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Almeida, Carlos Eduardo Saldanha de. "Vascular access: the impact of ultrasonography." Einstein (São Paulo) 14, no. 4 (December 2016): 561–66. http://dx.doi.org/10.1590/s1679-45082016rw3129.
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ABSTRACT Vascular punctures are often necessary in critically ill patients. They are secure, but not free of complications. Ultrasonography enhances safety of the procedure by decreasing puncture attempts, complications and costs. This study reviews important publications and the puncture technique using ultrasound, bringing part of the experience of the intensive care unit of the Hospital Israelita Albert Einstein, São Paulo (SP), Brazil, and discussing issues that should be considered in future studies.
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Coelho, Fernando Morgadinho Santos, Bento Fortunato Cardoso dos Santos, Miguel Cendoroglo Neto, Luis Fernando Lisboa, Adriana Serra Cypriano, Tania Oliveira Lopes, Marina Jorge de Miranda, Ana Maria H. Ávila, Jonas Bordin Alonso, and Hilton Siqueira Pinto. "Temperature variation in the 24 hours before the initial symptoms of stroke." Arquivos de Neuro-Psiquiatria 68, no. 2 (April 2010): 242–45. http://dx.doi.org/10.1590/s0004-282x2010000200017.
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A few studies have performed to evaluate the temperature variation influences over on the stroke rates in Brazil. METHOD: 176 medical records of inpatients were analyzed after having had a stroke between 2004 and 2006 at Hospital Israelita Albert Einstein. The temperature preceding the occurrence of the symptoms was recorded, as well as the temperature 6, 12 and 24 hours before the symptoms in 6 different weather substations, closest to their houses in São Paulo. RESULTS: Strokes occurred more frequently after a variation of 3ºC between 6 and 24 hours before the symptoms. There were most hospitalizations between 23-24ºC. CONCLUSION: Incidence of stroke on these patients was increased after a variation of 3º Celsius within 24 hours before the ictus. The temperature variations could be an important factor in the occurrence of strokes in this population.
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Siegel, Björn. "‘We Were Refugees and Carried a Special Burden’." European Judaism 54, no. 1 (March 1, 2021): 27–44. http://dx.doi.org/10.3167/ej.2021.540104.
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By using the example of Jewish immigration to São Paulo in the 1930s and 1940s and analysing the history of the Congregação Israelita Paulista (CIP) under the leadership of Fritz Pinkuss, this article shows how emotions were used in different ways. Such an approach gives new insight into the complexity of migration history. The Brazilian government under Gétulio Vargas openly embraced emotional mobilisation against ‘Semites’ and ‘foreigners’, and in so doing wanted to introduce a new understanding of the nation and secure their political influence. At the same time, Pinkuss also used emotions in his communal policies to establish a new religious union, a new form of inclusion and solidarity in the Jewish community. By transferring German Jewish traditions to Brazil and emphasising their flexibility, Pinkuss not only created a new emotional bond, but also laid the ground for integration of the émigré community into Brazilian society.
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Scheinberg, Morton, José Goldenberg, Daniel P. Feldman, and João Luiz Nóbrega. "Retrospective study evaluating dose standards for infliximab in patients with rheumatoid arthritis at Hospital Israelita Albert Einstein, São Paulo, Brazil." Clinical Rheumatology 27, no. 8 (May 8, 2008): 1049–52. http://dx.doi.org/10.1007/s10067-008-0908-y.
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Annicchino, Giuliana, Helena Malvezzi, Carla de Azevedo Piccinato, and Sérgio Podgaec. "Is there an Increased Risk for Unfavorable Obstetric Outcomes in Women with Endometriosis? An Evaluation of Evidences." Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics 42, no. 04 (April 2020): 200–210. http://dx.doi.org/10.1055/s-0040-1708885.
