scholarly journals Implementation methodology of practices based on scientific evidence for assistance in natural delivery: a pilot study

2015 ◽  
Vol 49 (5) ◽  
pp. 716-725 ◽  
Author(s):  
Clodoaldo Tentes Côrtes ◽  
Rafael Cleison Silva dos Santos ◽  
Adriana de Souza Caroci ◽  
Sheyla Guimarães Oliveira ◽  
Sonia Maria Junqueira Vasconcelos de Oliveira ◽  
...  
Keyword(s):  
Medical Records ◽  
Best Practice ◽  
Statistical Difference ◽  
Clinical Audit ◽  
Scientific Evidence ◽  
Phase 1 ◽  
Maternity Hospital ◽  
Vertical Position ◽  
Significance Level ◽  
Exact Test

AbstractOBJECTIVEPresenting methodology for transferring knowledge to improve maternal outcomes in natural delivery based on scientific evidence.METHOD: An intervention study conducted in the maternity hospital of Itapecerica da Serra, SP, with 50 puerperal women and 102 medical records from July to November 2014. The PACES tool from Joanna Briggs Institute, consisting of pre-clinical audit (phase 1), implementation of best practice (phase 2) and Follow-up Clinical Audit (phase 3) was used. Data were analyzed by comparing results of phases 1 and 3 with Fisher's exact test and a significance level of 5%.RESULTSThe vertical position was adopted by the majority of puerperal women with statistical difference between phases 1 and 3. A significant increase in bathing/showering, walking and massages for pain relief was found from the medical records. No statistical difference was found in other practices and outcomes. Barriers and difficulties in the implementation of evidence-based practices have been identified. Variables were refined, techniques and data collection instruments were verified, and an intervention proposal was made.CONCLUSIONThe study found possibilities for implementing a methodology of practices based on scientific evidence for assistance in natural delivery.

scholarly journals IMPLEMENTAÇÃO DE EVIDÊNCIAS CIENTÍFICAS NA ASSISTÊNCIA AO PARTO NORMAL: ESTUDO LONGITUDINAL

2017 ◽  
Vol 8 (1) ◽  
pp. 27
Author(s):  
Rafael Cleison Silva Dos Santos
Keyword(s):  
Clinical Practice ◽  
Longitudinal Study ◽  
Educational Intervention ◽  
Medical Records ◽  
Clinical Audit ◽  
Scientific Evidence ◽  
Maternity Hospital ◽  
The State ◽  
The Impact ◽  
Childbirth Care

Objetivo: avaliar o impacto de uma intervenção educativa sobre práticas obstétricas e desfechos perineais. Método: estudo longitudinal, segundo a metodologia de implementação de evidências científicas na prática clínica, realizado com enfermeiros e médicos, puérperas e prontuários em uma maternidade pública de referência no estado do Amapá. Resultado: após a intervenção educativa, mais profissionais recomendaram as posições lateral e verticais no período expulsivo do parto; mais puérperas relataram as práticas de puxo dirigido e manobra de Kristeller; menos prontuários indicaram a laceração espontânea e graus de lacerações maiores. Conclusão: a intervenção educativa proporcionou resultados melhores, mas não estatisticamente significativos.Descritores: Auditoria clínica, Períneo, Pesquisa translacional.IMPLEMENTATION OF SCIENTIFIC EVIDENCES IN NORMAL CHILDBIRTH CARE: LONGITUDINAL STUDYObjective: to evaluate the impact of an educational intervention on obstetric practices and perineal outcomes. Method: longitudinal study, according to the methodology of implementation of scientific evidence in clinical practice, performed with nurses and doctors, puerperas and medical records in a referred public maternity hospital in the state of Amapá. Result: after the educational intervention, more professionals recommended the lateral and vertical positions in the expulsive period of childbirth; More puerperas reported the practices of directed pull and maneuver of Kristeller; Less medical records indicated spontaneous laceration and higher degrees of lacerations. Conclusion: the educational intervention provided better results, but not statistically significant.Descriptors: Clinical audit, Perineum, Translational research.IMPLEMENTACIÓN DE LA EVIDENCIA CIENTÍFICA EN LA ATENCIÓN DE PARTO NORMAL: UN ESTUDIO LONGITUDINALObjetivo: Evaluar el impacto de una intervención educativa sobre las prácticas obstétricas y resultados perineales. Método: Estudio longitudinal, de acuerdo con la metodología de implementación de la evidencia científica en la práctica clínica, realizada con las enfermeras y los médicos, las madres y los registros en una referencia maternidad pública en el estado de Amapá. Resultado: Después de la intervención educativa, la mayoría de los profesionales recomiendan las posiciones laterales y verticales en la segunda etapa del parto; más madres reportaron las prácticas de extracción y maniobra dirigida Kristeller; a menos que los registros que se indican las laceraciones espontáneas y un mayor grado de laceraciones. Conclusión: La intervención educativa poca mejora de las prácticas y los resultados perineales.Descriptores: Auditoría clínica, Perineo, Investigación traslacional.

