OBJECTIVE: To evaluate whether age group, complications or comorbidities are associated with the length of hospitalization of women undergoing cesarean section. METHODS: A cross-sectional study was carried out between June 2012 and July 2017, with 64,437 women undergoing cesarean section and who did not acquire conditions during their hospital stay. Hospital discharge data were collected from national health institutions, using the Diagnosis-Related Groups system (DRG Brasil). The DRG referring to cesarean section with additional complications or comorbidities (DRG 765) and cesarean section without complications or associated comorbidities (DRG 766) were included in the initial diagnosis. The influence of age group and comorbidities or complications present at admission on the length of hospital stay was assessed based on the means of the analysis of variance. The size of the effect was verified by Cohen’s D, which allows evaluating clinical relevance. The criticality levels were identified using the Duncan test. RESULTS: The longest length of hospital stay was observed in the age group from 15 to 17 years old and among those aged 45 years old or more. The hospital stay of women with complications or comorbidities at the time of admission was also longer. Moreover, it was noted that the increase in criticality level was associated with an increase in the mean length of hospital stay. CONCLUSIONS: The length of hospital stay of women is higher among those belonging to the age group ranging from 15 to 17 years old and for those aged 45 years old or more. The presence of associated comorbidities, such as eclampsia, pre-existing hypertensive disorder with superimposed proteinuria and gestational hypertension (induced by pregnancy) with significant proteinuria increase the length of hospital stay. This study enabled the construction of distinct criticality level profiles based on the combination of age groups and the main comorbidities, which were directly related to the length of hospital stay.
The aim of this study was to systematically review the effect of permissive underfeeding/trophic feeding on the clinical outcomes of critically ill patients. A systematic review of randomized clinical trials to evaluate the mortality, length of stay, and mechanical ventilation duration in patients randomized to either hypocaloric or full-energy enteral nutrition was performed. Data sources included PubMed and Scopus and the reference lists of the articles retrieved. Two independent reviewers participated in all phases of this systematic review as proposed by the Cochrane Handbook, and the review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 7 randomized clinical trials that included a total of 1,717 patients were reviewed. Intensive care unit length of stay and mechanical ventilation duration were not statistically different between the intervention and control groups in all randomized clinical trials, and mortality rate was also not different between the groups. In conclusion, hypocaloric enteral nutrition had no significantly different effects on morbidity and mortality in critically ill patients when compared with full-energy nutrition. It is still necessary to determine the safety of this intervention in this group of patients, the optimal amount of energy provided, and the duration of this therapy.
Introduction: The use of tools for computer-aided diagnosis (CAD) has been proposed for detection and classification of breast cancer. Concerning breast cancer image diagnosing with ultrasound, some results found in literature show that morphological features perform better than texture features for lesions differentiation, and indicate that a reduced set of features performs better than a larger one. Methods: This study evaluated the performance of support vector machines (SVM) with different kernels combinations, and neural networks with different stop criteria, for classifying breast cancer nodules. Twenty-two morphological features from the contour of 100 BUS images were used as input for classifiers and then a scalar feature selection technique with correlation was used to reduce the features dataset. Results: The best results obtained for accuracy and area under ROC curve were 96.98% and 0.980, respectively, both with neural networks using the whole set of features. Conclusion: The performance obtained with neural networks with the selected stop criterion was better than the ones obtained with SVM. Whilst using neural networks the results were better with all 22 features, SVM classifiers performed better with a reduced set of 6 features.
Objective: to evaluate the association of Obstetric Nursing in the best practices of delivery and birth care in maternity hospitals. Method: a cross-sectional study, with 666 women selected for delivery. Parturition obstetric practices performed by professionals were categorized into: clearly useful practices that should be encouraged, practices that are clearly harmful or ineffective and that should be eliminated and practices used inappropriately at the time of parturition. Results: clearly useful practices were used in greater proportions in the hospitals that had Obstetric Nursing working, while clearly harmful practices and those used inappropriately were practiced in smaller proportions in hospitals that had Obstetric Nursing, both with statistical difference. Conclusion: institutions with Obstetric Nursing adopt better practices of delivery and birth care, based on scientific evidence, when compared to those that do not act.
