Pistas genealógicas de um Consultório na Rua: criminalização e assimilação / Genealogical clues from a Street Clinic: criminalization and assimilation / Pistas genealógicas de un Consultorio em la Calle: criminalización y asimilación

Este artigo, por meio de aproximação genealógica, buscou investigar o que chamaremos de pistas genealó-gicas do equipamento Consultório na Rua em município de médio porte no Sul do Brasil. Para o percurso da pesquisa, junto a uma vivência em um Consultório na Rua, nesse município do país, foram realizados entrevistas e levantamentos de documentos. Na investigação foi possível encontrar pistas que apontam para uma produção de criminalização e assimilação histórica dos viventes da rua pelo Estado brasileiro, de maneira que esses pontos precisam ser discutidos e problematizados para que tais regimes de verdade não sejam norteadores das políticas públicas para tais pessoas.

This article, employing a genealogical approach, aimed to examine the genealogical traces of the Street Clinic equipment in a medium-sized city in Brazil's southern region. In order to follow the path of the research, along with an experience in a Street Clinic in a Brazilian city, interviews and document surveys were conducted. In the investigation, it was possible to find elements of the production of criminalization and historical assimilation by the Brazilian State that need to be discussed and problematized so that such regimes of truth are not guiding the production of health care for people experiencing homelessness.

Este artículo, a través de un abordaje genealógico, buscó investigar pistas genealógicas del Consultorio en la Calle en una ciudad de tamaño medio en el sur de Brasil. Para el transcurso de la investigación, junto con una experiencia en un Consultorio en la Calle en un municipio de tamaño medio en el sur de Brasil, se efectuaron entrevistas y encuestas documentales. En la investigación, fue posible encontrar pistas que apuntan a una producción de criminalización y asimilación histórica de las personas en situación de calle por parte del Estado brasileño, por lo que estos puntos necesitan ser discutidos y problematizados para que tales regímenes de verdad no guíen políticas públicas para dicha población.

Administración del consultorio odontológico en contextos inflacionarios / Dental clinic administration in inflationary contexts

La administración es una herramienta fundamental que permite planificar, desarrollar y organizar cualquier empresa, independientemente del tamaño de la misma. Tener una sana administración del consultorio odontológico es imprescindi- ble para la toma de decisiones, más aún en contextos de crisis y alta inflación (AU)

Administration is a fundamental tool that allows plan- ning, developing, and organizing any company, regardless of its size. Having a healthy administration of the dental clinic is essential for decision making, even more so in contexts of crisis and high inflation (AU)

Entre territórios pandêmicos: cartografia de um Consultório na Rua durante a pandemia de covid-19 / Exploring pandemic territories: cartography of a street clinic during the covid-19 pandemic / Entre territorios pandémicos: cartografía de un Consultorio en la Calle durante la pandemia de covid-19

O objetivo do presente artigo foi realizar uma cartografia de um Consultório na Rua, durante o período da pandemia de covid-19. A cartografia foi produzida por uma vivência no consultório de um município de grande porte no sul do Brasil, de agosto de 2021 a janeiro de 2022. Foi perceptível que a locomoção e o funcionamento do serviço reconhecem outros territórios das Pessoas em Situação de Rua, muitas vezes não percebidos por outros pontos do Sistema Único de Saúde. Foram encontradas tanto as barreiras já estabelecidas historicamente quanto as emergentes da pandemia. Foi vivenciado que a esta população não utiliza o território do modo que a cidade racionalizada planeja, sendo, portanto, singular. O reconhecimento do serviço, aliado à compreensão de como as Pessoas em Situação de Rua vivem no território urbano, em cada realidade, mostrou-se essencial para a produção de cuidado.

The objective of this article was to conduct a cartographic study of a street clinic during the covid-19 pandemic. The cartography was based on an experiential approach in a street clinic located in a major city in southern Brazil, between August 2021 and January 2022. It became evident that the flows and operation of the service acknowledged the alternative territories inhabited by the homeless population, often overlooked by other parts of Brazil's Unified Health System. Both historically established barriers and those emerging from the pandemic were encountered. It was observed that the homeless population does not conform to rationalized urban plans, displaying unique patterns of engagement with the urban territory. Recognizing the significance of the service, coupled with a comprehensive understanding of the unique living conditions of homeless individuals, proved indispensable for the provision of effective care.

El objetivo de este artículo fue realizar una cartografía de un Consultorio en la Calle durante el período de la pandemia del covid-19. La cartografía fue producida por una experiencia en un Consultorio en la Calle en una gran ciudad del sur de Brasil, de agosto de 2021 a enero de 2022. Se pudo observar que la locomoción y operación del servicio reconocen otros territorios habitados por personas en situación de calle, a menudo no percibidos por otros puntos del Sistema Único de Salud. Se encontraron barreras, tanto históricamente establecidas como emergentes debido a la pandemia. Se constató que la población en situación de calle no utiliza el territorio de la forma planificada por la ciudad racionalizada. El reconocimiento del servicio, junto con la comprensión de cómo viven las personas en situación de calle en el territorio urbano en cada realidad, se mostró fundamental para la producción del cuidado.

