Mucormicosis de cabeza y cuello: Actualización en el diagnóstico y manejo médico-quirúrgico. Una revisión narrativa / Mucormycosis of the head and neck: Update on diagnosis and medical-surgical management. A narrative review

Resumen La mucormicosis, es una patología de baja prevalencia, rápidamente progresiva y de alta mortalidad que engloba un amplio espectro de infecciones del tipo oportunistas, causada por hongos de la familia Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunninghamellaceae, Syncephalastraceae y Radiomycetaeae. Actualmente es la tercera causa de infección fúngica invasiva, posterior a la candidiasis y aspergilosos, siendo su presentación clínica más frecuente la rinocerebral de origen paranasal, cuyo síntoma característico es la rinosinusitis aguda bacteriana con proyección a los dientes antrales, de rápido avance y fatalidad. En esta revisión se emplearon resultados extraídos manualmente de artículos indexados en las bases de datos MEDLINE y EBSCO a raíz de la búsqueda de los términos mucormycosis, oral surgery y patient care management con el objetivo de entregar una visión actualizada de la literatura, respecto al diagnóstico y tratamiento de la mucormicosis de cabeza y cuello.

Abstract Mucormycosis is a low-prevalence, rapidly progressive and high-mortality pathology that encompasses a wide spectrum of opportunistic infections caused by fungi of the Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunninghamellaceae, Syncephalastraceae, and Radiomycetaeae. It is currently the third cause of invasive fungal infection, after candidiasis and aspergillosis, with its most frequent clinical presentation being rhinocerebral of paranasal origin, whose characteristic symptom is acute bacterial rhinosinusitis with projection to the antral teeth, with rapid progression and fatality. In this review, manually extracted results from articles indexed in the MEDLINE and EBSCO databases were used following the search for the terms mucormycosis, oral surgery and patient care management with the aim of providing an updated view of the literature regarding the diagnosis and treatment of mucormycosis of the head and neck.

Abnormalities in preoperative examinations of plastic surgery patients / Anormalidades em exames pré-operatórios de pacientes de cirurgia plástica

Introduction: Preoperative tests (EPO) aim to detect abnormalities and give greater safety to the procedure. However, the request for these tests is still controversial, either because they do not bring about changes in conduct for the procedure or result in some harm to the patient. The objective is to assess the frequency of EPO requests and abnormalities in aesthetic plastic surgery patients, to verify what these abnormalities are, what preoperative management should be done based on the finding, and to associate the data obtained with the patient's profile and the planned surgery. Method: Retrospective study evaluating medical records of aesthetic plastic surgery patients who underwent routine EPO in a plastic surgery hospital in 2019. Results: 978 patients were studied, and 51% had some abnormality in EPO. 93.7% were women, with a mean age of 46.5 years. 12.3 exams were performed per patient, and abnormality was observed in 6.1% of EPO. The exams that had the most abnormalities were the lipidogram (23.8%) and the cardiac evaluation (14.1%). Hypothyroidism was the most common comorbidity (18.4% of patients); 70% of diabetics had a glycemic level above the recommended level. Only 3.4% of the patients suffered a change in preoperative management due to EPO abnormality, and in 57.9% of these cases, the surgery was postponed. Test alterations were more frequent in male patients (p<0.0001). Conclusion: The performance of routine EPO showed a low frequency of altered exams (3.4%) and implied changes in the preoperative conduct of plastic surgery patients.

Introdução: Os exames pré-operatórios (EPO) visam detectar anormalidades e dar maior segurança ao procedimento. No entanto, a solicitação desses exames ainda é controversa, seja por não trazerem mudanças de conduta para o procedimento ou resultar em alguns malefícios para o paciente. O objetivo é avaliar a frequência de solicitações e de anormalidades dos EPO em pacientes de cirurgia plástica estética, verificar quais são estas anormalidades, qual conduta pré-operatória mediante o achado e associar os dados obtidos com o perfil do paciente e cirurgia prevista. Método: Estudo retrospectivo avaliando prontuários de pacientes de cirurgia plástica estética que realizaram EPO de rotina em um hospital de cirurgia plástica durante o ano de 2019. Resultados: Foram estudados 978 pacientes e 51% desses apresentaram alguma anormalidade nos EPO. 93,7% eram mulheres, com média de idade 46,5 anos. Foram realizados 12,3 exames por paciente e observada anormalidade em 6,1% dos EPO. Os exames que mais tiveram anormalidades foram o lipidograma (23,8%) e os da avaliação cardíaca (14,1%). Hipotireoidismo foi a comorbidade mais achada (18,4% dos pacientes); 70% dos diabéticos estavam com o nível glicêmico acima do recomendado. Apenas 3,4% dos pacientes sofreram alteração da conduta pré-operatória devido anormalidade dos EPO e em 57,9% desses casos houve adiamento da cirurgia. Alterações de exames foram mais frequentes em pacientes do sexo masculino (p<0,0001). Conclusão: A realização de EPO de rotina mostrou baixa frequência de exames alterados (3,4%) e implicou em mudanças na conduta pré-operatória em pacientes de cirurgia plástica.

