1
|
Yin R, Jin Z, Lee BH, Alvarez GA, Stagnaro JP, Valderrama-Beltran SL, Gualtero SM, Jiménez-Alvarez LF, Reyes LP, Henao Rodas CM, Gomez K, Alarcon J, Aguilar Moreno LA, Bravo Ojeda JS, Cano Medina YA, Chapeta Parada EG, Zuniga Chavarria MA, Quesada Mora AM, Aguirre-Avalos G, Mijangos-Méndez JC, Sassoe-Gonzalez A, Millán-Castillo CM, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Hernandez-Chena BE, Jarad RMA, Villegas-Mota MI, Montoya-Malváez M, Aguilar-de-Moros D, Castaño-Guerra E, Córdoba J, Castañeda-Sabogal A, Medeiros EA, Fram D, Dueñas L, Carreazo NY, Salgado E, Rosenthal VD. Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings. World J Urol 2023; 41:3599-3609. [PMID: 37823942 DOI: 10.1007/s00345-023-04645-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries. METHODS From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period. RESULTS 31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01-1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01-1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06-1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08-1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75-4.49; p < 0.0001. The periods 2014-2016 and 2017-2019 had significantly higher risks than the period 2020-2022. Suprapubic catheters showed similar risks as indwelling catheters. CONCLUSION The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.
Collapse
Affiliation(s)
- Ruijie Yin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA
| | - Zhilin Jin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA
| | | | | | - Juan Pablo Stagnaro
- Instituto Central De Medicina, La Plata, Provincia de Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | - Judith Córdoba
- Hospital del Niño Dr José Renán Esquivel, Panama, Panama
| | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Hospital de Emergencias Pediatricas, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Estuardo Salgado
- Department of Infection Control, Hospital Marie Curie, Quito, Ecuador
| | - Victor Daniel Rosenthal
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA.
- International Nosocomial Infection Control Consortium, INICC Foundation, Miami, USA.
| |
Collapse
|
2
|
Rosenthal VD, Jin Z, Valderrama-Beltran SL, Gualtero SM, Linares CY, Aguirre-Avalos G, Mijangos-Méndez JC, Ibarra-Estrada MÁ, Jiménez-Alvarez LF, Reyes LP, Alvarez-Moreno CA, Zuniga-Chavarria MA, Quesada-Mora AM, Gomez K, Alarcon J, Millan-Oñate J, Aguilar-de-Moros D, Castaño-Guerrero E, Córdoba J, Sassoe-Gonzalez A, Millán-Castillo CM, Leyva-Xotlanihua L, Aguilar-Moreno LA, Bravo-Ojeda JS, Gutierrez-Tobar IF, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Flores-Sánchez BM, Cano-Medina YA, Chapeta-Parada EG, Gonzalez-Niño RA, Villegas-Mota MI, Montoya-Malváez M, Cortés-Vázquez MÁ, Medeiros EA, Fram D, Vieira-Escudero D, Dueñas L, Carreazo NY, Salgado E, Yin R. Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries. Am J Infect Control 2023; 51:1114-1119. [PMID: 36921694 DOI: 10.1016/j.ajic.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. METHODS From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). RESULTS About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk. CONCLUSIONS Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.
