quality in Intensive Care Medicine

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Burnout in general medicine and in intensive care medicine

Burnout in general medicine and in intensive care medicine

Krasner et al. (2009) evaluated the effects of an intensive educational program applied to primary care physicians, which included mindful meditation, self-awareness exercises, narratives about clinical experiences, and appreciative interviews. Participants benefited from mindfulness, which was correlated with improved mood, reduced emotional exhaustion, and improved professional satisfaction during the intervention with effects maintained for up to 15 months (Krasner et al., 2009). Goodman and Schorling (2012) evaluated four types of mindfulness practices. MBI scores have significantly improved after the program, both for physicians and other healthcare professionals, concerning the dimensions of emotional exhaustion, depersonalization, and professional satisfaction. There was also greater mental well-being, but there were no significant changes in scores of physical health (Goodman; Schorling, 2012). Shapiro et al. (2005) and Martín-Asuero and García-Banda (2010) reported that mindfulness-based interventions for stress reduction decreased the psychological stress and encouraged empathy, in addition to significantly increasing physicians’ quality of life. Rø et al. (2004) observed that even short-term counseling sessions – whether individually, for just one day, or as groups, lasting a week – significantly reduced the emotional exhaustion among Norwegian doctors.
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Nursing practice environment in intensive care units

Nursing practice environment in intensive care units

In addition, the variable “collegial nurse-phy- sician relations”, which has been historically de- scribed as conflictive and competitive, was the only work environment variable that had a positive as- sessment, suggesting that these professionals collab- orate with each other. A previous study shows that collaborative healthcare teams (nursing-medicine) increase patient safety, quality of care and improve nursing professionals’ energy and dedication. (27)

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Quality indicators in nutrition therapy within the intensive care setting of a Brazilian teaching hospital

Quality indicators in nutrition therapy within the intensive care setting of a Brazilian teaching hospital

MCCLAVE, Stephen A.; TAYLOR, Beth E.; MARTINDALE, Robert G.; WARREN, Malissa M.; JOHNSON, Debbie R.; BRAUNSCHWEIG, Carol; MCCARTHY, Mary S.; DAVANOS, Evangelia; RICE, Todd W.; CRESCI, Gail A.; GERVASIO, Jane M.; SACKS, Gordon S.; ROBERTS, Pamela R.; COMPHER, Charlene. Guidelines forth e provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Journal of Parenteral and Enteral Nutrition, Silver Spring, v. 40, n. 2, p. 159-211, 2016. DOI: https://doi. org/10.1177/0148607115621863
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Rev. bras. ter. intensiva  vol.23 número3 en v23n3a02

Rev. bras. ter. intensiva vol.23 número3 en v23n3a02

he irst has demonstrated great interest in the infections that aggravate the condition of patients under intensive therapy. It would not be wrong to describe this as the infectologist’s perspective of intensive care medicine. It is the ield of hospital infections applied to intensive care, with its epidemiological, therapeutic, prophylactic and even administrative issues, (since it afects quality indexes). In this intersection, due attention is given to catheter-induced bloodstream infections, urinary tract infections, surgical-wound infections, pneumonias brought on by mechanical ventilation, the bionomics of microorganisms as well as their evasion and resistance mechanisms, the employment of new antibiotics and antibiotic classes is delineated and the role of fungal agents is increasingly acknowledged in this context.
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Familycentered care in a pediatric intensive care unit: professionals’ perceptions

Familycentered care in a pediatric intensive care unit: professionals’ perceptions

The previously coded data was launched in a formatted database in the Excel spreadsheet editor, by double typing. After validation, the database was exported to the Statistical Package for Social Science, in which descriptive and analytical statistical analyses were performed. In the descriptive phase, the categor- ical variables were presented by absolute and relative frequency, while the measures of central tendency, variability and position were used for the description of the numerical variables.

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Pseudomonas aeruginosa in intensive care units in

Pseudomonas aeruginosa in intensive care units in

The analysis of the susceptibility profile in vitro dem- onstrated higher levels of resistance in the presence of cefepime, imipenem and ciprofloxacin, drugs used in the treatment of severe Pseudomonas infections. On the other hand, as shown in Table 1, tazobactam in combination with piperacillin, meropenem and ceftazidime were the drugs that demonstrated the lowest resistance, suggesting that these drugs, as well as polymyxin, can be used as therapeutic option for P. aeruginosa infection in both institutions. The higher resistance of cefepime when compared to ceftazidime might indicate the presence of OXA-31, an oxacillinase that has cefepime as its preferential substrate. 22
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Organization of rehabilitation care in Portuguese intensive care units

