<p>Uvod: Infekcija krvi izazvana multirezistentnim bakterijama roda Acinetobacter (MDRA) je praćena značajnim letalitetom i visokim tro&scaron;kovima bolničkog lečenja. Ciljevi istraživanja: Ustanoviti uče&scaron;će izolata Acinetobacter spp. u strukturi pozitivnih hemokultura i kretanje procenta rezistencije na antibiotike u zdravstvenim ustanovama sekundarnog i tercijarnog nivoa na teritoriji AP Vojvodine u periodu 2013-2015. godina; Utvrditi kod kojih pacijenata se najče&scaron;će javljaju infekcije krvi izazvane MDRA; Utvrditi faktore rizika za nastanak bolničke infekcije (BI) krvi izazvane MDRA i uticaj BI krvi izazvane ovim uzročnicima na dužinu trajanja hospitalizacije i na ishod lečenja pacijenata hospitalizovanih u zdravstvenim ustanovama sekundarnog i tercijarnog nivoa u AP Vojvodini. Materijal i metode: Podaci iz protokola mikrobiolo&scaron;ke laboratorije Centra za mikrobiologiju Instituta za javno zdravlje Vojvodine su kori&scaron;teni za retrospektivnu analizu učestalosti izolata Acinetobacter spp. u strukturi hemokultura i za praćenje kretanja procenta rezistentnih izolata Acinetobacter spp. na posmatrane vrste antibiotika u zdravstvenim ustanovama sekundarnog i tercijarnog nivoa u AP Vojvodini u periodu od 01.01.2013. do 31.12.2015. godine. Utvrđivanje faktora rizika za nastanak infekcije krvi izazvane MDRA je sprovedeno kao prospektivna kohortna studija u jedinicama intenzivnih nega (JIN) u zdravstvenim ustanovama u AP Vojvodini u periodu od 01.01.2013. do 31.03.2016. godine. Grupu 1 (n=164), studijsku grupu kohortne studije su činili ispitanici sa BI krvi izazvanom MDRA. Grupu 2 (n=328), kontrolnu grupu kohortne studije, sačinjavali su pacijenti JIN bez izolata Acinetobacter spp. u hemokulturi. Kontrole su bile uključene u istraživanje samo ako je dužina njihovog boravka u JIN (dužina trajanja hospitalizacije do otpusta) bila ista ili duža od dužine boravka para iz studijske grupe do izolacije MDRA iz hemokulture. Kontrole su bile uparene sa slučajem iz studijske grupe u odnosu (1:2) prema: uzrastu (+/-5 godine), vrsti JIN i vremenu (isti kalendarski mesec u kojem je kod para iz studijske grupe izolovana pozitivna hemokultura). U cilju utvrđivanja predisponirajućih faktora za letalni ishod (14-dnevni letalitet) pacijenata u JIN sa infekcijom krvi izazvanom MDRA sprovedena je anamnestička studija. Rezultati: Uče&scaron;će izolata Acinetobacter spp. u strukturi hemokultura pacijenata uzrasta 18 i vi&scaron;e godina hospitalizovanih u zdravstvenim ustanovama u AP Vojvodini u periodu 2013-2015. godina iznosilo je 13,9%. Primoizolati Acinetobacter spp. iz uzoraka hemokultura pacijenata su u 96,1% (198/204) bili multirezistentni. Analizom kretanja rezistencije izolata Acinetobacter spp. na ispitivane antibiotike jedino je na cefepim ustanovljeno statistički značajno smanjenje uče&scaron;ća rezistentnih izolata (od 98,5% u 2014. godini do 83,3% u 2015. godini), (p=0,025). Izolati Acinetobacter spp. su najče&scaron;će registrovani kod pacijenata hospitalizovanih u JIN (71,1% (145/204)). Multivarijantnom analizom izdvojili su se nezavisni prediktori za nastanak infekcije krvi izazvane MDRA: prijem iz drugog odeljenja/bolnice, prijemne dijagnoze politrauma i opekotina, prethodna kolonizacija gornjeg respiratornog trakta MDRA, prisustvo dva i vi&scaron;e komorbiditeta, prethodna primena mehaničke ventilacije, vi&scaron;i indeks invazivnih procedura, prethodna primena derivata imidazola i prethodna primena četiri i vi&scaron;e klasa antibiotika. Pacijenti sa infekcijom krvi izazvanom MDRA su statistički značajno duže boravili u JIN (24.5&plusmn;17,5) u odnosu na neinficirane kontrole (19,7&plusmn;12,6), (p=0,001) i statistički značajno če&scaron;će su imali letalan ishod (51,2% (84/164) u odnosu na pacijente bez infekcije krvi izazvane ovim mikroorganizmom (25,0% (82/328), (p&lt;0,0001). Multivarijantnom analizom, kao nezavisni prediktori letalnog ishoda pacijenata, izdvojili su se: starija životna dob, prijemnom dijagnoza akutne respiratorne insuficijencije i primena neadekvatne antimikrobne terapije nakon izolacije uzročnika iz hemokulture. Zaključak: Učestalost i struktura faktora rizika je ukazala da je snižavanje prevalencije i snižavanje letaliteta moguće ostvariti kombinovanom primenom mera koje obuhvataju racionalnu upotrebu antibiotika &scaron;irokog spektra u empirijskoj antimikrobnoj terapiji i striktno po&scaron;tovanje procedura vezanih za primenu invazivnih nastavaka.</p> / <p>Aim: Establish the participation of Acinetobacter spp. isolates in the structure of positive hemocultures and the percentage range of resistance to antibiotics in the health institutions of secondary and tertiary level on the territory of AP of Vojvodina in the period from 2013 to 2015; determine which patients most commonly get BSI caused by MDRA; determine risk factors for the occurrence of healthcare-associated infection (HAI) of blood caused by MDRA and the impact of HAI of blood caused by these pathogens to the duration of hospitalization, and the treatment outcome of patients admitted to the health care institutions of secondary and tertiary levels in the AP of Vojvodina. Material and Methods: Data from the protocol of the microbiological laboratory of the Center for Microbiology, Institute of Public Health of Vojvodina were used for retrospective analysis of the frequency of isolates of Acinetobacter spp. in the structure of positive hemocultures and for monitoring the percentage isolates of Acinetobacter spp. resistant to the observed type of antibiotics in health institutions of secondary and tertiary levels in AP of Vojvodina in the period from January 1, 2013 to December 31, 2015. Determining the risk factor for the occurrence of BSI induced by MDRA was conducted as a prospective cohort study in intensive care units (ICU) in the health institutions in AP of Vojvodina in the period from January 1, 2013 to March 31, 2016. Group 1 (n=164), study group of the cohort study included the patients with HAI of blood induced by MDRA. Group 2 (n=328), control group of the cohort study consisted of ICU patients without isolates of Acinetobacter spp. in the hemoculture. Controls were included in the study only if the length of their stay in the ICU (duration of hospitalization until discharge) was the same or longer than the length of the stay of their study group counterparts until the isolation of MDRA from blood culture. Controls were matched with the cases of the study group in the ratio (1: 2) according to: age (+/- 5 years), type of ICU and time (the same calendar month in which positive hemoculture was isolated in the the study group pair). In order to determine the predisposing factors of lethal outcome (14-day lethality) of patients in the ICU with the BSI caused by MDRA, anamnestic study was conducted. Results: Participation of Acinetobacter spp. isolates in the structure of hemocultures of patients, aged 18 