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Abstract Objective The present study is a systematic review of the literature to assess whether the presence of endometriosis determines or contributes to adverse obstetric outcomes. Data Sources The present work was carried out at the Hospital Israelita Albert Einstein, São Paulo, state of São Paulo, Brazil, in accordance to the PRISMA methodology for systematic reviews. A review of the literature was performed using PubMed, Web of Science and Scopus databases. The keywords used were: pregnancy outcome, pregnancy complications, obstetrical complications, obstetrics, obstetric outcomes and endometriosis. The survey was further completed by a manually executed review of cross-referenced articles, which was last performed on November 30, 2018. Selection of studies The survey disclosed a total of 2,468 articles, published from May 1946 to October 2017. A total of 18 studies were selected to be further classified according to their quality and relevance. Data Collection The Newcastle–Ottawa Quality Assessment Scale was used for classification. Five studies of greater impact and superior evidence quality and 13 studies of moderate evidence quality were selected. We analyzed the studies for the characteristics of their patients plus how endometriosis was diagnosed and their respective obstetric outcomes taking into account their statistical relevance. Data Synthesis Analyses of the higher impact and better quality studies have shown high incidence of preterm birth and placenta previa in patients with endometriosis. Conclusion Placenta previa and preterm birth are the most statistically significant outcomes related to endometriosis, as indicated by our systematic review. The present information is useful to alert obstetricians and patients about possible unfavorable obstetric outcomes.
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Amos, B. K., I. V. Smirnov, and M. M. Hermann. "Comparison of machine learning models for coronavirus prediction." Advanced Engineering Research 22, no. 1 (March 30, 2022): 67–75. http://dx.doi.org/10.23947/2687-1653-2022-22-1-67-75.
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Coronavirus, also known as COVID-19, was first detected in Wuhan, China, in December 2019. It is a family of viruses ranging from the common cold to severe acute respiratory syndrome (SARS). The symptoms of such a virus are similar to those of a cold or seasonal allergies. Like other respiratory viruses, it is mainly transmitted through airborne droplets when coughing or sneezing. Therefore, the recognition of COVID-19 requires careful laboratory analysis, and the reduction of recognition resources is a major challenge. On 11 March, 2020, the World Health Organization (WHO) declared COVID-19, caused by SARS-CoV-2, a pandemic, as there had been an exponential increase in cases worldwide, and demand for intensive beds and related structures had far exceeded existing capacity. The first examples of this are the regions of Italy. Brazil registered the first case of SARS-CoV-2 on 02/26/2020. Transmission of the virus in this country shifted very quickly from imported cases to local and, finally, community missions, with the Brazilian federal government announcing national community transmission on 03/20/2020. As of March 23, in the state of São Paulo with a population of about 12 million people, where the Israelita Albert Einstein Hospital is located, 477 cases of the disease and 30 related deaths were registered, and on March 27, there were already 1223 cases of COVID-19 with 68 concomitant deaths. To slow the spread of the virus in the state of São Paulo, quarantines and social distancing measures were introduced. One of the motivations for this challenge is the fact that, in the context of an extensive healthcare system with the possible limitation of SARS-CoV-2 testing, it is not practical to test every case, and test results can only be used in testing the target subpopulation. The study objective is to build a model based on machine learning that can predict the detection of SARS-CoV-2 from medical data. For this, various classification models of machine learning are compared, and the best one to predict coronaviruses is determined. The comparison is based on individuals in class 1, i.e., those with a positive test. Therefore, it is required to determine the machine learning model with the best response and F1 score for class 1.Materials and Methods. An open-source data set from the Israelita Albert Einstein Hospital in São Paulo, Brazil, was taken as a basis. The following machine learning models were used for the study: RandomForests (RF), K-Nearest Neighbor (KNN), Support Vector Machine (SVM), Logistic Regression (LR), Decision Tree (DT) and AdaBoost (AB), as well as the 10-time cross-validation technique. Some machine learning performance measures, such as accuracy, recall, and F1 score were evaluated.Results. Out of a total of 5,644 people tested during the COVID-19 pandemic, 5,086 people tested negative and 558 people tested positive. At the same time, support for machine vectors showed the best results in detecting coronavirus with a recall of 75 % and an F1 score of 60 % compared to models: Random drill, KNN, LR, AB, and DT.Discussion and Conclusions. It was found that when using AB algorithms, greater accuracy is achieved, but the stability of the LSVM algorithm is higher. Therefore, it can be recommended as a useful tool for detecting COVID-19.