The implementation and evaluation of a modified full appointment mode for daytime chemotherapy safety / 复旦学报（医学版）

Objective To explore the operation effect of the improved full-appointment mode of ambulatory chemotherapy,so as to provide reference for further improving the treatment process.Methods The enhanced full-appointment mode had been implemented in Fudan University Shanghai Cancer Center outpatient information system,which seamlessly integrated daytime chemotherapy assessment with comprehensive information management,formulated precise rules for chemotherapy appointments,and ensured efficient integration of relevant data.A comparative analysis was conducted between the period after optimization(Jan to Sep 2022)and the corresponding period in the previous year(Jan to Sep 2021),considering factors such as patient waiting time,human involvement,patient safety during chemotherapy,as well as nurse and patient satisfaction.Results After optimization,the time spent by patients was reduced from 52.12(32.73-83.05)to 20.04(11.87-41.10)minutes,with statistically significant difference(z=-78.144,P＜0.001).Additionally,the time spent by patients before and after optimization was significantly different in the distribution of＜30 minutes,30-60 minutes,and＞60 minutes(χ2=5 958.455,P＜0.001).Previously,one nurse and 2-3 security personnel were required to schedule appointments in the daytime chemotherapy center,while after optimization,there was no longer a need for nurses to arrange appointment windows and the number of security personnel was reduced to one,thereby optimized human operations.It was observed that the number of cases involving chemotherapy infusion reactions decreased from 59 to 46 following optimization,and the number of patients requiring rescue observation reduced from four to one.Notably,no rescue events occurred during non-day shifts,thus enhanced patient safety during treatment hours outside regular working hours.Furthermore,there was a statistically significant improvement in both nurses'and patients'satisfaction levels before and after implementation of these optimizations(P＜0.05).Conclusion The modified full appointment mode reduced patient waiting time,optimized human resources utilization,enhanced patient safety during chemotherapy,and improved satisfaction levels among both nurses and patients.The implementation of the modified full appointment mode for daytime chemotherapy centers was beneficial to their overall operation.

The influence of incentive and target assessment mechanism on the operation and management efficien-cy of nurse-led clinics / 现代医院

Objective To study the effect of incentive and target assessment mechanism on the operation and manage-ment efficiency of nurse-led clinics.Methods 45 cases in the nurse-led clinic managed by the target assessment mechanism in our hospital from June to December 2021 were selected as the control group,and 46 cases managed by the incentive joint target assessment mechanism in our hospital from February to July 2022 were selected as the observation group.The annual workload,doctors'recognition of nurses,nursing quality and self-efficacy scale(GSES)scores before and after intervention were compared between the two groups,and the satisfaction of nurses in charge of patients was compared between the two groups.Results Be-fore intervention,there was no difference in the annual workload between the two groups(P＞0.05).After intervention,the an-nual workload of the two groups increased,and the observation group was higher than the control group(P＜0.05).Before inter-vention,there was no difference in the scores of recognition degree between the two groups(P＞0.05).After intervention,the scores of communication ability,quality management ability,emergency ability,independent work ability and specialist problem solving ability of the two groups increased,and the observation group was higher than the control group(P＜0.05).Before inter-vention,there was no difference in nursing quality score between the two groups(P＞0.05).After intervention,the quality of nursing cases,the quality of patient safety management,the quality of post work and the total mean score of the two groups were increased,and the observation group was higher than the control group(P＜0.05).Before intervention,there was no difference in GSES scores between the two groups(P＞0.05).After intervention,GSES scores of the two groups increased,and the obser-vation group was higher than the control group(P＜0.05).The total satisfaction rate of patients in observation group was 96.25% ,higher than 86.25% in control group(P＜0.05).Conclusion The incentive and target assessment mechanism can significantly improve nurses'annual workload and nursing quality,doctors'recognition of nurses and patients'satisfaction with nursing.

Operation management of teaching clinic for standardized training of pediatric residents / 中华医学教育探索杂志

A teaching clinic is an outpatient clinic specialized for teaching, where trainees are responsible for medical activities such as medical history taking, physical examination, and diagnosis and treatment, under the assistance and guidance of teachers. Only a few hospitals in China have built up teaching clinics for standardized training of pediatric residents. This paper summarizes the experience in the operation management of the standardized residency training teaching clinic in Children's Hospital, Zhejiang University School of Medicine. The teaching clinic takes teaching as its core task, adheres to humanistic care, and follows the principle of hierarchical progression. Its operation involves organizational approval, preliminary arrangements, outpatient appointments, the implementation of teaching activities, and other processes, which are carried out under organizational management and quality management. We have explored a preliminary strategy for evaluating the teaching effects of teaching clinics, and proposed some suggestions for the future development of pediatric residency training teaching clinics such as increasing objective evaluation methods and increasing pediatric subspecialty teaching clinics.

Exploration and practice of humanistic care in children’s fever clinics from the perspective of narrative medicine / 中国医学伦理学

To explore the application of humanistic care in children’s fever clinics， the children’s fever clinics of Guangzhou Women and Children’s Medical Center conducted relevant research using narrative medicine as a guiding concept. This paper elaborated on the medical humanistic dilemmas and narrative care needs in children’s fever clinics， and focused on exploring the practice paths of narrative medicine in pediatric with Chinese characteristics from five dimensions， including the cultivation of nursing staff’s abilities of professional narrative and humanistic care， the establishment of health lectures featuring narrative patient education， the alleviation of medical anxiety for children and their families， related support of narrative nursing， and caring services. The aim was to improve the narrative care ability of nurses in children’s fever clinics， develop methods for pediatric patients that can eliminate the fear of seeking medical treatment， and protect children’s physical and mental health. A carrier of care， support， and emotional expression can be provided for parents. The foundation for nursing staff to achieve professional growth through narrative reflection can be laid. Thus， it can assist in establishing a life narrative community relationship between doctors and patients， and jointly explore the meaning of life.