and older, hospitalized in medical institutions in AP of Vojvodina in the period from 2013 to 2015 amounted to 13.9%. Acinetobacter spp. primoisolates from the patients&#39; hemoculture samples were in 96.1% (198/204) multi-drug resistant. Analysing the Acinetobacter spp. isolates resistance to the tested antibiotics, Cefepime was the only to prove to cause statistically significant decrease in the share of resistant isolates (from 98.5% in the year 2014 to 83.3% in 2015), (p=0.025). Isolates of Acinetobacter spp. are most frequently registered in patients hospitalized in ICU (71.1% (145/204)). Multivariate analyses separated independent predictors for the occurrence of blood infection caused by the MDRA: patient transfers from another ward/hospital, admission diagnoses of polytrauma and burns, previous colonization of the upper respiratory tract MDRA, the presence of two or more co-morbidity, previous use of mechanical ventilation, higher index of invasive procedures, previous use of Imidazole derivates and the previous use of four or more classes of antibiotics. Patients with BSI caused by MDRA stayed statistically much longer in the ICU (24.5&plusmn;17.5) as compared to uninfected controls (19.7&plusmn;12.6), (p=0.001) and significantly more likely to have the lethal outcome (51.2% (84/164)) compared to patients without bloodsteram infections caused by this micro-organism (25.0% (82/328) (p&lt;0.0001). Using multivariate analysis, independent predictors of death of patients, were found to be: advanced age, admission diagnosis of acute respiratory insufficiency and the application of inadequate antibiotic therapy after the isolation of pathogens from the hemoculture. Conclusion: The frequency and the structure of the risk factors suggested that the reduction of the prevalence and lowering of lethality can be achieved by combined administration of measures that include the rational use of broad spectrum antibiotics in the empirical antimicrobial treatment and strict compliance with the procedures related to the use of invasive follow-ups.</p>

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Normal";mso-tstyle-rowband-size:0;mso-tstyle-colband-size:0;mso-style-noshow:yes;mso-style-priority:99;mso-style-qformat:yes;mso-style-parent:"";mso-padding-alt:0in 5.4pt 0in 5.4pt;mso-para-margin-top:0in;mso-para-margin-right:0in;mso-para-margin-bottom:10.0pt;mso-para-margin-left:0in;line-height:115%;mso-pagination:widow-orphan;font-size:11.0pt;font-family:"Calibri","sans-serif";mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;}</style><![endif]-->Uvod: Traumatsko moždano o&scaron;tećenje (TMO) predstavlja globalni zdravstveni problem koji pogađa oko 10 miliona ljudi godi&scaron;nje &scaron;irom sveta. Te&scaron;ka traumatska moždana o&scaron;tećenja (TTMO) čine 10% svih TMO i imaju visoku stopu mortaliteta i neizvestan oporavak. Ranije prepoznavanje sistemskih faktora koji utiču na ishod lečenja može da ima značajan uticaj na pravovremeno započinjanje terapijskih mera i smanjivanje morbiditeta i mortaliteta. Cilj istraživanja: Identifikovati sistemske faktore koji imaju značajan uticaj na ishod lečenja povređenih sa TTMO u Jedinici intenzivnog lečenja (JIL) tokom prvog dana hospitalizacije. Metodologija: Ispitivanje je sprovedeno kao retrospektivno-prospektivna studija koja je obuhvatila 115 povređenih ispitanika sa TTMO koji su hospitalizovani u JIL Urgentnog centra Kliničkog centra Vojvodine (UC KCV) u periodu od 1.01.2014.-1.10.2017. Iz medicinske dokumentacije, za svakog ispitanika uključenog u istraživanje su uzeti u razmatranje i analizu sledeći parametri u toku prvih 24 časa od momenta prijema u JIL: demografske i op&scaron;te karakteristike ispitanika od značaja za istraživanje i sistemski prediktivni faktori (sistolni i srednji arterijski pritisak- SAP/MAP, glikemija-&Scaron;UK, telesna temperatura-TT, pH, parcijalni pritisak kiseonika-PaO2 i parcijalni pritisak ugljem dioksida- PaCO2) registrovani u pet vremenskih tačaka (0h, 6h, 12h,18h, 24h). Svi gore navedeni podaci su posmatrani i analizirani kao prediktorski faktori tj. nezavisne varijable u odnosu na zavisnu varijablu &bdquo;ishod lečenja&ldquo; definisanu kao Glazgovska skala ishoda (Glasgow outcome scale-GOS) nakon otpusta povređenih iz JIL na Kliniku za neurohirurgiju KCV i GOS nakon otpusta iz Klinike za neurohirurgiju KCV i &bdquo;tok lečenja&ldquo; definisan kroz dužinu boravka povređenih u JIL UC KCV, dužinu boravka na Klinici za neurohirurgiju KCV, odnosno ukupno trajanje hospitalizacije u KCV, kao i otpust kući ili u odgovarajući rehabilitacioni centar. Statistička analiza je izvr&scaron;ena pomoću statističkog paketa IBM SPSS 23. Podaci su predstavljeni tabelarno i grafički, a statistička značajnost određivana je na nivou p &lt; 0,05. Prikupljeni podaci su obrađeni adekvatnim statističkim metodima. Rezultati: Sistemski faktori koji su se izdvojili kao prediktori smrtnog ishoda (GOS 1) kod povređenih sa TTMO tokom prvog dana boravka u JIL su upotreba vazoaktivne potpore i glikemija. Upotreba vazoaktivne potpore povećava verovatnoću za smrtni ishod 4,7 puta (OR=0,214; 95%CI: 0,096-0,479; p&lt;0,05). i vrednosti glikemije &gt; 10 mmol/l povećavaju verovatnoću za smrtni ishod u nultom satu (OR= 0,240, 95%CI: 0,087-0,662; p=0,05) i u 24 satu (OR=0,206, 95%CI: 0,037 &ndash; 0,929; p=0,05). Sa svakim porastom telesne temperature za jednu jedinicu u posmatranom intervalu raste verovatnoća za pozitivan ishod (OR =2,118 , 95%CI: 1,097 &ndash; 4,091; p&lt;0,05) i vrednosti glikemije u intervalu od 4-8 mmol/l povećavaju verovatnoću za pozitivan ishod 2,5 puta. Sistemski faktori koji su se izdvojili u smislu predikcije ishoda lečenja ispitanika nakon otpusta iz JIL su vrednosti glikemije i telesna temperatura. Vrednost glikemije na prijemu u intervalu od 6,9 do 7,4 mmol/l povećavaju verovatnoću boljeg oporavka (GOS 4-5 vs. GOS 2-3). Niže vrednosti glikemiije u narednim vremenskim tačkama (6h, 12h, 18h) takođe povećavaju verovatnoću za bolji oporavak. Ukoliko je telesna temperatura u 6-om i 12-om satu, vi&scaron;a od 36,5 &deg;C veća je verovatnoća za bolji neurolo&scaron;ki oporavak, prilikom otpusta iz JIL, odnosno Klinike za neurohirurgiju KCV. Ispitanici koji su imali vi&scaron;e vrednosti telesne temperature su imali duže trajanje hospitalizacije (OR=4,096; 95%CI; 0,709-7,483;p&lt;0,05). Na dužinu boravka u JIL, kao i na otpust kući ili odgovarajući rehabilitacioni centar nije imao uticaj nijedan posmatrani sistemski faktor. Zaključak: Sistemski prediktivni faktori toka i ishoda lečenja povređenih sa TTMO su upotreba vazoaktivne potpore, glikemija i telesna temperatura.