Hospital Alvorada

Resumo O estudo investiga como a Inteligência Artificial (IA) pode aprimorar a gestão de projetos públicos, promovendo eficiência, transparência e eficácia na administração pública. O objetivo é compreender o impacto da IA na execução e controle de projetos públicos, destacando seus benefícios e desafios. A metodologia adotada consiste em uma pesquisa bibliográfica e análise crítica de literatura nacional e internacional, com base em artigos e estudos de caso sobre a aplicação da IA no setor público. Os resultados evidenciam que a IA contribui para a automação de processos, otimização de recursos e melhoria da tomada de decisão, além de fortalecer a transparência e o combate à corrupção por meio da análise de grandes volumes de dados. No entanto, desafios como viés algorítmico, privacidade de dados e governança ainda limitam seu uso equitativo. Conclui-se que a IA pode ser uma ferramenta poderosa para modernizar a administração pública, desde que sua implementação seja orientada por transparência, responsabilidade e engajamento cidadão.

Aim The microbial epidemiology and antimicrobial resistance (AMR) patterns of fracture-related infections (FRIs) remain underexplored in Brazil, both regionally and nationwide. This knowledge gap limits effective local management strategies due to distinct scenario of AMR across Brazilian hospital settings. We aimed to address this issue in a multicenter prospective observational cohort study conducted in eleven Brazilian hospitals from different regions involving FRI patients. Method Clinical data were prospectively collected using the REDCap® electronic platform. Bacterial isolates were identified by MALDI-TOF MS, and antibiotic susceptibility testing was performed using disk diffusion and microdilution methods. Statistical analyses were conducted using the Chi-squared test. Results Among 197 FRI patients analyzed (70.6% male, median age of 49 years [IQR 36–64]), lower limb fractures predominated (74.6%), with 25.4% classified as open fractures (54.9% Gustilo III). Recurrences rates were highest with Staphylococcus aureus infection (31%, p =0.05), and DAIR (debridement, antibiotic and implant retention) approach (39%, p =0.02). Analysis of 312 isolates from 199 culture-positive cases revealed polymicrobial infections in 40.6%, with distinct geographic variation (highest in Paraná, p =0.02). Gram-negative bacilli (GNB) comprised 38.5% of all isolates but 46.1% in polymicrobial infections ( p =0.03). Overall, predominant pathogens included S. aureus (36.5%), Enterobacteriaceae (18.9%), CoNS (12.2%), Pseudomonas spp. (9.0%), and Enterococcus spp. (7.1%). While S. aureus dominated monomicrobial infections (61%, p <0.001), Enterobacteriaceae, CoNS, and Enterococcus were more frequent in polymicrobial cases ( p <0.05). Regional disparities included higher Pseudomonas spp. in Rio de Janeiro ( p =0.02) and “Other Gram-positive” isolates in São Paulo (88.9%, p <0.01). MRSA comprised 35.1% of S. aureus starins. Additionally, AMR Profiles for S. aureus highlighted Erythromycin resistance of 70% (range: 50–80% by state), while linezolid, tetracycline, and SMX-TMP showed lower resistance rates (5%), Clindamycin resistance varied regionally (São Paulo: 48%, p=0.05; Rio de Janeiro: 11%, p=0.03). Among Enterobacteriaceae, high tetracycline resistance was identified (47% overall; 88% in Rio de Janeiro, p=0.02). Meropenem, piperacillin-tazobactam, and gentamicin exhibited the lowest resistance rates (12–19%), with 14.5% ESBL producers. Conclusions This large national multicenter study highlights S. aureus (including MRSA) as the predominant pathogen in Brazilian FRIs, with alarming recurrence rates for DAIR procedures (39%), reinforcing the need to redefine surgical strategies to improve outcomes. Polymicrobial infections (40.6%) exhibited geographic variability (notably in Paraná) and regional disparities in pathogen distribution ( Pseudomonas in Rio) and resistance patterns (clindamycin: 11–48%) underscoring the urgency of localized stewardship. These findings demand targeted microbiological epidemiology studies to optimize FRI management.

To evaluate tuberculosis diagnosis with the use of the lateral flow urine lipoarabinomannan assay (LF-LAM) in addition to the Xpert® MTB/RIF Ultra assay on sputum in HIV-positive inpatients and outpatients. This was a prospective cross-sectional study including HIV-positive patients ≥ 18 years of age with an indication for LF-LAM in accordance with Brazilian National Ministry of Health criteria. A total of 140 patients were included in the study. LF-LAM was positive in 23 (16.4%). An additional 12 (8.6%) were diagnosed with the aid of LF-LAM, this increase in tuberculosis detection being statistically significant. LF-LAM-positive patients were younger and had lower CD4 counts in comparison with LF-LAM-negative patients. Smoking was more common among LF-LAM-negative patients than among LF-LAM-positive patients. The use of LF-LAM significantly increases the detection of tuberculosis in HIV-positive patients, mostly in those who are hospitalized. These findings highlight the utility of LF-LAM, especially in regions with high tuberculosis and HIV infection incidence.

