Situações difíceis e sentimentos no cuidado paliativo oncológico / Difficult situations and feelings in palliative oncology care / Situaciones difíciles y sentimientos en el cuidado paliativo oncológico

O ato de cuidar cotidianamente de pessoas com dor, falta de ar e em morte iminente pode potencializar situações difíceis para profissionais da área. Contudo, raramente são discutidas nos serviços e no processo de formação profissional. Objetivou-se, então, analisar situações difíceis e sentimentos que emergem do cuidado de saúde. Esta é uma pesquisa de perspectiva fenomenológica e qualitativa, baseada em 30 situações difíceis de profissionais de saúde que atuam exclusivamente no cuidado paliativo oncológico. As entrevistas foram realizadas de agosto de 2019 a fevereiro de 2020. Os resultados mostram que as principais dificuldades foram motivadas pela identificação (quando o profissional vê semelhança com o paciente que cuida), morte ruim (com sofrimento), quando o paciente era jovem, morte de mãe com filho pequeno e quando havia divergência entre o proposto pelo profissional e a recusa do paciente. Percebeu-se relação entre tipos de situações difíceis e categoria profissional. Os profissionais expressaram tanto sentimentos desagradáveis (tristeza, impotência, angústia, medo) quanto agradáveis (compaixão, gratidão). Os resultados mostram que o ocultamento do processo de morrer ao longo do desenvolvimento civilizatório transformou-o em tabu, angustiante inclusive para quem trabalha com cuidados paliativos. Contribuem, também, para mostrar uma importante dimensão subjetiva do cuidado, geralmente negligenciada, que gera sofrimento, mas também ressignificação. Para que alguém cumpra seu propósito, é necessário encontrar sentido no trabalho, possibilitado pela modificação do estado interno do profissional pela experiência, que gera transformação e novo significado e saber a partir da práxis.

The act of caring for people in pain, shortness of breath, and imminent death on a daily basis can intensify difficult situations for health professionals. However, difficult situations are rarely discussed in the services and in the professional training process. This study aimed to analyze difficult situations and feelings that emerge from healthcare. This is a phenomenological and qualitative study based on 30 difficult situations of health professionals who work exclusively in palliative oncological care. The interviews were conducted from August to February 2020. The results show that the main difficulties were motivated by identification (when the professional recognizes similarities in the patient they are caring for), a bad death (with suffering), caring for young patients, the death of a mother with a small child, and when there was a divergence between what the professional proposed and the patient's choice. There was a relationship between types of difficult situations and professional category. The professionals expressed both unpleasant feelings (sadness, impotence, anguish, fear) and pleasant feelings (compassion, gratitude). The results show that the concealment of the dying process throughout the societies' development turned it into a taboo, causing distress even in those who work in palliative care. They also show an important subjective dimension of care, usually neglected, which generates suffering, but also resignification. To properly provide care, health professionals must find meaning in the work, made possible by the modification of the their internal mindset via experience, which generates transformation, new meaning, and knowledge from praxis.

El acto de atender diariamente a personas con dolor, dificultad para respirar y muerte inminente puede potenciar situaciones difíciles para los profesionales del área. Sin embargo, casi nunca se discuten en los servicios y en el proceso de formación profesional. El objetivo fue analizar situaciones difíciles y sentimientos que emergen del cuidado de la salud. Investigación de perspectiva fenomenológica y cualitativa, basada en 30 situaciones difíciles de profesionales de la salud que actúan exclusivamente en el cuidado paliativo oncológico. Las entrevistas se realizaron entre agosto y febrero de 2020. Los resultados enseñan que las principales dificultades se motivaron por la identificación (cuando el profesional ve similitud con el paciente que atiende), mala muerte (con sufrimiento), cuando el paciente era joven, muerte de una madre con hijo pequeño y cuando hubo discrepancia entre lo propuesto por el profesional y el rechazo del paciente. Se observó una relación entre tipos de situaciones difíciles y categoría profesional. Los profesionales expresaron tanto sentimientos desagradables (tristeza, impotencia, angustia, miedo) como agradables (compasión, gratitud). Los resultados indican que ocultar el proceso de morir a lo largo del desarrollo de la civilización lo convirtió en un tabú e, incluso, es angustiante para las personas que trabajan con cuidados paliativos. También contribuye a mostrar una importante dimensión subjetiva del cuidado, generalmente ignorada, que genera sufrimiento, pero también resignificación. Para que cumpla con su propósito es necesario encontrar sentido en el trabajo, posibilitado por la modificación del estado interno del profesional a través de la experiencia, generando transformación y un nuevo significado y conocimiento a partir de la praxis.