</p> / <p>Introduction: Traumatic brain injury (TBI) is a global health problem that affects about 10 million people worldwide annually. Severe traumatic brain injury (STBI) account for 10% of all TBI and has high morbidity and unreliable recovery. Early recognition of systemic factors that affect the treatment outcome can have a significant impact on the timely initiation of therapeutic measures and the reduction of morbidity and mortality. The objective of the research: to identify systemic factors that have a significant impact on the treatment outcome of the STBI patients in the Intensive Care Unit (ICU) during the first day of hospitalization. Methodology: The study was conducted as a retrospective-prospective study that included 115 injured patients with STBI who were hospitalized in the ICU, Emergency Center (EC) of the Clinical Center of Vojvodina (CCV) in the period from 01.01.2014 to 1.10.2017. From the medical documentation, for each participant involved in the research, the following parameters within the first 24 hours after the admission were considered and analyzed: demographic and general characteristics of the participants of importance for research and systemic predictive factors (systolic and mean arterial pressure-SAP / MAP, glycemia, body temperature -TT, pH, partial pressure of oxygen-PaO2 and partial pressure of carbon dioxide-PaCO2) registered at five time points (0h, 6h, 12h,18h, 24h). All of the above data were observed and analyzed as predictors, ie, independent variables in relation to the dependent variable &quot;treatment outcome&quot; defined as the Glasgow Outcome Scale (GOS) after the transfer from the ICU to the Clinic of neurosurgery of the CCV and GOS after discharge from a Clinic of neurosurgery and &quot;treatment course&quot; defined by length of stay in ICU, or the total duration of hospitalization in CCV, as well as the release to the home or the appropriate rehabilitation center. Statistical analysis was performed using the IBM SPSS 23 statistical package. The data are presented in tables and graphs, and the statistical significance was determined at p &lt;0.05. The collected data were processed with adequate statistical methods. Results: Systemic factors that had predictive value for the lethal outcome (GOS 1) in STBI during the first day of ICU stay were the use of vasopressors and glycemia. The use of vasopressors increases the likelihood of fatal outcome 4.7 times (OR= 0,214; 95%CI: 0,096-0,479; p&lt;0,05) and glycemic values &gt; 10 mmol/l increase the likelihood of fatal outcome on admission (OR=0,240, 95%CI: 0,087-0,662; p=0,05) and after 24 hours (OR=0,206, 95%CI: 0,037 &ndash; 0,929; p=0,05). With each increase in body temperature for one unit in the observed interval, the probability of a positive outcome increases (OR=2,118, 95%CI: 1,097 &ndash; 4,091;p&lt;0,05) and glycemic values in the range 4-8 mmol/l increase the probability of a positive outcome 2.5 times. Systemic factors that predict the treatment outcome of the patients after their discharge from ICU are glycemia and body temperature. The blood sugar on admission in the ICU in the range from 6.9 to 7.4 mmol/l increases the opportunity of a better recovery (GOS 4-5 vs. GOS 2-3). Lower glycemic values at the next time points (6h, 12h, 18h) also increase the opportunity of a better recovery. If the body temperature in the 6th and 12th-hour postadmission is higher than 36.5&deg; C, the greater opportunity for better neurological improvement when the patient is discharged from ICU, or from the Clinic of neurosurgery. Participants who had higher values of body temperature had a longer duration of hospitalization (OR 4.096; 95% CI; 0.709-7.483;p&lt;0,05). The length of the stay in ICU, as well as the release to the home or the appropriate rehabilitation center, was not affected by any observed systemic factor. Conclusion: Systemic predictive flow factors and outcome of treatment factors with STBI use of vasopressors, glycemia and body temperature.</p>

<p>Uvod: Antimikrobna rezistencija bakterija predstavlja globalni problem. Najvažniji faktor za njen nastanak je neadekvatna primena antibiotika, koja podrazumeva: Upotrebu antibiotika bez odgovarajuće dijagnoze, neadekvatan izbor leka, dužinu<br />primene i doziranje. Zbog specifičnosti populacije vitalno ugroženih bolesnika u jedinicama intenzivne terapije (JIT) i bolničkih infekcija uzrokovanih multirezistentnim bakterijama, primena antibiotika je na ovim odeljenjima učestala. Pokazana je povezanost između razvoja antimikrobne rezistencije i veličine potro&scaron;nje antibiotika u JIT. Cilj: Analiza primene antibiotika prema indikacijama na Klinici za anesteziju i intenzivnu terapiju, KC Vojvodine, zatim analiza stanja antimikrobne rezistencije<br />najče&scaron;ćih uzročnika bolničkih infekcija i analiza korelacije između navedenih uzročnika bolničkih infekcija i empirijski primenjivane antibiotske terapije na Klinici za anesteziju i intenzivnu terapiju. Materijal i metode: Prospektivna, opservaciona studija, sprovedena u jednogodi&scaron;njem period, u JIT, Klinike za anesteziju i intenzivnu terapiju, uključila je 856 ispitanika, oba pola, starijih od 18 godina kod kojih je tokom hospitalizacije u JIT bio primenjen antibiotik. Ispitanici su, radi prikupljanja podataka, bili podeljeni u dve grupe u zavisnosti od toga da li su imali bolničku infekciju ili ne. Adekvatnost primene antibiotika je analizirana prema indikacijama (hirur&scaron;ka profilaksa, bolničke infekcije, vanbolničke infekcije i drugo), a u odnosu na izbor antibiotika, dužinu primene, režim doziranja, veličinu pojedinačne doze i način promene terapije (prema preporukama farmakoterapijskog vodiča The Sanford guide to antimicrobial therapy i antimikrobnoj osetljivosti bakterijskih uzročnika bolničkih infekcija u JIT. Za izračunavanje potro&scaron;nje antibiotika u JIT kori&scaron;ćena je ATC/DDD metodologija. Podaci o antimikrobnoj osetljivosti dobijeni su iz rezultata mikrobiolo&scaron;ke obrade uzorkovanog materijala. Statistička analiza je izvr&scaron;ena pomoću statističkog paketa IBM SPSS 21 Statistics. Podaci su predstavljeni tabelarno i grafički, obrađeni su standardnim statističkim testovima, a statistička značajnost određivanja je bila na nivou p&lt; 0,05. Ispitivanje povezanosti između potro&scaron;nje anibiotika i antimikrobne rezistencije urađeno je primenom Pirsonovog koeficijenta korelacije. Rezultati: Izbor antibiotika kod bolesnika u JIT nije bio adekvatan u 52,19% preskripcija. Izbor empirijski indikovanih antibiotika za lečenje bolničkih infekcija nije bio u skladu antimikrobnom osetljivo&scaron;ću izolovanog uzročnika u 78,44% preskripcija. Izbor antibiotika za hirur&scaron;ku profilaksu nije bio adekvatan u 55,6% preskripcija. Antimikrobna rezistencija Acinetobacter spp.na karbapeneme, fluorohinolone i cefalosporine bila je preko 90%, na aminoglikozide preko 70%. Klebsiella pneumoniae bila je rezistentna na fluorohinolone i cefalosporine 80%, dok je na grupu karbapenema bila 18%. Pseudomonas aeruginosa je bio rezistentan na karbapeneme i aminoglikozide preko 50%, na antipseudomonasne cefalosporine preko 40%. Na kolistin nije zabeležena rezistencija