Computerized system for managing nursing care indicators at Hospital São Paulo

Indicators are tools that permit to define parameters that will be used to make comparisons between a result and its expected value, as well as to add a value of judgement in this regard. The purpose of this study is to describe the experience of a group of nurses in the development of a computerized system to manage nursing care indicators at Hospital S?o Paulo. Four stages were used to implement the indicator management system: developing a nursing care indicator handbook; performing a manually registered pilot test; developing the computerized system; and performing the pilot test of the computerized system in eleven units at the hospital.     

Blood transfusion utilization and recipient survival at Hospital das Clinicas in São Paulo, Brazil

BACKGROUND: The characteristics of blood recipients including diagnoses associated with transfusion and posttransfusion survival are unreported in Brazil. The goals of this analysis were: 1) to describe blood utilization according to clinical diagnoses and patient characteristics and 2) to determine the factors associated with survival of blood recipients. STUDY DESIGN AND METHODS: A retrospective cross‐sectional analysis was conducted on all inpatients in 2004. Data came from three sources: The first two files consist of data about patient characteristics, clinical diagnosis, and transfusion. Analyses comparing transfused and nontransfused patients were conducted. The third file was used to determine survival recipients up to 3 years after transfusion. Logistic regression was conducted among transfused patients to examine characteristics associated with survival. RESULTS: In 2004, a total of 30,779 patients were admitted, with 3835 (12.4%) transfused. These patients had 10,479 transfusions episodes, consisting of 39,561 transfused components: 16,748 (42%) red blood cells, 15,828 (40%) platelets (PLTs), and 6190 (16%) plasma. The median number of components transfused was three (range, 1‐656) per patient admission. Mortality during hospitalization was different for patients whose admissions included transfusion or not (24% vs. 4%). After 1 year, 56% of transfusion recipients were alive. The multivariable model of factors associated with mortality after transfusion showed that the most significant factors in descending order were hospital ward, increasing age, increasing number of components transfused, and type of components received. CONCLUSION: Ward and transfusion are markers of underlying medical conditions and are associated with the probability of survival. PLT transfusions are common and likely reflect the types of patients treated. This comprehensive blood utilization study, the first of its kind in Brazil, can help in developing transfusion policy analyses in South America.     

Normative prenatal evaluation at a philanthropic maternity hospital in São Paulo

This cross-sectional study counted with the participation of 301 pregnant women seen in 2009 at a philanthropic maternity hospital in the city of S?o Paulo (a prenatal support program named Pré-Natal do Amparo Maternal - PN-AM). The objectives of this study were to evaluate the prenatal care according to the initial gestational age, the number of appointments that were held, the continuity of the assistance, and relate the appropriateness with the socio-demographic, obstetric and local variables of the initial prenatal care. The analysis criteria used was initiating prenatal care before 120 days of gestation and attending at least six appointments. The relationship between the variables was analyzed using the Chi-Square Test. Results showed that 41.5% of the pregnant women initiated prenatal care at another health care service and transferred spontaneously to the PN-AM; 74.1% initiated the prenatal care early and 80.4% attended at least six appointments; 63.1% met both criteria simultaneously. Appropriate prenatal care showed a statistically significant difference for mother's age, steady partner, employment, place of residence, having a companion during the appointment and place where prenatal care was initiated.     

Patient safety in oncology surgery: experience of the São Paulo State Cancer Institute

Patient safety concerns in surgery are increasing. The frequency of surgery-related adverse events and errors is high, and most could be avoided. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) proposed the Universal Protocol (UP-JCAHO) for preventing wrong site, wrong procedure, and wrong person surgery. In Brazil, very few health-care institutions have adopted this Protocol. Thus, there is a need to improve its dissemination and assess its effectiveness. The aim of the present study was to report the experiences of the Sao Paulo State Cancer Institute (ICESP, acronym in Portuguese) in implementing the UP-JCAHO. The Protocol comprises three steps: pre-operative verification process, marking the operative site and Time out immediately before starting the procedure. The ICESP surgical center (SC) has been functioning since November 2008. The UP-JCAHO is applied to all surgeries. A total 1019 surgeries were performed up to June 2009. No errors or adverse events were registered. The implementation of the UP-JCAHO is simple. It can be a useful tool to prevent error and adverse events in SC.     