High-value care for critically ill oncohematological patients: what do we know thus far? / Cuidados de alto valor para pacientes oncohematológicos graves: o que sabemos até agora?

ABSTRACT The number of patients with cancer requiring intensive care unit admission is increasing around the world. The improvement in the pathophysiological understanding of this group of patients, as well as the increasingly better and more targeted treatment options for their underlying disease, has led to a significant increase in their survival over the past three decades. Within the organizational concepts, it is necessary to know what adds value in the care of critical oncohematological patients. Practices in medicine that do not benefit patients and possibly cause harm are called low-value practices, while high-value practices are defined as high-quality care at relatively low cost. In this article, we discuss ten domains with high-value evidence in the care of cancer patients: (1) intensive care unit admission policies; (2) intensive care unit organization; (3) etiological investigation of hypoxemia; (4) management of acute respiratory failure; (5) management of febrile neutropenia; (6) urgent chemotherapy treatment in critically ill patients; (7) patient and family experience; (8) palliative care; (9) care of intensive care unit staff; and (10) long-term impact of critical disease on the cancer population. The disclosure of such policies is expected to have the potential to change health care standards. We understand that it is a lengthy process, and initiatives such as this paper are one of the first steps in raising awareness and beginning a discussion about high-value care in various health scenarios.

RESUMO O número de pacientes oncológicos com necessidade de internação em unidades de terapia intensiva está aumentando em todo o mundo. A maior compreensão fisiopatológica desse grupo de pacientes, bem como opções de tratamento cada vez melhores e mais direcionadas à doença subjacente, tem levado a um aumento significativo da sobrevida nas últimas três décadas. Dentro dos conceitos organizacionais é necessário saber o que agrega valor ao cuidado de pacientes onco-hematológicos graves. As práticas terapêuticas não benéficas aos pacientes e possivelmente causadoras de danos são chamadas práticas de baixo valor, enquanto as práticas de alto valor são definidas como cuidados de alta qualidade a um custo relativamente baixo. Neste artigo discutimos dez domínios com evidências de alto valor no cuidado de pacientes com câncer: (1) políticas de internação na unidade de terapia intensiva; (2) organização da unidade de terapia intensiva; (3) investigação etiológica da hipoxemia; (4) manejo da insuficiência respiratória aguda; (5) manejo da neutropenia febril; (6) tratamento quimioterápico de urgência em pacientes graves; (7) experiência do paciente e da família; (8) cuidados paliativos; (9) cuidados com a equipe da unidade de terapia intensiva; e (10) impacto a longo prazo da doença grave na população oncológica. Esperase que a divulgação dessas políticas traga mudanças aos padrões atuais do cuidado em saúde. Entendemos que é um processo longo, e iniciativas como o presente artigo são um dos primeiros passos para aumentar a conscientização e possibilitar discussão sobre cuidados de alto valor em vários cenários de saúde.

Uptake pattern of training programs over two decades at an International Ophthalmic Training Institute in India

Purpose: Inadequacy of trained human resources is a critical challenge for eye?care delivery worldwide. Recognizing this, the World Health Organization (WHO) and the International Agency for Prevention of Blindness had identified the development of human resources as one of the focal areas in the global initiative “Vision 2020: The Right to Sight.” The global action plan of the WHO also emphasized the need for trained workforce for ensuring comprehensive eye?care services. We aimed to present the uptake pattern of training programs offered at a high?volume training institute in India. Methods: We did a retrospective analysis of data related to training programs conducted between 2000 and 2019. Trainees included ophthalmologists, allied ophthalmic personnel, and eye?care management professionals from all over the world. We analyzed the overall growth over the 20 years in the WHO regions. The uptake patterns were also analyzed across four segments of 5?year?periods by the type of training. Results: Overall, 9091 trainees from 118 countries attended training in over 40 courses that included long? and short?term clinical training for ophthalmologists (54.2%) and short?term training for eye?care managers (29.5%), allied ophthalmic personnel (6.2%), and eye?care technicians (10.2%). The majority of the trainees (81.3%) came from the Southeast Asian region, of which 87.4% were from India. Most (98.3%) of the trainees belonged to developing countries. We found an overall average growth of 4.8% in the training uptake across the four 5?year segments over the 20 years. Conclusion: Comparatively better representation of trainees from the developing countries is encouraging as the prevalence of blindness and visual impairment is higher in those countries, warranting improved eye?care delivery. Given the strong influence of distance and associated costs of accessing training, the development of similar institutes in other regions might help enhance the global efforts to eliminate needless blindness.

