Routine workflow in a reference clinical research center in face of COVID-19

OBJECTIVE

To develop and validate the content of workflows for trial participants care in a clinical research center during the Covid-19 pandemic.

METHOD

development study by consensus of experts carried out from March to July 2020 in southern Brazil. The flowcharts were developed following literature and validated by specialists considering comprehensiveness, clarity and pertinence, obtaining a 100% agreement index on each item of the developed instruments. The study was approved by the Ethics Committee of the institution.

RESULTS

two flowcharts of care were elaborated and validated: "Flow diagram to conduct protocols with research participant " and "Flow diagram in protocols with research participant with suspected or confirmed COVID-19 infection"; which describes activities to ensure continuity of care.

FINAL CONSIDERATIONS

a routine workflow can promote the continuity and safety of clinical research protocols. It is expected that the adopted flowcharts in this study can guide other institutions with a similar research profile.

[Late-onset neonatal sepsis in preterm infants with birth weight under 1.500 g]

OBJECTIVE

The research objective was to characterize preterm infants with birth weight under 1500 g, and to identify the incidence of late-onset neonatal sepsis among this population.

METHODS

A prospective cohort study with a sample of 30 preterm newborns that weighed under 1500 g and were hospitalized in the NICU of the university hospital. Data were collected from January to December 2013 using a structured instrument.

RESULTS

Of the 30 neonates included in the study, 14 developed late-onset neonatal sepsis with a prevalence of coagulase-negative staphylococci.

CONCLUSIONS

The incidence of late-onset neonatal sepsis indicates a vulnerability in preterm infants due to immunological immaturity. These results reveal that knowledge of the profile of newborn infants admitted to the NICU and the risk factors to which they are exposed are central to the planning of nursing care for these patients. Future studies should address strategies for preventing nosocomial infection.

Open versus closed enteral nutrition systems for critically ill adults: is there a difference?

OBJECTIVE

To compare the volume, total calories, and protein received by critically ill patients between open and closed enteral nutrition (EN) systems and identify the main reasons for EN discontinuation.

METHODS

A cohort study in which adult patients admitted to the intensive care unit (ICU) were followed-up in two periods: throughout November 2009 with all patients (n = 85) receiving EN using the open system (OS group); and from October 2010 to April 2011 with patients (n = 170) receiving EN using the closed system (CS group). Parametric and nonparametric tests were used to compare the variables, taking into account their distribution.

RESULTS

Demographic and clinical characteristics were similar in both groups. There were minor differences with no statistical significance between groups: more calories/kg were prescribed to the OS group (p < 0.001), and a higher volume (mL/kg, p = 0.002) and protein (g/kg, p = 0.001) were prescribed to the CS group. Fasting, enteral feeding or gastrointestinal problems, and performance of procedures and ICU routines in different frequencies between groups (p = 0.001) led to the discontinuation of EN.

CONCLUSION

There was no clinically relevant difference between the volume, energy, and protein intake of EN prescribed and administered in OS and CS groups. Clinical instability, procedures, and ICU routines led to EN discontinuation in both groups.

Enteral nutrition: differences between volume, energy and protein prescribed and administered in adults

OBJECTIVES

Different conditions require that critically ill patients to receive lower than prescribed enteral nutrition volumes, energy and protein. This study objective was to evaluate the prescribed versus administered enteral nutrition difference in adults admitted to an intensive care unit.

METHODS

In 2009, patients were followed for 30 days from the start of enteral nutrition to its discontinuation, or discharge from the intensive care unit. Parametric and nonparametric tests were used to evaluate prescribed versus administered differences.

RESULTS

Eighty five patients were enrolled; mean age was 58.6±18.0 years and 40% were male. The patients remained in hospital for 29.5 days (IQ: 15.2 - 48.7) and were under enteral nutrition for 10 (IQ: 4.2 - 27.5) days. Lower than enteral nutrition prescribed volume (-428±243ml/day), energy (-665±412 Kcal/day) and protein (-30±19 g protein/day) was received. Individual patients' evaluation demonstrated that about 40% of the prescribed volume was not actually given. The main reasons for enteral nutrition interruptions were nausea and vomiting, abdominal distension, constipation and clinical complications (52%); diagnostic procedures (41.6%); and transition to oral feeding (5.6%).

CONCLUSION

Patients admitted to intensive care unit receive less than the prescribed enteral nutrition. The routine care and gastrointestinal tract complications lead to enteral nutrition interruptions, contributing to less than prescribed calories administration.

[The use of the Delphi technique for competencies investigation: an experience report]

The Delphi technique has been used in nursing research, with electronic means as an option. This article has the objective of reporting researchers' experience on the application of this technique in a study about nurses' competencies for the performance of Essential Public Health Functions. Experts were searched on the Lattes Platform of the National Council of Scientific and Technologic Development (CNPq) in Brazil. Two groups with 50 participants each, one with nurses and other with faculty with representation of every geographic region of the country were organized. The competencies validation instrument was sent by electronic means. Although it is reported that this form reduces the time for sending and receiving the questionnaires, difficulties to obtain contact with the experts, lack of return of the participants and a long time to answer the instrument were observed. Health care professionals need to understand the importance of their participation in researches with the utilization of this technique.