Conocimiento y manejo de cuidados respiratorios especializados en pacientes con enfermedades neuromusculares en unidades de cuidado intensivo: aproximación por encuesta a profesionales de la salud

Introducción: En las enfermedades neuromusculares la disminución de la capacidad vital se relaciona con dismunición de la capacidad tusígena y luego ventilatoria, la combinación de ambas genera complicaciones graves por falla ventilatoria. En los pacientes que son intubados, limita la extubación, sino se realizan cuidados respiratorios especializados. El conocimiento y aplicación de los profesionales que atienden a estos pacientes en cuidados intensivos resulta esencial. Objetivos: Reportar el conocimiento y aplicación especializada de cuidados respiratorios en enfermedades neuromusculares en las Unidades de Cuidados Intensivos. Materiales y métodos: Estudio cualitativo, descriptivo de corte transversal, no probabilístico, a criterio. La población accesible fueron profesionales de la Salud de las Unidades de Cuidados Intensivos, y el análisis de las respuestas de una encuesta estructurada, enviada a distintos profesionales a nivel mundial. Resultados: Se incluyeron los cuestionarios de 41 profesionales, el 34% de los profesionales reportaron la utilización regular de Asistente Mecánico de la Tos; 22% refirieron la utilización regular de apilamiento de aire; 31% reportaron la utilización regular de Asistencia Ventilatoria No Invasiva, 56.1% de los profesionales afirmaron conocer la diferencia entre Ventilación No Invasiva y Soporte Ventilatorio No Invasivo, 34% de los profesionales refirieron tener formación especializada en el área. Conclusión: Pese a existir una alta proporción de profesionales con conocimiento especializado, un grupo importante no los aplica rutinariamente. La justificación es principalmente por la dificultad de adquisición y financiación de los equipos necesarios.

Introduction: In neuromuscular diseases, the decrease in vital capacity relates to decreased coughing and then ventilatory capacity, the combination of both generating serious complications due to ventilatory failure. In intubated patients, the extubation process is difficult unless specialized respiratory care is provided. The knowledge and treatment application of the professionals who care for these patients in intensive care is of outmost importance. Objectives: Report the knowledge and specialized application of respiratory care in neuromuscular diseases in Intensive Care Units. Materials and methods: Qualitative, descriptive, cross-sectional, non-probabilistic study, at criteria. The accessible population were Health professionals from the Intensive Care Units, and the analysis of the responses of a structured survey, sent to different professionals worldwide. Results: The questionnaires of 41 professionals were included, 34% of the professionals reported the regular use of the Mechanical Cough Assistant; 22% reported the regular use of air stacking; 31% reported the regular use of Non-Invasive Ventilatory Assistance. 56.1% of the professionals stated that they knew the difference between Non-Invasive Ventilation and Non-Invasive Ventilatory Support, 34% of the professionals reported having specialized training in the area. Conclusion: Despite the existence of a high proportion of professionals with specialized knowledge, an important group does not routinely apply them. The justification is mainly due to the difficulty of acquiring and financing the necessary equipment.

Conocimiento y manejo de cuidados respiratorios especializados en pacientes con enfermedades neuromusculares en unidades de cuidado intensivo: aproximación por encuesta a profesionales de la salud / Knowledge and management in specialized respiratory care of patients with neuromuscular diseases in intensive care units: survey to health professionals

Introducción: En las enfermedades neuromusculares la disminución de la capacidad vital se relaciona con disminución de la capacidad tusígena y luego ventilatoria, la combinación de ambas genera complicaciones graves por falla ventilatoria. En los pacientes que son intubados, limita la extubación, sino se realizan cuidados respiratorios especializados. El conocimiento y aplicación de los profesionales que atienden a estos pacientes en cuidados intensivos resulta esencial. Objetivos: Reportar el conocimiento y aplicación especializada de cuidados respiratorios en enfermedades neuromusculares en las Unidades de Cuidados Intensivos. Materiales y métodos: Estudio cualitativo, descriptivo de corte transversal, no probabilístico, a criterio. La población accesible fueron profesionales de la Salud de las Unidades de Cuidados Intensivos, y el análisis de las respuestas de una encuesta estructurada, enviada a distintos profesionales a nivel mundial. Resultados: Se incluyeron los cuestionarios de 41 profesionales, el 34% de los profesionales reportaron la utilización regular de Asistente Mecánico de la Tos; 22% refirieron la utilización regular de apilamiento de aire; 31% reportaron la utilización regular de Asistencia Ventilatoria No Invasiva, 56.1% de los profesionales afirmaron conocer la diferencia entre Ventilación No Invasiva y Soporte Ventilatorio No Invasivo, 34% de los profesionales refirieron tener formación especializada en el área. Conclusión: Pese a existir una alta proporción de profesionales con conocimiento especializado, un grupo importante no los aplica rutinariamente. La justificación es principalmente por la dificultad de adquisición y financiación de los equipos necesarios.

Introduction: In neuromuscular diseases, the decrease in vital capacity relates to decreased coughing and then ventilatory capacity, the combination of both generating serious complications due to ventilatory failure. In intubated patients, the extubation process is difficult unless specialized respiratory care is provided. The knowledge and treatment application of the professionals who care for these patients in intensive care is of outmost importance. Objectives: Report the knowledge and specialized application of respiratory care in neuromuscular diseases in Intensive Care Units. Materials and methods: Qualitative, descriptive, cross-sectional, non-probabilistic study, at criteria. The accessible population were Health professionals from the Intensive Care Units, and the analysis of the responses of a structured survey, sent to different professionals worldwide. Results: The questionnaires of 41 professionals were included, 34% of the professionals reported the regular use of the Mechanical Cough Assistant; 22% reported the regular use of air stacking; 31% reported the regular use of Non-Invasive Ventilatory Assistance. 56.1% of the professionals stated that they knew the difference between Non-Invasive Ventilation and Non-Invasive Ventilatory Support, 34% of the professionals reported having specialized training in the area. Conclusion: Despite the existence of a high proportion of professionals with specialized knowledge, an important group does not routinely apply them. The justification is mainly due to the difficulty of acquiring and financing the necessary equipment.