ni jedne izolovane bakterijske vrste. Značajna pozitivna korelacija zabeležena je između potro&scaron;nje empirijski indikovanog meropenema i rezistencije Acinetobacter spp. Zaključak: U vise od 50% slučajeva primena antibiotika u JIT nije bila u skladu sa stanjem antimikrobne rezistencije bakterijskih uzročnika bolničkih infekcija i savremenim farmakoterapijskim protokolima. Antimikrobna rezistencija Acinetobacter spp, Klebsiellae pneumoniae и Pseudomonas aeruginosae je iznosila preko 20% na antibiotike preporučene savremenim farmakoterapijskim smernicama, osim u slučaju rezistencije Klebsiellaе pneumoniae na grupu karbapenema. Između pojave rezistencije Acinetobacter spp. i potro&scaron;nje empirijski indikovanog meropenema utvrđena je statistički značajna pozitivna povezanost, dok za druge dve navedene bakterijske vrste ova povezanost nije bila statistički značajna. Na osnovu podataka o najče&scaron;ćim bakterijskim uzročnicima i njihovoj antimikrobnoj osetljivosti za empirijsku<br />terapiju pneumonija mogao bi biti preporučen jedino kolistin, dok bi za lečenje urinarnih infekcija mogao biti preporučen imipenem ili meropenem. Potrebno je promeniti farmakoterapijski pristup u primeni antibiotika u JIT.</p> / <p>Uvod: Antimikrobna rezistencija bakterija predstavlja globalni problem. Najvažniji faktor za njen nastanak je neadekvatna primena antibiotika, koja podrazumeva: Upotrebu antibiotika bez odgovarajuće dijagnoze, neadekvatan izbor leka, dužinu<br />primene i doziranje. Zbog specifičnosti populacije vitalno ugroženih bolesnika u jedinicama intenzivne terapije (JIT) i bolničkih infekcija uzrokovanih multirezistentnim bakterijama, primena antibiotika je na ovim odeljenjima učestala. Pokazana je povezanost između razvoja antimikrobne rezistencije i veličine potro&scaron;nje antibiotika u JIT. Cilj: Analiza primene antibiotika prema indikacijama na Klinici za anesteziju i intenzivnu terapiju, KC Vojvodine, zatim analiza stanja antimikrobne rezistencije<br />najče&scaron;ćih uzročnika bolničkih infekcija i analiza korelacije između navedenih uzročnika bolničkih infekcija i empirijski primenjivane antibiotske terapije na Klinici za anesteziju i intenzivnu terapiju. Materijal i metode: Prospektivna, opservaciona studija, sprovedena u jednogodi&scaron;njem period, u JIT, Klinike za anesteziju i intenzivnu terapiju, uključila je 856 ispitanika, oba pola, starijih od 18 godina kod kojih je tokom hospitalizacije u JIT bio primenjen antibiotik. Ispitanici su, radi prikupljanja podataka, bili podeljeni u dve grupe u zavisnosti od toga da li su imali bolničku infekciju ili ne. Adekvatnost primene antibiotika je analizirana prema indikacijama (hirur&scaron;ka profilaksa, bolničke infekcije, vanbolničke infekcije i drugo), a u odnosu na izbor antibiotika, dužinu primene, režim doziranja, veličinu pojedinačne doze i način promene terapije (prema preporukama farmakoterapijskog vodiča The Sanford guide to antimicrobial therapy i antimikrobnoj osetljivosti bakterijskih uzročnika bolničkih infekcija u JIT. Za izračunavanje potro&scaron;nje antibiotika u JIT kori&scaron;ćena je ATC/DDD metodologija. Podaci o antimikrobnoj osetljivosti dobijeni su iz rezultata mikrobiolo&scaron;ke obrade uzorkovanog materijala. Statistička analiza je izvr&scaron;ena pomoću statističkog paketa IBM SPSS 21 Statistics. Podaci su predstavljeni tabelarno i grafički, obrađeni su standardnim statističkim testovima, a statistička značajnost određivanja je bila na nivou p&lt; 0,05. Ispitivanje povezanosti između potro&scaron;nje anibiotika i antimikrobne rezistencije urađeno je primenom Pirsonovog koeficijenta korelacije. Rezultati: Izbor antibiotika kod bolesnika u JIT nije bio adekvatan u 52,19% preskripcija. Izbor empirijski indikovanih antibiotika za lečenje bolničkih infekcija nije bio u skladu antimikrobnom osetljivo&scaron;ću izolovanog uzročnika u 78,44% preskripcija. Izbor antibiotika za hirur&scaron;ku profilaksu nije bio adekvatan u 55,6% preskripcija. Antimikrobna rezistencija Acinetobacter spp.na karbapeneme, fluorohinolone i cefalosporine bila je preko 90%, na aminoglikozide preko 70%. Klebsiella pneumoniae bila je rezistentna na fluorohinolone i cefalosporine 80%, dok je na grupu karbapenema bila 18%. Pseudomonas aeruginosa je bio rezistentan na karbapeneme i aminoglikozide preko 50%, na antipseudomonasne cefalosporine preko 40%. Na kolistin nije zabeležena rezistencija ni jedne izolovane bakterijske vrste. Značajna pozitivna korelacija zabeležena je između potro&scaron;nje empirijski indikovanog meropenema i rezistencije Acinetobacter spp. Zaključak: U vise od 50% slučajeva primena antibiotika u JIT nije bila u skladu sa stanjem antimikrobne rezistencije bakterijskih uzročnika bolničkih infekcija i savremenim farmakoterapijskim protokolima. Antimikrobna rezistencija Acinetobacter spp, Klebsiellae pneumoniae i Pseudomonas aeruginosae je iznosila preko 20% na antibiotike preporučene savremenim farmakoterapijskim smernicama, osim u slučaju rezistencije Klebsiellae pneumoniae na grupu karbapenema. Između pojave rezistencije Acinetobacter spp. i potro&scaron;nje empirijski indikovanog meropenema utvrđena je statistički značajna pozitivna povezanost, dok za druge dve navedene bakterijske vrste ova povezanost nije bila statistički značajna. Na osnovu podataka o najče&scaron;ćim bakterijskim uzročnicima i njihovoj antimikrobnoj osetljivosti za empirijsku<br />terapiju pneumonija mogao bi biti preporučen jedino kolistin, dok bi za lečenje urinarnih infekcija mogao biti preporučen imipenem ili meropenem. Potrebno je promeniti farmakoterapijski pristup u primeni antibiotika u JIT.</p> / <p>Introduction: Antimicrobial resistance is a global health problem.The most important factor in the development of antimicrobial resistance is inadequate use of antibiotics, which means: inadequate diagnosis of bacterial infection, inadequate antibiotic choice, dosage and duration of therapy. Specificities of critically ill patients and nosocomial infections caused by multidrug-resistant pathogens are important reasons for large antibiotic consumption in ICU settings. Many studies have confirmed a positive correlation between antibiotic use and antimicrobial resistance. Aims: The aims of this study were: to analyze the use of antibiotics at the ICU of the Clinic for anesthesia and intensive care at the Clinical Centre of Vojvodina, according to indications for antibiotic treatment; to analyze the pattern of antimicrobial resistance ofthe most common bacteria causing hospital acquired infections in our participants and to analyze the correlation between the consumption of empirically indicated antibiotics and antimicrobial resistance pattern. Methodology: Prospective observational study was conducted during a one-year period at the Clinic for anesthesia and intensive care, Clinical Centre of Vojvodina. The study included 856 participatns, aged over 18 years and of