Improving the Waiting Time in Outpatient Clinics Using Lean Approach in Hospital: A Systematic Review

@#Introduction: The use of the lean approach in healthcare has rapidly gained popularity globally, although this approach was more routinely used in the manufacturing sector as opposed to health. Besides, recent studies confirm the suitability of the lean approach applications for improving the quality of medical care. This study aimed to determine the Lean approach’s capacity to improve the waiting time in outpatient clinics in hospitals. Methods: The systematic review approach was employed to help in the research procedures. Search databases used included Ovid, Google scholar, PubMed, MEDLINE, and archive. Besides, search terminologies such as the Lean approach, Hospital-implementation, waiting time, and patient flow were used to help identify sources that best suited the investigation process. Results: The review revealed that the lean approach is suitable for the reduction of waiting times as well as for improving efficiency in the clinic. The outcomes provide a basis for reducing the average waiting time within the hospital. Conclusion: This study recommended that healthcare facilities and departments should take a keen interest in implementing the Lean approaches, as they are crucial for reducing waiting time.

Application of narrative pharmacy in cardiovascular pharmacy clinic / 中国药房

OBJECTIVE To explore the effects of narrative pharmacy management on medication compliance， negative emotions， and quality of life in patients with cardiovascular disease complicated with negative emotions. METHODS A total of 49 patients with drug use problems and negative emotions attending the cardiovascular pharmacy clinic of Wuhan First Hospital from February to August 2023 were selected as the study objects， narrative pharmacy model was applied for patient management during their visits； pharmaceutical care and emotional management were performed after 2 weeks of treatment and a follow-up visit was conducted to evaluate and record the management effect one month later. RESULTS Adopting a narrative pharmacy management model， 49 patients were involved in 114 drug related consultation questions. Compared with the visit， after one month of management， the number of medication types taken by patients significantly decreased [4.00 （2.00， 6.00） vs. 3.00 （1.50， 5.00）， P＜0.05]， the incidence of adverse reactions significantly decreased （32.65% vs. 2.04%， P＜0.001）， the rate of blood pressure and lipid compliance significantly increased （30.61% vs. 95.92%， P＜0.001）， and the score of the patient’s medication compliance significantly improved （[ 3.94±2.44） vs. （6.78±2.07）， P＜0.01]. The depression score significantly decreased [3.00 （2.00， 4.50） vs. 2.00 （0.00， 3.00）， P＜0.001]， the anxiety score significantly reduced [3.00 （2.00， 4.50） vs. 1.00 （0.00， 2.00）， P＜0.001]， quality of life score was significantly improved [22.00 （19.00， 22.00） vs. 23.00 （23.00， 24.50）， P＜0.01]. In the satisfaction survey， there was a slight increase in the overall satisfaction proportion （91.84% vs. 97.96%， P＞0.05）. CONCLUSIONS The application of narrative pharmacy in cardiovascular pharmacy clinic can improve patient compliance， reduce adverse drug reactions， enhance the effectiveness of drug treatment， avoid drug interactions， effectively improve the anxiety and depression， and ultimately improve the quality of life.

Establishment of pharmaceutical care model for lower extremity artery disease based on patients’disease self-management ability / 中国药房

OBJECTIVE To construct the integrated pharmaceutical care model of in-hospital pharmaceutical care+out-hospital pharmacy outpatient service for patients with lower extremity artery disease （LEAD）， so as to improve patients’ disease self- management ability， and the efficacy and safety of therapy. METHODS The in-hospital pharmaceutical care and out-hospital pharmacy outpatient service model was constructed for LEAD patients， including pharmaceutical evaluation， self-management ability education， and pharmacy follow-up， to perform long-term management of patients. Totally 65 LEAD patients admitted to the vascular surgery department of our hospital， receiving pharmacist management， from September， 2021 to December， 2022 were selected as the study objects， and pharmacists conducted in-hospital pharmaceutical care+continuous out-patient management. The efficacy indicators， safety indicators， and patients’s disease self-management ability indicators were compared before and after 3 months of pharmacist management. RESULTS After 3 months of pharmacists’ participation in the management of 65 patients， Fontaine stage decreased in 55 patients， there was the significant difference in Fontaine stage before and after management （P＜ 0.001）. The proportion of patients who completely followed the guidelines for medication increased from 63.1% to 96.9%； the incidence of small bleeding was reduced by 7.7% after pharmacists’ management. The scores of Morisky medication compliance and patients’ disease self-management ability were higher than 3 months ago （P＜0.001）. Patient proportion with “good” medical satisfaction increased by 18.4%. CONCLUSIONS The in-hospital pharmaceutical care and out-hospital pharmacy outpatient service model of LEAD patients can effectively improve patients’ disease self-management ability， and improve the efficacy and safety of therapy.

Analysis of the current situation of comprehensive management at intensive diabetes treatment clinic in Peking Union Medical College Hospital / 中华临床营养杂志