Financial challenges to access tuberculosis treatment in Ribeirão Preto - São Paulo

The objective of this study was to analyze the financial challenges that patients have to deal with to access the Tuberculosis (TB) Care Reference Centers in Ribeir?o Preto. Adjustments were made to the Primary Care Assessment (PCAT) and an opinion poll was made with one-hundred patients following treatment and 16 health care professionals working at TB Reference Centers in Ribeir?o Preto. Anova, Kruskall Wallis and chi-square tests were used. Most patients were males and most health care professionals were female. Differences were found between Centers C and A, in that Center C (p=0.028) offers a bus pass, and in A (p=0.010) patients paid for their own transportation. The indicator medical appointment in 24 hours showed a satisfactory level. There were disagreements between the reports from patients and health professionals as to the center offering the bus pass. Patients face challenges in their treatment, such as costs with transportation or being late for work, which result in losses in the family income.     

Representation of pregnant smokers on cigarette use: a study carried out at a hospital in the interior of the state of São Paulo

This study sheds light on the smoking pregnant women's outlook on cigarette use. The Theory of Social Representations was used as a theoretical reference. For data analysis, the Collective Subject Discourse was constructed. Of the 27 women that were interviewed, 18 had finished elementary education, 8 had completed secondary education, and one had college level education; 14 had a stable union and 6 were married. Four themes emerged from the interviews: (1) starting to smoke: a natural, social practice; (2) satisfaction versus guilt; (3) shattering news: effects of smoking on pregnancy; and (4) quitting: between will and ability. Pregnant women revealed negative ideas about smoking, considering smoking the worst of addictions and a potential cause for complications to the fetus and the mother. Smoking was represented in a prejudicial manner, disregarding the existence of treatment and the need for it. Emerging difficulties were related to quitting, for which professionals, information and adequate approaches for treatment and support for achieving success are utmost necessities.     

Prevalence and determinants of exclusive breastfeeding in the city of Serrana, São Paulo, Brazil

The objective of this cross-sectional and quantitative study was to identify the prevalence and determinants of exclusive breastfeeding among infants less than six months of age in the city of Serrana, Sao Paulo, Brazil in 2009. A validated semi-structured questionnaire was administered to the guardians of the children less than six months of age who attended the second phase of a Brazilian vaccination campaign against polio. Univariate and multivariate analysis presented in odds ratios and confidence intervals was accomplished. Of the total of 275 infant participants, only 29.8% were exclusively breastfed. Univariate analysis revealed that mothers who work outside the home without maternity leave, mothers who did not work outside the home, adolescent mothers, and the use of pacifiers have a greater chance of interrupting exclusive breastfeeding. In the multivariate analysis, mothers who work outside the home without maternity leave are three times more likely to wean their children early. Results provide suggestions for the redirection and planning of interventions targeting breastfeeding.     

Adult ostomy patients in the city of São Paulo: a study of specialized equipment costs

This study was aimed at analyzing the monthly cost of the use of specialized equipment by ostomy patients. It is a retrospective study carried out at two Outpatient Health Centers in S?o Paulo. The data were collected in 635 records of adult ostomy patients assisted in June of 2005. For the costs, the data were obtained in electronic databases and official publications from the State of S?o Paulo Health Secretary, and the results were submitted to the Kolmogorov-Smirnov, Mann-Whitney, Kruskal-Wallis, Bonferroni and Spearman tests. Most of the individuals were female (51%), aged > or = 60 years, with temporary colostomy (64.5%). The average monthly cost was US$ 51.0 per patient, higher for cancer urostomy patients with permanent stomas, with neoplasia in the urinary tract and assisted by the service with a therapist nurse. Statistically significant correlation between the monthly cost and the time with stoma was found. This study has contributed for the assessment of the cost of ostomy patients in the State of S?o Paulo.     

Profile of newborns who underwent cardiac surgery in a private hospital in the city of São Paulo

The aim of this cross-sectional study was to characterize newborns that underwent cardiac surgery in a private hospital, a reference center in neonatal cardiac surgery, in the city of S? Paulo. Data were collected from medical reports from July, 2001 to December, 2005. Newborns with gestational age of more than 35 weeks were included in the study. Newborns that died on the first 48 postoperative hours and with other malformations were excluded. Most of the neonates were term, weighted 2500 grams or more, and underwent surgery in the first week of life. There were 24 different diagnoses identified and 14 different types of surgery performed. In the first post-operative day, all newborns had invasive devices for vital signs monitoring or for treatment and life support, which shows not only the complexity of the treatment but the need for planning and organizing health services in order to provide adequate care for these patients.     