Knowledge and perception of health-care professionals on clinical trials in India: A pan-Indian cross-sectional survey

Purpose: The purpose of the study was to evaluate the knowledge and perception of health-care professionals (HCPs), such as doctors/surgeons, pharmacists, nurses, optometrists, and lab technicians, on clinical trials (CTs) in India. Methods: The study was a pan-Indian cross-sectional survey initiated by the Indian Ophthalmology Clinical Trial Network (IOCTN) by using a previously validated questionnaire for three months of data collection. An online survey was used to record information regarding demographics, CT knowledge, and CT perception among HCPs. Results: A total of 630 responses were recorded from HCPs: 207 doctors and surgeons, 159 pharmacists, and 264 laboratory technicians, nurses, and optometrists across India. Over 90% of HCPs had a clear knowledge on the purpose of CTs, the informed consent (IC) process, ethical approval by the Drugs Controller General of India (DCGI). About 80% and 90% were aware of confidentiality of patients, voluntariness of participation, and good clinical practice. Surprisingly, less than 50% had lesser knowledge regarding monetary incentives of CT participants (CTPs). A slightly positive perception was observed regarding the potential benefits of CTPs, compensation related to injury, and importance of obtaining IC. Less than 50% had a negative perception that monetary compensation to CTPs led to bias and deprivation of standard treatments. However, no significant difference was observed between other aspects of demographics and perception regarding CTs. Conclusion: We observed doctors and surgeons to be having the highest regarding CTs, followed by pharmacists. The survey highlighted the necessity of scheduling awareness programs among the HCPs, which would improve their misconceptions and perception of CTs while interacting with patients for CT enrollment.

Knowledge, attitude, and practice on adverse drug reaction monitoring among health-care professionals in a tertiary care hospital

Background: Pharmacovigilance has constantly gained importance in the past 15 years, relating to absolute amount of adverse drug reactions (ADRs) and to the fact that several hospital admissions are due to ADRs. Knowledge of ADRs and practice of pharmacovigilance by healthcare professionals will definitely help to evaluate the quality of pharmacotherapy in hospitals and effectively decrease the occurrence of ADRs. Aims and Objectives: The objectives are as follows: (1) To assess the knowledge, attitude, and practice of health care professionals (HCPs) toward ADR monitoring and (2) to assess the causation of underreporting of ADRs. Materials and Methods: This study was a cross-sectional questionnaire-based study. The questionnaire was distributed to 328 HCPs which included al doctors, nurses and pharmacists serving in ESIC Medical College and Hospital, Kalaburagi. HCPs who did not give consent to fill the questionnaire were excluded from the study. Results: The response rate was 82.92%. In our study, only 25.75% were aware that ADR reporting is to be done by doctors, nurses and pharmacists, and 40.44% felt that ADR reporting should primarily done by doctors alone. Overall participants who knowledge about ADRs and pharmacovigilance were 48.8%. Although 75.7% participants agreed that ADR reporting is important, over 76.5% HCPs felt that reporting ADR would be an obligation. In this study 12.5% HCPs have ever reported ADR despite having experienced one during their clinical practice. Majority of the HCPs had a belief that a single ADR reporting would not change the ADR database; hence, this could be one of the reasons for low rate of reporting ADRs. Conclusion: In our study, though the level of knowledge and attitude toward ADR reporting was adequate among the HCPs, there was poor practice of ADR reporting. Necessary measures to be taken to create awareness among HCPs about Pharmacovigilance Programme in India. They should be trained to spontaneously report ADRs.

A prospective comparative study to evaluate the impact of educational interventions on knowledge, attitude, and practice about pharmacovigilance among nurses

Background: Nurses play a key role in patients’ healthcare and drug administration. They are primary source of possible adverse drug reaction (ADR) alerts to clinician. At present, we have little data about awareness of pharmacovigilance (PhV) among nurses in India. Aim and Objective: Aim and objective of the study is to evaluate impact of educational interventions (EIs) on knowledge, attitude, and practice of hospital staff nurses working in medical and surgical wards. Materials and Methods: We conducted a prospective comparative study in two groups (EI and non-EI) among staff nurses working in medical and surgical wards of a tertiary care teaching hospital. One group of nurses working in medical wards were provided with various EIs while in non-EI group of nurses working in surgical wards no EI was provided. Respondents were asked to fill a pre-test questionnaire followed by interactive EIs in EI group and post-test questionnaire in both groups. Impact of EI among respondents was evaluated by correctness of response to questionnaire. Results: A total of (n = 200) respondents were enrolled in study. Number of staff nurses in each (EI and non-EI) group were (n = 100 [50%]). Overall, (n = 100 [50%]) were from the medical and (n = 100 [50%]) from surgical specialty. Post-EI period there was statistically significant improvement in knowledge, attitude and practice (KAP) domains. Conclusion: Our study serves as reliable evidence that through EI; statistically significant improvement in KAP of staff nurses toward ADR reporting and PhV system can be achieved. This indicates that creating more awareness among healthcare professionals through EIs will help in promoting ADR reporting and this will improve the PhV system in India.