scholarly journals The Project Appropriate Birth and Reduction of Cesarean Section Rates: an analysis using the Robson classification system

2021 ◽  
Author(s):  
Daniela Ferreira D’Agostini Marin ◽  
Amanda Wernke ◽  
Daniela Dannehl ◽  
Dyulie Araujo ◽  
Gustavo Koch ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Classification System ◽  
Phase 1 ◽  
Maternity Hospital ◽  
Cross Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Significance Level ◽  
Robson Classification ◽  
Before And After

OBJECTIVE: The objective of this study was to evaluate C-section rates, before and after the implementation of the Project Appropriate Birth based on the Robson 10-group classification system. DESIGN: An observational, cross-sectional study. SETTING: Maternity hospital in South Brazil. POPULATION: All pregnant women attending, April 2016 through April 2017 (phase 1, pre-implementation of the Project Appropriate Birth) and June 2017 through June 2018 (phase 2, post-implementation of the Project Appropriate Birth). METHODS: Maternal and obstetric characteristics were evaluated, including Robson’s classification, based on the characteristics of pregnancy and childbirth. Chi-square test and crude and adjusted prevalence ratios were used to analyze study variables. The significance level was set at 5%. MAIN OUTCOME MEASURES: C-section rate for each group, their contribution to the overall c-section rate and the differences in these contributions before and after PPA implementation. RESULTS: C-section rates decreased from 62.4% to 55.6%, which represented a 10.9% reduction after the implementation of the Project Appropriate Birth. Pregnant women in Robson classification groups 1 through 4 had the greatest decrease in C-section rates, ranging from 49.1% to 38.6%, which represents a 21.5% reduction. The greatest contributors to the overall C-section rates were group 5 and group 2, accounting for more than 60% of the C-section deliveries. CONCLUSION: The Project Appropriate Birth had an important impact on the reduction of C-section rates, especially in Robson classification groups 1 through 4, which indicates that providing mothers with evidence-based interventions for labor and childbirth assistance will contribute to reduce C-section rates.

Skull and Face Injuries and Associated Factors in Pedestrian Victims of Traffic Accidents: A Single Trauma Center Analysis

2020 ◽  
Vol 2 (1) ◽  
pp. 53-59
Author(s):  
Josimara A. de Araújo Varela ◽  
Tatiana F.T. Palitot ◽  
Smyrna L.X. de Souza ◽  
Alidianne F.C. Cavalcanti ◽  
Alessandro L. Cavalcanti
Keyword(s):  
Medical Records ◽  
Associated Factors ◽  
Traffic Accidents ◽  
Age Group ◽  
Chi Square ◽  
Cross Sectional ◽  
Significance Level ◽  
The Face ◽  
Chi Square Test ◽  
The City

Objective: This study aimed to analyze the presence of lesions in the skull and face and the associated factors in pedestrian victims of traffic accidents. Methods: A cross-sectional, descriptive-analytical study carried out through the analysis of medical records of pedestrian victims of traffic accidents in an emergency service in the city of Campina Grande, Brazil, during the year of 2016. Information was collected regarding gender, age group, day of the week, time of the accident, type of vehicle involved, presence of trauma to the skull and face, and outcomes. The Chi-square and Fisher's Exact tests were used, with a significance level of 5%. Results: A total of 1,884 medical records were evaluated, out of which 7.1% (n = 133) involved pedestrians. Men were the most frequent victims (68.4%), and victims of age 60 years old or over (30.5%) predominated. Almost one-third of the cases were recorded during the weekends (30.5%), and the most prevalent time was at night (52.7%). Regarding the type of vehicle involved, motorcycles predominated (47.4%). Head trauma was present in 37.6% of victims, while facial injuries corresponded to 8.2%. In 12% of cases, the victims died. The variables of gender, age group, occurrence on weekends, and trauma to the face showed a statistically significant association with the occurrence of traffic accidents (Chi-square test; p<0.05). Conclusion: Among pedestrian victims of traffic accidents, there is a predominance of men aged 65 years or over. Accidents are frequent at night, and motorcycles are the main vehicles involved. The presence of trauma to the skull and face regions is high.

