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.     

Nursing work at a day hospital in João Pessoa-Paraíba from the perspective of the psychiatric reform

This is the report of an investigation that was carried out in order to apprehend themes that explain nursing work at a day hospital in Jo?o Pessoa, State of Paraíba, in the perspective of the psychiatric reform. The authors used the referential of dialectical and historical materialism and work as an analytical category. The empirical material was analyzed through the technique of discourse analysis. The study revealed a coincident theme--to change the model of traditional psychiatric assistance--and, in this sense, the work of nursing incorporates, in addition to its formal, technically specialized quality, a political quality, thus indicating a new meaning to the nursing work process.     

SAPS 3—From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission

Objective To develop a model to assess severity of illness and predict vital status at hospital discharge based on ICU admission data.Design Prospective multicentre, multinational cohort study.Patients and setting A total of 16,784 patients consecutively admitted to 303 intensive care units from 14 October to 15 December 2002.Measurements and results ICU admission data (recorded within ±1 h) were used, describing: prior chronic conditions and diseases; circumstances related to and physiologic derangement at ICU admission. Selection of variables for inclusion into the model used different complementary strategies. For cross-validation, the model-building procedure was run five times, using randomly selected four fifths of the sample as a development- and the remaining fifth as validation-set. Logistic regression methods were then used to reduce complexity of the model. Final estimates of regression coefficients were determined by use of multilevel logistic regression. Variables selection and weighting were further checked by bootstraping (at patient level and at ICU level). Twenty variables were selected for the final model, which exhibited good discrimination (aROC curve 0.848), without major differences across patient typologies. Calibration was also satisfactory (Hosmer-Lemeshow goodness-of-fit test =10.56, p=0.39, =14.29, p=0.16). Customised equations for major areas of the world were computed and demonstrate a good overall goodness-of-fit.Conclusions The SAPS 3 admission score is able to predict vital status at hospital discharge with use of data recorded at ICU admission. Furthermore, SAPS 3 conceptually dissociates evaluation of the individual patient from evaluation of the ICU and thus allows them to be assessed at their respective reference levels.Electronic Supplementary Material Electronic supplementary material is included in the online fulltext version of this article and accessible for authorised users:     

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.     

Bridging the gap: can a link nurse initiative influence palliative care in an acute hospital?

With 90% of people needing some inpatient hospital care in the final year of life, it is evident that the provision and awareness of palliative care, and education surrounding this, are widely needed. This study aims to evaluate a palliative care link nurse initiative (PCLN) in an NHS acute hospital, identifying key factors affecting link nurses' ability to influence palliative care practice. This qualitative study used semi-structured interviews and a focus group to show the anticipated and actual influence of link nurses on practice. Findings suggest that link nurses had increased knowledge and skills in palliative care due to education provided. Link nurses were seen to have an influence on the presence and quality of palliative care practice in hospital wards. Factors that could help link nurses to have greater influence are reported, as are difficulties in providing care and accessing training.     

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.     

Doctor at triage – Effect on waiting time and patient satisfaction in a Jamaican hospital

IntroductionWaiting time in the Emergency Departments is a major source of patient dissatisfaction in hospitals. Triage attempts to have the most critically ill patients seen first with an overall reduction in waiting time. Triage teams may include specially trained nurses or alternatively a specialist physician. The aim of this study was to determine if inclusion of a specialist physician on the triage team at the University Hospital of the West Indies (UHWI) in Kingston Jamaica reduced waiting time and improved patient satisfaction.MethodsA prospective, cross sectional survey of ambulatory care patients was undertaken in 2006. Triage was completed by a team consisting of a doctor and two nurses during the first week and by nurses only during the second week.ResultsThe study showed that there was no significant difference in the length of time patients spent in the emergency department based on whether or not they were triaged by a physician led team or by a team of nurses only. Type of triage team did not affect the level of patient satisfaction. Waiting time was significantly influenced by factors which came into play after triage such as the wait for X-ray and laboratory services.ConclusionsThere appears to be no reduction in waiting times experienced by patients at the UHWI emergency department as a result of inclusion of a specialist emergency physician in the triage process. This suggests that specialist emergency department nurses are adequately trained in triage, and that delays in the triage process at UHWI are due to other factors.     

Patientsmate©: the implementation and evaluation of an online prospective audit system

Introduction Inaccuracy in Hospital Inpatient Enquiry (HIPE)/Casemix‐based data has been reported as high as 26%. This results in financial waste and makes effective audit impossible. We aimed to develop a novel web‐based outcome audit system. Methods A web‐based online audit system, Patientsmate©, was developed using an integrated database system written in the programme language PHP. Data were inputted by the surgical team responsible for the patients care. A prospective comparison study of the new Patientsmate© and the standard HIPE systems, was performed over a 1‐month period and involving two general surgical teams in April 2010. In addition, a Likert‐scale based questionnaire was designed and hosted within the Patientsmate© system. A focus group of those clinicians directly involved in data accessing and input were then invited to complete the questionnaire in order to assess usability of the system. Results During the study period there were a total of 108 patients and 88 procedures. Our study confirms the accuracy of clinician derived data, with the Patientsmate© system more accurately recording number of patients (83% vs. 80.6%), number of procedures (85.2% vs. 68.1%) and hospital day case rate (52% vs. 47.1%). Inputting data using Patientsmate© for a single patient took 6–7 minutes. Of those using the system, 75% reported feeling comfortable after using it once only and 100% were satisfied with the layout of the online interface. Conclusion The Patientsmate© system allows for increased accuracy in outcome‐based data as compared with the HIPE system, facilitating audit, financial savings and the appropriate allocation of services.     

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.     

How to optimize the prescription of laboratory tests? Success and failures in an academic hospital

In the context of the flat-rate reimbursements in healthcare, we reviewed physicians’ behavior towards laboratory test ordering. We demonstrated how it could be improved when a specific stage of the patient management is considered. We took a multi-step approach to analyze the laboratory test orders in the context of planned laparoscopic cholecystectomy in a general teaching hospital. A reference order set was defined through a collaborative analysis between clinicians and laboratory physicians. The clinical and financial impacts were then evaluated over a period of 24 months. After the introduction of the reference order set, the number of laboratory tests per order decreased significantly for patients with cholecystitis of low severity. Above the monitoring of repeated orderings during a single stay, the major impacts were achieved by a drastic reduction of inappropriate orders, particularly in the field of bacteriology. The main effects of the order set were maintained throughout a follow-up period of 24 months. Our study demonstrated that, when considering laboratory test ordering optimization, reference order sets could achieve high levels of efficiency. To ensure high compliance to reference order sets, extensive collaboration between clinicians and laboratory physician is mandatory even if very sophisticated information systems are available.