Sleep Quality among Healthcare Professionals in a Tertiary Care Hospital

Introduction: A person spends one third life in sleep, so the quality and quantity of sleep is of utmost importance. Health Care Professionals (HCPs) are more prone to inconsistency in sleep both in quality and quantity, which leads to deflection from health and well-being of themselves and care of others. This study aims to assess the various factors influencing sleep quality and daytime sleepiness among medical and nursing healthcare professionals. Methodology: A cross sectional study was conducted using a structured questionnaire to collect socio-demographic and work-related information, co-morbidity and quality of Sleep using ESS (Epworth Sleepiness Scale) and PSQI (Pittsburgh Sleep Quality Index) scale. Results: Among the 150 HCPs, 64.7% were medical and 35.3% were nursing professionals. 53.6% of medical and 66% of nursing professionals reported poor sleep quality. Increased coffee consumption influences sleep quality and it was found to be statistically significant. Nursing professionals had more excessive daytime sleepiness (58.5%) with significant p-value (p=0.01). Conclusion: According to our study results, sleep quality was poor among nursing professionals which highlights the need for measures to improve their quality of sleep.

Evaluation of safety profile of ChAdOx1-nCoV-19 Coronavirus (Covisheild) Vaccine among health care professionals in a tertiary care hospital: 6 months follow-up observation

Background: As there were no vaccines available for any strains of coronaviruses, it was inevitable to develop safe and effective vaccines for the prevention of infection. There were limited data on the safety of the vaccine in the real-world environment, so the present study is undertaken to assess the safety of the vaccine. Aim and Objectives: The objective of the study is to evaluate the safety profile of ChAdOx1-nCoV-19 Coronavirus Vaccine (Covishield) among health care professionals. Materials and Methods: This is 6 months follow-up observation of vaccinated individuals, 545 health care workers have taken Covishield Vaccine for a duration of 1 month in a tertiary care hospital in two doses with 28 days apart. Demographic data such as age, gender, and comorbidities were noted. They were given a World Health Organization-based Adverse Event Following Immunization form to fill if they have any of the symptoms. Their phone numbers were collected to check for any adverse reactions every week after the first dose till the next dose and every month for another 6 months. Results: Adverse reactions were reported by 147 out of 297 vaccinated individuals after the first dose, 40 members out of 248 individuals after the second dose 24 h after vaccination. Pain at the site of infection and body ache/myalgia was seen in 27% of individuals. Reactions were mild in most of the individuals which resolved in a day without medication. Conclusions: Although the frequency of adverse reactions was observed in more individuals, they were mostly mild and self-limiting. This may show that vaccine has an acceptable safety profile in our observation among health care professionals.

Sleep quality and body composition in a nursing team

Recent studies have shown that nursing professionals have affected sleep quality, yet no relation between sleep quality and body composition has been established. The present study investigated the relation between body composition and sleep quality in nursing professionals. It was a transversal, quantitative, descriptive, and analytical study. Nursing workers from HC-UFU were randomly selected to participate in this study. Interviews were done with validated questionnaire to evaluate sleep quality of the professionals, and a bioimpedance exam was done with a tetrapolar device. Two hundred forty-three professionals of the nursing team participated in the survey, mostly females (n=205; 84.4%), nursing technicians (53.1%). Average abdominal circumference was 91.97±13.83 cm, body fat was 31.668.24% or 24.0711.50 kg. The body mass index (BMI) was 27.094.63. Most participants evaluated sleep quality as bad (n=99; 40.7%) and "Sleep Latency" between 31 and 60 minutes (n=74; 30.5%) in the dominion "Subjective Sleep Quality". Correlations were observed between: percentage of body water X Sleep Duration Dominion (r=-0.135; p<0.05); water resistance in the body X Dominion Sleep Efficacy (r=0.149; p<0.05); percentage of body fat X "Disfunction During the Day" (r=0.233; p<0.01); fat mass (kg) and fat percentages X "Sleep disturbance"(r=0.148; r=0.177; r=0.182; p<0.01) respectively; BMI X "Sleep Disturbance", (r=0.146; p<0.05) as well as percentage of lean mass and body water X "Sleep Disturbance" (r=-0.244; r=0.247; p<0.01). This is the first study comparing sleep quality with body composition data in a nursing team. It became clear that more studies should be done to obtain greater knowledge about the health profile of nursing teams and, therefore, establish better plans and solutions for the group studied.

Percepção de risco de adoecimento por COVID-19 e depressão, ansiedade e estresse entre trabalhadores de unidades de saúde / Perceived risk from COVID-19 and depression, anxiety, and stress among workers in healthcare units / Percepción de riesgo de enfermedad por COVID-19 y depresión, ansiedad y estrés entre trabajadores de unidades de salud

O objetivo foi analisar as associações entre a percepção de risco de adoecimento por COVID-19 e os sintomas de depressão, ansiedade e estresse em profissionais atuantes em unidades de saúde. Estudo transversal com trabalhadores de diversas categorias profissionais que buscaram voluntariamente um dos primeiros Centros de Referência em Testagem de COVID-19 no Município do Rio de Janeiro, Brasil. Os trabalhadores foram convidados a responder a um questionário online entre maio e agosto de 2020. Foram utilizadas a escala Percepção de Risco de Adoecimento por COVID-19 e a Escala de Depressão, Ansiedade e Estresse (DASS-21). Foram estimados razão de chance (OR) e intervalo de 95% de confiança. Do total (N = 2.996), 81,5% eram mulheres com idade média de 40,7 anos. Cerca da metade apresentava grau leve, moderado ou severo de depressão, ansiedade ou estresse, sendo a frequência de trabalhadores com sintomas severos, respectivamente, 18,5%, 29,6% e 21,5%. Observou-se que as associações entre a percepção de risco e os sintomas de depressão, ansiedade e estresse foram mais fortes à medida que aumentava a classificação de gravidade de cada sintoma. Os trabalhadores com alta percepção de risco de adoecimento por COVID-19 apresentaram OR mais elevadas para sintomas severos de depressão (OR = 4,67), ansiedade (OR = 4,35) e estresse (OR = 4,97). Os achados apontam a demanda por medidas de proteção à saúde dos trabalhadores, que não devem se restringir aos equipamentos de proteção individual. É essencial que os gestores promovam espaços coletivos de discussão e ações que favoreçam a recuperação dos trabalhadores em contexto pandêmico de longa duração.