Objective:To assess the goal fulfillment in terms of blood glucose, blood pressure, blood lipid, and the composite indicator of these three in patients with diabetes who received intensified treatment at Peking Union Medical College Hospital and regular follow-up for 12 months, analyze the influencing factors, and explore the comprehensive management model for intensive diabetes treatment outpatient services.Methods:This study was a prospective, observational cohort study. The diabetes patients who received long-term regular follow-up at the intensive diabetes treatment outpatient clinic of Peking Union Medical College Hospital from 2012 to 2023 were selected as the research subjects. They were followed up and clinical data were collected at the 1st, 3rd, 6th, 9th, and 12th months of follow-up. The study assessed the goal fulfillment rates in terms of blood glucose, blood pressure, blood lipid, and the composite indicator of these three, with the goals of glycated hemoglobin (HbA1c)<7%, blood pressure<130/80 mmHg, and low-density lipoprotein cholesterol (LDL-C)<2.6 mmol/L. The study also analyzed the impact of factors, including gender, age, type of diabetes, duration of diabetes, body mass index, comorbidities, complications, and treatment regimens, on the outcomes of comprehensive diabetes management.Results:A total of 232 patients were included in the study, of whom 210 were with type 2 diabetes (90.5%), 13 with type 1 diabetes (5.6%), 5 with latent autoimmune diabetes of the adult (2.2%), 3 with diabetes after total pancreatectomy (1.3%), and 1 with mitochondrial diabetes (0.4%). After 3 months of intensified management, the goal fulfillment rates of blood glucose (67.7% vs. 34.1%, Kappa=0.336, P<0.001), blood pressure (53.4% vs. 37.5%, Kappa=0.159, P=0.001), blood lipid (59.1% vs. 39.2%, Kappa=0.198, P<0.001), and the composite indicator (20.7% vs. 3.0%, Kappa=0.177, P<0.001) were significantly increased. Continued treatment at 6, 9, and 12 months showed stable and sustained increases in the goal fulfillment rates of blood glucose, blood pressure, blood lipid, and the composite indicator. Logistic regression analysis showed that baseline hyperglycemia ( P=0.002), disease duration ≥5 years ( P<0.001), smoking ( P=0.009), alcohol consumption ( P=0.038), presence of diabetic complications ( P=0.001), combination therapy with oral antidiabetic drugs and insulin ( P<0.001), and use of antiplatelet drugs ( P=0.037) were risk factors for uncontrolled HbA1c. Baseline hypertension ( P<0.001), alcohol consumption ( P=0.030), and comorbid dyslipidemia ( P=0.028) were risk factors for uncontrolled blood pressure. Baseline uncontrolled LDL-C ( P=0.020) and non-use of statins ( P<0.001) were risk factors for uncontrolled blood lipid. Conclusions:Among patients with the long-term follow-up at our intensive diabetes treatment clinic, the goal fulfillment rates of blood glucose, blood lipid, blood pressure, and the composite indicator of these three are relatively higher. However, it is still necessary to improve patient compliance as much as possible, emphasize weight management, and persist on the comprehensive diabetes treatment.

Traumatismes dento-maxillo-faciaux dans la ville de Ouagadougo: étude épidémiologique et clinique de 1221 cas sur une période de 365 jours / Dento-maxillo-facial trauma in the city of Ouagadougou: epidemiological and clinical study of 1221 cases over a 365-day period

Introduction : Les traumatismes dento-maxillo- faciaux (TDMF) représentent l'ensemble des lésions intéressants la face et les maxillaires. De par leur gravité, ils constituent une urgence en odontostomatologie. L'objectif de cette étude était de déterminer les facteurs étiologiques et d'identifier leurs différentes formes anatomocliniques dans notre contexte d'exercice. Méthodes : Il s'est agi d'une étude multicentrique transversale descriptive, à collecte rétrospective allant du 1er janvier au 31 décembre 2018. Elle a été réalisé dans des trois services de chirurgie buccale et maxillo- faciale des Centres Hospitaliers Universitaires de la ville de Ouagadougou. Résultats : Au total 1221 cas ont été colligés dans ces 3 CHU. La tranche d'âge de ]15-30] ans a été la plus représentée. Les accidents de la circulation routière ont constitué les principales causes 1012 cas (82,9%). Au plan anatomoclinique les lésions des parties molles constituaient 1221 cas (100%) et les lésions osseuses 721 cas (59 %). Conclusion : Les lésions occasionnées par les TDMF peuvent constituer de véritables urgences vitale et fonctionnelle. La sensibilisation des populations sur la sécurité routière, le renforcement du plateau technique de ces services et la collaboration interdisciplinaire permettraient de renforcer l'efficacité de la prise en charge des TDMF.

Complications of clandestine abortions: a cross-sectional study at the Provincial General Hospital of Kananga in the Democratic Republic of Congo

Introduction: the complications of clandestine abortions are formidable throughout the world, particularly in Africa. This study aims to determine the epidemiological and therapeutic profile of the complications of clandestine abortions in the gynecology service of the Provincial Hospital of Kananga. Methods: this is a cross-sectional study conducted from the medical records of pregnant women who experienced the complications of clandestine abortions in the gynecology department of the Provincial Hospital of Kananga from January 01, 2015, to December 31, 2019. It is based on the no probabilistic sampling of suitability. We recorded 38 cases of 58 patients. Results: the frequency of complications of clandestine abortions is 65.51% with an average age of pregnant women of 27.86 (SD 3.23) years and 70% of pregnant women under 30 years old, nulliparity was more concerned in 34.21% (n=13). Pupil students and unemployed are more affected in 55.26% (n=21). Cervical dilation and curettage practiced by nurses led to more complications from clandestine abortions in 69.07% (n=26). Incomplete abortions are the complications most encountered in 1 case out of 3. The aspiration-curettage is established in 1 out of 3 cases, and the mortality rate linked to complications of clandestine abortion was 21.05% (n=8). Conclusion: complications of clandestine abortions constitute a real public health problem in the town of Kananga, incomplete abortions are most encountered and the mortality rate linked to these complications is serious.