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Negrini, Romulo, Izabella Mikaella Souza Campos D’Albuquerque, Rita de Cássia Sanchez e Oliveira, Raquel Domingues da Silva Ferreira, Luciana Francine Bocchi De Stefani, and Sergio Podgaec. "Strategies to reduce the caesarean section rate in a private hospital and their impact." BMJ Open Quality 10, no. 3 (August 2021): e001215. http://dx.doi.org/10.1136/bmjoq-2020-001215.
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There is a concern around the world of an increasing caesarean section rate. It was estimated that between 2010 and 2015, caesarean section rates increased by almost 50%. There are several implications for this, considering that caesarean sections are associated with higher costs and worse clinical outcomes. In this context, several interventions have been considered to increase vaginal delivery rates, including the Adequate Childbirth Project (PPA) in Brazil. This study aimed to verify the impact of the strategies adopted internally in the Hospital Israelita Albert Einstein (HIAE) located in São Paulo, Brazil, regarding the reduction of caesarean sections and their perinatal results. Actions to support our study were implemented in two phases based on the PPA schedule. These actions involved three axes: a multidisciplinary team, pregnant women and facility improvements. All pregnant women admitted for childbirth at the HIAE between 2014 and 2019 were included in this study. The overall rate of vaginal delivery in this study population and among primiparous women and the percentage of admissions to the neonatal intensive care unit (NICU) were analysed in three periods: before the implementation of PPA actions (period A), after the first phase of the project (period B) and after its second phase (period C). The results showed an increase in the average vaginal delivery rate from 23.57% in period A to 27.88% in period B, and to 30.06% in period C (AxB, p<0.001; BxC, p=0.004). There was a decrease in the average of NICU admissions over the periods (period A 19.22%, period B 18.71% and period C 13.22%); a significant reduction was observed when periods B and C (p<0.001) were compared.
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Antunes, Yuri Philippe Pimentel Vieira, Diogo Diniz Gomes Bugano, Auro del Giglio, Rafael Aliosha Kaliks, Theodora Karnakis, and Lucíola de Barros Pontes. "Clinical features and overall survival among elderly cancer patients in a tertiary cancer center." Einstein (São Paulo) 13, no. 4 (December 11, 2015): 487–91. http://dx.doi.org/10.1590/s1679-45082015ao3067.
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ABSTRACT Objective To evaluate the epidemiological profile and overall survival of a large population of elderly individuals diagnosed with solid tumors in a tertiary hospital. Methods This retrospective study included patients aged >65 years, diagnosed with solid tumors between January 2007 and December 2011, at Hospital Israelita Albert Einstein, São Paulo, Brazil. The medical records were reviewed to obtain information about clinical variables and overall survival. Results A total of 806 patients were identified, and 58.4% were male. Mean age was 74 years (65 to 99 years). The most common types were prostate (22%), colorectal (21%), breast (19%), and lung cancer (13%), followed by bladder (8%), pancreas (6%), and other types (11%). The majority of patients were diagnosed at early stage disease. After a median follow-up of 27 months (15 to 45 months), 29% of the patients (234/806) died, predominantly in the group older than 70 years. For the entire cohort, the median 2-year survival rate was 71%. Median overall survival was not reached within the study period. In a multivariate analysis, age (HR: 1.35; 95%CI: 1.25-1.45; p<0.001) and disease stage (HR: 1.93; 95%CI: 1.75-2.14; p<0.001) were independent negative predictors of poor survival. Conclusion The most prevalent tumors were prostate, colorectal, breast, and lung cancer, with the larger proportion diagnosed at initial stages, reflecting the great number of patients alive at last follow-up.
