Enfermagem em Prática Avançada no pronto atendimento: uma reflexão promissora / Nursing in Advanced Practice in emergency care unit: a promising reflection

OBJETIVO: Refletir acerca das Unidades de Pronto Atendimento 24h como cenário de atuação para a Prática Avançada de Enfermeiros nos serviços de urgência e emergência. MÉTODO: Este estudo utilizou a metodologia de reflexão. RESULTADOS: A Enfermagem de Prática Avançada é uma especialidade em que atuam enfermeiros com conhecimento e habilidades ampliado, capazes de tomar decisões complexas, além de possuírem nível avançado de práticas específicas. Os serviços de urgência e emergência são cenários promissores ao desenvolvimento da Enfermagem de Prática Avançada, incluindo as Unidade de Pronto Atendimento 24h, pela capacidade de atendimentos de alta complexidade e atuação de profissionais altamente capacitados. Portanto, há necessidade de reflexão sobre avanços e entraves na atuação, regulamentação, sobretudo no que se refere a este cenário, pouco discutido no contexto da Enfermagem de Prática Avançada no Brasil. CONCLUSÃO: Existe grande necessidade de ampliação da discussão da Enfermagem de Prática Avançada para os demais níveis de atenção no Brasil. Há serviços com amplo potencial a serem desenvolvidos, sendo um deles as Unidades de Pronto Atendimento 24h. Observa-se que o enfermeiro de práticas avançadas nestes serviços poderá trazer grandes benefícios para a população, além de melhorar a qualidade da assistência, trazendo maior autonomia aos profissionais destes serviços.

OBJECTIVE: To reflect about the Emergency Care Unit an action scenario for the Advanced practice of nurses in emergency and urgency services. METHOD: This study utilized the methodology of reflection. RESULTS: Advanced Practice Nursing is a specialty in which nurses with expanded knowledge and additional skills can make complex decisions in addition to having an advanced level of specific practices. Emergency and urgency services are promising scenarios for the development of Advanced Practice Nursing, including the 24-hour Care Unit, especially due to the capacity of high complexity care and the performance of highly qualified professionals. Therefore, there is a need for reflection on the advances, obstacles in the performance and regulation, especially in relation to this scenario, which is little discussed in the context of Advanced Practice Nursing in Brazil. CONCLUSION: There is a great need to expand the discussion of Advanced Practice Nursing to the other levels of care in Brazil. There are services with vast potential to be developed, one of them being the 24-hour Care units. It is observed that nurses from advanced practices in these services can bring great benefits to the population, in addition to improving the quality of care, bringing greater autonomy for nurses in these services.

Mapeamento de práticas integrativas e complementares em saúde no SUS/PA, Brasil, 2022 / Mapping of integrative and complementary health practices in SUS/PA, Brazil, 2022

As modalidades de tratamento Medicina Tradicional Chinesa/Acupuntura (MTC/A) fazem parte das Práticas Integrativas e Complementares em Saúde implementadas pelo Ministério da Saúde, via Sistema Único de Saúde (SUS). Realizar o mapeamento dos municípios do Estado do Pará que ofertam serviço de acupuntura e suas complementares. A pesquisa foi realizada em dados secundários fornecidos pela Secretaria de Saúde do Pará (SESPA), revisão de literatura narrativa e bases legais. O mapeamento das práticas MTC/A em 89 municípios, de janeiro a maio de 2022, tomou por base a estrutura das Regionais de Saúde do Pará. Os dados impossibilitam avaliar a frequência mensal dos atendimentos, pois as informações foram compactadas pelo total dos cinco meses. O gestor estadual não monitora o registro de dados nos sistemas do SUS; o que foi expresso permite afirmar que, efetivamente, as práticas de MTC/A não estão implantadas no SUS Pará, sendo registros pontuais

The treatment modalities Traditional Chinese Medicine/Acupuncture (TCM/A) are part of the Integrative and Complementary Health Practices implemented by the Ministry of Health, through the Unified Health System (SUS). To map the municipalities in the State of Pará that offer acupuncture services and their complements. The research was conducted on secondary data provided by the Pará Health Department (SESPA), review of narrative literature and legal bases. The mapping of TCM/A practices in 89 municipalities, from January to May 2022, was based on the structure of the Pará Health Regions. The data make it impossible to evaluate the monthly frequency of visits, since the information was compressed for the total of five months. The state manager does not monitor the recording of data in the SUS systems; what was expressed allows us to affirm that, effectively, the practices of TCM/A are not implemented in SUS Pará, being punctual records.