Aims & Objectives: In the hospital setting, the technique of intravenous venipuncture is widely employed, particularly through the insertion of peripheral venous catheters for intravenous therapy, marking it as one of the most commonly performed interventions by nursing staff. However, puncturing a peripheral vein can pose a challenge for healthcare professionals, especially when dealing with pediatric patients, due to the small size of their veins. In this context, the use of ultrasound technology not only reduces the discomfort experienced by children during multiple puncture attempts but also enhances parental satisfaction with the quality of care provided. This report aims to elucidate how the utilization of ultrasound-guided puncture, within the nursing practice, can significantly minimize the necessity for multiple puncture attempts. Methods: Experience report conducted at a large hospital in São Paulo in pediatric units for children identified with difficult intravenous access (DIVA) after unsuccessful attempts at conventional puncture. In these cases, the vascular access and infusion therapy team was called upon to perform ultrasound-guided puncture. Results: It was observed that out of 53 children attended from January 2021 to June 2023 with an average age between (0 to 7 years), the success rate on the 1st attempt of puncture was 77.35%. Conclusions: Ultrasound-guided puncture for children encountering difficulties with intravenous access emerges as a highly effective strategy in pediatrics. This approach facilitates the delivery of intravenous therapy via peripheral veins, thus obviating the need for a peripherally inserted central catheter (PICC) or a central venous catheter (CVC) insertion in cases where conventional puncture techniques have proven unsuccessful. Keywords: difficult intravenous access, ultrasound-guided venipuncture

Aims & Objectives: Background: Length of stay is often utilized as a key indicator of hospital efficiency. Consequently, initiatives aimed at improving this and other metrics have spurred various efforts to elevate care standards, encompassing a thorough evaluation of diverse practical scenarios. Objective: To elucidate how the implementation of targeted data tabulation tools and regular multidisciplinary meetings played a pivotal role in successfully optimizing care for long-term patients in the pediatric ICU. This, in turn, facilitated early identification of potential cases, decreased length of stay, and bolstered overall hospital management. Methods: A descriptive study rooted in experiential insights, focusing on the reduction of length of stay for long-term patients within a prominent hospital located in São Paulo’s metropolitan area, specifically in the pediatric intensive care unit. Results: Several factors emerged as primary contributors to prolonged hospitalization. These factors were delineated in a tabular format to facilitate swift identification. Subsequently, the data were collated and deliberated upon during weekly multidisciplinary meetings. This iterative process enabled the identification and resolution of key factors contributing to prolonged patient stays in the intensive care unit, ultimately resulting in a reduction of long-term stay rates (hospitalization exceeding 10 days) from 13.17% (April/2023) to an average of 9.6% after 11 months of implementing weekly meetings. Conclusions: The identified factors hold significant potential for diminishing average length of stay, thereby curtailing hospital costs and enhancing bed turnover rates. Moreover, they serve to reinforce a culture of patient-centric care, addressing their needs and allaying discharge-related apprehensions effectively. Keywords: patient-centric care, prolonged hospitalization, long term patients

Antonini et al. evaluated gynecologists', obstetricians', and family and community physicians knowledge of breast cancer screening and their adherence to recommendations defined by the BI-RADS™ system. The study demonstrated that inadequate training resulted in insufficient screening and failure to follow the protocols recommended by the BIRADS™ system. ■ Variability in screening protocols: only 42.8% of gynecologists and obstetricians follow the 40-74 years protocol, while 76.6% of family physicians follow the 50-69 years protocol. ■ High rate of incorrect BIRADS. interpretation: there were 46.3% incorrect responses among gynecologists and obstetricians and 77.9% among family physicians, highlighting significant knowledge gaps. ■ Misconception about breast ultrasound: 39.1% of gynecologists and obstetricians and 20.3% of family physicians incorrectly consider ultrasound as a screening method. ■ Impact of inadequate training: inadequate training leads to improper screening practices that do not align with the BIRADS. recommended guidelines. To evaluate the knowledge and practices of gynecologists, obstetricians, and family and community physicians in Brazil regarding breast cancer screening, mammographic findings defined by the BIRADS™ system, and their approach to suspected clinical lesions. This was an observational, cross-sectional, descriptive study conducted using an online research questionnaire distributed via email to 9,000 gynecologists and obstetricians and 5,600 family and community and preventive medicine doctors actively practicing in Brazil. Among gynecologists and obstetricians, 42.8% follow the 40-74 years screening, 33.5% follow the 50-69 years screening, and 23.6% do not follow any specific protocol. Among the family and community physicians, 76.6% follow the 50-69 years screening protocol, and 23.4% do not follow any specific protocol. When we evaluated the responses regarding the behaviors of each BIRADS™ classification, 46.3% of responses were wrong among gynecologists and obstetricians, and 77.9% were wrong among community and preventive medicine doctors, exhibiting a significant difference. The role of breast ultrasound in screening was evaluated; 39.1% of gynecologists and obstetricians and 20.3% of community and preventive medicine doctors consider it as a screening method. Among gynecologists and obstetricians who do not follow any screening protocol, 94.7% consider ultrasound as a screening method. Among community and preventive medicine doctors, only 26.5% of physicians who follow the 50-69 years screening method consider it as a screening method. Inadequate training results in gynecologists and obstetricians, and family and community physicians performing inadequate screening and not following the recommended practices outlined in the BIRADS™ system.