The objective was to analyze associations between perceived risk from COVID-19 and symptoms of depression, anxiety, and stress among workers in healthcare units. This was a cross-sectional study of workers from different professions who appeared voluntarily at one of the first COVID-19 Testing Centers in the municipality of Rio de Janeiro, Brazil. The workers were invited to answer an online questionnaire from May to August 2020. The COVID-19 Risk Perception Scale and the Depression, Anxiety, and Stress Scale (DASS-21) were used. Odds ratios (OR) and 95% confidence intervals were estimated. Of the total sample (N = 2,996), 81.5% were women, and mean age was 40.7 years. About half presented mild, moderate, or severe depression, anxiety, or stress, and the rates for workers with severe symptoms were 18.5%, 29.6%, and 21.5%, respectively. The associations between perceived risk and symptoms of depression, anxiety, and stress increased with the increase in each symptom's severity. Workers with higher perceived risk from COVID-19 showed higher OR for severe symptoms of depression (OR = 4.67), anxiety (OR = 4.35), and stress (OR = 4.97). The findings point to the demand for measures to protect workers' health and that should not be limited to personal protective equipment. It is essential for health system administrators to promote collective spaces for discussion and actions to favor workers' recovery in the context of a prolonged pandemic.

El objetivo fue analizar las asociaciones entre la percepción de riesgo de enfermedad por COVID-19 y los síntomas de depresión, ansiedad y estrés en profesionales activos en unidades de salud. Estudio transversal con trabajadores de diversas categorías profesionales que buscaron voluntariamente uno de los primeros Centros de Referencia en Tests de COVID-19 en el municipio de Río de Janeiro, Brasil. Los trabajadores fueron invitados a responder a un cuestionario online entre mayo y agosto de 2020. Se utilizaron la escala Percepción de Riesgo de Enfermedad por COVID-19 y la Escala de Depresión, Ansiedad y Estrés (DASS-21). Se estimaron razón de oportunidad (OR) e intervalo de 95% de confianza. Del total (N = 2.996), un 81,5% eran mujeres con una edad media de 40,7 años. Cerca de la mitad presentaba grado leve, moderado o severo de depresión, ansiedad o estrés, siendo la frecuencia de trabajadores con síntomas severos, respectivamente, 18,5%, 29,6% y 21,5%. Se observó que las asociaciones entre la percepción de riesgo y los síntomas de depresión, ansiedad y estrés fueron más fuertes a medida que aumentaba la clasificación de la gravedad de cada síntoma. Los trabajadores con alta percepción de riesgo de enfermedad por COVID-19 presentaron OR más elevadas para síntomas severos de depresión (OR = 4,67), ansiedad (OR = 4,35) y estrés (OR = 4,97). Los resultados apuntan la demanda de medidas de protección a la salud de los trabajadores, que no se deben restringir a equipamientos de protección individual. Es esencial que los gestores promuevan espacios colectivos de discusión y acciones que favorezcan la recuperación de los trabajadores en un contexto pandémico de larga duración.

Investigating Emergency Department Healthcare Professionals’ Intention to Use the Poison Information System

@#Introduction: The objective of this paper is to investigate the behavioural intention to use the Poison Information System (PIS) among healthcare professionals based on the extension of the Technology Acceptance Model. Methods: A quantitative approach used a five-point Likert scale questionnaire adapted from previous research. Data were obtained from 136 health professionals working in the Emergency Department of public hospitals in Malaysia. Results: A multiple linear regression model showed that approximately 40% of the variation in intention to use was related to positive attitude, staff category, and inversely to computer anxiety. Perceived usefulness, perceived ease of use, and computer usage were related to intention to use, but their correlation was accounted for by positive attitude, staff category, and computer anxiety. A factor analysis grouped positive attitude, intention to use, and perceived usefulness on Factor I and perceived ease of use, inverse computer anxiety, and computer habit on Factor II. Cluster analysis indicated three clusters. Gender, age, experience, and staff category were strongly inter-related; intention to use clustered with perceived ease of use and perceived usefulness; positive attitude clustered with computer habit; and the latter two clustered together. Conclusion: These findings show that positive attitude, staff category, and computer anxiety of healthcare professionals, working in emergency departments, may have the greatest effect on PIS usage.

