The aim of this study was to assess the level of agreement between an institutional protocol and the Manchester protocol for the risk assessment of patients attended in an emergency room of a public hospital in Belo Horizonte -MG -Brazil. This is a descriptive and comparative study, in which 382 patients' reports were evaluated and the risk was classified, using the institutional protocol and the Manchester protocol. Rates were calculated through weighted and unweighted kappa, in order to determine the level of agreement between the protocols.The results showed that the correlation between the protocols is average when considering that classification errors occurred between neighboring colors (kappa=0.48), and good when considering that classification errors occurred between extreme colors (kappa=0.61).The Manchester protocol increased the patients' level of priority of patients and has been considered more inclusive. Clasificación de riesgo en primeros auxilios: concordancia entre un protocolo institucional brasileño y el de ManchesterEste estudio tuvo por objetivo verificar el grado de concordancia entre un protocolo institucional y el protocolo de Manchester para la clasificación de riesgo de pacientes atendidos en primeros auxilios de un hospital público de Belo Horizonte -MG -Brasil.Se trata de estudio descriptivo comparativo en el cual 382 fichas fueron evaluadas y, realizada la clasificación de riesgo utilizando los protocolos mencionados encima, a partir del registro realizado por los enfermeros. Índices kappa ponderado y no ponderado fueron calculados para determinar el grado de concordancia entre los protocolos.Los resultados mostraron que la concordancia entre los protocolos es media, cuando considerados los errores de clasificación ocurridos entre colores vecinos (kappa=0,48) y buena, cuando considerados los errores de clasificación ocurridos entre colores extremos (kappa=0,61). Se concluye que el protocolo de Manchester aumentó el nivel de prioridad de los pacientes, demostrando ser un protocolo que incluye más.

Patients hospitalized in the Intensive Care Unit (ICU) may present risk for corneal injury due to sedation or coma. This study aimed to estimate the incidence of corneal injuries; to identify the risk factors and to propose a risk prediction model for the development of corneal injury, in adult patients, in an intensive care unit of a public hospital. This is a one year, prospective cohort study with 254 patients. The data were analyzed using descriptive statistics, univariate and logistic regression. Of the 254 patients, 59.4% had corneal injuries and the mean time to onset was 8.9days. The independent variables that predispose to risk for punctate type corneal injury were: duration of hospitalization, other ventilatory support device, presence of edema and blinking less than five times a minute. The Glasgow Coma Scale and exposure of the ocular globe were the variables related to corneal ulcer type corneal injury. The injury frequencies were punctate type (55.1%) and corneal ulcers (11.8%). Risk prediction models for the development of punctate and corneal ulcer type corneal injury were established. Lesões na córnea: incidência e fatores de risco em Unidade de Terapia IntensivaPacientes internados em unidade de terapia intensiva (UTI) podem apresentar risco para lesão na córnea devido à sedação ou coma. Este estudo teve por objetivo estimar a incidência das lesões na córnea, identificar os fatores de risco e propor modelo de predição de risco para o desenvolvimento de lesão na córnea, em pacientes adultos, em unidade de terapia intensiva, de um hospital público. É estudo de coorte prospectiva de um ano, com 254 pacientes. Os dados foram analisados por estatística descritiva, univariada e de regressão logística. Dos 254 pacientes, 59,4% tiveram lesão na córnea e o tempo médio para o seu aparecimento foi de 8,9 dias. As variáveis independentes que predispõem ao risco para lesão na córnea, tipo puntacta, foram: tempo de internação, outro dispositivo de assistência ventilatoria, presença de edema e piscar de olhos menor que cinco vezes por minuto. Escala de coma de Glasgow e exposição de globo ocular foram as variáveis relacionadas à lesão na córnea do tipo úlcera de córnea. As lesões foram do tipo puntacta (55,1%) e úlceras de córnea (11,8%). Modelos de predição de risco para lesões na córnea do tipo puntacta e úlcera foram estabelecidos.Descritores: Doenças da Córnea; Úlcera da Córnea; Fatores de Risco; Diagnóstico de Enfermagem; Unidades de Terapia Intensiva; Enfermagem. Lesiones en la córnea: incidencia y factores de riesgo en Unidad de Terapia IntensivaPacientes internados en Unidad de Terapia Intensiva (UTI) pueden presentar riesgo de lesión en la córnea debido a la sedación o al coma. Este estudio tuvo por objetivo estimar la incidencia de las lesiones en la córnea; identificar los factores de riesgo y proponer un modelo de predicción de riesgo para el desarrollo de lesión en la córnea, en pacientes adultos, en Unidad de Terapia Intensiva, de un hospital público. Estudio de cohorte prospectivo de un año co...

4This study aimed to identify risk factors associated with surgical site infections in orthopedic surgical patients at a public hospital in Minas Gerais, Brazil, between 2005 and2007. A historical cohort of 3,543 patients submitted to orthopedic surgical procedures. A descriptive analysis was conducted and surgical site infection incidence rates were estimated. To verify the association between infection and risk factors, the Chi-square Test was used. The strength of association of the event with the independent variables was estimated using Relative Risk, with a 95% confidence interval and p<0.05. Riesgo para infección de sitio quirúrgico en pacientes sometidos a cirugías ortopédicasEstudio para identificar factores de riesgo asociados a infecciones de sitio quirúrgico en Un análisis descriptivo fue realizado y la tasa de incidencia de infección fue estimada.Para verificar la asociación entre la infección y los factores de riesgo se usó el test chicuadrado. La fuerza de la asociación del evento con las variables independientes fue estimada por el Riesgo Relativo, con un intervalo de confianza de 95% y p <0,05. La incidencia de infección de sitio quirúrgico fue 1,8%. Fueron estadísticamente asociados a la infección el potencial de contaminación de la herida quirúrgica, las condiciones clínicas del paciente, el tiempo quirúrgico y el tipo de procedimiento ortopédico. La identificación de asociación de infección de sitio quirúrgico con los factores de riesgo mencionados es importante y contribuye para la práctica clínica del enfermero.