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Choukhan, C. F., I. Lasri, R. El Hatimi, M. R. Lemnaouar, and M. Esghir. "SARS-CoV-2 Prediction Strategy Based on Classification Algorithms from a Full Blood Examination." Scientific World Journal 2023 (August 22, 2023): 1–15. http://dx.doi.org/10.1155/2023/3248192.
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A fast and efficient diagnosis of serious infectious diseases, such as the recent SARS-CoV-2, is necessary in order to curb both the spread of existing variants and the emergence of new ones. In this regard and recognizing the shortcomings of the reverse transcription-polymerase chain reaction (RT-PCR) and rapid diagnostic test (RDT), strategic planning in the public health system is required. In particular, helping researchers develop a more accurate diagnosis means to distinguish patients with symptoms with COVID-19 from other common infections is what is needed. The aim of this study was to train and optimize the support vector machine (SVM) and K-nearest neighbors (KNN) classifiers to rapidly identify SARS-CoV-2 (positive/negative) patients through a simple complete blood test without any prior knowledge of the patient’s health state or symptoms. After applying both models to a sample of patients at Israelita Albert Einstein at São Paulo, Brazil (solely for two examined groups of patients’ data: “regular ward” and “not admitted to the hospital”), it was found that both provided early and accurate detection, based only on a selected blood profile via the statistical test of dependence (ANOVA test). The best performance was achieved by the improved SVM technique on nonhospitalized patients, with precision, recall, accuracy, and AUC values reaching 94%, 96%, 95%, and 99%, respectively, which supports the potential of this innovative strategy to significantly improve initial screening.
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Cruz, Roberto de Oliveira, Mariza Aparecida Mota, Fabiana Mendes Conti, Ricardo Antônio d'Almeida Pereira, Jose Mauro Kutner, Maria Giselda Aravechia, and Lilian Castilho. "Prevalence of erythrocyte alloimmunization in polytransfused patients." Einstein (São Paulo) 9, no. 2 (June 2011): 173–78. http://dx.doi.org/10.1590/s1679-45082011ao1777.
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Objective: To determine the incidence and the rate of red blood cell alloimmunization in polytransfused patients. Methods: A polytransfused patient was defined as having received at least 6 units of red cell concentrates during a 3-month period. The records of all patients (n = 12,904) who had received red blood cell units were examined retrospectively by searching the computer database at Hospital Israelita Albert Einstein in São Paulo, Brazil, over a 6-year period, between 2003 and 2009. Results: During this time, 77,049 red cell concentrate transfusions were performed in 12,904 patients. There were 3,044 polytransfused patients, 227 of whom (7.5%) presented with irregular erythrocyte antibodies. The prevalence of alloantibody specificity was: Anti-E>anti-D>anti-K>anti-C>anti-Dia>anti-c>anti-Jka>anti-S in 227 polytransfused patients. We found combinations of alloantibodies in 79 patients (34.8%), and the most common specificities were against the Rh and/or Kell systems. These antibodies show clinical significance, as they can cause delayed hemolytic transfusion reactions and perinatal hemolytic disease. About 20% of the patients showed an IgG autoantibody isolated or combined with alloantibodies. Interestingly, a high incidence of antibodies against low frequency antigens was detected in this study, mainly anti-Dia. Conclusion: Polytransfused patients have a high probability of developing alloantibodies whether alone or combined with autoantibodies and antibodies against low frequency antigens. Transfusion of red blood cells with a phenotype-compatible with RH (C, E, c), K, Fya, and Jka antigens is recommended for polytransfused patients in order to prevent alloimmunization and hemolytic transfusion reactions.
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Bertagnon, José Ricardo Dias, Conceição Aparecida de Mattos Segre, and Gloria Maria Dall Colletto. "Weight-for-length relationship at birth to predict neonatal diseases." Sao Paulo Medical Journal 121, no. 4 (2003): 149–54. http://dx.doi.org/10.1590/s1516-31802003000400002.