scholarly journals AB1046 JOINT MANIFESTATIONS IN A COHORT OF PATIENTS WITH SARCOIDOSIS IN A THIRD LEVEL HOSPITAL.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1814.3-1814
Author(s):  
I. Madroñal García ◽  
C. Aguilera Cros ◽  
L. Mendez Diaz
Keyword(s):  
Medical Records ◽  
Unknown Etiology ◽  
Joint Involvement ◽  
List Type ◽  
Chi Square ◽  
Exact Test ◽  
Approximate Result ◽  
Chronic Course ◽  
Level Hospital ◽  
Larger Sample

Background:Sarcoidosis (S) is a systemic granulomatous disease of unknown etiology, which most frequently affects the ganglion, lung and skin, although it can affect other organs, including the musculoskeletal system.Objectives:- Describe the clinical, analytical and radiological characteristics of patients diagnosed with S presenting joint manifestations.- To assess the association between patients who have joint manifestations and the use of corticosteroids (C) and immunosuppressants (IS), with respect to those without joint involvement.Methods:Retrospective descriptive study of patients with diagnosis of S with joint manifestations, treated in our Hospital from 2017 to 2019. Data were obtained by reviewing medical records. Chi square tests and Fisher’s exact test have been performed to establish the differences described in the objectives.Results:From a database of 102 patients with S, 18 presented joint manifestations (50% women), with a mean age of 57 ± 6 years. Of these patients, 4 (22.2%) have presented positive ANA. Regarding the clinic, 3 patients presented the association of polyarthritis and bilateral ankle swelling, 8 patients presented with polyarthritis, 3 monoatritis and 4 patients presented bilateral ankle swelling. 61.1% had fever at the onset of the disease.14 patients (77.8%) had high ACE values at the onset of the disease, without presenting significant differences with respect to all patients diagnosed with S who do not have joint involvement.All patients received treatment with C and 10 patients (55.5%) needed an IS treatment, finding no differences with respect to patients who do not have joint involvement (p=0.92).On the course of the disease, the majority of patients with joint involvement have a chronic course (72.2%). Nor were significant differences found when compared with patients who have no joint involvement (p = 0.73).Conclusion:Patients with joint involvement in our study have been 17.6% (18), an approximate result to that described in the literature (over 10%), although our result may be increased by the fact that the patients who are followed in Rheumatology present or have presented joint involvement. No significant differences were found between patients with S who presented joint involvement and those who did not, with respect to the initial ACE values, treatment and disease course. Prospective, multicenter and larger sample studies are necessary to better understand these associations.Disclosure of Interests:None declared

Understanding Opioid Prescribing Practices of Resident Physicians

2021 ◽  
pp. 000313482110604
Author(s):  
Julia M. Coughlin ◽  
Samantha L. Terranella ◽  
Ethan M. Ritz ◽  
Thomas Q. Xu ◽  
John F. Tierney ◽  
...  
Keyword(s):  
Best Practice ◽  
Monitoring Program ◽  
Resident Training ◽  
Prescribing Practices ◽  
Exact Test ◽  
Opioid Prescribing ◽  
Resident Physicians ◽  
Order Sets ◽  
Patient’S History ◽  
Safe Opioid Prescribing

Background To compare opioid prescribing practices of resident physicians across a variety of surgical and nonsurgical specialties; to identify factors which influence prescribing practices; and to examine resident utilization of best practice supplemental resources. Methods An anonymous survey which assessed prescribing practices was completed by residents from one of several different subspecialties, including internal medicine, obstetrics and gynecology, general surgery, neurosurgery, orthopedic surgery, and urology. Fisher’s exact test assessed differences in prescribing practices between specialties. Results Only 35% of residents reported receiving formal training in safe opioid prescribing. Overall, the most frequently reported influences on prescribing practices were the use of standardized order sets for specific procedures, attending preference, and patient’s history of prescribed opioids. Resident physicians significantly underutilize best practice supplemental resources, such as counseling patients on pain expectations prior to prescribing opioid medication; contacting established pain specialists; screening patients for opioid abuse; referring to the Prescription Monitoring Program; and counseling patients on safe disposal of unused pills ( P < .001). Discussion The incorporation of comprehensive prescribing education into resident training and the utilization of standardized order sets can promote safe opioid prescribing.