Collapse
Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, FL, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Miguel Ángel Ibarra-Estrada
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | - Judith Córdoba
- Hospital del Niño Dr José Renán Esquivel, Panama, Panama
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Hospital de Emergencias Pediatricas, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
3
|
Rosenthal VD, Jin Z, Valderrama-Beltran SL, Gualtero SM, Linares CY, Aguirre-Avalos G, Mijangos-Méndez JC, Ibarra-Estrada MÁ, Jimenez-Alvarez LF, Reyes LP, Alvarez-Moreno CA, Zuniga-Chavarria MA, Quesada-Mora AM, Gomez K, Alarcon J, Oñate JM, Aguilar-De-Moros D, Castaño-Guerra E, Córdoba J, Sassoe-Gonzalez A, Millán-Castillo CM, Xotlanihua LL, Aguilar-Moreno LA, Bravo-Ojeda JS, Gutierrez-Tobar IF, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Flores-Sánchez BM, Cano-Medina YA, Chapeta-Parada EG, Gonzalez-Niño RA, Villegas-Mota MI, Montoya-Malváez M, Cortés-Vázquez MÁ, Medeiros EA, Fram D, Vieira-Escudero D, Yin R. Multinational prospective cohort study over 24 years of the risk factors for ventilator-associated pneumonia in 187 ICUs in 12 Latin American countries: Findings of INICC. J Crit Care 2023; 74:154246. [PMID: 36586278 DOI: 10.1016/j.jcrc.2022.154246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/07/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA; International Nosocomial Infection Control Consortium (INICC) Foundation, Miami, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Miguel Ángel Ibarra-Estrada
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| |
Collapse
|
4
|
Rosenthal VD, Yin R, Valderrama-Beltran SL, Gualtero SM, Linares CY, Aguirre-Avalos G, Mijangos-Méndez JC, Ibarra-Estrada MÁ, Jimenez-Alvarez LF, Reyes LP, Alvarez-Moreno CA, Zuniga-Chavarria MA, Quesada-Mora AM, Gomez K, Alarcon J, Oñate JM, Aguilar-De-Moros D, Castaño-Guerra E, Córdoba J, Sassoe-Gonzalez A, Millán-Castillo CM, Xotlanihua LL, Aguilar-Moreno LA, Ojeda JSB, Tobar IFG, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Flores-Sánchez BM, Cano-Medina YA, Chapeta-Parada EG, Gonzalez-Niño RA, Villegas-Mota MI, Montoya-Malváez M, Cortés-Vázquez MÁ, Medeiros EA, Fram D, Vieira-Escudero D, Jin Z. Multinational Prospective Cohort Study of Mortality Risk Factors in 198 ICUs of 12 Latin American Countries over 24 Years: The Effects of Healthcare-Associated Infections. J Epidemiol Glob Health 2022; 12:504-515. [PMID: 36197596 DOI: 10.1007/s44197-022-00069-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America. METHODS A prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression. RESULTS Between 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06-1.30; p < 0.0001); catheter-associated urinary tract infection (CAUTI) acquisition (aOR = 1.34; 95% CI: 1.15-1.56; p < 0.0001); older age, rising risk 2% yearly (aOR = 1.02; 95% CI: 1.01-1.02; p < 0.0001); longer indwelling central line(CL)-days, rising risk 3% daily (aOR = 1.03; 95% CI: 1.02-1.03; p < 0.0001); longer indwelling urinary catheter(UC)-days, rising risk 1% daily (aOR = 1.01; 95% CI: 1.01-1.26; p < 0.0001); higher mechanical ventilation (MV) (aOR = 6.47; 95% CI: 5.96-7.03; p < 0.0001) and urinary catheter-utilization ratio (aOR = 1.19; 95% CI: 1.11-1.27; p < 0.0001); lower-middle level income country (aOR = 2.94; 95% CI: 2.10-4.12; p < 0.0001); private (aOR = 1.50; 95% CI: 1.27-1.77; p < 0.0001) or public hospital (aOR = 1.47; 95% CI: 1.24-1.74; p < 0.0001) compared with university hospitals; medical hospitalization instead of surgical (aOR = 1.67; 95% CI: 1.59-1.75; p < 0.0001); neurologic ICU (aOR = 4.48; 95% CI: 2.68-7.50; p < 0.0001); adult oncology ICU (aOR = 3.48; 95% CI: 2.14-5.65; p < 0.0001); and others. CONCLUSION Some of the identified mortality RFs are unlikely to change, such as the income level of the country, facility ownership, hospitalization type, ICU type, and age. But some of the mortality RFs we found can be changed, and efforts should be made to reduce CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and lower VAPs and CAUTI rates.