Coping religioso/espiritual e qualidade de vida dos pacientes com câncer hematológico submetidos ao transplante de células-tronco hematopoéticas / Religious/spiritual coping and quality of life of patients with hematological cancer undergoing hematopoietic stem cell transplantation

Resumo: O objetivo desta tese foi investigar o impacto do coping religioso/espiritual na qualidade de vida relacionada à saúde dos pacientes adultos com câncer hematológico no quinto ano após a realização do transplante de células-tronco hematopoéticas. Trata-se de um estudo quantitativo, longitudinal, observacional e analítico, realizado em hospital público do sul do Brasil, referência para esta modalidade de tratamento, com 55 participantes adultos, que se submeteram a esta terapia. A coleta de dados ocorreu de setembro de 2013 a janeiro de 2021, com avaliações nas etapas basal (antes de iniciar o condicionamento), pancitopenia, préalta hospitalar (quando se dá a "pega" medular), pós 100 dias, pós 180 dias, pós 360 dias e anualmente até completar cinco anos da realização do procedimento. Os instrumentos utilizados para avaliação foram sociodemográfico e clínico, Quality of life Questionnaire Core 30 e Functional Assessment of Cancer Therapy - Bone Marrow Transplant, ambos traduzidos, adaptados e validados para o português - Brasil, e a escala de coping religioso/espiritual aplicada na última etapa da avaliação. Leucemias foram o diagnóstico mais frequente (65%), assim como o transplante de células-tronco alogênico foi a modalidade predominante (71%). No tocante aos óbitos, a maior causa foi por recidiva da doença (26%) e o maior número ocorreu no primeiro ano (37%). A qualidade de vida global (56,6/100) e geral (90,7/148) apresentou os menores escores na etapa de pancitopenia, com melhores índices no quinto ano, (80,4/100) e (116,1/148), respectivamente. A análise com o modelo linear misto generalizado apontou alterações significativas dos escores de qualidade de vida relacionada à saúde e domínios entre as etapas ao longo do tempo (p<0,05). Quanto ao coping religioso/espiritual, houve média utilização (3,19/5,00), com maior uso do coping religioso/espiritual positivo (3,15/5,00), quando comparado ao coping religioso/espiritual negativo (1,77/5,00), com razão de 0,6. Observou-se associação significativa negativa entre os escores de qualidade de vida relacionada à saúde, domínios e ao coping religioso/espiritual negativo (p<0,05). A tese de que o uso de coping religioso/espiritual positivo leva a melhores índices de qualidade de vida relacionada à saúde não pode ser comprovada, pois não houve associação significativa no teste de correlação. No entanto, quando realizada a análise de correlação entre o uso do coping religioso/espiritual negativo e a qualidade de vida relacionada à saúde, observou-se correlação negativa significativa para a maioria dos domínios de ambos os instrumentos de qualidade de vida relacionada à saúde. Este resultado indica que a utilização de estratégias de enfrentamento negativas como posição negativa frente à religiosidade/espiritualidade está associada a uma pior qualidade de vida relacionada à saúde e domínios no quinto ano, o que comprova parcialmente a hipótese deste estudo. Ademais, as correlações entre os domínios dos dois instrumentos de avaliação da qualidade de vida relacionada à saúde sustentam o modelo teórico utilizado, que infere haver uma interação ativa entre os domínios. O estudo poderá contribuir no reconhecimento da multidimensionalidade do constructo qualidade de vida relacionada à saúde, mostrando ainda que a avaliação do domínio espiritual é necessária para detectar possíveis comprometimentos nesta área.

Abstract: The current thesis aimed to investigate the impact of religious/spiritual coping on the health-related quality of life of adult patients with blood cancer five years after hematopoietic stem-cell transplantation. This is a quantitative, longitudinal, observational, and analytical study, conducted in a public hospital in southern Brazil, a center for this type of treatment, with 55 adult participants who underwent this therapy. Data collection took place from September 2013 to January 2021, with assessments at baseline (before starting conditioning regimen), pancytopenia, pre-hospital discharge (when the spinal cord "engraftment" takes place), after 100 days, after 180 days, after 360 days, and annually out to five years of the procedure. For the assessment, we used sociodemographic and clinical instruments, the quality-of-life Questionnaire Core 30 and Functional Assessment of Cancer Therapy - Bone Marrow Transplant, both translated, adapted, and validated for Portuguese - Brazil, and the religious/spiritual coping scale applied in the latter evaluation stage. Leukemia was the most frequent diagnosis (65%), and allogeneic stem cell transplantation was the predominant modality (71%). Regarding deaths, the most frequent cause was disease relapse (26%) and the most occurred in the first year (37%). The overall (56.6/100) and general (90.7/148) quality of life had the lowest scores in the pancytopenia stage, with better rates in the fifth year, (80.4/100) and (116.1/148), respectively. The analysis with the generalized mixed linear model showed significant changes in health-related quality of life scores and domains between stages over time (p<0.05). There was an average use of religious/spiritual coping (3.19/5.00), with greater adoption of positive religious/spiritual coping (3.15/5.00), when compared to negative religious/spiritual coping (1.77 /5.00), with a ratio of 0.6. There was a significant negative association between health-related quality of life scores, domains, and negative religious/spiritual coping (p<0.05). The thesis that the adoption of positive religious/spiritual coping leads to better health-related quality of life indexes cannot be proven, as there was no significant association in the correlation test. Yet, when analyzing the correlation between the use of negative religious/spiritual coping and health-related quality of life, a significant negative correlation was observed for most domains of both health-related quality of life instruments. This result suggests that the use of negative coping strategies as a negative attitude towards religiosity/spirituality is associated with a worse quality of life-related to health and domains in the fifth year, which partially validates the hypothesis of this study. Moreover, the correlations between the domains of the two health-related quality of life assessment instruments support the theoretical model adopted, which infers that there is an active interaction between the domains. The study may contribute to the acknowledgment of the multidimensionality of the health-related quality of life construct, also showing that the assessment of the spiritual domain is necessary to detect possible impairments in this area.