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CONTEXT: Intrauterine growth curves are extremely useful for classifying newborn children and predicting neonatal diseases. However, such curves rely on knowledge of the gestational age, which is not always easily obtained. Therefore, the study of other anthropometric measurements and their interrelationship is always desirable, in order to attain such objectives. OBJECTIVE: To evaluate whether newborns' birth weight and length can identify neonatal diseases, independent of knowledge of the gestational age. TYPE OF STUDY: Retrospective study. SETTING: Institute of Teaching and Research of Hospital Israelita Albert Einstein, São Paulo, Brazil. PARTICIPANTS: During the period from February 1995 to January 1998, 8,397 live newborns were studied in the hospital's maternity ward. PROCEDURES: The weight and length of live newborns were obtained at birth, thus allowing the analysis of weight-for-length adequacy, i.e. the distribution of birth weight for each class of birth lenght. These measurements were determined for the first 4,634 live newborns and the 10th and 90th percentiles were established. These parameters were applied to the next 3,763 consecutive newborns of the same population. The relationships between these variables and some neonatal diseases were investigated. The significance level adopted was p < 0.05. MAIN MEASUREMENTS: Birth weight and length, weight-for-length adequacy (10th and 90th percentiles for weight distribution in each 1-cm length class), weight/length index (10th and 90th percentiles of newborn's weight divided by the length) and frequent neonatal diseases in this population. RESULTS: There was a significant association of adequacy and index with the following affections: asphyxia, jaundice, hypoglycemia, hypomagnesemia, congenital pneumonia, pulmonary hypertension and sepsis. Additionally, there was a relationship between the index and respiratory distress syndrome, transient tachypnea and persistent ductus arteriosus. CONCLUSIONS: Weight-for-length adequacy and weight/length index alone, without the knowledge of gestational age, were able to identify newborns at risk for some selected neonatal diseases.
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Bernaldo, Adélia Jeha Nasser, and Conceição Aparecida de Mattos Segre. "Bilirubin dosage in cord blood: could it predict neonatal hyperbilirubinemia?" Sao Paulo Medical Journal 122, no. 3 (May 2004): 99–103. http://dx.doi.org/10.1590/s1516-31802004000300005.
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CONTEXT: With early discharge, many newborns have to be readmitted to hospital for hyperbilirubinemia to be treated, and this has been held responsible for the reappearance of kernicterus. OBJECTIVE: To evaluate whether bilirubin levels in cord blood could predict neonatal hyperbilirubinemia that would require treatment, in full-term newborns up to their third day of life. TYPE OF STUDY: Prospective study. SETTING: Neonatal Unit of Hospital Israelita Albert Einstein, São Paulo, Brazil. PARTICIPANTS: 380 full-term newborns considered normal: with or without ABO/Rh blood group incompatibility and without other complications. PROCEDURES: Blood was taken from the umbilical cord for analysis of conjugated, unconjugated and total bilirubin serum levels. The newborns were followed up until discharge, and unconjugated bilirubin that required phototherapy was compared to the cord bilirubin assay. Discriminant analysis was used to classify newborns: with or without risk of needing phototherapy by the third day of life. MAIN MEASUREMENTS: Bilirubin assay in cord blood; mother's and newborn's blood groups; phototherapy indication. RESULTS: The mean value for unconjugated bilirubin in cord blood was significantly higher in newborns whose unconjugated bilirubin required phototherapy. The presence of ABO blood group incompatibility was a significant variable in relation to unconjugated bilirubin that required phototherapy. The most useful cutoff point for unconjugated bilirubin in cord blood was 2.0 mg/100 ml. DISCUSSION: Cord blood could be collected, stored and used for further analysis of unconjugated bilirubin levels as a means for considering whether or not to discharge a moderately jaundiced child from hospital, in association with other resources. CONCLUSIONS: Blood incompatibility between mother and child was a predictor for the appearance of hyperbilirubinemia that required treatment. Considering a cutoff point of 2.0 mg/100 ml, it could be concluded that 53% of the newborns who had greater unconjugated bilirubin levels in cord blood would reach levels requiring phototherapy by the third day of life.