Incontinence-associated dermatitis: a cohort study in critically ill patients ABSTRACTObjectives: Estimate incidence, determine risk factors and propose a prediction model for the development of incontinence-associated dermatitis critically ill adult patients. Method: Concurrent cohort study with 157 critically ill patients. Data collection was daily performed between February and July 2015, at a public teaching hospital of Belo Horizonte, Minas Gerais. Data was entered in a database and subjected to descriptive, survival and multivariate analysis. Results: An overall incidence of 20.4% was obtained. Nineteen (19) risk factors significantly associated with the disorder were found. The variables identified in the risk prediction model were male, trauma, use of hypnotics/sedatives, lactulose, nutritional support, loose stools and complaints of burning. Conclusion:The results showed that dermatitis is a common clinical finding in critically ill adult patients and requires special attention from the nursing staff.

Revisão integrativa para identificar as evidências disponíveis na literatura sobre os melhores cuidados de enfermagem para o paciente com temperatura corporal elevada. A busca foi realizada nas bases de dados PubMed/MedLine, LILACS, CINAHL e Cochrane Reviews. A amostra foi constituída de 16 estudos. Os estudos foram avaliados em relação ao nível de evidência e grau de recomendação. Os artigos da amostra são de revisão sistemática, ensaio clínico randomizado, estudo de caso, descritivo, transversal, qualitativo, relato de experiência e quase-experimental. As melhores evidências referem-se aos cuidados com crianças e adultos com febre. Existe uma carência de estudos com delineamento experimental que testem os cuidados de enfermagem recomendados na literatura a pacientes com temperatura corporal elevada nas diferentes faixas etárias, principalmente com idosos. Sugere-se o desenvolvimento de pesquisas clínicas que analisem os cuidados de enfermagem a pacientes adultos com o diagnóstico de enfermagem de hipertermia, especialmente relacionados à utilização de métodos físicos, como realização de banho morno, aplicação de compressas mornas, bolsas de gelo e ventilação do ambiente.

Descriptive and sectional study to describe socio-demographic, clinical and functional independence profile of 97 institutionalized elderly in two nursing homes of Itaúna-MG. A socio-demographic and clinical data and Independence Daily Living Activity of Katz instruments were used. It was found a predominance of elderly women (59%), mean age of 77, illiterate (55%), white (67%), single (63%), without children (68%) and 30% lived alone and had difficulty to perform daily living activities, which is the main reason for institutionalization. The majority of elderly people (72%) had cardiovascular disease; 80.4% used neuroleptics/ psychotropic drugs, only 2.1% did not use drugs and 23% were independent to perform daily living activities. These seniors require more skilled care, justified by addiction, diseases, risk of complications and medications used.

No abstract

The applicability of the risk index for surgical site infection of the National Nosocomial Infection Surveillance (NNIS) has been evaluated for its performance in different surgeries.In some procedures, it is necessary to include other variables to predict. Objective: to evaluate the applicability of the NNIS index for prediction of surgical site infection in orthopedic surgeries and to propose an alternative index. The study involved a historical cohort of 8236 patients who had been submitted to orthopaedic surgery. Statistical analysis was performed using multivariate logistic regression to fit the model. The incidence of infection was 1.41%. Prediction models were evaluated and compared to the NNIS index.The proposed model was not considered a good predictor of infection, despite moderately stratified orthopedic surgical patients in at least three of the four scores. The alternative model scored higher than the NNIS models in the prediction of infection. Infección de sitio quirúrgico en pacientes sometidos a cirugías ortopédicas: el índice de riesgo NNIS y la predicción de riesgo La aplicabilidad del Índice de Riesgo de Infección Quirúrgica del National NosocomialInfection Surveillance-NNIS ha sido evaluada en cuanto a su desempeño en diferentes cirugías. En algunos procedimientos es necesaria la inclusión de otras variables de predicción. El objetivo de este estudio fue evaluar la aplicabilidad del Índice NNIS para la predicción de la Infección de Sitio Quirúrgico en cirugías ortopédicas y proponer un índice alternativo. Se realizó un estudio de cohorte histórica en 8.236 pacientes sometidos a cirugías ortopédicas. Se utilizó el modelo logístico multivariado para ajustar el modelo. La incidencia de infección fue 1,41%. Modelos de predicción fueron evaluados y comparados al Índice NNIS. El modelo propuesto fue aquel que presentó mayor precisión en clasificar pacientes con y sin infección. El Índice NNIS no fue considerado un buen factor de predicción de la infección, a pesar de haber estratificado moderadamente a los pacientes quirúrgicos ortopédicos en por el menos tres de los cuatro puntajes. El modelo alternativo fue superior al modelo NNIS en la predicción de infección.