Effect of improved management of placenta accreta spectrum disorders on maternal and infant outcomes / 中华围产医学杂志

Objective:To evaluate the role of improved management procedures in placenta accreta spectrum disorders (PAS) and its impact on maternal and infant outcomes.Methods:This retrospective study involved 164 pregnant women who were diagnosed with PAS complicated with placenta previa and delivered at Nanjing Drum Tower Hospital, Nanjing University Medical School from January 2019 to December 2022. All subjects were allocated to pre-improvement group (January 2019 to December 2020, n=96) and post-improvement group (January 2021 to December 2022, n=68). The management was improved in the following five aspects: (1) The time for scheduled delivery was postponed to 37 weeks from 34-36 weeks;(2) Intraoperative cell salvage was encouraged despite autologous blood donation during pregnancy;(3) Original surgical incision was utilized instead of mid-longitudinal incision in the lower abdomen to reduce operative trauma; (4) A lower segment incision of the uterus was not prohibited based on pre-operative PAS classification and intra-operative situation to enter the uterine cavity, even through the placenta instead of pass-by;(5) The interface between lower uterine segment and bladder was dissected before instead of after the baby was born and uterine blood supply was stopped by tourniquet or Scharr forceps. Statistical methods such as t-test, Chi-square test or Fisher exact probability method were used to compare the difference in maternal and infant outcomes between the two groups. Results:After the improvement, the delivery rate beyond 37 weeks decreased significantly [83.3% (80/96) vs 69.1% (47/68), χ 2=4.60, P=0.038]. There was no significant difference in the distribution of elective, subemergency and emergency surgeries before and after the improvement ( χ 2=0.36, P=0.834). Compared to the pre-improvement group, the proportion of women who underwent cesarean section through previous abdominal incisions increased significantly [74.0% (71/96) vs 91.1% (64/68), χ 2=11.11, P=0.001] in the post-improvement group, while the proportion of application of abdominal longitudinal incision and classical cesarean section decreased significantly [84.3% (81/96) vs 57.3% (39/68), χ 2=14.81, P<0.001; 83.3% (80/96) vs 61.8% (42/68), χ 2=9.72, P=0.003]. No significant difference was found between the two groups in terms of the transfusion rate of allogeneic red blood cell, platelet and other blood components, pre-discharge hemoglobin level, subtotal hysterectomy rate, bladder injury, thrombus event, the admission rate of intensive care unit and unplanned reoperation rate (all P>0.05). The incidence of admission in neonatal intensive care unit (NICU) and necrotizing enterocolitis decreased significantly after improvement [24.7% (24/97) vs 11.8% (8/68), χ 2=4.31, P=0.038; 4.1% (4/97) vs 0.0% (0/68), χ 2=58.06, P<0.001]. The incidence of respiratory distress syndrome, mechanical ventilation, and neonatal septicemia also decreased, but without statistical difference. Conclusions:After adopting a series of improvement measures, such as delaying planned delivery to 37 weeks of gestation, individualized cesarean section plan, and changing the method of obtaining autoblood, the number of premature infants and the NICU admission rate decreased significantly without increasing the risk of maternal complications and emergency operation. Furthermore, the incidence of adverse events such as maternal organ injury, unplanned reoperation, and re-admission remains at a low level. Therefore, this improved management is feasible.

Influence of shared medical appointments on health-related quality of life and quality of sleep in patients after liver transplantation / 中华健康管理学杂志

Objective:To observe the influence of shared medical appointments on health-related quality of life and quality of sleep in patients after liver transplantation.Methods:By randomized controlled study, a total of 124 patients after liver transplantation were included from our hospital from January 2018 to January 2019, and according to the lottery method, all subjects were divided into the routine management group ( n=64) who received routine outpatient intervention and the shared medical management group ( n=60) who received shared medical appointments management. The health-related quality of life and quality of sleep were investigated and compared by post-liver transplant quality of life questionnaire (pLTQ) and Pittsburgh sleep quality index (PSQI) before intervention (the day of discharge) and after intervention (the end of the last shared outpatient service). Results:After intervention, the dimension scores of worry, economics, body function, emotional function, health service, complication and total score of pLTQ were improved in tow groups than before intervention [the routine management group: (41.90±7.61), (18.13±4.22), (22.22±5.10), (14.92±3.28), (20.39±4.87), (14.63±3.99), and (132.19±37.09) vs (32.25±5.55), (12.77±3.47), (17.58±4.72), (9.23±1.38), (15.17±4.81), (10.89±1.51) and (98.00±29.03) score, t=8.20, 7.85, 3.58, 12.79, 6.10, 7.01, 5.81, all P<0.001; shared medical management group: (46.12±7.92), (24.16±5.34), (25.55±5.42), (17.90±3.60), (24.81±5.12), (17.93±3.60) and (155.47±41.00) vs (32.57±5.69), (12.81±3.82), (17.00±4.70), (9.60±1.39), (15.39±4.84), (11.00±3.52) and (98.37±28.96) score, t=10.76, 13.39, 9.23, 16.66, 10.36, 10.66, 8.81, all P<0.001], and those in the shared medical management group were higher than those in routine management group ( t=3.03, 6.95, 3.53, 4.82, 4.93, 4.83, 3.32, all P<0.05). After intervention, the total score of PSQI scale were lower than before intervention in the routine management group [(10.48±2.14) vs (11.89±2.45) score, t=3.47, P=0.001], and the dimensions score of sleep quality, full-sleep time, sleep time, sleep efficiency, sleep disorders, daytime function, hypnotic and total score of PSQI were lower than before intervention in the shared medical management group [(1.41±0.32), (0.54±0.13), (1.17±0.26), (1.11±0.35), (1.21±0.27), (1.30±0.33), (1.08±0.21) and (8.05±1.75) vs (1.88±0.53), (0.86±0.37), (1.84±0.41), (2.05±0.56), (1.39±0.33), (1.47±0.43), (1.22±0.32) and (11.71±2.43) score, t=-5.88, -6.32, -10.69, -11.03, -3.27, -2.43, -3.65, -9.47, all P<0.05], and those in the shared medical management group were lower than those in routine management group ( t=-6.68, -6.39, -10.43, -10.97, -2.62, -2.12, -3.54, -6.90, all P<0.05). Conclusion:Shared medical appointments model can improve the health-related quality of life and quality of sleep in patients after liver transplantation, and improve the effectiveness of outpatient intervention.