Serviços de acupuntura no Sistema Único de Saúde do Pará, como prática integrativa e complementar: um recorte temporal de janeiro a maio de 2022 / Acupuncture services in the Single Health System of the Pará, as an integrative and complementary practice: a time frame from january to may 2022

A acupuntura é uma das técnicas do segmento Medicina Tradicional Chinesa/Acupuntura que faz parte das Práticas Integrativas e Complementares em Saúde implementada pelo Ministério da Saúde, via Sistema Único de Saúde. O objetivo do trabalho foi realizar um mapeamento dos municípios do Estado do Pará que ofertam o serviço de acupuntura e suas complementares, no período de 2017 a 2019. A pesquisa foi realizada em dados secundários fornecidos pela Secretaria de Saúde do Pará, revisão de literatura narrativa e bases legais. O mapeamento de municípios que ofereceram as práticas foi realizado no período de janeiro a maio de 2022, tomou por base a estrutura das Regionais de Saúde. Os dados não permitiram avaliar a prestação de serviço da Acupuntura nos 89 municípios pesquisados, pois estavam compactados no conjunto dos meses. As práticas de saúde não estão efetivamente implantadas no Pará e não há monitoramento de suas atividades

Acupuncture is one of the techniques of the Traditional Chinese Medicine/Acupuncture segment that is part of the Integrative and Complementary Health Practices implemented by the Ministry of Health, via the Unified Health System. The objective of this work was to perform a mapping of the municipalities of the State of Pará that offer the acupuncture service and its complementary, in the period from 2017 to 2019. The research was carried out in secondary data provided by the Health Department of Pará, review of narrative literature and legal bases. The mapping of municipalities that offered the practices was carried out from January to May 2022, based on the structure of the Regional Health. The data did not allow evaluating the provision of acupuncture service in the 89 municipalities research, because they were compacted in the set of months. Health practices are not effectively enforced in Pará and there is not monitoring of their activities.

Emotional labor of nurses in the front line against the COVID-19 pandemic / Trabajo emocional de enfermeros de primera línea frente a la pandemia de COVID-19 / Trabalho emocional de enfermeiros da linha de frente do combate à pandemia de COVID-19

ABSTRACT Objective: To analyze nurses' experiences in the front line of the fight against the COVID-19 pandemic regarding the performance of emotional labor (EL), aiming at its characterization and identification of support strategies and development opportunities of nurses and practices. Methods: Qualitative, descriptive, and exploratory study, with content analysis of eleven written narratives and reports from a focus group composed of nurses with experience in caring for patients with COVID-19 from different Hospital Centers in Lisbon, Portugal. Results: Five themes were extracted: 1) Challenges experienced by nurses in the frontline; 2) Emotions experienced by nurses in service care; 3) Emotional responses of nurses and patients: impact on care; 4) EL of nurses in the patient care process; 5) Opportunities for development in the face of the emotional challenge required of nurses in combating COVID-19. Final considerations: The nurses demonstrated the ability to transform this profoundly emotional experience positively.

RESUMEN Objetivo: Analizar las experiencias de enfermeros de primera línea frente a la pandemia de COVID-19 cuanto al desempeño del trabajo emocional (TE) visando su caracterización e identificación de estrategias de suporte y oportunidades de desarrollo de enfermeros y de prácticas. Métodos: Estudio cualitativo, descriptivo y exploratorio, con análisis de contenido de 11 narrativas escritas y relatos de un grupo focal compuesto por enfermeros con experiencia de cuidados a pacientes con COVID-19, de diferentes Centros Hospitalarios de Lisboa, Portugal. Resultados: Extrajeron cinco temas: 1) Desafíos vividos por enfermeros en primera línea; 2) Emociones experienciadas por enfermeros en la prestación de cuidados; 3) Respuestas emocionales de enfermeros y pacientes: impacto en los cuidados; 4) TE de enfermeros en el proceso de cuidados al paciente; 5) Oportunidades de desarrollo delante desafío emocional exigido de los enfermeros frente a la COVID-19. Consideraciones finales Los enfermeros demostraron capacidad de transformar positivamente esta experiencia profundamente emocional.