scholarly journals Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon

2016 ◽  
Vol 50 (2) ◽  
pp. 263-271 ◽  
Author(s):  
Sandra Maria Sampaio Enes ◽  
Simone Perufo Opitz ◽  
André Ricardo Maia da Costa de Faro ◽  
Mavilde de Luz Gonçalves Pedreira
Keyword(s):  
Intermittent Infusion ◽  
Brazilian Amazon ◽  
Fisher Exact Test ◽  
Intravenous Therapy ◽  
Chi Square ◽  
Significance Level ◽  
Exact Test ◽  
Dorsal Hand Vein ◽  
Mean Time ◽  
Intravenous Catheters

Abstract OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%), phlebitis was the most frequent complication (31.1%). The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%), in 20G catheter (39.3%), inserted in the dorsal hand vein arc (36.9 %), with mean time of usage of 68.4 hours. The type of infusion (p=0.044) and the presence of chronic disease (p=0.005) and infection (p=0.007) affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection.

scholarly journals Prevalence of hepatitis B and C seropositivity in pregnant women

2014 ◽  
Vol 48 (1) ◽  
pp. 89-96 ◽  
Author(s):  
Carla Natalina da Silva Fernandes ◽  
Michelly de Melo Alves ◽  
Michelly Lorrane de Souza ◽  
Gleyce Alves Machado ◽  
Gleiber Couto ◽  
...  
Keyword(s):  
Data Analysis ◽  
Hepatitis B ◽  
Confidence Interval ◽  
Pregnant Women ◽  
Exploratory Study ◽  
Maternity Hospital ◽  
Hospital Records ◽  
Significance Level

The aim of the study was to identify the prevalence of hepatitis B and C seropositivity in pregnant women attended in a public maternity hospital located in Catalao-GO from 2005 to 2009. Descriptive, exploratory study conducted through patients` hospital records. For data analysis, we used SPSS version 18.0. The confidence interval (CI) was calculated using the Person χ² test, considering a significance level of 5% (p <0.05). The prevalence of HBV was 5.64% and HCV 0.098%, predominantly in young pregnant women aged between 20 and 30 years old, single and in their first pregnancy.

scholarly journals Differences in controlled versus uncontrolled arterial hypertension in a primary health care centre—a quality improvement cycle study

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
M T Reis ◽  
A C Roque ◽  
M Pinto ◽  
L M Santiago
Keyword(s):  
Arterial Hypertension ◽  
Medical Records ◽  
Best Practice ◽  
Growth Dynamics ◽  
Primary Health Care Centre ◽  
Population Based ◽  
Significant Rise ◽  
Clinical Activity ◽  
Health Care Centre ◽  
Scientific Meetings

Abstract Background Cardiovascular diseases are the leading cause of death worldwide and uncontrolled Arterial Hypertension (AH) is the most important involved risk factor. An observational study published in 2019 found differences between controlled and uncontrolled AH patients, namely less frequent chronotherapy and family history health records. We aimed to study medical designed population based interventions to reach an increase in controlled AH defining a set of growth dynamics (Δ) ≥ +5 in AH prevalence of control defined for a value of 140/90 mmHg. Methods 2019 results were presented in small medical teams weekly periodic scientific meetings and upon such awareness strategies were developed for improving AH control, according to the best practice evidence available. Data were collected, 6 months later, in a randomized representative sample of AH patients in each Primary Care Health Unit for a confidence interval 95%, error margin of 5%. Descriptive and inferential analysis, for a P &lt; 0.001 and growth dynamics (Δ) were calculated. Results In a n = 148 sample there was a significant improvement in the rate of controlled hypertension (43.9% to 67.9%, P &lt; 0.001, Δ = +54.0). Chronotherapy improved from 29.0% to 66.2% (P &lt; 0.001), Δ = +128.3) and family medical records also improved (88.1% to 100%, Δ + 11.9). Conclusions Significant rise in the prevalence of AH control was achieved after informative and formative intervention. Chronotherapy was significantly improved, allowing a 67.9% AH control. Family medical records also significantly improved. Healthcare professional’s knowledge and reflection about their clinical activity seem to be important tools to achieve better results and hopefully health outcomes, in Arterial Hypertension.

scholarly journals EVALUATION OF PATIENTS WITH SUBAXIAL CERVICAL FRACTURES BY THE NEW AOSPINE CLASSIFICATION

2019 ◽  
Vol 18 (4) ◽  
pp. 268-271
Author(s):  
Pedro Augusto Celestino de Oliveira ◽  
Alberto Gotfryd ◽  
Maria Fernanda Cafaro ◽  
Nelson Astur ◽  
Rodrigo Mendonça ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Medical Records ◽  
Tertiary Hospital ◽  
Categorical Variables ◽  
Neurological Involvement ◽  
Chi Square ◽  
Level Of Evidence ◽  
Significance Level ◽  
Cervical Fractures ◽  
Type C