both genders. The participants were divided into two cohorts, depending on whether they showed symptoms of hospital-acquired infection or not. Adequacy of antibiotic use was analyzed with regard to indication for antibiotic treatment (surgical prophylaxis, treatment of hospital acquired infection, outpatient infection or other) and with regard to antibiotic choice, dosage and duration of treatment. An adequate antibiotic choice was compared to the resistance pattern of positive bacterial isolates as outlined by The Sanford guide to antimicrobial therapy). To calculate the consumption of antibiotics in ICU we used ATC/DDD methodology. Data on antibacterial sensitivity was obtained from the results of microbiological analysis of sample materials. IBM SPSS version 21 was used for statistical analysis, standard statistical tests were applied. The results were presented in tables and graphs. Statistically significant correlation was set at the value of p˂0.05. Pearson correlation coefficient was used to measure the strength between variables. Results: Antibiotic choice was inadequate in 52,19% of all antibiotic prescriptions for all indications. Antibiotic choice in surgical prophylaxis was inadequate in 55,59% of prescriptions for this indication. Inadequate choice of empirically indicated antibiotics (for treatment of hospital-acquired infections) according to antimicrobial resistance pattern occurred in 78,44% of all prescription for this indication. The three the most important bacterial causative agents of hospital acquired infections in ICU were: Acinetobacter spp, Klebsiella pneumonia and Pseudomonas aeruginosa. The resistance of Acinetobacter spp. to antibiotic groups was as follows: to carbapenems, fluoroquinolones and cephalosporins over 90% and to aminoglycosides over 70%. The antimicrobial resistance of Klebsiella pneumoniae was: to fluoroquinolones and cephalosporins over 80% and to carbapenems up to 20%. The resistance pattern of Pseudomonas aeruginosa was as follows: to carbapenems and aminoglykozides over 50%, and to antipseudomonal cephalosporins over 40%. Statistically significant correlation was found between the consumption of empirically prescribed meropenem and antimicrobial resistance of Acinetobacter spp. Conclusion:In more than 50% of antibiotic prescriptions at ICU, regardless of indication, the choice of prescribed antibiotics was inadequate. Antimicrobial resistance pattern of Acinetobacter spp, Klebsiella pneumoniae and Pseudomonas aeruginosa to antibiotics recomennded by contemporary guidelines for antimicrobial therapy was over 20%, except in the case of the resistance of Klebsiellae peneumoniae to carbapenems. Statistically significant correlation was found between the consumption of empirically prescribed meropenem and antimicrobial resistance of Acinetobacter spp. No statistically significant correlation was observed in the other two bacterial strains. Initial, empiric therapy for nosocomial pneumonia in our ICU, should be colistin, and for urinary tract infection imipenem or meropenem. It is important to change antibiotic prescribing praxis in ICU.</p>

The aims of this thesis were to explore nurses' experiences of stress in the ICU (I), to analyze experiences of moral concerns in intensive care nursing from the perspective of relational ethics (II), to describe the synthesis of the concept of moral stress and to identify preconditions for moral stress (III) and to analyse and describe lived experiences of support in situations characterized by critical care situations and moral stress in intensive care (IV).The design was exploratory and descriptive. Material in studies I, II and IV consisted of interviews with intensive care nurses (10 head nurses and 26 staff nurses) employed in general, thoracic and neonatal intensive care units in five hospitals located in different parts of Sweden. The material in study III data from two studies of professional issues in nursing were used for the analysis: one concerned psychiatric nursing and the other was the previously referred study I.In study I qualitative content analysis and descriptive interpretation was used in the analysis. The main theme 'stress induced by dissonant imperatives' formulated in the analysis. Dissonant imperatives are composed of the four sub-themes: 1) controlled by the working situation - needing to be in control, 2) constrained by prioritisation - wanting to do more, 3) lacking authority to act - knowing that something should be done, and 4) professional distance - interpersonal involvement. In study II qualitative content analysis and descriptive interpretation were used in the analysis. A main theme was formulated, 'caring about-caring for: tensions between moral obligations and work responsibilities in intensive care nursing'. Five sub-themes were formulated 1) believing in a good death, 2) knowing the course of events, 3) feelings of distress, 4) reasoning about the physicians and 5) expressing moral awareness. In the study III a hypothetical-deductive method was used. The findings indicate that moral stress is independent of context-given specific pre-conditions: 1) nurses are morally sensitive to the patient's vulnerability, 2) nurses experience external factors preventing them from doing the best for the patient, and 3) nurses feel that they have no control over the situation. In the study IV an interpretive method was used. The first level of analysis of data identified contextual factors, such as type and purpose of support and working conditions. Thereafter five tentative interpretations were revealed: 1) receiving organised support is a matter of self-determination, 2) whether to participate or to be off duty is experienced mutually as exclusive, 3) dealing with moral stress is experienced as a private matter, 4) colleagues managing moral stress serve as models in stress support, and 5) not being able to deal with moral stress urges one to seek outside support. A comparison of these interpretations identified three major themes: availability, accessibility and receptivity of support. The main interpretation of data was: "lived experience of moral stress support involves an interconnectedness between structural and existential factors".A comprehensive understanding was formulated using the four studies (I, II, III and IV). Moral stress was found to be influential on the caring competence. Conflicts between different competences were found leading to a shift in focus away from the patients leading to a possible decrease in the caring competence. Moreover, the subtle resistance among nurses toward participation in organized moral stress support may obstruct the development of nurses' caring competence. Accordingly, imbalance, due to moral stress, between different competences hinders the development of collectively shared caring competence.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 5 uppsatser.

