WERTHER BRUNOW DE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Fluid Overload in the PICU: Still a Challenge(2018) COLLETI JUNIOR, Jose; CARVALHO, Werther Brunow de
- Changes in lipid metabolism in pediatric patients with severe sepsis and septic shock(2018) BERMUDES, Ana Carolina G.; CARVALHO, Werther B. de; ZAMBERLAN, Patricia; MURAMOTO, Giovana; MARANHAO, Raul C.; DELGADO, Artur F.Objectives: Limited knowledge exists regarding the lipid profiles of critically ill pediatric patients with systemic inflammatory response syndrome. The aim of this study was to evaluate the relationship between the intensity of the inflammatory response and changes in the lipid profiles of critically ill pediatric patients admitted to a pediatric intensive care unit (PICU) with severe sepsis/septic shock. Methods: This was a prospective and observational study at a 15-bed PICU at a public university hospital. We analyzed the lipid profiles of 40 patients with severe sepsis/septic shock admitted to the PICU on the first and seventh days of hospitalization. C-reactive protein was used as a marker for systemic inflammation. Forty-two pediatric patients seen in the emergency department and without systemic inflammatory response syndrome were used to provide control values. Results: On day 1 of admission to the PICU, the patients had significantly lower levels of total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) as well as higher concentrations of triacylglycerols compared with the control group. There was a significant increase in the TC, HDL, LDL, and apolipoprotein levels from day 1 to day 7 of the study. Conclusions: During severe sepsis/septic shock, we found lower serum levels of lipoproteins and apolipoproteins, and these were negatively correlated with C-reactive protein. As the inflammatory response improved, the levels of TC, HDL, LDL, and apolipoproteins increased, suggesting a direct relationship between changes in the lipid profiles and inflammation.
- EVALUATION OF USABILITY OF A NEONATAL HEALTH INFORMATION SYSTEM ACCORDING TO THE USER’S PERCEPTION(2018) PADRINI-ANDRADE, Lucio; BALDA, Rita de Cássia Xavier; ARECO, Kelsy Catherina Nema; BANDIERA-PAIVA, Paulo; NUNES, Marynéa do Vale; MARBA, Sérgio Tadeu Martins; CARVALHO, Werther Brunow de; RUGOLO, Ligia Maria Suppo de Souza; ALMEIDA, João Henrique Carvalho de; PROCIANOY, Renato Soibelmann; DUARTE, José Luiz Muniz Bandeira; REGO, Maria Albertina Santiago; FERREIRA, Daniela Marques de Lima Mota; ALVES FILHO, Navantino; GUINSBURG, Ruth; DINIZ, Edna Maria de Albuquerque; SANTOS, Juliana Paula Ferraz dos; TESTONI, Daniela; SILVA, Nathalia Moura de Mello e; GONZALES, Maria Rafaela Conde; SILVA, Regina Vieira Cavalcante da; MENESES, Jucille; GONÇALVES-FERRI, Walusa Assad; PERUSSI-E-SILVA, Ricardo; BOMFIM, OlgaABSTRACT Objective: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. Methods: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. Results: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as “good”, “excellent” or “better than imaginable”. The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. Conclusion: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.
- Why Bedside Clinical Neurologic Assessments in PICUs Are Not Good Enough?(2018) CARVALHO, Werther Brunow de; COLLETI JUNIOR, Jose
- Challenges in Electronic Medical Record Implementation in the PICU(2018) COLLETI JR., Jose; CARVALHO, Werther Brunow de
- Opioid tapering and weaning protocols in pediatric critical care units: a systematic review(2018) BICHAFF, Pedro; SETANI, Karina T.; MOTTA, Emiliana H. G.; DELGADO, Artur F.; CARVALHO, Werther B.; LUGLIO, MicheleOBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly. METHODS: A systematic review was made from data of four different databases. Forty-nine articles of observational and experimental studies were selected based on the inclusion criteria (critical pediatric patients in acute use of opioids) and exclusion criteria (previous chronic use of opioids, other medications). The data regarding specific themes were separated in sections: initial dose of methadone, use of protocols in clinical practice, abstinence scales and adjuvant drugs. RESULTS: The articles showed a great heterogeneity of ways to calculate the initial dose of methadone. The pediatric intensive care units of the study had different weaning protocols, with a lower incidence of abstinence when a pre-defined sequence of tapering was used. The Withdrawal Assessment Tool - 1 was the most used scale for tapering the opioids, with good sensitivity and specificity for signs and symptoms. CONCLUSION: There is still little evidence of other medications that can help prevent the abstinence syndrome of opioids. This study tries to promote a better practice during opioid weaning.