Organization of rehabilitation care in Portuguese intensive care units

This study has potential limitations. We attempted to minimize the bias by inquiring of all the national ICUs that were part of the SPCI database, and the participation rate was quite positive (82.76%). To avoid the possibility of receiving more than one response from the same respondent, we blocked the user after one response (not the IP, because it could be the same in units at the same institution). To stimulate participation, we reduced the size of the survey, choosing not to include questions to characterize the profiles of respondents or rehabilitation elements. To collect as much information as possible, we allowed blank responses and, afterwards, all surveys with more than two-thirds of valid answers were selected. There may have been some bias for just asking the head nurse or the person in charge and for not questioning elements from other areas of expertise. This option was chosen because we consider that within the multidisciplinary team and taking into account the various specificities related to this topic, the head nurse is a figure present in all contexts and is able to respond to different issues.
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Organization of rehabilitation care in Portuguese intensive care units

Organization of rehabilitation care in Portuguese intensive care units

Foram enviados inquéritos para os enfermeiros-chefes ou responsáveis de 58 UCI, pertencentes a 51 hospitais. Foram respondidos 54 inquéritos, sendo 6 excluídos por apresentarem menos de dois terços de respostas válidas, totalizando 48 inquéritos válidos. A elevada adesão a este inquérito se deu, em parte, pela pertinência do tema e também por conta da metodologia utilizada, já que o in- quérito foi enviado após um primeiro contato telefônico, que objetivou apresentar o investigador e os objetivos da investigação.

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Palliative care: A proposal for undergraduate education in Medicine

Palliative care: A proposal for undergraduate education in Medicine

Objective: to propose essential competencies for the teaching of palliative care on undergraduate Medicine courses. Method: a documentary analysis of the literature on general competencies in palliative care was initially carried out, to construct a framework with suggestions of essential competencies for undergraduate education in Brazil. The elaborated material was then presented individually to eight professionals from a range of areas for analysis. All the professionals had specialized training in palliative care, and the material was accompanied by an interview with three open questions. The categorical thematic content analysis proposed by Bardin was used in the documentary analysis and the interviews with the professionals. Results: the initial documentary analysis resulted in five categories, eight subcategories and 96 units of analysis, based on which the researcher was able to construct the suggestions for competences, which were distributed with their respective contents in a framework with five modules. Six categories, 12 subcategories and 168 analysis units emerged from the interviews with the professionals following a reading of the material. From the discourse contained in the subcategories and units of analysis, suggestions emerged for a better distribution of the modules, resulting in the renaming of the same (Basic principles of palliative care, Symptom management, Teamwork, Ethical and legal issues, Care in the last moments of life). Conclusion: the discussion and improvement of the palliative care competencies suggested in this study will be essential at medical education forums, providing clarity about what is really required in general practitioner training.
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Quality of work life: repercussions for the health of nursing worker in intensive care

Quality of work life: repercussions for the health of nursing worker in intensive care

Most nurses face in their daily lives, difficulties to assist the customer who is under his care. Difficulties such as workload, work pace intense organizational configuration just consider the subjective aspects of the worker, power relations and hierarchical extremely demarcated failure quantitative and qualitative material, deficit in staff, lack of time for family, shifts prolonged labor, physical and mental fatigue, among other issues that often unfeasible the proper fulfillment of the tasks. These factors ultimately lead to the suffering of the worker, and therefore, the low Quality of Working Life.
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Quality of life after intensive care unit: a multicenter cohort study protocol for assessment of long-term outcomes among intensive care survivors in Brazil

Quality of life after intensive care unit: a multicenter cohort study protocol for assessment of long-term outcomes among intensive care survivors in Brazil

manifested interest and had availability to implement the study protocol were selected by convenience sampling. For logistical and financial reasons, 6 of the included ICUs are located in Porto Alegre in the Southern region. To increase the representativeness of the sample, we included one interested hospital with characteristics similar to those of each of the other 4 Brazilian regions. ICU survivors are recruited while still at the hospital, 24 to 120 hours after discharge from the ICU. They are followed up for a period of 12 months by means of structured telephone interviews conducted at 3, 6 and 12 months after ICU discharge (Figure 2).
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Basic human needs in intensive care          /          Necessidades humanas básicas em terapia intensiva

Basic human needs in intensive care / Necessidades humanas básicas em terapia intensiva

As factors that favor the identification of BHNs, the multiprofessional interaction is relevant and provides the necessary support to severely compromised patients. It is observed the presence of nutritionists, psychologists, speech therapists, pharmacists, social workers, among others, as support staff, but with equal importance for integral and quality assistance. In order to guarantee the safety and reduction of suffering of the client and his/her relatives, the collaborative practice between the different health professionals with different professional experiences promotes the highest quality of care. 19
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Intensive care units in Latin America

Intensive care units in Latin America

Nevertheless, there are three general clinical situations that can serve as guidance in formulating criteria for admission and discharge: (a) patients showing symptom[r]

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Impacto de um programa de educação continuada na qualidade assistencial oferecida pela fisioterapia em terapia intensiva

Impacto de um programa de educação continuada na qualidade assistencial oferecida pela fisioterapia em terapia intensiva

he study was divided into three phases. In the irst phase, we established 15 indicators of quality related to physiotherapy based on their relevance to patient care under mechanical ventilation (MV) or not and the ability to perform objective measurements (Electronic supplementary material - ESM - Table 1). hese indicators were applied to three patient settings, which were the whole population, those under MV and those treated with an artiicial airway. hey were evaluated either by analyzing the patient's chart or the physiotherapy shift change register or by bedside observation. hese indicators were assessed one to three times per day, depending on the indicator. hus, the denominator used to calculate the indicator varied. he baseline data for the compliance with the indicators were collected during one month (October
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Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study

Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study

portation team was composed of a physician, a nurse and a physiotherapist. Hemodynamic and respiratory parameters were measured immediately before disconnecting the patient from the basal ventilator and, after returning to the ICU, immediately before disconnection from the transfer ventilator. In order to evalu- ate safety, any complication during transporta- tion was registered. Within this context, the main complications analyzed were hypoxemia (defined as arterial oxygen saturation below 90%), accidental disconnection and hypoten- sion (defined as mean arterial pressure below 65 mmHg). These complications were selected because they were considered life-threatening. Agitation was also registered since, although non-threatening, it is the most common complication during transportation.
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Bloodstream Infections in a  Neonatal Intensive Care Unit

Bloodstream Infections in a Neonatal Intensive Care Unit

In developed countries GPB is the most common cause of nos- ocomial sepsis in the NICU [18]. However, nosocomial sepsis caused by GNB is more frequent in developing countries [4,6]. Some authors have reported that K. pneumoniae account for most infections in developing countries [4,6]. In technologi- cally advanced NICUs, following the adoption of tertiary neo- natal care with a high rate of invasive device use, CNS stands out as the main agent of neonatal nosocomial sepsis [7,18]. In national studies, some authors [9-11,15] have reported that the most commonly isolated pathogen from blood cultures of neonates diagnosed with nosocomial sepsis was CNS, fol- lowed by K. pneumoniae, whereas others [19,20] have reported K. pneumoniae as the most common pathogen. In our study, K.pneumoniae and A. Baumannii were responsible for 40.5% and 29.7% of nosocomial sepsis, respectively. The high rate of A. Baumannii was due to an outbreak that occurred during the study period. It is a ubiquitous microorganism implicated in a number of outbreaks in NICUs [21,22].
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Nosocomial diarrhea in the intensive care unit

Nosocomial diarrhea in the intensive care unit

Nosocomial diarrhea often goes unnoticed in hospitalized patients. Even if specifically tested for, it is generally considered a consequence of an enteral diet a hospital- acquired gastrointestinal infection; other risk factors to which these patients are exposed are not even considered. Fernandes et al. [1] defined severe diarrhea as a change in the normal intestinal habit of the patient, with an increase in the frequency and/or a reduction in the consistency of the feces. McFarland [2], Fernandes et al. [1] and Bauer et al. [3] define nosocomial diarrhea as a common response to an array of harm caused by therapy, which frequently occurs in hospitalized patients, including intolerance to or overdose of medications, ingestion of hyperosmolar solutions or laxatives, diseases associated with antibiotics, therapeutic procedures, chronic disease, overeating or the acquisition of a hospital pathogen (bacteria or virus).
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Bone Fractures in a Neonatal Intensive Care Unit

Bone Fractures in a Neonatal Intensive Care Unit

a maioria das fraturas nos prematuros é assintomática e diagnosticada acidentalmente. Na nossa série, a baixa in- cidência de fraturas neste grupo de RNs também pode ser justificada por se tratar de um estudo retrospetivo. Assim é fundamental prevenir a DOMP, mas também a detetar precocemente, através da doseamento periódico, principal- mente, dos níveis séricos de FA e P, por forma a instituir o seu tratamento, e desta forma prevenir as fraturas.

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ECOSYSTEM APPROACH IN INTENSIVE CARE: NURSES KNOWLEDGE

ECOSYSTEM APPROACH IN INTENSIVE CARE: NURSES KNOWLEDGE

Objective: This study aimed to identify the nurses' knowledge about the ecosystem approach in the Intensive Therapy Unit (ITU). Method: Characterized as a descriptive-exploratory research, with a qualitative approach. The subjects were three nurses who worked more than one year in this space in Santa Maria, RS. The data was collected in August and September 2011. We used thematic analysis to examine the research findings. Results: In the categorization two themes emerged: Ecosystem Approach in the Intensive Therapy Unit and Intensive Therapy Unit as a healthy and sustainable environment. It was emphasized that the knowledge-based ecosystem paradigm enables the understanding of complex space activities of the ITU through the interactions of its constituents. Conclusion: Thus, a systemic view, when considering the multiple dimensions of the integral elements of that space / environment and their interactions, it is appropriate to enhance the dynamics of the constant changes in this workspace. Descriptors: Nursing, Work environment, Ecosystem, Health.
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Sao Paulo Med. J.  vol.131 número4

Sao Paulo Med. J. vol.131 número4

In conclusion, patients admitted to non-internal medicine wards present several medi- cal comorbidities. Given the burden of chronic diseases in the aging population world- wide, the outcomes from implementing a hospitalist consultant or co-management system in non-medical wards should be investigated in prospective, large-scale studies.

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