Trata-se de estudo exploratório descritivo com abordagem qualitativa sobre a primeira etapa do Processo de Enfermagem (PE). Teve como objetivo a construção de um instrumento de coleta de dados para pacientes de Unidade de Terapia Intensiva (UTI), fundamentado na Teoria das Necessidades Humanas Básicas (NHB), a partir de instrumento existente em um hospital público de ensino. Essa construção ocorreu por meio da técnica de Grupo Focal, composto por quatro enfermeiras assistenciais da UTI e quatro enfermeiras residentes do segundo ano do programa de Residência Integrada em Saúde (RIS) na ênfase em Terapia Intensiva. As discussões produzidas em cada sessão do grupo focal foram analisadas conforme o preconizado por Horta, ou seja, grupos e subgrupos das Necessidades Humanas Básicas. Essa construção ficou estruturada em sete grupos: Identificação; História pregressa; História da doença atual; Avaliação geral; Avaliação das Necessidades Psicobiológicas; Avaliação das Necessidades Psicossociais; e, Avaliação das Necessidades Psicoespirituais. O grupo de Avaliação das Necessidades Psicobiológicas contém 11 subgrupos de necessidades: Regulação Neurológica; Oxigenação; Percepção dos Órgãos dos Sentidos; Regulação Cardiovascular; Alimentação e Eliminação Intestinal; Hidratação e Eliminação Urinária; Integridade Física; Segurança Física; Sono e Repouso; Cuidado Corporal; e, Sexualidade. O grupo de Avaliação das Necessidades Psicossociais ficou constituído por três subgrupos de necessidades: comunicação, gregária e segurança emocional. E o grupo de Avaliação das Necessidades Psicoespirituais ficou composto pelos subgrupos religião, religiosidade e espiritualidade. A testagem desse instrumento possibilitou que as participantes identificassem a ausência de alguns itens não sugeridos durante a sua construção e a necessidade da elaboração de um manual de orientação para o seu preenchimento. Esse manual foi construído após a versão final do instrumento e contém informações de semiologia do adulto, o que pode auxiliar na avaliação dos sinais e sintomas do paciente e servir como guia de consulta breve. Sugere-se para pesquisas futuras a validação do instrumento, verificando se os itens contemplados no mesmo possibilitam a identificação de Diagnósticos de Enfermagem prioritários em pacientes críticos. Também se recomenda a validação do manual de orientação. Outra sugestão é incluir o ensino do PE no programa de atividades da RIS, em consonância com a implantação dessa metodologia no campo das práticas. A aplicação do PE nas instituições de ensino objetiva a formação de profissionais cientes das suas responsabilidades assistenciais e educacionais, fornecendo-lhes subsídios para atuarem como multiplicadores de melhores práticas de cuidado em saúde e enfermagem. / This is an exploratory descriptive study with a qualitative approach on the first stage of the Nursing Process (NP). The research aimed to build an instrument to collect data for patients of the Intensive Care Unit (ICU), based on the Theory of Basic Human Needs (BHN) from an existing instrument from a public teaching hospital. It happened through the technique of focus group, consisting of four clinical nurses of the ICU and four residents of the second year of the residency program in Integrated Health (RIS) with emphasis on intensive care. The discussions produced in each focus group session were analyzed as recommended by Horta; groups and subgroups of Basic Human Needs. The construct was structured into seven groups: Identity, Past Records, Current illness record, General assessment, Psychobiological Needs Assessment; Psychosocial Needs Assessment, and Psychospiritual Needs Assessment. The group of Psychobiological Needs Assessment is formed by 11 subgroups of needs: Neurological Regulation; Oxygenation; Perception of Sense Organs, Cardiovascular Regulation, Food and Intestinal Elimination; Hydration and Urinary Elimination, Physical Integrity, Physical Security, Sleep and Rest; Body Care; and Sexuality. The group of Psychosocial Needs Assessment was made up of three subgroups of needs: communication, gregarious, and emotional security. The group of Psychospiritual Needs Assessment was formed by the subgroups religion, religiosity, and spirituality.The testing of this instrument enabled the participants to identify the absence of some items not suggested during its construction, as well as the need to prepare a guidance manual for completing it. This handbook was built after the final version of the instrument and contains information on adult semiology, which can help assess the patient's signs and symptoms and serve as a guide for short consultation. It is suggested for future research the validation of the instrument, making sure that the items included enable the identification of priority Nursing Diagnoses in critical patients. It is recommended also the validation of the guidance manual. Another suggestion is to include the teaching of PE in the program of RIS activities, in line with the implementation of this methodology in practice. The application of PE in educational institutions aimed at training professionals aware of their responsibilities and educational assistance, providing them tools to act as multipliers of best practices in health care and nursing / Se trata de un estudio exploratorio descriptivo con abordaje cualitativo acerca de la primera etapa del Proceso de Enfermería (PE). Tuvo como objetivo construir un instrumento de recolección de datos para pacientes de una Unidad de Terapia Intensiva (UTI), fundamentado en la Teoría de las Necesidades Humanas Básicas (NHB), a partir de un instrumento ya existente en un hospital público de enseñanza. La construcción se hizo por medio de la técnica de Grupo Focal, compuesto por cuatro enfermeras asistenciales de la UTI y cuatro enfermeras residentes del segundo año del programa de Residencia Integrada en Salud (RIS), con énfasis en Terapia Intensiva. Las discusiones producidas en cada sesión del grupo focal se analizaron de acuerdo con lo establecido por Horta, es decir, grupos y subgrupos de las Necesidades Humanas Básicas. Dicha construcción se estructuró en siete grupos: Identificación; Historia precedente; Historia de la enfermedad actual; Evaluación general; Evaluación de las Necesidades Psicobiológicas y Evaluación de las Necesidades Psicoespirituales. El grupo de Evaluación de las Necesidades Psicobiológicas contiene 11 subgrupos de necesidades: Regulación Cardiovascular; Alimentación y Eliminación Intestinal; Hidratación y Eliminación Urinaria; Integridad Física; Seguridad Física; Sueño y Reposo; Cuidado corporal; y Sexualidad. El grupo de Evaluación de las Necesidades Psicosociales se constituyo por tres subgrupos de necesidades: comunicación, gregaria y seguridad emocional. Y el grupo de Evaluación de las Necesidades Psicoespirituales se compuso por los subgrupos religión, religiosidad y espiritualidad. La prueba del instrumento les posibilitó a los participantes identificar la ausencia de algunos ítems que no habían sido sugeridos durante su construcción, así como, la necesidad de elaboración de un manual de orientación para su llenado. Ese manual fue construido tras la versión final del instrumento y contiene informaciones de semiología del adulto, lo que puede auxiliar en la evaluación de las señales y síntomas del paciente y servir como guía de consulta breve. Se sugiere para investigaciones futuras la validación del instrumento, verificando si los ítems que encierra posibilitan la identificación de Diagnósticos de Enfermería prioritarios en pacientes críticos. Se recomienda, también, la validación del manual de orientación. Otra sugerencia es incluir la enseñanza del PE en el programa de actividades de la RIS, acorde a la implantación de esa metodología en el campo de las prácticas. La aplicación del PE en instituciones de enseñanza pretende formar profesionales conscientes de sus responsabilidades asistenciales y educacionales, ofreciéndoles recursos para que puedan actuar como multiplicadores de mejores prácticas de cuidado en salud y enfermería.