RESUMO Objetivo: Analisar as experiências de enfermeiros da linha de frente do combate à pandemia de COVID-19 quanto ao desempenho do trabalho emocional (TE) visando à sua caracterização e identificação de estratégias de suporte e oportunidades de desenvolvimento dos enfermeiros e das práticas. Métodos: Estudo qualitativo, descritivo e exploratório, com análise de conteúdo de 11 narrativas escritas e relatos de um grupo focal composto por enfermeiros com experiência de cuidados a pacientes com COVID 19, de diferentes Centros Hospitalares de Lisboa, Portugal. Resultados: Extraíram-se cinco temas: 1) Desafios vividos pelos enfermeiros na linha de frente; 2) Emoções experienciadas por enfermeiros na prestação de cuidados; 3) Respostas emocionais de enfermeiros e pacientes: impacto nos cuidados; 4) Trabalho Emocional de enfermeiros no processo de cuidados ao paciente; 5) Oportunidades de desenvolvimento face ao desafio emocional exigido dos enfermeiros no combate à COVID-19. Considerações finais: Os enfermeiros demonstraram capacidade de transformar positivamente esta experiência profundamente emocional.

Relationship of inflammatory markers and pain in patients with head and neck cancer prior to anticancer therapy

Pain is a common symptom in patients with cancer, including those with head and neck cancer (HNC). While studies suggest an association between chronic inflammation and pain, levels of inflammatory cytokines, such as C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α), have not been correlated with pain in HNC patients who are not currently undergoing anticancer treatment. The purpose of this study was to examine the relationship between these inflammatory markers and perceived pain in HNC patients prior to anticancer therapy. The study group consisted of 127 HNC patients and 9 healthy controls. Pain was assessed using the Brief Pain Inventory (BPI), and serum levels of CRP and TNF-α were determined using the particle-enhanced turbidimetric immunoassay (PETIA) and ELISA techniques, respectively. Patients experiencing pain had significantly higher levels of CRP (P<0.01) and TNF-α (P<0.05) compared with controls and with patients reporting no pain. There were significantly positive associations between pain, CRP level, and tumor stage. This is the first study to report a positive association between perceived pain and CRP in HNC patients at the time of diagnosis. The current findings suggest important associations between pain and inflammatory processes in HNC patients, with potential implications for future treatment strategies.

Current and Future Trends in the Clinical Diagnosis of Rickettsioses Sensu Lato.

Aims: The aim of this review is to present Rickettsioses sensu lato, with emphasis on their current and future clinical diagnosis. The review presents the conditions, the agents that cause them, and the current gold standards on their diagnosis in national and international reference centres. Additionally, this review covers the various emerging technologies available in the diagnosis of Rickettsioses and discusses their potential for future use as gold standards in the diagnosis of these diseases. Introduction: The introduction presents Rickettsioses sensu lato and gives a broad overview of the conditions they cause, the issues associated with their current diagnosis and the need for their improved, earlier and more accurate diagnosis, in order to prevent current issues with false negatives, misdiagnosis or delay in the diagnosis associated with these conditions, which often renders them grave or lethal. Main Body: The main body of the review presents in independent sections Rickettsias, Ehrlichia, Anaplasma, Bartonella and Coxiella and the conditions associated with each of these bacteria. Spotted fever, endemic typhus, human granulocytic anaplasmosis, human monocytic ehrlichioses, bartonellosis and Q-fever are some of the conditions associated with this group of proteobacteria. The emphasis is on the clinical diagnosis of these conditions and an overview of the current practice, gold standards in reference laboratories and improvements in these methodologies is presented. The last part of the review focuses on novel technologies in bacterial detection and their application specifically on Rickettsioses sensu lato, demonstrating how these technologies are being applied in this field and how they could improve current standards and resolve issues associated with the clinical diagnosis of rickettsioses. Conclusion: Rickettsioses sensu lato are conditions associated with proteobacteria historically included in the Rickettsiaceae family, able to cause a number of conditions, often grave or lethal. One of the major issues associated with poor clinical outcome is the lack of early and accurate differential diagnostic methodologies. Current methods, including serological and molecular biology techniques have various advantages and disadvantages, which new technologies available or currently in development may be in a position to resolve and the issues associated with the institution of such technologies.