Factors Related to Care Management for Older Adults Requiring Home Care in the End-of-life Period and Implications for Training / 日本プライマリ・ケア連合学会誌

Introduction: To identify factors related to the quality-of-care management performance of older adults who required home care in the end-of-life period and implications for training.Methods: A total of 2,540 care management offices were randomly selected, and one care manager from each office completed a self-administered questionnaire. The End-of-life Care Management Scale was used to assess care management performance. Multiple regression analysis was performed after bivariate analysis using attributes and other factors.Results: The most important factors were previous training in disease, previous training in multidisciplinary collaboration, sex, previous training in nursing, had a visiting nurse agency, years of experience, and previous training in team building, in descending order.Conclusion: Quality-of-care management execution may be improved by focusing on and prioritizing training content where contributions are indicated and utilizing visiting nurses.

Evaluación de la calidad de cuidados de enfermería en una institución privada en el periodo agosto/ septiembre de 2021 / Evaluation of the quality of nursing care in a private institution in the period august / september 2021

Es de importancia analizar desde el punto de vista de gestión de calidad y seguridad del paciente donde los cuidados enfermeros se consideran un elemento unificador y exigen a los profesionales a trabajar con un método evaluando sistemáticamente los cuidados y posicionan a los profesionales enfermeros como parte importante del equipo de salud. Esta calidad de servicio puede ser estimada a través de un indicador de calidad que sirve para medir también el grado de satisfacción del cliente. Teniendo como objetivo evaluar el proceso de calidad de las prácticas de enfermería que aportan a la seguridad de los pacientes. Es de relevancia entender que la calidad y la seguridad del paciente, deben ser enfrentadas como un proceso continuo, que permita mediciones que traduzcan en mejoras signifcativas y que puedan llevar a programas de intervenciones.Se revisaron conceptos como calidad del cuidado, gestión del cuidado, indicadores de calidad para medir el grado de satisfacción del profesional como del cliente[AU]

It is important to analyze from the point of view of quality management and patient safety where nursing care is considered a unifying element because it does not allow the development of discipline, it requires professionals to work with a method systematically evaluating care and position nursing professionals as an important part of the health team. Tis quality of service can be measured through a quality indicator that also serves to measure the degree of customer satisfaction. Aiming to evaluate the quality process of nursing practices that contribute to the safety of patients.It is important to understand that quality and patient safety must be addressed as a continuous process, allowing measurements that translate into significant improvements and that can lead to intervention programs.Concepts such as quality of care, care management, quality indicators to measure the degree of satisfaction of the professional and the client were reviewed[AU]

É importante analisar do ponto de vista da gestão da qualidade e segurança do paciente onde a assistência de enfermagem é considerada um elemento unifcador, pois não permite o desenvolvimento da disciplina, exige que o profssional trabalhe com um método que avalie sistematicamente o cuidado e posicione o profssional de enfermagem como parte importante da equipe de saúde. Essa qualidade de serviço pode ser medida por meio de um indicador de qualidade que também serve para medir o grau de satisfação do cliente. Com o objetivo de avaliar o processo de qualidade das práticas de enfermagem que contribuem para a segurança dos pacientes. É importante entender que a qualidade e a segurança do paciente devem ser tratadas como um processo contínuo, permitindo medições que se traduzam em melhorias significativas e que podem levar a programas de intervenção. Conceitos como qualidade do atendimento, gestão do atendimento, indicadores de qualidade foram revisados para medir o grau de satisfação do profssional e do cliente[AU]

Implementation of a patient blood management program based on a low-income country-adapted clinical decision support system

ABSTRACT Introduction: Patient blood management (PBM) programs are associated with better patient outcomes, a reduced number of transfusions and cost-savings The Clinical Decision Support (CDS) systems are valuable tools in this process, but their availability is limited in developing countries This study assesses the feasibility and effectiveness of an adapted CDS system for low-income countries. Methods: This was a prospective study of the PBM program implementation, in a 200-bed tertiary hospital, between February 2019 and May 2020. Outcome measures were red blood cell (RBC), fresh frozen plasma (FFP) and platelet unit transfusions, the transfusion of a single unit of red blood cells and an RBC adequacy index (RAI). Results: Comparing the post-PBM program era with the pre-PBM system era, there was a decrease in red blood cell transfusions (p = 0.05), with an increase in single unit red blood cell transfusions (p = 0.005) and RAI (p < 0.001). Conclusions: The PBM programs, including electronic transfusion guidelines with pre-transfusion medical auditing, was associated with improved transfusion practices and reduced product acquisition-related costs.