Collapse
Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. .,INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Miguel Ángel Ibarra-Estrada
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | - Judith Córdoba
- Hospital del Nino Dr Jose Renan Esquivel, Panama, Panama
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
5
|
Arriero GD, Taminato M, Kusahara DM, Fram D. Compliance to empirical contact precautions for multidrug-resistant microorganisms. Am J Infect Control 2020; 48:840-842. [PMID: 31733810 DOI: 10.1016/j.ajic.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
Health care-associated infections impact patient morbidity and mortality, and institutions adopt evidence-based measures to prevent and control such infections. In this study, professionals were observed during patient care under empirical contact precautions. A total of 243 observations were performed in which 39.5% complied with all measures. The positivity rate of surveillance cultures was 38.36%, and adherence to the measures in patients with colonization was 43.1%.
Collapse
|
6
|
Taminato M, Fram D, Pereira RRF, Sesso R, Belasco AGS, Pignatari AC, Barbosa DA. Infection related to Klebsiella pneumoniae producing carbapenemase in renal transplant patients. Rev Bras Enferm 2019; 72:760-766. [PMID: 31269143 DOI: 10.1590/0034-7167-2019-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/23/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the risk factors related to Klebsiella pneumoniae carbapenemase infection after renal transplantation. METHODS This was a retrospective epidemiological (case-control) study, conducted from October 2011 to march 2016. Transplanted patients with infection by this bacteria during hospitalization were selected as cases. The controls were paired by age, sex, type of donor and transplant time. The proportion of cases and controls was 1:2. RESULTS Thirty hundred and five patients were included in the study (45 cases and 90 controls). The risk factors found for infection by KPC were: time of hospitalization after the transplant (OR: 4.82; CI95% 2.46-9.44), delayed kidney function (OR: 5.60; CI95% 1.91-11.01) and previous infectious for another microorganism ( OR: 34.13 CI95% 3.52-132.00). CONCLUSION The risk of acquisition of this bacterium was directly related to invasive procedures and exposure to the hospital environment. The findings reinforce the importance of prevention measures and control of infection by this microorganism.
Collapse
Affiliation(s)
| | - Dayana Fram
- Universidade Federal de São Paulo. São Paulo, Brasil
| | | | - Ricardo Sesso
- Universidade Federal de São Paulo. São Paulo, Brasil
| | | | | | | |
Collapse
|
7
|
Alecrim RX, Taminato M, Belasco A, Longo MCB, Kusahara DM, Fram D. Strategies for preventing ventilator-associated pneumonia: an integrative review. Rev Bras Enferm 2019; 72:521-530. [DOI: 10.1590/0034-7167-2018-0473] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/20/2018] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to identify studies about strategies for prevention of ventilator-associated pneumonia deployed in health services and classify their level of evidence. Method: integrative review of the literature, in 7 databases, which included the following descriptors: Prevention and Control AND Pneumonia Ventilator-Associated AND Intensive Care Units AND Bundle AND Patient Care. Results: twenty-three scientific productions were included. Of the preventive measures identified, 9 (39.1%) correspond from three to five strategies. The most frequent were: 22 (95.6%) lying with head elevated, 19 (82.6%) oral hygiene with chlorhexidine and 14 (60.8%) reduction of sedation whenever possible. Final Consideration: the application of measures based on scientific evidence is proven to be effective when carried out in conjunction, impacting the reduction of the incidence of ventilator-associated pneumonia.
Collapse
Affiliation(s)
| | | | | | | | | | - Dayana Fram
- Universidade Federal de São Paulo, Brazil; Universidade Federal de São Paulo, Brazil
| |
Collapse
|
8
|
Alecrim RX, Taminato M, Belasco AGS, Barbosa D, Kusahara DM, Fram D. Boas práticas na prevenção de pneumonia associada à ventilação mecânica. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Avaliar a adesão dos profissionais de saúde a um conjunto de boas práticas de prevenção de Pneumonia Associada à Ventilação Mecânica, índice de conformidade às medidas individuais e associação de características clínicas dos pacientes e adesão ao conjunto de boas práticas com a pneumonia. Métodos: Estudo de coorte prospectivo realizado em uma Unidade de Terapia Intensiva de um hospital universitário no período de maio de 2017 a outubro de 2017. A amostra foi composta por pacientes internados no período do estudo, que preencheram os critérios de inclusão, a coleta de dados foi realizada por meio de consulta a prontuários. Resultados: O item com maior adesão foi a avaliação diária da sedação e redução sempre que possível, 81 (91,0%), seguido da troca do circuito a cada 7 dias, 76 (82,6). A manutenção da pressão do cuff entre 20 e 30 mm H2O foi o item com menor adesão 22 (23,9%). A adesão ao conjunto completo apresentou conformidade em 20 (21,7%) das oportunidades. O estudo mostrou que quanto maior a adesão às medidas de boas práticas, menor é o risco de Pneumonia Associada à Ventilação Mecânica, porém não foi um dado estatisticamente significante. Os pacientes cirúrgicos e em uso de ventilação mecânica apresentaram maior risco de desenvolver PAV (p= 0,05). Conclusão: A Pneumonia Associada à Ventilação Mecânica pode trazer grave repercussão para o paciente, a aplicação de medidas com embasamento científico é fundamental, a fim de se prevenir a ocorrência deste agravo, que é uma das mais frequentes infecções relacionadas à assistência à saúde dentro das Unidades de Terapia Intensiva brasileiras.