Knowledge, Preventive Behaviour And Risk Perception About COVID-19 In Health Care Professional Students

Background:With 3.95 lakhs of active COVID-19 cases in India and Tamilnadu being the second largest hub of COVID-19, the health and social impact on the public, especially the health care warriors would be considerable.Objective:To evaluate and compare the levels of knowledge, preventive behavior and risk perception of South Indian Health Care Professional(HCP) Students regarding COVID-19.Material And Methods:An institution based cross sectional questionnaire survey was conducted in a tertiary care centre and teaching hospital in May-June 2020 amongst 873 students pursuing various HCP course s. The questionnaire comprised four sections -demographic details, COVID–19 related knowledge, preventive behavior and risk perception.Result:Females volunteered to complete the survey (n= 623; 71.4%) more than males (n= 250; 28.6%). Most participants had received awareness about COVID-19 (n=860; 98.5%) from many resources of information. While females (97.50 ± 8.94) had significantly higher scores on items for preventive behavior than males (94.7±15.55; p=0.006), the scores were similar for knowledge and risk perception. There was a statistically significant difference inrisk perception among various courses with students pursuing Pharmacy having higher risk perception. Items regarding use of masks in general and hospital set ups and availability of antivirals for COVID-19 received many incorrect responses.Conclusion: HCPstudents presented with high levels of COVID-19 related knowledge and preventive behavior, but moderate risk perception. Continuing educational programs and preventive behavioral training are the need of the hour to strengthen the knowledge and alleviate anxiety of HCP students towards the pandemic.

Síndrome de Burnout em profissionais de saúde atuantes na atenção básica: um estudo transversal / Burnout syndrome in primary health care professionals: a cross-sectional study

INTRODUÇÃO: A Síndrome de Burnout (SB) é uma condição de estresse crônico associada ao trabalho composto por três dimensões: exaustão emocional, despersonalização e redução da realização profissional. Profissionais atuantes nos Núcleos Ampliados de Apoio à Saúde da Família (NASF-AB) e Atenção Básica são expostos as vulnerabilidades do SUS, inseguranças e conflitos que podem levá-lo ao esgotamento profissional. OBJETIVO: Investigar a prevalência da SB em profissionais de saúde que atuam no NASF-AB de Teresina/PI, nos anos de 2018 e 2019. MÉTODOS: Trata-se de um estudo transversal, quantitativo com aplicação de questionários, conduzido com 13 profissionais atuantes no NASF-AB. Para coleta de dados e investigação foram aplicados três questionários: o primeiro referente a variáveis sociodemográficas; o segundo foi a versão reduzida do questionário Job Stress Scale (JSS); e por fim, o questionário Maslach Burnout Inventory (MBI) RESULTADOS: A maioria dos profissionais era do sexo feminino (92,3%) e possuíam idade ≤ 35 anos. Na aplicação do JSS, 7 (53,8%) apresentaram alta demanda e 6 (46,2%) baixa demanda; 8 (61,5%) alto controle e 5 (38,5%) baixo controle; 9 (69,2%) alto apoio social e 4 (30,8%) baixo apoio social. No MBI, 10 profissionais (76,9%) apresentaram elevado nível de exaustão emocional. Apesar disso 11 profissionais (84,6%) mostraram-se realizados profissionalmente e todos os entrevistados (100%) obtiveram baixa despersonalização. CONCLUSÃO: No estudo não foi possível verificar com precisão a prevalência da SB nos profissionais. No entanto, pode-se concluir que tais profissionais apresentam um grande risco de desenvolverem a SB por apresentaram níveis elevados de Demanda e Exaustão Emocional nos questionários JSS e MBI, respectivamente.

INTRODUCTION: Burnout syndrome (BS) is a workassociated chronic stress condition composed of three dimensions: emotional exhaustion, depersonalization, and reduction of professional achievement. Professionals working in the Enlarged Family Health Support Centers (NASF-AB) and Primary Care are exposed to the vulnerabilities of the UHS, insecurity, and conflicts that can lead to professional exhaustion. OBJECTIVE: To investigate the prevalence of BS in health professionals working in the NASF-AB of Teresina/PI, in 2019. METHOD: This is a quantitative, cross-sectional study conducted with 13 professionals working in NASF-AB. For data collection and investigation, three questionnaires were applied: the first referring to sociodemographic variables; the second was the reduced version of the Job Stress Scale (JSS); and finally, the Maslach Burnout Inventory (MBI) questionnaire. RESULTS: Most professionals were female (92.3%) and aged ≤ 35 years. In the application of the JSS, 7 professionals (53.8%) presented high demand and 6 (46.2%) low demand; 8 (61,5%) high control and 5 (38.5%) low control; 9 (69,2%) high social support and 4 (30.8%) low social support. In the MBI, 10 professionals (76.9%) presented a high level of emotional exhaustion. Despite this, 11 professionals (84.6%) were professionally accomplished, and all interviewees (100%) obtained low depersonalization. CONCLUSION: The study was not able to verify accurately the prevalence of BS in professionals. Nevertheless, these professionals present a high risk of developing BS because they presented high levels of Emotional Demand and Exhaustion in the JSS and MBI questionnaires, respectively