RESUMOObjetivo: avaliar a associação da Enfermagem Obstétrica nas boas práticas da assistência ao parto e nascimento em maternidades. Método: estudo transversal, com 666 mulheres selecionadas por ocasião da realização de parto. As práticas obstétricas realizadas pelos profissionais que assistiam o processo de parturição foram categorizadas em: práticas claramente úteis e que devem ser estimuladas, práticas claramente prejudiciais ou ineficazes e que devem ser eliminadas e práticas usadas de modo inapropriado no momento de parturição. Resultados: práticas claramente úteis foram utilizadas em maiores proporções nos hospitais que possuíam a Enfermagem Obstétrica atuante, enquanto práticas claramente prejudiciais e aquelas usadas de modo inapropriado foram praticadas em menores proporções em hospitais que possuíam a Enfermagem Obstétrica, ambas com diferença estatística. Conclusão: instituições com Enfermagem Obstétrica adotam melhores práticas de atenção ao parto e nascimento, baseadas em evidências científicas, quando comparadas às que ela não atua. Descritores: Enfermagem Obstétrica; Trabalho de Parto; Parto; Parto Humanizado; Obstetrícia; Nascimento.
RESUMENObjetivo: evaluar la asociación de la Enfermería Obstétrica en las buenas prácticas de la asistencia al parto y el nacimiento en maternidades. Método: estudio transversal, con 666 mujeres seleccionadas con ocasión de la realización del parto. Las prácticas obstétricas realizadas por los profesionales que asistían al proceso de parturición se clasificaron en: prácticas claramente útiles y que deben ser estimuladas, prácticas claramente perjudiciales o ineficaces y que deben ser eliminadas y prácticas utilizadas de modo inapropiado en el parto. Resultados: las prácticas claramente útiles fueron utilizadas en mayores proporciones en los hospitales que poseían la Enfermería Obstétrica actuante, mientras prácticas claramente perjudiciales y aquellas usadas de modo inapropiado fueron practicadas en menores proporciones en hospitales que poseían la Enfermería Obstétrica, ambas con diferencia estadística. Conclusión: las instituciones con E...
Objective: To analyze the factors associated with the performance of episiotomy. Methods: Cross-sectional study, developed with data from the research “Born in Belo Horizonte: Labor and birth survey, “conducted with 577 women who had their children via vaginal birth. In order to verify the magnitude of the association between episiotomy and its possible determinants, logistic regression models were constructed to estimate the odds ratio. Results: Episiotomy was performed in 26.34% of women, and 59.21% knew they had been subjected to it. We observed that younger women, primiparous women, women assisted by a professional other than the obstetric nurse and women who had their babies in a private hospital have an increased chance of being submitted to this procedure. Conclusion: Considering the rates of episiotomy, this study highlights the need for the absolute contraindication to indiscriminate performing it.
Resumo Objetivo: Analisar a tendência das notificações de sífilis gestacional e congênita em Minas Gerais, Brasil, de 2009 a 2019. Métodos: Estudo ecológico de série temporal, considerando-se como unidade de análise o estado de Minas Gerais, a partir de dados notificados no Sistema de Informação de Agravos de Notificação (Sinan). Empregou-se o modelo autorregressivo de Prais-Winsten para verificação de tendência. Resultados: Foram notificados 20.348 casos de sífilis gestacional e 11.173 casos de sífilis congênita. O percentual médio de incremento anual foi de 36,7% (IC95% 32,5;41,0) para a taxa de incidência de sífilis gestacional, e de 32,8% (IC95% 28,0;37,8) para a taxa de incidência de sífilis congênita (p<0,001). Conclusão: A análise de tendência temporal evidenciou que as taxas de incidência de sífilis gestacional e sífilis congênita apresentaram tendências crescentes significativas, o que se pode relacionar ao tratamento inadequado ou à não realização de tratamento da sífilis durante o período gestacional.
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