Cette thèse a pour but d’analyser comment se déroule le processus de construction de l’identité professionnelle et comment ce processus a lieu moyeannt la précarité de la reconnaissance au travail de part de ses pairs et par l’hiérarchie. L’identité professionnelle correspond à un processus qui commence lors de la fin des cours de formation; qui continue tout au long de la confrontation avec les relations, l’ambiance et le marché de travail et qui rend possible la construction d’une image personnelle que l’individu veut présenter. Par l’analyse du processus de socialisation du professionnel dans les relations de travail il devient possible non seulement de comprendre le processus de construction de l’identité professionnelle, mais aussi de s’approcher du concept de profession dans l’actualité. En faisant cette analyse, on vérifie, par conséquent, la construction de l’identité au travail, qui se fonde sur trois éléments – la reconnaissance, l’autonomie et la coopération au travail – et qui confère à l’individu la possibilité d’un retour sur soi même capable de lui faire se sentir inclus dans des cercles d’égaux. Afin d’analyser le processus de construction de l’identité professionnelle, on a décidé d’ajouter un quatrième élement, celui de la connaissance professionnelle, lequel, tout comme les autres éléments cités ci-dessous, est l’un des axes d’analyse de cette thèse. Comme source de matériel empirique, on a choisi l’analyse du professionnel physiothérapeute inséré dans une unité de traitement intensif, en vue de l’indéfinition éventuelle de ses attributions et de ses contributions au travail de l’unité de traitement intensif, par rapport au travail du médecin, par exemple. La méthodologie utilisée dans cette thèse s’est fondée sur une approche qualitative, avec des questionnaires demistructurés qui ont été présentés le long de 2009 à 20 physiothérapeutes, 17 médecins et 17 infirmiers qui travaillent dans 14 unités de traitement intensif dans la ville de Porto Alegre, aussi que sur l’observation directe de deux unités de traitement intensif. L’analyse de contenu des donnés collectées permis comprendre le matériel empirique associé au référentiel théorique. Comme résultat de cette étude, on voit le rôle du processus de construction de l’identité au travail comme une étape conditionnante de la construction de l’identité professionnelle. En plus, cette étude démontre l’importance de la connaissance professionnelle, caracterisée par la connaissance scientifique, contextuelle et réflexive, comme condition pour qu’un travailleur puisse construire une identité professionnelle stabilisée. Moyennant l’impossibilité que l’individu ne construise une identité au travail stabilisée à cause de la précarité de la reconnaissance au travail, on s’aperçoit de la difficulté que le professionnel trouve pour gagner de la visibilité et pour construire la connaissance professionnel dans les relations de travail. Ladite difficulté tend à compromettre la construction de l’identité professionnel. / Esta tese tem por objetivo analisar como ocorre o processo de construção da identidade profissional e como este processo acontece mediante a precariedade de reconhecimento no trabalho pelos pares e pela hierarquia. A identidade profissional corresponde a um processo que tem seu início na saída do curso de formação e que continua ao longo da confrontação com as relações, o ambiente e o mercado de trabalho e que proporciona a construção de uma imagem pessoal que o indivíduo quer apresentar. Entende-se que ao analisar o processo de socialização do profissional nas relações de trabalho torna-se possível compreender não apenas o processo de construção da identidade profissional, mas também permite se aproximar do conceito de profissão na atualidade. Ao realizar tal análise, verifica-se, por conseguinte, a construção da identidade no trabalho que tem por base três elementos – o reconhecimento, a autonomia e a cooperação no trabalho – e que confere ao indivíduo a possibilidade de um retorno a si mesmo capaz de sentir-se incluído em círculos iguais. Para analisar o processo de construção da identidade profissional, opta-se por agregar um quarto elemento, o conhecimento profissional, que junto aos elementos citados anteriormente compõem os eixos de análise desta tese. Como material empírico, optou-se por analisar o profissional fisioterapeuta inserido em UTI pela indefinição eventual de suas atribuições e contribuições no trabalho da UTI em comparação ao trabalho médico, por exemplo. A metodologia utilizada neste estudo amparou-se em uma abordagem qualitativa, com a utilização de roteiros de entrevista semi-estruturados que foram aplicados em 20 fisioterapeutas, 17 médicos e 17 enfermeiros atuantes em 14 diferentes UTIs na cidade de Porto Alegre ao longo do ano de 2009, bem como a observação direta de duas UTIs. Foi realizada uma análise de conteúdo dos dados coletados que permitiram a compreensão do material empírico associado ao referencial teórico. Como resultado deste estudo, destaca-se o papel do processo de construção da identidade no trabalho como etapa condicionante à construção da identidade profissional. Ademais, este estudo demonstra a importância do conhecimento profissional caracterizado pelo conhecimento científico, contextual e reflexivo, como condição para que o trabalhador possa construir uma identidade profissional estabilizada. Mediante a impossibilidade do indivíduo construir uma identidade no trabalho estabilizada em decorrência da precariedade de reconhecimento no trabalho, percebe-se a dificuldade do profissional em dar visibilidade e construir o conhecimento profissional nas relações de trabalho. Tal dificuldade tende a comprometer a construção da identidade profissional. / This thesis analyzes how the process of professional identity building takes place and, in particular, how it takes place in the context of precarious recognition by peers and superiors at work. Professional identity is a process that begins at the end of one’s studies, goes on throughout the period one faces labor relations, environment and market, and makes possible the building of a personal image that individuals want to present. By analyzing the professional’s process of socialization in labor relations, we can not only understand the process of professional identity building, but also approach the concept of profession in our days. By carrying out such an analysis, we see the building of identity at work, which is based on three elements – recognition, autonomy and cooperation at work – and which gives individuals a chance to return to themselves to feel included in peer circles. To analyze the process of professional identity building we choose to add a fourth element, professional knowledge, which, together with the other elements aforementioned, is an axe of this thesis. The empirical material source of this thesis was professional physiotherapists working at Intensive Care Units (ICUs), due to their frequently indefinite attributions and contributions to the work, in comparison to physicians’ work, for example. The methodology used in this thesis is based on a qualitative approach, with semi-structured questionnaires which were handed out to 20 physiotherapists, 17 physicians and 17 nurses working at 14 ICUs in Porto Alegre in 2009, as well as on direct observation of two ICUs. The content analysis of the data collected was used to understand the empirical material associated with the theory references. As an outcome of this study, we view the role of the identity at work building process as a stepping stone to professional identity building. Besides, this study highlights how important professional knowledge, characterized by scientific, contextual and reflexive knowledge, is as a condition for workers to build a stable professional identity. By being impossible for individuals to build a stable identity at work due to precarious recognition at work, we realize how difficult it is for them to gain visibility and build professional knowledge at labor relations. Such a difficulty tends to compromise professional identity building.