Clinical management of COVID-19: living guideline - 15 September 2022

The WHO COVID-19 Clinical management: living guidance contains the Organization's most up-to-date recommendations for the clinical management of people with COVID-19. Providing guidance that is comprehensive and holistic for the optimal care of COVID-19 patients throughout their entire illness is important. The latest version of this living guideline is available in pdf format (via the 'Download' button) and via an online platform, and is updated regularly as new evidence emerges. No further updates to the previous existing recommendations were made in this latest version. This updated (fifth) version contains 16 new recommendations for the rehabilitation of adults with post COVID-19 condition (see Chapter 24), which includes: strong recommendation that exertional desaturation and cardiac impairment following COVID-19 should be ruled out and managed before consideration of physical exercise training

Pharmaceutical Care in Primary Care: an Experience with Hypertensive Patients in the North of Brazil

Abstract Background: Uncontrolled blood pressure has been associated with poor adherence to drug treatment. Objectives: To assess blood pressure control in hypertensive patients attending primary health centers after implementation of a pharmaceutical follow-up program in a city of the north of Brazil. Methods: Observational, cross sectional, descriptive study with 163 hypertensive patients attending public primary health care centers - one located on the riverside and one in the urban area of the city of Santarem, western Pará, Brazil. Adherence to the anti-hypertensive treatment was assessed using the eight-item Morisky test. Pharmacotherapy follow-up (Dader method) of patients with uncontrolled hypertension and non-adherent to anti-hypertensive treatment was performed. Results of the normality test showed that the data did not follow a normal distribution. Continuous variables were then compared using the Wilcoxon signed-rank test, and categorical variables by the likelihood ratio and the McNemar tests. Statistical significance was set at 5%. Results: Of the total sample, 94.5% were not adherent to anti-hypertensive drug therapy and 77.2% had uncontrolled hypertension. Adherence rate was higher in men than women (p=0.006). Pharmacotherapy follow-up improved blood pressure levels, particularly systolic blood pressure (p<0.001). Conclusion: An individualized pharmacotherapeutic follow-up, considering regional and cultural specificities, can contribute to the treatment of hypertensin in the primary care.

Las brechas de género en las áreas de trabajo del sistema de salud argentino / Gender gaps in the work areas of the Argentine health system

Studies with a gender perspective focus on the way in which women and men relate to each other in different spheres, reflecting the distribution of power between them. This type of work division conditions the working life of women, who tend to dedicate fewer hours to paid work than men, affecting their labor income, as well as other non-monetary compensations. The objective of this study was to characterize the men and women employed in the health sector of Bahía Blanca, from a gender perspective. For this, the Permanent Household Survey of the Instituto Nacional de Estadística y Censos (INDEC, as per its initials in Spanish) was analyzed using a quantitative methodology. The main results indicate that, although the sector is composed of a majority of women, this proportion being even greater than in the rest of the country, with more education and work experience than their male counterparts, women face conditions of horizontal and vertical labor segregation. At the same time, differences are observed in the contracting conditions. The study of work from a gender perspective will contribute to the design of policies that propose gender equity, that is, the absence of systematic and unfair differences in the working conditions and opportunities between women and men. In particular, this information can be very useful for developing strategies that tend to improve the situation of women when health care management is decentralized to lower levels of government.

Los estudios con perspectiva de género se centran en la forma en que se relacionan mujeres y varones en distintos ámbitos, reflejando la distribución de poder entre ambos. La división del trabajo según el género condiciona las trayectorias laborales de las mujeres, quienes suelen destinar menos horas que los varones al trabajo remunerado, lo que repercute en su ingreso laboral, así como en otras compensaciones no monetarias. El objetivo de este trabajo fue caracterizar a las personas ocupadas del sector de salud del partido de Bahía Blanca, Argentina, desde una perspectiva de género. Para ello se analizó la Encuesta Permanente de Hogares del Instituto Nacional de Estadística y Censos (INDEC), utilizando una metodología cuantitativa. Los principales resultados señalan que, aun cuando el sector este compuesto por una mayoría de mujeres, incluso mayor que en el resto del país, con mayor educación y experiencia laboral que sus compañeros varones, estas enfrentan condiciones de segregación laboral horizontal y vertical, a la vez que se observan diferencias en las condiciones de contratación. El trabajo desde una mirada de género contribuirá al diseño de políticas que se propongan la equidad de género, es decir la ausencia de diferencias sistemáticas e injustas en las condiciones y las oportunidades de trabajo entre mujeres y varones. En particular, esta información puede resultar de gran utilidad para diseñar estrategias que tiendan a mejorar la situación de las mujeres cuando la gestión de la atención de salud se encuentra descentralizada a los niveles inferiores de gobierno.