ABSTRACT Objective: To evaluate the profile of patients with fracture and / or dislocation of the subaxial cervical spine using the new AOSpine classification and to correlate it with the trauma mechanism and the type of neurological deficit. Methods: Analyses were performed of the medical records of patients admitted to a tertiary hospital with fracture and / or subaxial cervical dislocation during the period from 2009 to 2016. For the evaluation of the association between the two categorical variables, the Chi-square test was used with a significance level of p <0.05. Results: A total of 67 medical records were analyzed, in which a higher prevalence of type C fractures (49.3%) was observed. The neurological subclassification N4 (35.8%) was the most prevalent type found, followed by subtype N0 (26.9%). Among the main injury mechanisms found, the most prevalent was the motorcycle accident (29.9%). There was no statistically significant association between the injury mechanism and the AOSpine morphological classification (p> 0.05) or neurological deficit (p> 0.05). Conclusion: Cervical fractures of type C, due to automobile accidents were the most prevalent. It was not possible to determine an association between the degree of neurological involvement and the morphology of the injury. Level of Evidence II; Retrospective study.

scholarly journals Avaliação das Variantes Genéticas dos Genes AMELX e ENAM na Cárie Dentária em Adolescentes

2021 ◽  
Vol 24 (5-esp.) ◽  
pp. 650-654
Author(s):  
Gabriela Paschoalini Romagni ◽  
Paula Marino Costa ◽  
Sandra Mara Maciel ◽  
Maria Paula Jacobucci ◽  
Regina Célia Poli-Frederico
Keyword(s):  
Genetic Component ◽  
World Health ◽  
Caries Experience ◽  
Nucleotide Polymorphisms ◽  
Chi Square ◽  
Single Nucleotide ◽  
Significance Level ◽  
Exact Test ◽  
Polymerase Chain ◽  
Health Organization

A doença cárie é considerada, atualmente, como biofilme sacarose dependente, entretanto, estudos recentes apontam que fatores genéticos também podem influenciar seu desenvolvimento. Variantes nos gene amelogenina (AMELX) e enamelina (ENAM), responsáveis pela formação do esmalte, têm sido propostas como potencialmente envolvidos na doença. O objetivo deste estudo foi avaliar se a ocorrência de cárie dentária em adolescentes está relacionado às variantes nos genes AMELX e ENAM. Para a avaliação da prevalência de cárie foi utilizado o índice de dentes cariados, perdidos e obturados (CPO-D), segundo critérios da Organização Mundial de Saúde. As amostras de DNA foram extraídas das células da mucosa oral. Para a análise dos polimorfismos de nucleotídeo único (SNPs) dos genes AMELX (rs17878486) e ENAM (rs7671281) foi utilizada  a técnica de amplificação de fragmentos de DNA pela reação em cadeia da polimerase foi realizada (PCR) em tempo real pelo sistema TaqMan (Applied Biosystems, Foster City, EUA). Para a análise estatística, foi utilizado o teste exato de Fisher e qui-quadrado com nível de significância de 5%. Apenas os fatores socioeconômicos influenciaram a experiência de cárie. Concluiu-se que o componente genético, na população deste estudo, não influenciou o desenvolvimento da cárie.   Palavras-chave: Polimorfismo genético. Adolescentes. Esmalte.   Abstract Caries disease is currently considered a sucrose-dependent biofilm, however recent studies indicate that a genetic component can also influence its development. Variants in the amelogenin (AMELX) and enamelin (ENAM) genes, responsible for the enamel formation, have been proposed as potentially involved in the disease. The purpose of this study was to evaluate whether the occurrence of dental caries in adolescents is related to variants in the AMELX and ENAM genes. To assess the caries prevalence, the index of decayed, missing and filled teeth (DMFT) were used, according to World Health Organization criteria. DNA samples were extracted from oral mucosa cells. For the analysis of single nucleotide polymorphisms (SNPs) of the AMELX (rs17878486) and ENAM (rs7671281) genes, the amplifying DNA fragments technique  by the polymerase chain reaction was performed (PCR) in real time by the TaqMan system (Applied Biosystems, Foster City, USA). For the statistical analysis, Fisher's exact test and chi-square were used with a 5% significance level. Only socioeconomic factors influenced the caries experience. It was concluded that the genetic component in the population of this study, did not influence the development of caries.   Keywords: Genetic polymorphism. Adolescents. Enamel.

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