To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil.
This was a prospective, observational and multicenter ...study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated.
Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051).
Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.
Purpose: To investigate the opinions of Brazilian medical residents in Obstetrics and Gynaecology on abortion legislation according to their personal beliefs.
Material and methods: A multicentre ...cross-sectional study. Residents at 21 university teaching hospitals completed a self-report questionnaire on their opinions in abstract terms, and about punishing women who abort in general and women they know.
Results: In abstract terms, 8% favoured allowing abortion under any circumstances (fully liberal); 36% under socioeconomic or psychological constraints (broadly liberal); 75.3% opposed punishing a woman who has aborted (liberal in general practice); and 90.2% opposed punishing women they knew personally (liberal in personal practice). Not having a stable partner and not being influenced by religion were factors associated with liberal opinions. In personal practice, however, 80% of those who are influenced by religion were liberal. The percentage of respondents whose opinions were liberal was significantly greater among those who believed that abortion rates would remain the same or decrease following liberalisation.
Conclusions: Judgements regarding the penalisation of women who abort are strongly influenced by how close the respondent is to the problem. Accurate information on abortion needs to be provided. Although about one third of the respondents were broadly liberal, the majority oppose punishment.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Anesthetic management during cardiopulmonary bypass (CPB) is challenging in many aspects. Evidence of mortality reduction due to the use of volatile agents during cardiac surgery has led to their ...increased use in CPB. Partly because of the difficulty to administer volatile agents during CPB, total intravenous anesthesia (TIVA) has become the most popular technique used by cardiac anesthetists throughout this critical period. The aim of this review is to provide an overview of volatile agents’ administration to ensure maintenance of adequate depth of anesthesia during CPB and weighting risks and benefits of this technique compared to TIVA.
To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future ...AMPCs.
The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs.
The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system.
Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.
Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current ...and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.
This research aimed to discuss, scientifically, about Primary Health Care and Teaching Literacy, reflecting on science and education professionals in training, both initial and continued. Not only ...from biopolitical perspective lenses (FOUCAULT, 2002), our analyses gain corporality when we resort to the need that these health professionals (doctors, nurses, physiotherapists, health agents, speech therapists, etc.) and education (teachers, pedagogues, psychopedagogues) are in constant training processes. We understand that there is a need for training for these professionals, and the ideal is that there are restructurings and resignifications through literacy techniques tied to new educational technologies. Thus, the objective of our work is to discuss how training and training processes for health and education professionals are essential to improve the execution of their practices, in addition to contributing to the refiguration of training materials from ministries (Health HS and Education MEC). Therefore, we present strategies to enhance the practice of these professionals aiming for excellence in the spheres of work.
A trial was carried out with objective of identifying economical sources of alimentary supplementation for cows milk in exclusive feeding regime of elephant-grass pasture (Pennisetum purpureum cv. ...Napier), submitted to the fertilization and irrigation. The experimental design was completely randomized with three treatments: T1 = cows grazing exclusively in elephant-grass pasture; T2 = T1 + bank of leucena protein and T3 = T1 + concentrated ration, supplied in the amount of 1 kg for each 3 kg of milk produced above 5 kg. The largest production milk was obtained of the animals of T3 (11.11 kg of milk/cow/day and 3,594.08 kg of milk/cow/lactation), followed by T2 (9.19 kg of milk/cow/day and 2,740.15 kg of milk/cow/lactation) and T1 (8.54 milk/cow/day kg and 2,520.36 milk/cow/lactation kg). The lower profitability was obtained with cows grazing elephant-grass supplemented with concentrates.
Este trabalho teve por objetivo identificar fontes econômicas de suplementação alimentar para vacas leiteiras em regime exclusivo de pastagem de capim-elefante (Pennisetum purpureum cv. Napier), submetido à adubação e à irrigação. O delineamento experimental utilizado foi inteiramente casualizado com três tratamentos: T1 = vacas em lactação mantidas exclusivamente em pastagem de capim-elefante; T2 = T1 + banco de proteína de leucena e T3 = T1 + ração concentrada, fornecida na quantidade de 1 kg para cada 3 kg de leite produzido acima de 5 kg. A maior produção leiteira foi obtida dos animais do T3 (11,11 kg de leite/vaca/dia e 3.594,08 kg de leite/vaca/lactação), seguida do T2 (9,19 kg de leite/vaca/dia e 2.740,15 de leite/vaca/lactação) e T1 (8,54 kg de leite/vaca/dia e 2.520,36 kg de leite/vaca/lactação). A menor rentabilidade foi obtida com vacas em pastagem de capim-elefante suplementada com concentrados.
The objective of this study was to evaluate the morphogenetic and structural characteristics of Brachiaria brizantha cv. Marandu, subjected to five levels of nitrogen with cutting interval of 35 ...days. The work was conducted in the period May to June and October to November of 2011, in the experimental field of Embrapa Meio-Norte UEP - Parnaíba, in the municipality of Parnaíba , Piauí . The experimental design was randomized blocks with treatments consisting of five levels of nitrogen (0, 250, 500, 750 and 1,000 kg ha- 1.year- 1) with four replications. The morphogenetic evaluations included the rates of appearance, elongation and leaf senescence. Structural consisted of the number of live unfolded leaves and total number of leaves. Nitrogen, in the form of urea, was applied to coverage being applied immediately after the three cuts, by dividing the total annual dose by the number of cuts. Nitrogen fertilization in Brachiaria brizantha has a positive effect on elongation and leaf appearance rates, and the total number of living leaves.
Foram avaliadas as características morfogênicas e estruturais da Brachiaria brizantha cv. Marandu, submetida a cinco doses de nitrogênio e manejada com intervalo de corte de 35 dias. O trabalho foi conduzido no período de maio a junho e de outubro a novembro de 2011, no Campo Experimental da Embrapa Meio-Norte UEP - Parnaíba, localizada no município de Parnaíba, Piauí. O delineamento experimental foi em blocos casualizados e os tratamentos constituídos por cinco níveis de nitrogênio (0, 250, 500, 750, e 1.000 kg ha-1.ano-1) com quatro repetições. As avaliações morfogênicas englobaram as taxas de aparecimento, alongamento e senescência foliar. As características estruturais consistiram do número de folhas vivas expandidas e número de folhas totais. O nitrogênio, na forma de ureia, foi aplicado em cobertura, imediatamente após os três cortes, fracionando a dose total anual pelo número de cortes. A adubação nitrogenada na Brachiaria brizantha cv. Marandu exerceu efeito positivo nas taxas de alongamento e aparecimento foliar, no número de folhas vivas e totais.
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