CAPS (C)ad(ê): memórias de trabalhadores de saúde mental / CAPS (C)ad(ê): mental health workers memories

Com o objetivo de investigar as estratégias de atenção, gestão do trabalho e arranjos de cuidado desenvolvidos em um Centro de Atenção Psicossocial álcool e outras drogas / CAPS ad de um município de médio porte no interior do estado do Rio de Janeiro, descrevo e analiso memórias de 12 trabalhadores de saúde mental. Partindo de uma experiência de trabalho desde o ano de 2016 e do convívio com outros profissionais do Sistema Único de Saúde / SUS e do Sistema Único de Assistência Social / SUAS, elaboro inicialmente minhas memórias sobre a organização da equipe e as dinâmicas dos atendimentos, partilhando algumas delas com colegas de trabalho. Esperamos, em uma reunião conjunta de memórias, analisar a gestão do cuidado para usuários de drogas em contexto social, institucional e político marcado por processos de precarização. Consideramos que esses processos incidem sobre serviços públicos de saúde, relações de trabalho e redes de suporte social, por meio da escassez e da distribuição desigual de recursos, bem como da exposição a esquemas de violência e vulnerabilização. Concluímos que o serviço estudado lida com processos crônicos de fragilização das relações de trabalho, subfinanciamento e isolamento em termos de redes de atenção, o que impacta as relações de continuidade do cuidado no SUS. Além disso, as memórias de trabalhadores indicaram também fatores fundamentais para serem considerados em estratégias avaliativas dos serviços, como por exemplo, vinculação profissional, formação continuada, diretrizes para atuação, supervisão, como também participação de usuários e familiares.

With the objective of investigating the attention strategies, work management and care arrangements developed in a Psychosocial Care Center for alcohol and other drugs / CAPS ad in a medium-sized municipality in the interior of the state of Rio de Janeiro, I describe and analyze memories of 12 mental health workers. Starting from a work experience since 2016 and from the interaction with other professionals from the Unified Health System / SUS and the Unified Social Assistance System / SUAS, I initially elaborate my memories about the organization of the team and the dynamics of the assistance, sharing some of them with co-workers. We hope, in a joint meeting of memories, to analyze the management of care for drug users in a social, institutional and political context marked by processes of precariousness. We consider that these processes affect public health services, work relationships and social support networks, through scarcity and unequal distribution of resources, as well as exposure to schemes of violence and vulnerability. We conclude that the service studied deals with chronic processes of weakening work relationships, underfunding and isolation in terms of care networks, which affects the continuity of care relationships in the SUS. In addition, the workers' memories also indicated fundamental factors to be considered in evaluation strategies of the services, such as professional bonding, continuing education, guidelines for performance, supervision, as well as the participation of users and family members.

Approaches of the systematization of nursing care, complexity and ontology in the professional practice of nurses / Aproximaciones entre sistematización de asistencias de enfermería, complejidad y ontologia en la práctica profesional del enfermero / Aproximações entre sistematização da assistência de enfermagem, complexidade e ontologia na prática profissional do enfermeiro

ABSTRACT Objective: To reflect on the approaches of the Systematization of Nursing Care, ontology and complex thinking in professional nursing practice. Method: A reflective theoretical study grounded on the Complexity Theory of Edgar Morin and on the ontological principles of computational application which enables representing nursing concepts. Results: The paradigm of complexity breaks the linearity and expands the meaning of Systematization of Nursing Care, supporting a conceptualization of new entities and objectives, moving away from reductionism in work practice. Ontology is considered as a potential technology for creating a standardized language capable of representing the Systematization of Nursing Care from the perspective of complex thinking. Conclusion: Ontology furthers the formal representation of Systematization of Nursing Care knowledge, creating strength in its identity, organization, and sharing its knowledge and information. Supporting the dissemination of common nursing vocabulary contributes to nurses' daily experience and decisions.

RESUMEN Objetivo: Reflexionar sobre las aproximaciones entre la Sistematización de la Asistencia de Enfermería, ontología y pensamiento complejo en la práctica profesional del enfermero. Método: Estudio teórico reflexivo fundamentado en la teoría de la complejidad de Edgar Morin y en los principios ontológicos con aplicación computacional posibles de representación conceptual en la enfermería. Resultados: El paradigma de la complejidad rompe con la linealidad y amplía el significado de la Sistematización de la Asistencia, favoreciendo la conceptualización de nuevas entidades y objetivos, alejándose del reduccionismo en la práctica laboral. La ontología se considera una tecnología potencial para crear un lenguaje estandarizado capaz de representar la Sistematización de la Atención de Enfermería desde la perspectiva del pensamiento complejo. Conclusión: La ontología facilita la representación formal del conocimiento de la la Sistematización de la Asistencia, fortaleciendo su identidad, organización, intercambio de conocimiento e información. Unido al pensamiento complejo, favorece la difusión de vocabulario común al área de enfermería que contribuya en la experiencia y decisiones de los enfermeros.