Insuficiência renal aguda em uma unidade de terapia intensiva no norte do Brasil. / Acute kidney injury in a neonatal intensive care unit in northern Brazil.

Objetivo: Identificar o perfil clínico-epidemiológico da Insuficiência renal aguda IRA, condições associadas a ela e taxa de mortalidade entre os neonatos. Método: estudo retrospectivo, descritivo e analítico de 15 prontuários de neonatos diagnosticados com IRA na UTI Neonatal da Fundação Santa Casa de Misericórdia do Pará (FSCMPA), entre junho de 2009 a junho de 2012. Resultados. A IRA neonatal na UTI neonatal da FSCMPA esteve em 3,76% dos pacientes. Dos pacientes estudados, 8 (53,3%) eram do sexo feminino e 7 (46,7%) do sexo masculino. Neonatos com até 07 dias de vida que desenvolveram IRA representaram 13 (86,7%) casos. A assistência pré-natal foi observada em 12 (80%) casos. Quanto ao diagnóstico, em 53% dos casos foram realizados em até 7 dias e em 47% após 7 dias. Condições associadas: elevada prematuridade (80%) e baixo peso (53,3%) neonatos, com mortalidade em 87,5%. Oligúria esteve presente em 13 (86,7%) pacientes, síndrome do desconforto respiratório em 40%, asfixia neonatal em 26,7%, sepse em 40% e nefropatia em 13,3%. A indicação de Nutrição Parenteral Prolongada ocorreu em 86,7% e a de diálise em 66,7% dos neonatos. A mortalidade observada foi em torno de 73%, sendo os prematuros os mais acometidos (82%). Conclusão: A IRA é causa frequente de morbidades em neonatos e os resultados obtidos em um curto período são semelhantes a outros estudos.

Acute Kidney Injury (AKI) is a common clinical pathology in neonatal intensive care units (ICU) often associated with conditions that contribute for AKI, such as sepsis, perinatal asphyxia and neonates preterms. Objective. Identify the clinical epidemiologic profile of AKI, its associated contributing conditions and the mortality rate among newborns Methods. Retrospective, descriptive and analytical study from among 15 promptuaries of neonates with AKI admitted to ICU of Fundação Santa Casa de Misericórdia do Pará (FSCMPA) from June 2009 to June 2012.Results. AKI was shown in 3,76%of the patients in FSCMPA neonatal ICU. Of the 15 neonates, 8 females and 7 males were reviewed in the study. Neonates with AKI aged until 7 days were 13 (86,7%) cases. Prenatal care was performed in 12 (80%) cases. Regarding the diagnosis, 53% were performed within 7 days and 47% were over 7 days. Associated contributing conditions: preterms were 80%, low birth weight was 53,3%, of whom 87,5% died. Oliguria was observed in 86,7%, respiratory distress syndrome, in 40%, perinatal asphyxia, in 26,7%, sepsis in 40% and nephropatologies, in 13,3% of the newborns. Prolonged Parenteral Nutrition was done in 86,7% and dialysis in 66,7% of the neonates. Mortality rate was significantly higher (73%), most of whom were preterms (82%). Conclusion. AKI is a common cause of diseases in neonates and short-term outcomes in our institution are similar with other studies.

Human bartonellosis: seroepidemiological and clinical features with an emphasis on data from Brazil - A review

Bartonellae are fastidious Gram-negative bacteria that are widespread in nature with several animal reservoirs (mainly cats, dogs, and rodents) and insect vectors (mainly fleas, sandflies, and human lice). Thirteen species or subspecies of Bartonella have been recognized as agents causing human disease, including B. bacilliformis, B. quintana, B. vinsonii berkhoffii, B. henselae, B. elizabethae, B. grahamii, B. washoensis, B. koehlerae, B. rocha-limaea, and B. tamiae. The clinical spectrum of infection includes lymphadenopathy, fever of unknown origin, endocarditis, neurological and ophthalmological syndromes, Carrion's disease, and others. This review provides updated information on clinical manifestations and seroepidemiological studies with an emphasis on data available from Brazil.