Ferenczi e a clínica psicanalítica contemporânea: uma revisão sobre suas contribuições ao papel do analista / Ferenczi and the contemporary psychoanalytic clinic: a review of his contributions to the role of the analyst / Ferenczi et la clinique psychanalytique contemporaine: une revue de ses contributions au rôle de l'analyste / Ferenczi y la clínica psicoanalítica contemporánea: Una revisión de sus contribuciones al papel del analista

Objetivou-se fazer uma revisão sistemática da produção científica nacional e internacional, no período de 2015 a 2020, sobre a obra de Sándor Ferenczi e suas contribuições à clínica psicanalítica na contemporaneidade, no que concerne ao papel do analista. Os seguintes descritores foram utilizados: "Ferenczi" "clínica psicanalítica" e "analista". As bases de dados pesquisadas foram: P@rthenon, SciELO e Pepsic. Foi utilizada a metodologia da Análise de Conteúdo. O processo de análise levou a leitura dos títulos, resumos e textos completos, e 52 artigos preencheram os critérios. A pesquisa compreendeu que a retomada dos trabalhos de Ferenczi quanto ao papel do analista evidenciam uma nova configuração de relação analítica baseada em uma ética do cuidado. O papel do analista apresenta-se como uma possibilidade de contorno e sustentação às experiências traumáticas, colaborando com o paciente, na produção de sentidos e elaborações dessas experiências

This is a systematic review of national and international scientific papers published between 2015 and 2020 on Sándor Ferenczi's work and his contributions to the contemporary psychoanalytic clinic, mainly regarding the role of the analyst. Search was conducted on the P@rthenon, Scielo and Pepsic databases using "Ferenczi," "psychoanalytic clinic" and "analyst" as search descriptors. After reading the titles, abstracts and full texts a total of 52 articles met the inclusion criteria. Resumption of Ferenczi's work on the role of the analyst reveals a new configuration of analytical relations based on an ethics of care. The analyst presents a possibility of shaping and underpinning traumatic experiences, collaborating with the patient to produce meanings and elaborations of these experiences

Il s'agit d'une revue systématique des articles scientifiques nationaux et internationaux publiés entre 2015 et 2020 sur l'œuvre de Sándor Ferenczi et ses contributions à la clinique psychanalytique contemporaine, notamment en ce qui concerne le rôle de l'analyste. La recherche a été effectuée sur les bases de données P@rthenon, Scielo et Pepsic en utilisant « Ferenczi ¼, « clinique psychanalytique ¼ et « analyste ¼ comme descripteurs. Après la lecture des titres, des résumés et des textes intégraux, 52 articles répondaient aux critères d'inclusion. La reprise des travaux de Ferenczi sur le rôle de l'analyste révèle une nouvelle configuration des relations analytiques fondées sur une éthique du soin. L'analyste offre la possibilité de concevoir et d'étayer les expériences traumatiques, en collaborant avec le patient pour produire de significations et d'élaborations de ces expériences

El objetivo fue realizar una revisión sistemática de la producción científica nacional e internacional, en forma de artículo científico, de 2015 a 2020, sobre la obra de Sándor Ferenczi y sus aportes a la clínica psicoanalítica en la contemporaneidad, en torno al papel del analista. Se utilizaron los siguientes descriptores: "Ferenczi", "clínica psicoanalítica" y "analista". Las bases de datos buscadas fueron: P@rthenon, Scielo y Pepsic. Se utilizó la metodología de Análisis de Contenido. El proceso de análisis condujo a la lectura de títulos, resúmenes y textos completos y 52 artículos cumplieron los criterios. La investigación entendió que la reanudación del trabajo de Ferenczi sobre el rol del analista revela una nueva configuración de relación analítica basada en una ética del cuidado. El rol del analista se presenta como una posibilidad de modelar y sostener experiencias traumáticas, colaborando con el paciente, en la producción de significados y elaboraciones de estas experiencias

A clínica ampliada e o trabalho dos psicólogos no PAIF: pressupostos e desafios / The expanded clinic and the work of psychologists at PAIF: assumptions and challenges / La clínica ampliada y el trabajo de los psicólogos del PAIF: supuestos y desafíos

Resumo O presente trabalho tem como objetivo, a partir de uma pesquisa qualitativa de cunho bibliográfico, refletir sobre a clínica ampliada como uma possível ferramenta para o psicólogo exercer suas práticas cotidianas no contexto das políticas públicas, especificamente no Sistema Único de Assistência Social (SUAS), no trabalho com famílias do Programa de Atenção Integral à Família (PAIF), se diferenciando do modelo de clínica tradicional. Inicialmente, foi realizado um levantamento sobre a clínica ampliada no Brasil e seus fundamentos para, em um segundo momento, elencar possíveis articulações da atuação do psicólogo no PAIF com a clínica ampliada, a fim de refletir e ressignificar as atividades dessa categoria profissional no âmbito da proteção social prevista pelo SUAS. Concluiu-se que pressupostos presentes na clínica ampliada - como, por exemplo, a análise das demandas concretas das populações atendidas, garantia de direitos, negação do usuário enquanto objeto e trabalho direcionado à emancipação dos sujeitos - também se encontram descritos nos documentos que parametrizam o SUAS, o que torna viável considerá-la como uma perspectiva possível para o trabalho da Psicologia no âmbito da Assistência Social.