RESUMO Objetivo: Refletir sobre as aproximações entre Sistematização da Assistência de Enfermagem, ontologia e pensamento complexo na prática profissional do enfermeiro. Método: Estudo teórico reflexivo fundamentado na Teoria da Complexidade de Edgar Morin e nos princípios ontológicos com aplicação computacional possíveis de representações conceituais na enfermagem. Resultados: O paradigma da complexidade rompe com a linearidade e amplia o significado da Sistematização da Assistência de Enfermagem, favorecendo a conceituação de novas entidades e objetivos, distanciando-se do reducionismo na prática laboral. Considera-se a ontologia como potencial tecnologia para criação de linguagem padronizada capaz de representar a Sistematização da Assistência de Enfermagem na perspectiva do pensamento complexo. Conclusão: A ontologia facilita a representação formal do conhecimento da Sistematização da Assistência de Enfermagem, gerando fortalecimento da sua identidade, organização, compartilhamento do conhecimento e informação. Aliada ao pensamento complexo, favorece a difusão de vocabulário comum à enfermagem, contribuindo na experiência e decisões dos enfermeiros.

Application of 6S and PDCA cycle lean management in nursing management of orthopedic trauma surgery / 中华创伤杂志

Objective:To explore the application effect of 6S and PDCA cycle lean management in nursing management of orthopaedic trauma surgery.Methods:A retrospective cohort study was conducted to analyze the clinical data of 80 patients with orthopedic trauma admitted to University-Town Hospital of Chongqing Medical University from January 2020 to November 2021, including 51 males and 29 females; aged 23-68 years [(44.5±9.2)years]. According to the order of operation date, 40 patients from January 2021 to November 2021 received routine management plus 6S and PDCA cycle lean management (lean management group), and 40 patients from January 2020 to December 2020 received routine surgical nursing management (routine management group). The nursing quality score in operating room (instrument and equipment management, surgical instrument preparation, surgical coordination, disinfection and isolation), qualified rate of infection monitoring in operating room (air in operating room, hand hygiene of medical staffs and sterile articles in operating room), surgeons′ satisfaction with operating nurses (circulating nurses and scrub nurses), self- rating anxiety scale (SAS) of patients before operation, incidence of complications at postoperative 12 days and patients′ satisfaction with nurses in operating room at postoperative 2-3 days.Results:The four dimensions of the nursing quality score in operating room in lean management group were (27.8±1.5)points, (18.1±1.1)points, (26.6±1.5)points and (18.1±0.8)points, significantly higher than (23.7±2.3)points, (14.6±1.1)points, (22.4±1.8)points and (13.7±1.1)points in routine management group (all P<0.01). The three dimensions of qualified rate of infection monitoring in operating room in lean management group were all 100%, showing no significant differences in routine management group (75%, 100%, 100%) (all P>0.05). Surgeons′ satisfaction with circulating nurses and scrub nurses in lean management group was 90% and 85%, higher than 73% and 65% in routine management group (all P<0.05). Preoperative SAS in lean management group was (32.5±8.2)points, significantly lower than (54.6±10.7)points in routine management group ( P<0.01). The incidence of postoperative complications in lean management group was 0, significantly lower than 15%(6/40) in routine management group ( P<0.05). Patients′ satisfaction with nurses in operating room in lean management group was 95% (38/40), significantly higher than 78%(31/40) in routine management group ( P<0.05). Conclusion:6S and PDCA cycle lean management can effectively improve the nursing quality of orthopedic trauma surgery, reduce patients′ anxiety and postoperative complications, and improve surgeons′ and patients′ satisfaction, which is worthy of further clinical application.

Nurse-Led Diabetes Clinic (NLDC) for a comprehensive diabetes care management

@#Chronic disease is rapidly becoming a greater burden in the world and the leading cause of mortality because of epidemiological transformation. Diabetes is one; with 6.7 million deaths registered in 2021. In the Philippines, a report by the International Diabetes Foundation (IDF) projects the number of patients with Diabetes in 2030 to reach 5.4 million and 7.5 million by 2045. Diabetes treatment in the Philippines is poor and challenging in terms of resources, government support, and economy. The national health insurance system does not have comprehensive diabetes care coverage and private insurance companies offer limited diabetes coverage. As a result, patients rely on "out-of-pocket" expenses for their laboratory testing and medications, and consequently, nonadherence to therapy. There is a need for an intervention in diabetes care management as Diabetes Mellitus (DM) prevalence posts an upward trend. This paper recommends the following policy statements to strengthen DM care management in a comprehensive, integrated, and coordinated nurse-led care system through “3Rs”: “Reactivating” the health promotion activities; “Rephrasing” the existing care provisions; and “Re-establishing” care models that will boost the DM management care among the Filipinos.

Current status and challenges of prenatal and postnatal integrated management of fetal congenital heart defect / 中华围产医学杂志

Early and prompt comprehensive prevention and treatment of fetal congenital heart disease (CHD) has become an international consensus and trend, with the aim of improving its prenatal detection rate, diagnostic accuracy, and the overall pregnancy outcome. Prenatal and postnatal integrated management of fetal CHD has been shown to be clinically effective in the prevention and treatment of CHD, which consists of early and accurate diagnosis, identification of structure-related multi-dimensional etiology, standardized consultation, primary prevention for the next fetus, and postnatal management. This review summarizes the current status, challenge, and future trend of implementing prenatal and postnatal integrated management of fetal CHD in China.