O presente estudo teve como objetivo classificar e abordar o manejo dos episódios de exacerbação da Doença Pulmonar Obstrutiva Crônica (DPOC) e como as técnicas de reabilitação pulmonar podem melhorar o prognóstico e trazer qualidade de vida para os pacientes. A DPOC é uma doença prevalente no Brasil, tendo em vista que os maiores fatores de risco para o desenvolvimento da doença estão relacionados com o tabagismo e com a exposição à fumaça proveniente da combustão de diversos tipos de materiais e substâncias tóxicas e nocivas ao aparelho respiratório. A DPOC nada mais é do que uma inflamação dos alvéolos pulmonares e que ao longo de seu desenvolvimento pode gerar fibrose dos tecidos/estruturas pulmonares ocasionando um padrão obstrutivo do fluxo aéreo. A exacerbação da DPOC é caracterizada como agudização dos sintomas, como dispnéia, tosse, sibilância e, também, de complicações como infecção secundária ao processo inflamatório. Um dos maiores desafios do controle da doença está relacionado aos episódios de exacerbação que cursam com internação hospitalar, visto que é um preditor ruim de prognóstico do paciente. Portanto, o manejo desse paciente utilizando as técnicas de reabilitação pulmonar é tão importante quanto o tratamento farmacológico da doença, pois além de evitar novos episódios de exacerbação, também reduz o número de internações e impacta positivamente na qualidade de vida do paciente pneumopata. Ainda são necessários novos estudos a respeito da reabilitação pulmonar que intervenha de forma mais precoce nas doenças pulmonares de padrão obstrutivo, além de uma maior cobertura pelo SUS de equipes multiprofissionais que atuam em regime hospitalar e domiciliar.

O presente trabalho abordará a temática pertencente ao ramo do direito de família e sucessões, mais especificamente no que se refere a possibilidade da sucessão das mídias digitais analisando os limites regulados pelos princípios constitucionais de Privacidade e Intimidade. Também irá expor importantes decisões proferidas por tribunais nacionais sobre o tema, abordando igualmente propostas legislativas com a finalidade de regulamentação específica da sucessão digital, juntamente com o esclarecimento das medidas adotadas pelas plataformas fornecedoras dos serviços digitais frente aos usuários. O método adotado para o trabalho é a pesquisa bibliográfica qualitativa, com o intuito de aprimoramento teórico sobre a tema. A problemática se consiste em analisar como os tribunais de justiça estão decidindo sobre a sucessão digital frente a ausência de legislação inerente ao tema. Os resultados obtidos baseiam-se na possibilidade alternativa de planejamento sucessório dos bens e redes virtuais, a fim de afastar complicações na transmissão sucessória do acervo virtual do falecido, tendo em vista a extrema morosidade do Poder Legislativo quanto a promulgação de leis específicas para positivar o processo sucessório dos bens digitais.

O artigo centra-se no processo de obra da Casa em Alenquer, iniciada em 1995 – e encomendada por Emílio Vilar (1964- ). A investigação revisita a sua importância para o atelier Aires Mateus (1988) e as circunstâncias sobre a origem do ‘processo’. A obra teve relevância no percurso profissional de Francisco Aires Mateus (1964- ) e Manuel Aires Mateus (1963- ), pela presença disciplinar e mediática – inclusive ter sido publicada em 2001, antes de estar finalizada. Nesse sentido, questionam-se as investigações que a Casa em Alenquer desenvolveu e proporcionou: circunscrevendo em conceitos. O artigo recorre exclusivamente à análise de fontes primárias, não só desde as fotografias sobre a obra/processo, desenhos originais, entre outros, pertencentes do atelier e espólio físico-digital, como também dos diversos materiais de arquivo submetidos à Câmara Municipal de Alenquer para licenciamento. Assim, propõe-se uma análise sobre a materialização da obra. A partir de materiais nunca publicados, ambiciona-se revelar o ‘processo e construir uma ‘narrativa’ sobre a Casa em Alenquer.