Collapse
Affiliation(s)
| | | | | | | | | | - Dayana Fram
- Universidade Federal de São Paulo, Brasil; Universidade Federal de São Paulo, Brasil
| |
Collapse
|
9
|
Araújo NSS, Pereira RRF, Fram D, Hino P, Longo MCB, Taminato M. Quality of life in children with kidney transplant: Systematic review. Rev Bras Enferm 2018; 71:2818-2823. [PMID: 30540061 DOI: 10.1590/0034-7167-2018-0464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/30/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify in the literature studies that evaluate the quality of life in pediatric patients with kidney transplant through use of specific, validated instruments in Pediatrics. METHOD Systematic review of the literature with searches conducted in the following databases: Medline, PubMed, LILACS, CINAHL, SciELO and Cochrane Library. Main keywords: Quality of life, Kidney transplantation and Pediatrics. RESULTS A total of 366 studies were selected and eight observational studies were included that evaluated the quality of life of children with kidney transplant by means of evaluation instruments of quality of life. CONCLUSION The quality of life of children with kidney transplant is inferior compared to healthy children. The post-transplant period presents better results compared to pre-transplant children. The identification of mental, physical and social conditions related to the quality of life of this population allows for better planning the assistance provided to them.
Collapse
Affiliation(s)
| | | | - Dayana Fram
- Universidade Federal de São Paulo, Paulista Nursing School. São Paulo, São Paulo, Brazil
| | - Paula Hino
- Universidade Federal de São Paulo, Paulista Nursing School. São Paulo, São Paulo, Brazil
| | | | - Monica Taminato
- Universidade Federal de São Paulo, Paulista Nursing School. São Paulo, São Paulo, Brazil
| |
Collapse
|
10
|
Federico MP, Escudero DVDS, Fram D, Furtado GHC. ESTUDO DE TENDÊNCIA DA RESISTÊNCIA ANTIMICROBIANA DE ESCHERICHIA COLI EM UM HOSPITAL UNIVERSITÁRIO DE SÃO PAULO: SÉRIE TEMPORAL DE DEZ ANOS. Braz J Infect Dis 2018. [DOI: 10.1016/j.bjid.2018.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
11
|
Oliveira MSD, Silva RPM, Valle SDCND, Figueiredo END, Fram D. Chronic hepatitis B and D: prognosis according to Child-Pugh score. Rev Bras Enferm 2018; 70:1048-1053. [PMID: 28977233 DOI: 10.1590/0034-7167-2016-0205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/17/2017] [Indexed: 01/27/2023] Open
Abstract
Objective: compare chronic hepatitis B patients to those superinfected with hepatitis D virus, according to Child-Pugh score regarding disease severity. Method: retrospective descriptive study, performed with 59 patients followed in the ambulatory, of which 22 (37.3%) were chronically infected with hepatitis B virus (Group HBV) and 37 (62.7%) superinfected with Delta virus (Group HBV+HDV); variables of sex, age and items of Child-Pugh score were collected by consulting medical records. Results: out of the patients, 57.6% were male, with a mean age of 30.5 years. Score A, which indicates lesser severity, was found in 100% of group HBV and 78.4% of group HBV+HDV. Score B, which indicates greater severity, was found only in group HBV+HDV in 21.6% of the patients. Conclusion: by means of the Child-Pugh score, it was observed that patients with superinfection by HDV tended to present a worse prognosis. Objetivo: comparar os pacientes com hepatite B crônica com superinfectados pelo vírus D segundo escore de Child-Pugh quanto à gravidade da doença. Método: estudo descritivo retrospectivo, realizado com 59 pacientes acompanhados em ambulatório, sendo 22 (37,3%) cronicamente infectados pelo vírus da hepatite B (Grupo