Desenvolvimento e validação de instrumento para avaliação de desempenho por competências alinhado ao planejamento estratégico institucional / Development and validation of employee performance appraisal evaluation by competences alignment to institutional strategic planning

A avaliação de desempenho passou a ser empregada nas empresas com o objetivo de alcançar um desenvolvimento maior do homem, das relações humanas e do trabalho desenvolvido. É uma técnica utilizada para obter informações sobre o comportamento profissional do funcionário. Clientes e usuários estão cada vez mais exigentes com os produtos e serviços de que dispõem, e a questão da qualidade tem apresentado crescente preocupação em todo o mundo. A nova consciência de qualidade dos produtos e serviços concede mais valorização aos esforços do indivíduo, considerando-se que as pessoas envolvidaS são fundamentais, pois a qualidade depende do trabalho individual ou em grupo. A preocupação dos hospitais, atualmente, pela busca da qualidade dos serviços vem exigindo de seus profissionais e colaboradores uma nova postura...

Bartonella native valve endocarditis: the first brazilian case alive and well

Bartonella is an important cause of blood culture-negative endocarditis in recent studies. Seroprevalence studies in the States of Minas Gerais and Rio de Janeiro have shown Bartonella IgG positivity around 14 percent in healthy adults and 40 percent in HIV seropositive adults, respectively. A case report of a 46-year-old white male with moderate aortic regurgitation (AR) due to rheumatic heart disease (RHD), admitted due to worsening heart failure, is presented. Clinical features were apyrexia, anemia, polyclonal hypergammaglobulinemia, hematuria and splenomegaly. He was submitted to surgery due to worsening AR. Histopathology of the excised valve showed active bacterial endocarditis and underlying RHD. Routine blood cultures were negative. Indirect immunofluorescence (IFI) assays for Coxiella burnetii were non-reactive. Bartonella henselae IgG titer was 1:4096 prior to antibiotics and 1:512 14 months after treatment. History of close contact with a young cat during the months preceding his admission was elicited.

Optimal clone identifier for genomic shotgun libraries: "OC Identifier tool"

In DNA microarray experiments, the gene fragments that are spotted on the slides are usually obtained by the synthesis of specific oligonucleotides that are able to amplify genes through PCR. Shotgun library sequences are an alternative to synthesis of primers for the study of each gene in the genome. The possibility of putting thousands of gene sequences into a single slide allows the use of shotgun clones in order to proceed with microarray analysis without a completely sequenced genome. We developed an OC Identifier tool (optimal clone identifier for genomic shotgun libraries) for the identification of unique genes in shotgun libraries based on a partially sequenced genome; this allows simultaneous use of clones in projects such as transcriptome and phylogeny studies, using comparative genomic hybridization and genome assembly. The OC Identifier tool allows comparative genome analysis, biological databases, query language in relational databases, and provides bioinformatics tools to identify clones that contain unique genes as alternatives to primer synthesis. The OC Identifier allows analysis of clones during the sequencing phase, making it possible to select genes of interest for construction of a DNA microarray.

Study of hantavirus infection in captive breed colonies of wild rodents

Wild sigmondontine rodents are known to be the reservoir of several serotypes of New World hantaviruses. The mechanism of viral transmission is by aerosol inhalation of the excreta from infected rodents. Considering that the captive breed colonies of various wild mammals may present a potencial risk for hantaviral transmission, we examined 85 speciemens of Thrichomys spp. (Echimyidae) and 17 speciemens of Nectomys squamipes (Sigmodontinae) from our colony for the presence of hantavirus infections. Blood samples were assayed for the presence of antibodies to Andes nucleocapsid antigen using enzyme-linked immunosorbent assay (ELISA). Additionally, serum samples from workers previously exposed to wild rodents, in the laboratories where the study was conducted, were also tested by ELISA to investigate prevalence of anti-hantavirus IgG antibodies. All blood samples were negative for hantavirus antibodies. Although these results suggest that those rodent's colonies are hantavirus free, the work emphasizes the need for hantavirus serological monitoring in wild colonized rodents and secure handling potentially infected rodents as important biosafety measures.