Abstract This paper aims, based on a qualitative bibliographical research, to reflect on the expanded clinic as a possible tool for the psychologist to exercise his daily practices in the context of public policies, specifically in the Unified Social Assistance System (SUAS), in working with families from the Family Care Program (PAIF), differentiating itself from the traditional clinic model. Initially, a survey was carried out on the expanded clinic in Brazil and its foundations to, in a second moment, list possible articulations of the psychologist's performance in the PAIF with the expanded clinic, in order to reflect and re-signify the activities of this professional category within the scope of the social protection provided by SUAS. It was concluded that assumptions present in the extended clinic - such as, for example, analysis of the concrete demands of the populations served, guarantee of rights, denial of the user as an object and work aimed at the emancipation of the subjects - are also described in the documents that parameterize the SUAS which makes it feasible to consider it as a possible perspective for the work of Psychology in the context of Social Assistance.

Resumen Este trabajo tiene como objetivo, a partir de una investigación bibliográfica cualitativa, reflexionar sobre la clínica ampliada como posible herramienta para que el psicólogo ejerza sus prácticas cotidianas en el contexto de las políticas públicas, específicamente en el Sistema Único de Asistencia Social (SUAS), en el trabajo con familias del Programa de Atención a la Familia (PAIF), diferenciándose del modelo de clínica tradicional. Inicialmente, se realizó un levantamiento sobre la clínica ampliada en Brasil y sus fundamentos para, en un segundo momento, enumerar posibles articulaciones de la actuación del psicólogo en el PAIF con la clínica ampliada, con el fin de reflexionar y resignificar las actividades de esta. categoría profesional dentro del ámbito de la protección social que brinda el SUAS. Se concluyó que supuestos presentes en la clínica ampliada -como, por ejemplo, análisis de las demandas concretas de las poblaciones atendidas, garantía de derechos, negación del usuario como objeto y trabajo encaminado a la emancipación de los sujetos- también son descrito en los documentos que parametrizan el SUAS lo que posibilita considerarlo como una perspectiva posible para el trabajo de la Psicología en el contexto de la Asistencia Social.

Estética e política: contribuições para a elaboração de casos clínicos em psicanálise / Aesthetics and politics: contributions to the elaboration of clinical cases in psychoanalysis / Estética y política: aportes a la elaboración de casos clínicos en psicoanálisis / Esthétique et politique: contributions à l'élaboration de cas cliniques en psychanalyse

Resumo Este artigo foi desenvolvido com o objetivo de pensar que a escrita de um caso clínico em psicanálise precisa considerar os elementos estéticos e políticos para se manter precisa em relação à ética da psicanálise. Para tanto, faremos aproximações entre o conceito de Inconsciente de Sigmund Freud e de Inconsciente Estético, proposto pelo filósofo francês Jacques Rancière. Assim, num primeiro momento será apresentado, de forma breve, o inconsciente estético e a psicanálise. Em um segundo momento, vamos apresentar os apontamentos de Rancière sobre estética e promover possíveis articulações entre o filósofo e Freud, a partir do que eles conceituam sobre o inconsciente. Finalmente, vamos pensar como o caso clínico pode ser observado a partir dessa ótica, investigando a respeito das articulações entre Inconsciente e Inconsciente Estético.

Abstract This article aims to think that the writing of a clinical case in psychoanalysis needs to consider the aesthetic and political elements to remain accurate regarding the ethics of psychoanalysis. To this end, we will make approximations between the concept of the Unconscious of Sigmund Freud and the Aesthetic Unconscious, proposed by the French philosopher Jacques Rancière. Thus, first we will present a brief presentation on the aesthetic unconscious and psychoanalysis. In a second moment, we will present Rancière's notes on aesthetics and promote possible articulations between the philosopher and Freud, from what they conceptualize about the unconscious. Finally, we will consider how the clinical case can be observed from this perspective that we propose, of investigating about the articulations between the Unconscious and the Aesthetic Unconscious.

Resumen Este artículo tiene por objetivo discutir que la escrita de un caso clínico en psicoanálisis necesita considerar los elementos estéticos y políticos para permanecer fiel a la ética del psicoanálisis. Para ello, se realizará una breve presentación sobre el concepto de inconsciente, de Sigmund Freud, y el inconsciente estético propuesto por Rancière. Primero, se presenta de forma breve el inconsciente estético y el psicoanálisis. Después, se expone los planteamientos de Rancière acerca de la estética y se hace posibles articulaciones entre el filósofo y Freud desde sus ideas sobre el inconsciente. Por último, se discutirá cómo se puede observar el caso clínico desde esta perspectiva que se propone investigar las posibles articulaciones entre el inconsciente y el inconsciente estético.

Résumé Cet article a le but de penser que l'écriture d'un cas clinique en psychanalyse doit tenir compte des éléments esthétiques et politiques pour rester juste par rapport à l'éthique de la psychanalyse. Dans ce but, nous ferons des approximations entre le concept d'Inconscient de Sigmund Freud et l'Inconscient Esthétique, proposé para the philosophe français Jacques Rancière. Donc, dans un premier temps, nous ferons un bref exposé sur l'inconscient esthétique et la psychanalyse. Deuxièmement, nous présenterons les notes de Rancière sur l'esthétique et nous soutiendrons les articulations possibles entre le philosophe et Freud, à partir de ce qu'ils conceptualisent sur l'inconscient. Enfin, nous réfléchirons comment le cas clinique peut être observé dans la perspective que nous proposons, d'étudier sur les articulations de l'Inconscient et l'Inconscient Esthétique.