VHB) e 37 (62,7%) com superinfecção por vírus Delta (Grupo VHB+VHD); foram coletadas variáveis quanto ao sexo, idade e referentes ao escore de Child-Pugh por meio de consulta a prontuários. Resultados: entre os pacientes 57,6% era do sexo masculino, com idade média de 30,5 anos. O escore A, que indica menor gravidade, foi encontrado em 100% do grupo VHB e 78,4% do grupo VHB+VHD. O escore B, que indica maior gravidade, foi encontrado apenas no grupo VHB+VHD em 21,6% dos pacientes. Conclusão: por meio do escore de Child-Pugh, observou-se que os pacientes com superinfecção por VHD tendem a apresentar pior prognóstico.
Collapse
Affiliation(s)
- Marcelo Siqueira de Oliveira
- Universidade Federal de São Paulo, Paulista Nursing School, Postgraduate Program in Nursing. São Paulo, Brazil.,Universidade Federal do Acre, Multidisciplinary Center of Cruzeiro do Sul. Cruzeiro do Sul, Acre, Brazil
| | | | | | | | - Dayana Fram
- Universidade Federal de São Paulo, Paulista Nursing School, Department of Clinical and Surgical Nursing. São Paulo, Brazil
| |
Collapse
|
12
|
Oliveira MSD, Valle SDCND, Souza RMD, Silva RPM, Figueiredo END, Taminato M, Fram D. Evidências científicas sobre a hepatite Delta no Brasil: revisão integrativa da literatura. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Resumo Objetivo: Descrever o nível de evidência científica sobre a infecção por vírus da hepatite Delta (VHD) no Brasil. Métodos: Revisão integrativa da literatura, com buscas realizadas nas bases de dados do Medical Literature Analysis and Retrieval System Online, Literatura Latino-americana e do Caribe em Ciências da Saúde, Scientific Eletronic Library Online e Scopus, com análise centrada no nivelamento do rigor metodológico de acordo com o modelo de Melnyk e Fineout-Overholt. Resultados: A busca revelou uma média de duas publicações por ano no intervalo entre 1987 e 2017. Foram selecionados 33 artigos, tendo a maioria (91%) apresentado nível de evidência VI. As publicações ficaram concentradas em periódicos da área de medicina tropical (46%) e virologia (15%). Dos trabalhos, 85% tinha profissional médico com autor e o delineamento mais encontrado foi o descritivo/transversal (69,6%). Conclusão: A produção científica sobre a infecção por VHD no Brasil está centrada em estudos de prevalência, mostrando-se incipiente quanto à produção de estudos com delineamentos mais rígidos como ensaios clínicos.
Collapse
|
13
|
Taminato M, Fram D, Grothe C, Pereira RRF, Belasco A, Barbosa D. [Prevalence of infection in kidney transplantation from living versus deceased donor: systematic review and meta-analysis]. Rev Esc Enferm USP 2015; 49:509-14. [PMID: 26107713 DOI: 10.1590/s0080-623420150000300020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 02/20/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To verify if the type of donor is a risk factor for infection in kidney transplant recipients. METHODS Systematic Review of Literature with Meta-analysis with searches conducted in the databases MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO and CINAHL. RESULTS We selected 198 studies and included four observational studies describing infections among patients distinguishing the type of donor. Through meta-analysis, it was shown that in patients undergoing deceased donor transplant, the outcome infection was 2.65 higher, than those who received an organ from a living donor. CONCLUSION The study showed that deceased kidney donor recipients are at an increased risk for developing infections and so the need for establishing and enforcing protocols from proper management of ischemic time to the prevention and control of infection in this population emerges.