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Marques, Carolina Perrone, Carolina Leme de Moura Pereira, Jade Zezzi Nascimento, Tarcila Santos Datoguia, Felipe Galvão Batista Chaves, Juliana Dall Agnol Rocha, Amanda Inácio Dias Ennes, et al. "Real World Data on Treatment of Acute Myeloid Leukemia (AML) in a Private Healthcare Institution in Brazil, a Low-Middle Income Country - Importance of Allogeneic Hematopoietic Stem Cell Transplantation (HSCT)." Blood 142, Supplement 1 (November 28, 2023): 7440. http://dx.doi.org/10.1182/blood-2023-191152.
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Introduction: Treatment of patients with AML has evolved in the past decade, with development of novel drugs and increased knowledge about the genetic basis of disease. However, results of therapy in AML in LMICs have lagged those seen in more developed countries. A recently published paper highlighted the worse outcome of pts with AML treated in two public healthcare hospitals in Brazil compared with pts treated at an academic center at Oxford, UK, with lower overall survival (OS), lower rates of HSCT and a longer time to HSCT. 1 We hypothesized, however, that better outcomes could be seen in private healthcare institutions in Brazil with a higher rate of HSCT in first remission. Methods: We reviewed medical records of 122 patients with a diagnosis AML treated at Hospital Israelita Albert Einstein in São Paulo, Brazil, from 2010 until 2023. OS was defined as time from diagnosis until death from any cause and estimated by the Kaplan-Meier method. Risk was evaluated by the ELN 2022 risk classification. Results: A total of 122 consecutive patients were included. Median age was 63 years (range 24-91 years), and 45% were female. Per the ELN 2022 risk classification, 17% of patients were low risk, 33% were intermediate risk and 50% were considered high risk cases. Intensive chemotherapy was used in 62.5% of cases, while low-intensity regimens were employed in 37.5% of cases, including venetoclax in 21.4% of patients. After a median follow-up of 36 months, median OS of the whole cohort is 25.2 months (95% CI 19.2-83.8 months), and 3-years OS is 44% (95% CI 34-55%). As expected, patients in the high 2022 ELN risk category had lower 3-years OS probability (15.6% vs. 47.3%/91.6% for intermediate- and low-risk, respectively). Eighty-two patients (67.2% of the cohort) underwent HSCT, and 59% were in MRD-negative complete remission (CR) prior to HSCT. We next analyzed outcomes in patients younger than 60 years of age who received intensive chemotherapy, the subset of patients analyzed by Silveira et al. 1 Results are summarized in Table 1 and figure 1. The outcomes of our patients compare favorable to what has been reported here in Brazil and, like the data from the UK center, has a high rate of HSCT with a low time to transplant. Conclusion: Our results demonstrate that it is feasible to obtain favorable outcomes in patients with AML in a LMIC with a high rate of HSCT in first CR. It is also important to mention that our results also reflect the reality of a private healthcare institution in Brazil. However, even after considering this, our results carry an important message. There is limited availability of clinical trials and novel medications for AML in LMICs compared to the developed world, and options in the salvage setting are usually limited to intensive chemotherapeutic regimes. Allogeneic HSCT is a technique that is readily available in most countries and has the potential to cure AML, particularly when employed in first CR. We believe that physicians and institutions treating patients with AML in a LMIC should primarily focus on strategies that improve access to HSCT in first CR for these patients. References 1. Silveira DRA et al, Leuk Lymphoma 2021 Jan;62(1):147-157
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Jaures, Michele, Neila Maria Marques Negrini Pigatti, Roseny dos Reis Rodrigues, Fernanda Paulino Fernandes, and João Carlos de Campos Guerra. "Bleeding management after implementation of the Hemorrhage Code (Code H) at the Hospital Israelita Albert Einstein, São Paulo, Brazil." Einstein (São Paulo) 18 (2020). http://dx.doi.org/10.31744/einstein_journal/2020ao5032.