O acúmulo de tarefas alheias ao ofício e o emergir de um gênero profissional invasivo / Accumulation of unrelated tasks and the emergence of an invasive professional genre

Este estudo aborda o fenômeno do acúmulo de tarefas em contexto da atividade de trabalho humana, a partir de operadores teóricos da clínica da atividade, como instâncias do ofício, estilo, gênero profissional, poder de agir e trabalho bem feito. Tomou-se como base material empírico referente a narrativas de trabalhadores participantes de pesquisa desenvolvida em um Serviço de Verificação de Óbitos (SVO), por meio de entrevistas semiestruturadas e de instrução ao sósia, realizadas com técnicos em necropsia. O referido material discursivo possibilitou o entendimento de que as submissões desses trabalhadores à tarefas alheias a seu ofício fizeram com que eles precisassem recorrer ao gênero profissional inerente a outros cargos, e dele se apropriar, originando o que aqui propõe-se denominar gênero profissional invasivo. Nesse sentido, o objetivo deste estudo foi estabelecer o diálogo entre o acúmulo de tarefas alheias ao ofício e um possível desenvolvimento do gênero profissional, em termos da produção de um gênero profissional invasivo

This study addresses the accumulation of tasks in the context of human work activity, based on theoretical operators from the clinic of activity, such as instances of professional practice, style, professional genre, power to act and work well-done. Analysis used empirical material related to narratives of workers participating in research developed in a Division of Postmortem Inspection (SVO), by means of semi-structured interviews and instruction to the double conducted with necropsy technicians. Results showed that the need to perform unrelated tasks made these workers appeal to the professional genre inherent to other jobs and appropriate it, giving rise to an invasive professional genre. Thus, the objective was to establish a dialogue between the accumulation of unrelated tasks and the possible development of a professional genre in terms of an invasive professional genre

O inacessível à fala: fenômenos borderlines e o manejo clínico da esfera não verbal / L'inaccessible à la parole: les phénomènes borderline et la gestion clinique de la sphère non verbale / The inaccessible to speech: borderline phenomena and the clinical management of the non-verbal sphere / Lo inaccesible al habla: fenómenos borderlines y el manejo clínico de la esfera no verbal

O artigo tem como objetivo investigar os processos de comunicação subjacentes à linguagem verbal presentes na relação analítica. Analisaremos como o conceito de transferência se modifica na literatura psicanalítica, abrindo espaço para as dinâmicas intersubjetivas do setting. Dialogando com a teoria do apego e seus fundamentos etológicos, apresentaremos os fenômenos borderlines, marcados por intensas manifestações corporais no contexto das relações interpessoais. Em seguida, defenderemos a hipótese de que há em todo sujeito um núcleo inacessível à fala, que aparece como material clínico principalmente na análise de pacientes graves, onde a experiência traumática se inscreve em níveis sensoriais.

Resumos This article aims to investigate the communication processes underlying verbal language found in the analytical relationship. We will analyze how the concept of transference changes in psychoanalytic literature, opening space for the intersubjective dynamics present in the setting. Dialoging with attachment theory and ethology, we will present borderline phenomena, marked by intense bodily manifestations in the context of interpersonal relationships. Then, we will defend the hypothesis that an inaccessible nucleus to speech lies in every subject, which appears as clinical material mostly in the analysis of severely ill patients, where traumatic experience is inscribed in sensory levels..

L'article vise à étudier les processus de communication qui sous-tendent le langage verbal présent dans la relation analytique. Nous analyserons l'évolution du 29 concept de transfert dans la littérature psychanalytique, en ouvrant un espace à la dynamique intersubjective du cadre. En dialogue avec la théorie de l'attachement et ses fondements éthologiques, nous présenterons les phénomènes limites, marqués par des manifestations corporelles intenses dans le contexte des relations interpersonnelles. Nous défendrons ensuite l'hypothèse qu'il existe chez tout sujet un noyau inaccessible à la parole, qui apparaît comme matériel clinique principalement dans l'analyse des patients sévères où l'expérience traumatique s'inscrit sur les plans sensoriels..

Este artículo tiene como objetivo investigar los procesos de comunicación subyacentes al lenguaje verbal que se presentan en la relación analítica. Analizaremos cómo el concepto de transferencia cambia en la literatura psicoanalítica, abriendo espacio a las dinámicas intersubjetivas presentes en el setting. En diálogo con la teoría del apego y sus fundamentos etológicos, presentaremos fenómenos borderlines, marcados por intensas manifestaciones corporales en el contexto de las relaciones interpersonales. A continuación, defenderemos la hipótesis de que existe en todo sujeto un núcleo inaccesible al habla, que aparece como material clínico principalmente en el análisis de pacientes críticamente enfermos, en que la experiencia traumática se inscribe en niveles sensoriales.

Formación con simulación clínica para manejo adecuado de emergencias obstétricas: revisión narrativa / Clinical simulation training for the adequate management of obstetrics emergencies: A narrative review