Collapse
Affiliation(s)
- Mônica Taminato
- Paulista School of Nursing, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Dayana Fram
- Paulista School of Nursing, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Cibele Grothe
- Paulista School of Nursing, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Angélica Belasco
- School of Nursing, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Dulce Barbosa
- Paulista School of Nursing, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| |
Collapse
|
14
|
Fram D, Okuno MFP, Taminato M, Ponzio V, Manfredi SR, Grothe C, Belasco A, Sesso R, Barbosa D. Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case-control study. BMC Infect Dis 2015; 15:158. [PMID: 25879516 PMCID: PMC4377039 DOI: 10.1186/s12879-015-0907-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/13/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Infection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis. METHODS Risk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case-control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis. RESULTS There were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17-24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9-23.09). CONCLUSIONS Infection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.
Collapse
Affiliation(s)
- Dayana Fram
- School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil.
| | - Meiry Fernanda Pinto Okuno
- School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil.
| | - Mônica Taminato
- School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil.
- Infection Control Unit, Children's Institute and Institute for the Treatment of Childhood Cancer, School of Medicine, Universidade de São Paulo (University of São Paulo - ITACI/FMUSP), Av. Dr. Enéas Carvalho de Aguiar 647, São Paulo, 05403-000, Brazil.
| | - Vinicius Ponzio
- Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo (Paulista School of Medicine, Federal University of São Paulo - EPM/UNIFESP), R. Napoleão de Barros, 715, 7° andar, São Paulo, 04024-002, Brazil.
| | - Silvia Regina Manfredi
- Division of Dialysis, Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, (Kidney and Hypertension Hospital, Foundation Oswaldo Ramos - HRIM/FOR), R. Pedro de Toledo 282, São Paulo, 04039-030, Brazil.
| | - Cibele Grothe
- School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil.
| | - Angélica Belasco
- School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil.
| | - Ricardo Sesso
- Division of Nephrology, Paulista School of Medicine, Universidade Federal de São Paulo (Federal University of São Paulo - EPM/UNIFESP), R. Botucatu 740, São Paulo, 04023-900, Brazil.
| | - Dulce Barbosa
- School of Nursing, Paulista School of Nursing, Universidade Federal de São Paulo (Federal University of São Paulo - EPE/UNIFESP), R. Napoleão de Barros 754, São Paulo, 04024-002, Brazil.
| |
Collapse
|
15
|
Fram D, Taminato M, Ponzio V, Manfredi SR, Grothe C, Batista REA, Belasco A, Barbosa D. Risk factors for morbidity and mortality of bloodstream infection in patients undergoing hemodialysis: a nested case-control study. BMC Res Notes 2014; 7:882. [PMID: 25481650 PMCID: PMC4295365 DOI: 10.1186/1756-0500-7-882] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/21/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Infection is the leading cause of morbidity and the second most frequent cause of mortality among patients on renal replacement therapy. A major morbid event in this population is hospitalization because of infection. The aim of this study was to investigate the risk factors for morbidity and mortality related to bloodstream infection (BSI) among patients on hemodialysis. RESULTS Risk factors for morbidity and mortality related to BSI in patients on hemodialysis were investigated retrospectively by nested case-control, from January 2010 to June 2013. Patients were divided into two groups: those who progressed to hospitalization or death due to BSI (Group 1) and those who developed BSI, but did not progress to the same outcome (Group 2). Data were collected through consultation of patient records. For statistical analysis, logistic regression was used. There were 32 patients in Group 1 and 61 in Group 2. Logistic regression verified that, for each year of age, the chance of death or hospitalization for BSI increased 1.05 times [95% confidence interval (CI): 1.02-1.09]. Patients with BSI caused by Staphylococcus aureus had an 8.67 times higher chance of progressing to death or hospitalization (95% CI: 2.5-30.06). The isolation of multiresistant microorganisms in blood cultures of hemodialysis patients increased morbidity and mortality by 2.75 times (95% CI: 1.01-7.48). CONCLUSION Independent risk factors for morbidity and mortality among patients after developing BSI during hemodialysis were: age, blood culture positive for S. aureus, and antibiotic resistance. Control measures to prevent microbial dissemination, primarily the multiresistant ones, should be intensified in this population. More studies are needed to standardize specific measures not yet classically standardized, such as collection of surveillance culture samples, contact precautions, and decolonization.