Analysis on the effect of PDCA cycle method to promote the management of key monitoring drug / 药学实践杂志

Objective To observe the effect of applying PDCA cycle method to promote the management of key monitoring drug, and provide a basis for the management of key monitoring drug in medical institutions. Methods To compare the consumption of drugs and prescription reviews before and after the adoption of PDCA management in a hospital. The control group was the inpatients with traditional management method in 2019, and the observation group was the inpatients with PDCA method in 2020. Results After the implementation of PDCA cycle, the consumption amount of key monitoring drugs decreased significantly (P<0.001); The problems of irrational prescription such as drug use without indication, repeated drug use, inappropriate dosage and route of administration, and long course of treatment were effectively controlled (P<0.05). The qualified rate of prescription increased from 65.96% to 90.76% (χ2=27.010, P<0.001). The incidence of adverse reactions was significantly decreased (χ2 =37.044, P<0.001). Conclusion PDCA method aims at continuous closed-loop management of key monitoring drugs in medical institutions, which can control drug costs to the greatest extent, reduce the economic burden of patients, promote rational drug use, reduce the incidence of adverse reactions, and ensure the quality of medical care.

Estrategias de enseñanza-aprendizaje en gestión del cuidado de enfermería. Una revisión narrativa / Nursing care management teaching-learning strategies. A narrative review / Estratégias de ensino-aprendizagem na gestão do cuidado de enfermagem. Uma revisão narrativa

RESUMEN Introducción El proceso de enseñanza-aprendizaje en la enfermería requiere estrategias didácticas, objetivas y eficaces para que, tanto alumnos como profesionales noveles, desarrollen habilidades en la gestión del cuidado. Objetivo Analizar la evidencia publicada sobre las estrategias didácticas implementadas durante el proceso de enseñanza-aprendizaje para el desarrollo de habilidades enfocadas a la gestión del cuidado. Método Revisión narrativa de la literatura. La búsqueda de información se realizó en cinco bases de datos usando MeSH/DeCS y palabras clave. Se encontraron 1 391 textos; de estos fueron elegidos 52 por título y resumen; al final se analizaron 18 artículos. Resultados La principal estrategia empleada es el aprendizaje basado en problemas. Las habilidades más desarrolladas fueron interpersonales, como la comunicación; seguidas por las analíticas, como la planificación. Discusión y Conclusiones Las estrategias identificadas resultan ser eficaces y funcionales, por lo tanto, pueden ser utilizadas para desarrollar habilidades de gestión en alumnos de pregrado y profesionales de enfermería principiantes. Cabe señalar que ninguna es excluyente de otra, por lo que pueden emplearse en sinergia para lograr los objetivos de aprendizaje. Es importante que los docentes de enfermería empleen dichas estrategias de acuerdo con la evidencia existente y con su efectividad, para así construir un aprendizaje significativo.

ABSTRACT Introduction The process of teaching-learning in nursing requires didactic, objective, and efficacious strategies so that students and novice instructors develop nursing care management skills. Objective To analyze published evidence on didactic strategies implemented during the process of teaching-learning regarding the development of care management skills. Method This is a narrative review. Five databases were consulted using MeSH/DeCS terms and keywords. 1 391 texts were found. From these, 52 were chosen because of their titles and abstracts; and 18 were finally kept for the analysis. Results The main strategy used is learning based on problem-solving. Commonly developed interpersonal and communication-related skills, followed by analytical and planification ones. Discussion and Conclusions Identified strategies turned out to be efficient and functional, and therefore can be used in the development of care management skills among pre-grade nursing students and novice nursing professionals. These strategies can be used synergically to promote significant learning.

RESUMO Introdução O processo ensino-aprendizagem em enfermagem requer estratégias didáticas objetivas e eficazes para que tanto estudantes quanto profissionais iniciantes desenvolvam habilidades na gestão do cuidado. Objetivo Analisar a evidência publicada sobre as estratégias didáticas implementadas durante o processo de ensino-aprendizagem para o desenvolvimento de competências focadas na gestão do cuidado. Método Revisão narrativa da literatura. A busca das informações foi realizada em cinco bases de dados utilizando MeSH/DeCS e palavras-chave. 1391 textos foram encontrados, destes, 52 foram escolhidos por título e resumo; ao final, foram analisados 18 artigos. Resultados A principal estratégia utilizada é a aprendizagem baseada em problemas. As habilidades mais desenvolvidas foram as interpessoais, como a comunicação; seguido pelas análises, como planejamento. Discussão e Conclusões As estratégias identificadas resultam ser eficazes e funcionais, portanto, podem ser utilizadas para desenvolver habilidades de gestão em graduandos e profissionais de enfermagem iniciantes. Ressalta-se que nenhum é exclusivo do outro, para que possam ser utilizados em sinergia para atingir os objetivos de aprendizagem. É importante que os docentes de enfermagem utilizem essas estratégias de acordo com as evidências existentes e sua efetividade, a fim de construir uma aprendizagem significativa.