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Jha, Ritesh, Vandana Bhattacharjee, Abhijit Mustafi, and Sudip Kumar Sahana. "Improved disease diagnosis system for COVID-19 with data refactoring and handling methods." Frontiers in Psychology 13 (August 12, 2022). http://dx.doi.org/10.3389/fpsyg.2022.951027.
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The novel coronavirus illness (COVID-19) outbreak, which began in a seafood market in Wuhan, Hubei Province, China, in mid-December 2019, has spread to almost all countries, territories, and places throughout the world. And since the fault in diagnosis of a disease causes a psychological impact, this was very much visible in the spread of COVID-19. This research aims to address this issue by providing a better solution for diagnosis of the COVID-19 disease. The paper also addresses a very important issue of having less data for disease prediction models by elaborating on data handling techniques. Thus, special focus has been given on data processing and handling, with an aim to develop an improved machine learning model for diagnosis of COVID-19. Random Forest (RF), Decision tree (DT), K-Nearest Neighbor (KNN), Logistic Regression (LR), Support vector machine, and Deep Neural network (DNN) models are developed using the Hospital Israelita Albert Einstein (in São Paulo, Brazil) dataset to diagnose COVID-19. The dataset is pre-processed and distributed DT is applied to rank the features. Data augmentation has been applied to generate datasets for improving classification accuracy. The DNN model dominates overall techniques giving the highest accuracy of 96.99%, recall of 96.98%, and precision of 96.94%, which is better than or comparable to other research work. All the algorithms are implemented in a distributed environment on the Spark platform.
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Silva, Simone Cristina Azevedo, Selma Tavares Valério, and Mariana Lucas da Rocha Cunha. "Mediated training by bedside supervised practice for nurses during the COVID-19 pandemic: an observational study." Escola Anna Nery 27 (2023). http://dx.doi.org/10.1590/2177-9465-ean-2022-0310en.
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Abstract Objective to describe a strategy of mediated training by bedside supervised practice for nurses during the COVID-19 pandemic and to determine nurses’ perception about contribution of bedside training for the acquisition of knowledge and skills for healthcare practice in critical care settings. Methods this was an observational, longitudinal, retrospective and descriptive study that used a quantitative approach, conducted at a large private health care facility in the city of São Paulo, Brazil. The data collected refer to the period from April to June 2021. The research was approved by the Research Ethics Committee of Hospital Israelita Albert Einstein, under Protocol 5.423.393. Ten procedures were selected for supervision, such as tracheal aspiration, nasogastric tube, venipuncture, donning, dressing and equipment handling. Data obtained were analyzed using descriptive analyses and statistical tests. Results of the participants (72), 87.7% were women with mean age of 33 years and their mean work experience was 9 months (50%). Initially, professionals participated in the standard 26-hour institutional training and, later, in supervised practice-mediated training. The mean time per procedure was 45 minutes. The median proficiency in eight of the procedures was eight. Most professionals rated themselves as confident (98.9%) and satisfied with the training (99.4%). Conclusion and implications for practice the training enabled a structured process of identification and monitoring of care practice, allowing for an effective strategy to provide prepared professionals who work safely.
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Aneni, Ehimen C., Marcio S. Bittencourt, Miguel Caínzos Achirica, Michael J. Blaha, Ahmed M. Soliman, Mouaz H. Al-mallah, Matthew J. Budoff, Raul Santos, and Khurram Nasir. "Abstract P221: The Impact of Prevalent and New-onset Cardiometabolic Risk on the Incidence of Hepatic Steatosis." Circulation 141, Suppl_1 (March 3, 2020). http://dx.doi.org/10.1161/circ.141.suppl_1.p221.