Collapse
Affiliation(s)
- Dayana Fram
- School of Nursing, Escola Paulista de Enfermagem, Universidade Federal de São Paulo (School of Nursing, Federal University of São Paulo - EPE/UNIFESP), R, Napoleão de Barros 754, São Paulo, SP ZIP 04024-002, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Aoki BB, Fram D, Taminato M, Batista RES, Belasco A, Barbosa DA. Acute kidney injury after contrast-enhanced examination among elderly. Rev Lat Am Enfermagem 2014; 22:637-44. [PMID: 25296148 PMCID: PMC4292656 DOI: 10.1590/0104-1169.3440.2462] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 05/20/2014] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES to assess renal function in elderly patients undergoing contrast-enhanced computed tomography and identify the preventive measures of acute kidney injury in the period before and after the examination. METHOD longitudinal cohort study conducted at the Federal University of São Paulo Hospital, from March 2011 to March 2013. All hospitalized elderly, of both sexes, aged 60 years and above, who performed the examination, were included (n=93). We collected sociodemographic data, data related to the examination and to the care provided, and creatinine values prior and post exam. RESULTS an alteration in renal function was observed in 51 patients (54%) with a statistically significant increase of creatinine values (p<0.04), and two patients (4.0%) required hemodialysis. CONCLUSION There is an urgent need for protocols prior to and post contrast-enhanced examination in the elderly, and other studies to verify the prognosis of this population.
Collapse
Affiliation(s)
- Beatriz Bonadio Aoki
- Master's student, Escola Paulista de Enfermagem, Universidade Federal
de São Paulo, São Paulo, SP, Brazil
| | - Dayana Fram
- Doctoral student, Escola Paulista de Enfermagem, Universidade Federal
de São Paulo, São Paulo, SP, Brazil
| | - Mônica Taminato
- Doctoral student, Escola Paulista de Enfermagem, Universidade Federal
de São Paulo, São Paulo, SP, Brazil
| | - Ruth Ester Sayad Batista
- PhD, Adjunct Professor, Escola Paulista de Enfermagem, Universidade
Federal de São Paulo, São Paulo, SP, Brazil
| | - Angélica Belasco
- PhD, Adjunct Professor, Escola Paulista de Enfermagem, Universidade
Federal de São Paulo, São Paulo, SP, Brazil
| | - Dulce Aparecida Barbosa
- PhD, Associate Professor, Escola Paulista de Enfermagem, Universidade
Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
17
|
Taminato M, Fram D, Torloni MR, Belasco AGS, Saconato H, Barbosa DA. Screening for group B Streptococcus in pregnant women: a systematic review and meta-analysis. Rev Lat Am Enfermagem 2012; 19:1470-8. [PMID: 22249684 DOI: 10.1590/s0104-11692011000600026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 09/20/2011] [Indexed: 11/21/2022] Open
Abstract
Infection with Group B Streptococcus (GBS) is considered an important public health problem. It is associated with: Neonatal sepsis, meningitis, pneumonia, neonatal death, septic abortion, chorioamnionitis, endometritis and other perinatal infections. The aim of this study was to determine the best screening strategy for GBS in pregnant women. For this a systematic review and meta-analysis were carried out in the Nursing Department of the Federal University of São Paulo, Cochrane Center, Brazil. Sources used were, EMBASE, LILACS, Medline, list of references, personal communication and the Cochrane library. The criterion for the selection of the studies was; studies which analyze some type of screening for GBS in pregnant women. Independent of the comparator, all analyses were in favor of a universal screening program for reducing the incidence of neonatal sepsis. The evidence obtained in this study suggests that the strategy of universal screening of pregnant women associated with the use of prophylactic antibiotics is safe and effective.