IFN-gamma in human Chagas' disease: protection or pathology?

An apparently paradoxical role for IFN-gamma in human Chagas'disease was observed when studying the pattern of cytokine production by peripheral blood mononuclear cells (PBMC) obtained from two groups of chagasic patients after specific stimulation with Trypanosoma cruzi-derived antigens. The groups studied were 1) patients treated with bendnidazole during the acute phase of Trypanosoma cruzi infection and 2) chronically infected untreated patients. In the treated group, higher levels of IFN-gamma were produced by PBMC from individuals cured after treatment when compared to non-cured patients. In contrast, in the chronically infected group (not treated) higher levels of IFN-gamma were produced by PBMC from cardiac patients in comparison with asymptomatic (indeterminate) patients. This apparently paradoxical role for IFN-gamma in human Chagas'disease is discussed in terms of the possibility of a temporal difference in IFN-gamma production during the initial stages of the infection (acute phase) in the presence or absence of chemotherapy. The maintenance of an immune response with high levels of IFN-gamma production during the chronic phase of the infection may favor cure or influence the development of the cardiac form of the disease.

Epidemiological aspects of the Brazilian spotted fever: seasonal activity of ticks collected in an endemic area in São Paulo, Brazil

Carrapatos de vegetação e de animais foram coletados mensalmente durante o período de um ano (1993-1994) em uma área endêmica de febre maculosa brasileira no município de Pedreira, São Paulo. Seis espécies de carrapatos foram identificadas Amblyomma cajennense, Amblyomma cooperi, Amblyomma triste, Anocentor nitens, Rhipicephalus sanguineus e Boophilus microplus. Somente a primeira espécie foi suficientemente abundante para permitir um estudo quantitativo com atividade sazonal, embora a distribuição e fonte de captura de outras espécies fossem observadas e aqui relatadas. Estas informações são correlacionadas com a epidemiologia da rickettsiose transmitida por carrapato.

Ticks were collected from vegetation and animals at monthly intervals during one year (1993-1994) in an endemic area of Brazilian spotted fever in the Country of Pedreira, State of São Paulo. Six species of ticks were identified Amblyomma cajennense, Amblyomma cooperi, Amblyomma triste, Anocentor nitens, Rhipicephalus sanguineus and Boophilus microplus. Only the first species was sufficiently numerous to permit a quantitative study with seasonal activity, although the distribution and source of capture of other species were observed and are reported. This information is correlated with the epidemiology of tick-borne rickettsiosis.

Valor predictivo del comportamiento de la presión arterial durante la ergometría em pacientes coronarios / Predictive value of the blood pressure during exercise testing in patients with coronary diseases

Con el fin de determinar el valor predictivo del comportamiento de la Presión Arterial (P.A.) durante el esfuerzo, se estudiaron 180 pacientes (p.) - 173 hombres y 7 mujeres-, con edad promedio de 51 + ou - 9,8 años, con enfermedad coronaria comprobada angiográficamente, a los que se siguió por un período de 6 años. A todos se les efectuó una Prueba Ergométrica graduada en cinta deslizante (72 p.) o en cicloergómetro (108 p.) Se determinaron los eventos coronarios (E.C.) -muertes de origen cardiovascular e infarto agudo de miocardio-. Treinta y dos pacientes (18%) tuvieron un comportamiento paradojal de la presión arterial sistólica (P.A.S.), presentando un 50% de E.C. 27 % de los que tuvieron una respuesta tensional normal (P < 0.01). Once pacientes (6%) no alcanzaron a superar los 130 mm Hg de P.A.S. con una incidencia de 73% de E.C. vs. 29% de los que superaron esa cifra (P < 0.01). La respuesta hipertensiva sistólica y/o diastólica no fue predictiva de E.C. concluimos que el escaso incremento y el comportamiento paradojal de la P.A.S. son elementos predictores de mal pronóstico en enfermos coronarios