- CÂNULA NASAL DE ALTO FLUXO PÓS-EXTUBAÇÃO TRAQUEAL EM CRIANÇA COM OBSTRUÇÃO DE VIAS AÉREAS SUPERIORES: RELATO DE CASO(2018) COLLETI JUNIOR, José; LONGUI, Tâmara Eleamen; CARVALHO, Werther Brunow deABSTRACT Objective: To report a case of a patient who required tracheal intubation in a pediatric emergency department due to acute laryngitis and that, after the planned extubation, has successfully used the high-flow nasal cannula, which possibly prevented extubation failure. Case description: A male 8-month-old child was admitted to the pediatric emergency room with acute respiratory distress due to a high airway obstruction secondary to severe acute laryngitis. He was immediately intubated and referred to the pediatric intensive care unit. He presented extubation failure due to a significant laryngeal edema evidenced by bronchoscopy. In the second attempt to extubate, he presented respiratory distress, but, after the use of the high-flow nasal cannula, he became stable, reducing the heart and respiratory frequencies, and the extubation was successful. Comments: The use of the high-flow nasal cannula was effective and presented good response in this patient with acute laryngitis, suggesting that it is a possible adjuvant for the treatment, avoiding worsening respiratory conditions and the need for reintubation.
- Pediatric chronic patients at outpatient clinics: a study in a Latin American University Hospital(2018) ALVENO, Renata A.; V, Caroline Miranda; PASSONE, Caroline G.; WAETGE, Aurora R.; HOJO, Elza S.; FARHAT, Sylvia C. L.; ODONE-FILHO, Vicente; TANNURI, Uenis; CARVALHO, Werther B.; CARNEIRO-SAMPAIO, Magda; SILVA, Clovis A.Objective: To describe the characteristics of children and adotescentes with chronic diseases of outpatient clinics at a tertiary university hospital. Methods: A cross-sectional study was performed with 16,237 patients with chronic diseases followed-up in one year. The data were collected through the electronic system, according to the number of physician appointments in 23 pediatric specialties. Patients were divided in two groups: children (0-9 years) and adolescents (10-19 years). Early (10-14 years) and late (15-19 years) adolescent groups were also analyzed. Results: Of the total sample, 56% were children and 46% were adolescents. The frequencies of following pediatric specialties were significantly higher in adolescents when compared with children: cardiology, endocrinology, hematology, nephrology/renal transplantation, neurology, nutrology, oncology, palliative and pain care, psychiatry, and rheumatology (p< 0.05). The frequencies of emergency service visits (30% vs. 17%, p < 0.001), hospitalizations (23% vs. 11%, p < 0.001), intensive care unit admissions (6% vs. 2%, p< 0.001), and deaths (1% vs. 0.6%, p=0.002) were significantly lower in adolescents than in children. However, the number of physician appointments (>= 13) per patient was also higher in the adolescent group (5% vs. 6%, p = 0.018). Further analysis comparison between early and late adolescents revealed that the first group had significantly more physician appointments (35% vs. 32%, p= 0.025), and required more than two pediatric specialties (22% vs. 21%, p = 0.047). Likewise, the frequencies of emergency service visits (19% vs. 14%, p<0.001) and hospitalizations (12% vs. 10%, p= 0.035) were higher in early adolescents. Conclusions: This study evaluated a large population in a Latin American hospital and suggested that early adolescents with chronic diseases required many appointments, multiple specialties and hospital admissions. (C) 2017 Sociedade Brasileira de Pediatria.
- Avaliação do uso de sistemas de prontuário eletrônico nas unidades de terapia intensiva brasileiras(2018) COLLETI JUNIOR, José; ANDRADE, Alice Barone de; CARVALHO, Werther Brunow deABSTRACT Objective: To examine the prevalence of the use of electronic medical record systems in Brazilian intensive care units and the perceptions of intensive care physicians regarding the contribution of electronic medical record systems toward improving safety and quality in clinical practice. Methods: Using an online questionnaire, physicians working in Brazilian intensive care units answered questions about the use of electronic medical record systems in the hospitals in which they worked. They were asked about the types of electronic medical record systems used and their levels of satisfaction with these systems in terms of improving quality and safety. Results: Of the 4,772 invitations sent, 204 physicians responded to the questionnaire. Most used electronic medical record and prescription systems (92.6%), worked in private hospitals (43.1%), worked in general adult intensive care units (66.7%) and used Private System A (39.2%); most systems had been used for between 2 and 4 years (25.5%). Furthermore, the majority (84.6%) believed that the electronic system provided better quality than a paper system, and 76.7% believed that electronic systems provided greater safety than paper systems. Conclusion: Electronic medical record systems seem to be widely used by the Brazilian intensive care physicians who responded to the questionnaire and, according to the data, seem to provide greater quality and safety than do paper records.