Os recém-nascidos internados em unidades neonatais estão entre os pacientes mais predispostos aos erros de medicação, visto que, tanto a prescrição médica peso-dependente, quanto o preparo e administração através de fracionamento de fármacos com apresentação exclusiva para adultos, fazem parte de um complexo processo de uso de medicamentos nessa população. Esta pesquisa teve por objetivo analisar os fatores que interferem na segurança no uso de medicamentos em uma unidade de terapia intensiva e cuidados intermediários de neonatologia. Para a realização do estudo utilizou-se o delineamento qualitativo na perspectiva do pensamento ecológico restaurativo. Os dados foram coletados no período de dezembro de 2014 à março de 2015, através de grupos focais e caminhada fotográfica, com 1 enfermeiro e 15 técnico de enfermagem da neonatologia de um hospital público da Região Sul do Brasil. Utilizou-se uma análise descritiva do banco de dados de notificações espontâneas da instituição, para planejar o guia de temas do primeiro grupo focal. As informações foram organizadas através do programa Nvivo 10, e submetidas à análise de conteúdo do tipo temática. Os resultados demonstram que das 7318 notificações espontâneas recebidas pelo gerenciamento de riscos entre janeiro de 2013 e outubro de 2014, apenas 1,5% foi relacionada à neonatologia, a maioria referindo-se aos erros de medicação, sendo 65,3% arrolados à etapa de administração de medicamentos. A partir da análise de conteúdo emergiram as seguinte categorias: “abordagem individualizada e cultura de punição dos erros de medicação”, “fatores de (in)segurança relacionados à estrutura física e logística dos medicamentos na UTI neonatal”, “fatores de (in)segurança relacionados a rotinas e protocolos” e “a enfermagem como barreira para a ocorrência de falhas de prescrição médica”. O estudo demonstra a complexidade do processo de medicação em neonatologia, e aponta a necessidade de pesquisas que envolvam as diferentes categorias profissionais que participam do mesmo. / Newborns admitted to neonatal intensive care units are among the most vulnerable patients to medication errors. The use of drugs in this population involves a complex process ranging from prescription that has to consider a constant weight variation and development of systems related to metabolism and excretion of drugs, to conducting the preparation of subsequent doses of a fractionation drugs produced presentation for adults. This research aimed to analyze the factors that affect the safety of medication in an neonatal intensive and semi-intensive care unit. For the study we used the qualitative design, using descriptive analysis of spontaneous reporting database of the institution studied, and discussions in focus groups and photographic method, in the perspective of restorative ecological thinking. Data were collected through focus groups and photographic method, with nursing professionals of neonatology in a public hospital in Southern Brazil. Information was organized by Nvivo 10 program, and submitted to thematic analysis of content. The results show that there is little spontaneous reporting of incidents related to neonatology, however, most refers to medication errors, and 65.3% enrolled in drug delivery stage. Study participants indicated that the individualized approach of errors as well as factors related to physical structure and logistics of drugs, and lack of routines and protocols or unspecificity thereof, affect the safety of the use of drugs in neonatology. However, the questioning attitude of the nursing staff to medical prescription, and the adoption of measures on patient safety, is perceived as factors that act as a barrier to achieving the failures. / Los recién nacidos ingresados en unidades de cuidados intensivos neonatales son algunos de los pacientes más vulnerables a los errores de medicación. El uso de drogas en esta población implica un proceso complejo que va desde la prescripción de tener en cuenta una variación de peso constante y el desarrollo de los sistemas relacionados con el metabolismo y excreción de los fármacos, para llevar a cabo la preparación de las dosis posteriores de una droga de fraccionamiento presentación producido para adultos. Esta investigación tuvo como objetivo analizar los factores que afectan la seguridad de los medicamentos en una unidad de cuidados intensivos y semi-intensivos de neonatología. Para el estudio se utilizó el diseño cualitativo, utilizando análisis descriptivo de la base de datos de notificación espontánea de la institución estudiada, y las discusiones en grupos de enfoque y método fotográfico, en la perspectiva del pensamiento ecológico restaurativa. Los datos fueron recolectados a través de grupos de enfoque y método fotográfico, con los profesionales de enfermería de neonatología de un hospital público en el sur de Brasil. La información fue organizada por lo programa Nvivo 10, y se sometió a análisis temático de contenido. Los resultados muestran que hay poca notificación espontánea de los incidentes relacionados con la neonatología, sin embargo, la mayoría se refiere a los errores de medicación, y el 65,3% se matriculó en la etapa de administración de fármacos. Los participantes del estudio indicaron que el enfoque individualizado de errores, así como los factores relacionados con la estructura física y la logística de las drogas, y la falta de rutinas y protocolos o especificidad de los mismos, afectan a la seguridad del uso de medicamentos en neonatología. Cabe destacar sin embargo, que la actitud de cuestionamiento de la prescripción médica del personal de enfermería, y la adopción de medidas de seguridad de los pacientes, son percibidos como factores que actúan como una barrera para el logro de los fracasos.

In today’s world healthcare all over the world is profoundly challenged by rapid technological advancements, violence, terrorism, diverse cultures, proliferating chronic diseases, and the worst nursing shortage. In addition to these complex and daunting challenges healthcare continue to focus the attention on hospitals to review and modify the way care is delivered to patients. As key role players and consistent members of the multidisciplinary team critical care nurses are uniquely positioned to modify and review the quality of patient care through synergy between the patients’ needs, the nurses’ competencies, and the critical care environment. A collaborative approach towards enhancing synergy in a CCU was undertaken in a CCU in a private hospital in Gauteng. The study was guided by the American Association for Critical Care Nurses Synergy Model for Patient Care and conducted within the critical social theory paradigm. The nature of the research was descriptive, explorative and contextual and both qualitative and quantitative approaches were used. Action research cycles were followed to assess existing synergy between the patients’ needs, the nurses’ competencies and the characteristics of the environment in the CCU. An action plan was formulated and implemented towards enhancing synergy in the CCU. The implemented plan was adjusted based on observations and reflections following each of the five cycles of the project / Health Studies / D. Litt. et Phil. (Health Studies)

Made available in DSpace on 2015-07-22T20:50:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-07-28 / O objetivo deste estudo foi apreender, por meio de uma aproximação etnográfica, as representações sociais do stress das(os) enfermeiras(os) que trabalham no Centro de Terapia Intensiva e no Centro Cirúrgico de um hospital público da cidade de João Pessoa (PB). A intenção foi a de entender como as(os) enfermeiras(os) pensam, sentem, elaboram, associam e representam o stress em diferentes contextos de vida profissional e social. Por meio das narrativas e discursos verbais e não verbais dos interlocutores, buscou-se verificar como elas(es) elaboram aquilo que denominam stress, associando-o e definindo-o no seu cotidiano social e cultural. / The aim of this study was to apprehend, by means of an ethnographic approach, the social representations of stress in nurses that work at the Intensive Therapy Unit and Surgical Unit in a public hospital of João Pessoa (PB). We intended to understand how nurses think, feel, elaborate, associate and represent stress in different contexts of their professional and social lives. Through narratives and verbal and non-verbal discourses of the interlocutors, we tried to verify how they elaborate what they call stress, associating and defining it in their social and cultural quotidian. / TEDE / BV UNIFESP: Teses e dissertações