Collapse
Affiliation(s)
- Mônica Taminato
- Departamento de Enfermagem, Universidade Federal de São Paulo, SP, Brazil.
| | | | | | | | | | | |
Collapse
|
18
|
Fram D, Castrucci F, Taminato M, Godoy-Martinez P, Freitas M, Belasco A, Sesso R, Pacheco-Silva A, Pignatari A, Barbosa D. Cross-transmission of vancomycin-resistant Enterococcus in patients undergoing dialysis and kidney transplant. Braz J Med Biol Res 2010. [DOI: 10.1590/s0100-879x2010000100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
19
|
Fram D, Castrucci FM, Taminato M, Godoy-Martinez P, Freitas MCS, Belasco A, Sesso R, Pacheco-Silva A, Pignatari AC, Barbosa D. Cross-transmission of vancomycin-resistant Enterococcus in patients undergoing dialysis and kidney transplant. Braz J Med Biol Res 2009; 43:115-9. [PMID: 19967262 DOI: 10.1590/s0100-879x2009007500023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 11/16/2009] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to investigate the occurrence of vancomycin-resistant Enterococcus (VRE) cross-transmission between two patient groups (long-term dialysis and kidney transplant patients). Molecular typing, by automated ribotyping with the RiboPrinter Microbial Characterization System (Qualicon, USA), was used to analyze VRE isolates from 31 fecal samples of 320 dialysis patients and 38 fecal samples of 280 kidney transplant patients. Clonal spread of E. faecalis and E. casseliflavus was observed intragroup, but not between the two groups of patients. In turn, transmission of E. gallinarum and E. faecium between the groups was suggested by the finding of vancomycin-resistant isolates belonging to the same ribogroup in both dialysis and transplant patients. The fact that these patients were colonized by VRE from the same ribogroup in the same health care facility provides evidence for cross-transmission and supports the adoption of stringent infection control measures to prevent dissemination of these bacteria.
Collapse
Affiliation(s)
- D Fram
- Departamento de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Azar R, McKay R, Nassif R, Pohl A, Fram D, Hirst J, Mennett R, Mitchell J, Waters D, Kiernan F. Women experience more cardiac events than men after primary coronary angioplasty for acute myocardial infarction. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)80483-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Abstract
Transient visual-evoked cortical potentials (VECP's) were recorded for equal luminance chromatic flashes presented against a dark background and for substitutions of chromatic stimuli for achromatic fields of equal luminance. The VECP's for the flashed targets had larger amplitudes and shorter latencies than those for the substituted targets. These findings are consistent with previous psychophysical data which suggest that colored stimuli are processed in a short-latency achromatic channel and a long-latency chromatic channel. Subsequent factor analyses of the VECP's revealed a component which was interpreted as activity in the achromatic channel. These factor analyses also revealed three additional components which were tentatively identified as indications of previously undocumented high-level luminance and color processing mechanisms. Problems associated with the factor analytic approach to VECP waveform analysis are also discussed.
Collapse
|
22
|
Wilson A, Fram D, Sistar J. Implementation of a microprocessor-based visual-evoked cortical potential recording and analysis system. Am J Optom Physiol Opt 1981; 58:481-5. [PMID: 7270657 DOI: 10.1097/00006324-198106000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
An Imsai 8080 microcomputer is being used to simultaneously generate a color graphics stimulus display and to record visual-evoked cortical potentials. A brief description of the hardware and software developed for this system is presented. Data storage and analysis techniques are also discussed.
Collapse
|
23
|
Gillin JC, Wyatt RJ, Fram D, Snyder F. The relationship between changes in REM sleep and clinical improvement in depressed patients treated with amitriptyline. Psychopharmacology (Berl) 1978; 59:267-72. [PMID: 216045 DOI: 10.1007/bf00426633] [Citation(s) in RCA: 115] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
EEG sleep recordings were obtained on consecutive nights from six hospitalized depressed patients before, during, and after treatment with amitriptyline for a total of 370 nights of data, about 85% of all nights of the study. Amitriptyline significantly reduced time spent in rapid eye movement (REM) sleep and prolonged the REM latency throughout the treatment period. Three patients who improved during treatment showed a REM rebound when amitriptyline was discontinued, whereas three patients who did not improve showed no REM rebound.
Collapse
|