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Background: Little is known about hepatic steatosis (HS) incidence and its relationship to underlying or new-onset cardiometabolic risk. This study aims to assess the incidence of hepatic steatosis in an asymptomatic population and to determine its relationship to both prevalent and new-onset cardiometabolic risk factors. Methods: We analyzed retrospective data from a voluntary employer-sponsored routine health promotion evaluation at the Preventive Medicine Center of the Hospital Israelita Albert Einstein (São Paulo, Brazil) collected from October 2004 to December 2016.Medical and demographic history, anthropometric measures including blood pressure, body mass index (BMI) and waist circumference, and fasting blood samples were obtained. Participants also had ultrasonography to assess for HS. We included data from 8,448 individuals who had complete cardiometabolic and ultrasound data at baseline and repeated all tests at least 6 months later. Results: The mean age (standard deviation, SD) of participants was 40 (9) years. Over a mean (SD) follow-up of 3.4 (2.3) years, the incidence of HS was 14.7%. As shown in the table, diabetes, poor physical activity, elevated waist circumference and cigarette smoking at baseline were independently associated with hepatic steatosis. There was an additive effect of the increasing cardiometabolic risk factors (see graph) on the risk of developing HS. Participants with new-onset cardiometabolic risk factors also had a higher risk of incident HS after accounting for baseline demographics and cardiometabolic risk factors (see forest plot). This was most pronounced for incident obesity (BMI ≥ 30 Kg/m 2 ). Conclusion: In this relatively young population, the incidence of HS was high and was both independently and collectively associated with baseline cardiometabolic risk. New-onset cardiometabolic risk tracks with incident HS. This study emphasizes the need for assessing and mitigating cardiometabolic risk in the prevention of HS.
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Saeed, Gul, Ehimen Aneni, Bincy Abraham, Marcio S. Bittencourt, Miguel Cainzos Achirica, Raul D. Santos, and Khurram Nasir. "Abstract 14507: Suboptimal Blood Pressure Control Increases the Risk of Non-alcoholic Fatty Liver Disease." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.14507.
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Introduction: Recent blood pressure (BP) guidelines recommend aggressive control of BP to prevent target organ damage, however, no population-level studies have assessed the impact of aggressive BP control on the incidence of Nonalcoholic Fatty Liver Disease (NAFLD). In this study, we investigate the implications of suboptimal BP control for incident NAFLD. Methods: We analyzed data from 6,252 consecutive participants in an employer-mandated routine health evaluation at Hospital Israelita Albert Einstein (São Paulo, Brazil) collected between 2004 to 2016 who were free of NAFLD at baseline. NAFLD was defined as liver ultrasound detected hepatic steatosis among individuals with an alcohol use disorder identification test (AUDIT) score <8. Hypertension was defined as either self-reported history and/or use of BP-lowering medications. Suboptimal BP control was defined per the 2018 ACC/AHA criteria as systolic BP >/= 130mmHg and/or diastolic BP >/= 80 mmHg. Multivariate analysis was conducted adjusting for possible confounders as noted in the figure. Results: Over a median follow-up period of 2.9 years (range: 0.6 - 10.6 years), the incidence of NAFLD was 25.8% among individuals with hypertension (N=473) compared to 15.2% among non-hypertensive individuals (N=5,779; p<0.001). Amongst individuals with known hypertension and suboptimal BP control, the incidence was 29.7% compared to 14.3% among those with optimal BP (adjusted RR 1.80 [95%CI: 1.12 - 2.90]). Similarly, the risk of NAFLD was 18% greater among those without known hypertension but whose BP was suboptimal (adjusted RR: 1.18 [95% CI: 1.05 - 1.33]; figure). Conclusions: Among persons with known hypertension, suboptimal BP is an independent risk of NAFLD. In addition, among those without known hypertension, suboptimal BP is an independent predictor of future NAFLD. Intervention studies are needed to investigate the role of BP control in the prevention of NAFLD.