Las emergencias obstétricas son situaciones críticas que amenazan la salud de la madre y del bebé durante el embarazo o el parto. Este estudio se enfocó en validar la efectividad de la formación con simulación clínica en el manejo de estas situaciones. Realizamos una revisión narrativa de estudios publicados entre 2008 y 2022, recopilados de las bases de datos Scopus, ScienceDirect, MEDLINE/PubMed, Springer, SciELO y Google Scholar. Se recogieron y resumieron los datos de los estudios que cumplían con nuestros criterios de inclusión. Nuestros resultados subrayan que la simulación clínica se posiciona como una herramienta altamente eficaz en la formación de profesionales de la salud. Esta capacitación se traduce en mejoras significativas en diversos aspectos, incluyendo el rendimiento, los conocimientos, la confianza, la satisfacción, las actitudes, la autoeficacia, la capacidad para trabajar en equipo y las habilidades necesarias para enfrentar situaciones obstétricas críticas. Dentro de estas últimas destacan hemorragias posparto, eclampsia, distocia de hombros, paro cardíaco materno, prolapso del cordón umbilical y cesáreas. Esta formación disminuye los riesgos asociados con el aprendizaje en pacientes reales y cumple con los estándares éticos. La colaboración interdisciplinaria en el manejo de emergencias obstétricas se revela efectiva para brindar atención integral a los pacientes. Sin embargo, es fundamental enfatizar que para asegurar la seguridad del paciente y promover un enfoque de trabajo en equipo, es esencial que los profesionales de la salud reciban una formación adecuada y estén debidamente cualificados. A pesar de que la formación en simulación clínica es eficaz, su implementación puede resultar costosa y requerir recursos considerables. No obstante, consideramos que esta estrategia sigue siendo de un valor incalculable para la formación de profesionales en este campo. Investigaciones futuras de alta calidad contribuirán a fortalecer la evidencia sobre las mejores prácticas en la formación con simulación clínica en emergencias obstétricas.

Obstetric emergencies are critical situations that jeopardize the health of both the mother and the baby during pregnancy or childbirth. This study aimed to validate the effectiveness of clinical simulation training in managing these situations. We conducted a narrative review of studies published between 2008 and 2022, collected from databases including Scopus, Sciencedirect, PubMed, Springer, Scielo, and Google Scholar. Data from studies that met our inclusion criteria were meticulously gathered and summarized. Our findings strongly emphasize that clinical simulation emerges as a highly effective tool in the training of healthcare professionals. This training translates into substantial improvements in various aspects, including performance, knowledge, confidence, satisfaction, attitudes, self-efficacy, teamwork abilities, and the skills necessary to confront critical obstetric situations such as postpartum hemorrhage, eclampsia, shoulder dystocia, maternal cardiac arrest, umbilical cord prolapse, and cesarean sections. Importantly, this training reduces the inherent risks associated with learning on real patients and aligns with the highest ethical standards. Additionally, our results underscore that interdisciplinary collaboration in the management of obstetric emergencies proves to be an effective strategy for providing comprehensive patient care. However, it is crucial to highlight that, in order to ensure patient safety and promote a teamwork approach, it is imperative for healthcare professionals to receive adequate training and be duly qualified. Although we acknowledge that implementing clinical simulation training can entail significant costs and require substantial resources, we firmly believe that this strategy continues to hold immeasurable value in the education of professionals in this field. Ultimately, we anticipate that future high-quality research will further fortify the evidence base regarding best practices in clinical simulation training for obstetric emergencies, thus contributing to enhanced patient outcomes and the overall quality of healthcare in this critical domain.

Diseño, implementación y evaluación de un programa de aprendizaje de habilidades procedimentales básicas en enfermería utilizando la plataforma C1DO1 durante la pandemia por COVID-19 / Design, implementation and evaluation of a learning program for basic procedural skills in nursing using the C1DO1 platform during the COVID-19 pandemic

Introducción: La simulación remota brindó una alternativa concreta para entrenar las habilidades procedimentales básicas durante la pandemia. El objetivo de este artículo es describir el proyecto que mantuvo el entrenamiento de las habilidades procedimentales básicas de enfermería en alumnos de pregrado UC, utilizando la aplicación C1DO1, durante el segundo semestre del 2021. Materiales y Métodos: Se diseñaron cinco etapas en la plataforma C1DO1. Cada etapa consideró un procedimiento clínico básico. Los estudiantes practicaron las técnicas en su hogar y se grabaron ejecutando el procedimiento. El video fue revisado por un docente que proporcionaba una retroalimentación personalizada y medía su aprendizaje de manera formativa. Al finalizar todas las etapas, se aplicó una encuesta para evaluar la percepción y satisfacción con el proyecto. Resultados: 183 estudiantes se inscribieron en el proyecto, de los cuales 122 participaron activamente. El porcentaje de respuesta del instrumento de evaluación fue de un 71%. La satisfacción global alcanzó una nota de 6,1. El grado de acuerdo con la simulación remota fue de un 94%. La percepción de autoeficacia alcanzó un 89%. La retroalimentación personalizada fue considerada como muy importante por el 94% de los participantes y el 98% de los estudiantes aprobó la etapa que efectúo. Discusión: Existe un alto grado de acuerdo con el entrenamiento de habilidades procedimentales mediante la simulación remota, sin embargo, los estudiantes consideran esta metodología como un complemento al aprendizaje motor, aún faltan estudios que midan transferencia.

Introduction: Remote simulation provided a concrete alternative to train basic procedural skills, given the pandemic. This article aims to describe the project that maintained the training of basic nursing procedural skills in UC undergraduate students using the C1DO1 application during the second semester of 2021. Methods: Five stages were designed on the C1DO1 platform. Each stage considered a basic clinical procedure. The students practiced the techniques at home and recorded themselves performing the procedure. The video was reviewed by a teacher who provided personalized feedback and measured their learning in a formative way. At the end of all the stages, a survey was applied to the students to evaluate their perception and satisfaction with the project. Results: The total number of students enrolled in the project was 183 of which 122 actively participated. The response rate of the evaluation instrument was 71%. Global satisfaction with the project obtained a score of 6.1. The degree of agreement with the remote simulation was 94%. The perception of self-efficacy reached 89%. The personalized feedback was considered very important by 94% of the participants and 98% of the students approved the stage they carried out. Discussion: There is a high degree of agreement with the training of procedural skills through remote simulation, however, students see this methodology as a complement to motor learning, and studies that measure transfer are still lacking.