia de COVID-19. Métodos: pesquisa observacional, transversal, quantitativa com observação não participante. A coleta de dados foi orientada por instrumento desenvolvido para este estudo, constituído por cinco dimensões. Ocorreu em unidade de terapia intensiva de um hospital universitário na cidade do Rio de Janeiro. Resultados: foram realizadas 700 observações, que resultaram, no geral, em 402 (57,4%) procedimentos de adesão às boas práticas. Higiene das mãos (8%) e Realização de curativos (10%) foram as dimensões com menor adesão. Conclusões: as boas práticas de manutenção do cateter venoso central mostraram-se parcialmente presentes na rotina da equipe de enfermagem durante a pandemia de COVID-19. Em momentos críticos, intensificar a qualificação das equipes para uma melhor adaptação aos novos processos de trabalho é uma estratégia para sustentar a cultura de segurança do paciente.

The object of this study is the pictorial representation of the care provided by Camilo de Léllis, which has as objective: to present the life trajectory of Camillus de Lellis; to show the care provided by Camilo de Léllis, through the pictorial representation of Pierre Hubert Subleyras (1745) and comment the trajectory of caring given by him, as a contribution to the construction of the knowledge of the history of nursing. Method: steps followed for the investigation were the search of the literature of the articulated pictorial representation adhesion proposal. This entailed, in summary, a presentation of a biography of Camilo de Léllis and the decoding of the screen attributes examined. The result showed a care of the soul, beyond the physical body, in healing of illnesses with standards and systematization in the 18th century.