Perception of nurses on the learning evaluation process in training programs in a São Paulo hospital

This study was carried out with nurses of a university hospital in S?o Paulo. It was aimed at understanding their perception regarding the learning evaluation process in the training sessions they attended. In order to collect data, the authors used an instrument with the guiding question: What's your perception of the learning evaluation process in training programs? The discourses were analyzed according to Bardin's referential in the content analysis modality. The results showed opinions in three categories: 1) the difficulties noticed in the evaluation process, in which time availability, negative feelings towards the evaluation and little concern for training results are challenges nurses have to overcome daily; 2) the methodology used in the evaluation process, which should consider the different learning styles, and the experience, life history and previous knowledge of the professionals being trained; and 3) the teaching-learning evaluation process as an accurate indicator of past actions and a quality control of the teaching methods adopted in the training sessions.     

Trends in the prevalence of Chagas' disease among first-time blood donors in São Paulo,Brazil

BACKGROUND: Screening of blood donors for Chagas’ disease is mandatory in Brazil. Data about the prevalence of Chagas’ disease among first‐time blood donors has not been previously reported. The objective of this study was to report the trends in the prevalence of Chagas’ disease among first‐time blood donors in São Paulo, Brazil according to gender, age, and type of donation. STUDY DESIGN AND METHODS: The data was obtained at Fundação Pró‐Sangue/Hemocentro de São Paulo during the period of 1996 to 2001. Samples were considered positive if they were reactive to the three serologic tests used at screening (indirect immunofluorescence, indirect hemagglutination, and EIA). RESULTS: The prevalence of Chagas’ disease was two times higher among replacement blood donors than among altruistic donors (52 vs. 25 cases/10,000). The overall prevalence among blood donors decreased at a rate of 1.86 cases per 10,000 per year. An increase in the proportion of altruistic donors and a decrease in the prevalence primarily among younger donors were observed. CONCLUSION: The prevalence of Chagas’ disease is decreasing in the São Paulo population. Differences in the socioeconomic level between altruistic and replacement donors may be the reason for the differences in the prevalence among these groups. It will be important to target for study the population of young seroreactive blood donors to better understand how new infections are occurring.     

Quality of life in women with HIV/AIDS in a municipality in the state of São Paulo

High potency antiretroviral therapy brings benefits to people with HIV/AIDS, related to survival, chronicity and quality of life. The objective of this quantitative and cross-sectional study was to assess the quality of life of women with HIV/AIDS, using the WHOQOL--HIV bref and its association with sociodemographic variables. The study was performed in outpatient clinics specialized in care to HIV/AIDS patients. Of the 106 interviewed women, 99.1% were heterosexual and 92.4% were infected sexually. Among the domains of quality of life, spirituality had the highest score (65.7), followed by physical (64.7), psychological (60.6), social relationships (59.5). Level of independence (58.6) and environment (54.5) scored the lowest. The factors low socioeconomic and educational levels were associated with different domains of quality of life, showing the relationship between quality of life and living conditions. Challenges persist in the scope of social, affective and financial relations, which require effective interventions regarding empowerment of women with HIV/AIDS.     

Maternal and perinatal outcomes of an alongside hospital birth center in the city of São Paulo, Brazil

The aim of this study was to describe the maternal and perinatal results of care in the alongside hospital birth center Casa de Maria (CPN-CM), located in the city of S?o Paulo. The random sample included 991 women and their newborns, attended between 2003 and 2006. The results showed that 92.2% of women had a companion of her choice during childbirth and the practices commonly used were shower or immersion bath (92.9%), amniotomy (62.6%), walking (47.6%), massage comfort (29.8%) and episiotomy (25.7%). Regarding newborns, 99.9% of them had Apgar scores =7 in the fifth minute, 9.3% received aspiration of the upper airway, no one needed to be intubated and 1.4% were removed to the hospital. The model of care in the CPN-CM provides maternal and perinatal outcomes expected for low obstetric risk women, and means a safe option and less interventionist model in normal childbirth.