Evaluation of Workshop for Recommending Advance Care Planning (ACP) for Medical and Health Care Professionals

Purpose: We held workshops (WSs) that recommend the use of advance care planning (ACP) for medical and health care professionals, and clarified whether or not these WSs motivated them to engage in their own ACP using two indicators: the proportion of professionals who wanted to conduct ACP and changes in the Death Attitude Inventory (DAI). Method: After the WS, we divided participants into two groups, depending on whether or not they wanted to have end-of-life discussions with their family and loved ones. The changes in the DAI brought about by the WSs and their impressions of the WS were compared between the groups. Results: A total of 91 participants were analyzed, of which 42 (46.2%) wanted to have end-of-life discussions with their family and loved ones. In both groups, “afterlife view” and “death anxiety and fear” in the DAI were significantly reduced after the WS when compared to attitudes from before the WS. In the group which wanted to have end-of-life discussions, “death avoidance” (effect size −0.42) and “sense of purpose in life” (effect size 0.51) changed significantly and positively. Conclusion: About half of the participants wanted to perform ACP after having attended the WSs, apparently due to an increased sense of purpose in life and a reduced death avoidance.

Acciones del personal de salud del área estomatológica en relación a la COVID-19 / Actions taken by dental care providers in relation to COVID-19

Introducción: El brote de la enfermedad del coronavirus 2019 (COVID-19) ha sido declarado emergencia de salud pública de importancia internacional. Los estomatólogos, entre el personal sanitario, son los más expuestos a la enfermedad porque su área de trabajo es la boca, sitio que se reconoce como el lugar a partir del cual se contagia la enfermedad. Objetivo: Esclarecer elementos relacionados con la COVID-19 y las medidas a tener en cuenta para la prevención del contagio del personal de salud del área estomatológica. Comentarios principales: No se ha descubierto un método único que cumpla con todos los requisitos con respecto a las infecciones asociadas a la atención médica. En el enfrentamiento a la COVID-19 cumplen un papel importante las precauciones estándares, o sea, medidas que se aplican a todos los pacientes, independientemente del diagnóstico o de si se conoce si tiene una infección o está colonizado por un agente. El SARS-CoV-2 es un virus envuelto, y esta característica lo hace más sensible a la acción de las sustancias desinfectantes. Consideraciones globales: La COVID-19 manifiesta síntomas no específicos. Los más comunes son fiebre, anorexia y tos seca. La transmisión probablemente ocurre a través de la propagación del virus en el aire y por contacto. Con la implementación de precauciones estándares entre las que se encuentran la higiene de las manos, uso de equipos de protección personal y el cuidado del medio ambiente, se puede disminuir la posibilidad del contagio y contribuir a controlar la diseminación. Es importante que los proveedores de atención médica, dentro de los que se encuentra el personal de salud del área estomatológica, y el público conozcan este nuevo virus para que las acciones coordinadas, oportunas y efectivas puedan ayudar a prevenir casos adicionales o malos resultados ante el enfrentamiento a esta pandemia(AU)

ABSTRACT Introduction: The outbreak of coronavirus disease 2019 (COVID-19) has been declared a worldwide public health emergency. Dentists are the health care providers most directly exposed to this condition, since their area of activity is the mouth, a location recognized as the site through which the disease is transmitted. Objective: Clarify some notions about COVID-19 and the measures to be taken to prevent transmission to dental care providers. Main remarks: A single method has not been discovered which meets all the requirements concerning infections associated to medical care. In the struggle against COVID-19 an important role is played by standard precautions, i.e. measures applied to all patients, irrespective of their diagnosis or whether they are known to have an infection or be colonized by a given agent. SARS-CoV-2 is an enveloped virus, a characteristic that makes it more sensitive to the action of disinfectants. General considerations: COVID-19 presents non-specific symptoms, the most common of which are fever, anorexia and dry coughing. Transmission probably occurs by the spread of the virus in the air and by direct contact. Implementation of standard precautions, among which are hand hygiene, the use of personal protection equipment and care for the environment, will lead to a reduction in the chances of contagion and will contribute to control the spread of the disease. It is important for medical care providers, among them dental care professionals, and the public at large to know about this new virus, so that coordinated, timely and effective actions may be taken which will help prevent the occurrence of new cases or bad results in the struggle against this pandemic(AU)

Knowledge, attitude and practices of postgraduates, interns and nurses, on adverse drug reaction reporting in a tertiary care hospital: a comparative study

Background: Pharmacovigilance is multidisciplinary field of the detection, assessment, understanding, and prevention of adverse drug reactions (ADRs). The incidences of ADRs about 95% are undocumented worldwide. However, there is a lack of information on ADR burden in developing countries due to lack of resources, infrastructure, and expertise.Methods: A cross-sectional questionnaire-based study was conducted on 90 staff nurses 90interns and 90 postgraduates. The validated questionnaire contained items to check knowledge including 7 questions, 9 questions to analyze attitude and 5 for practices. Comparison between knowledge, attitude and practice data obtained from resident doctors and nurses was performed using Chi square test.Results: A total of 270 healthcare professionals participated in the study. In our study the participants had good knowledge regarding the purpose of monitoring and reporting ADRs etc. The result shows that health care professionals felt reporting of ADRs is a professional obligation and all ADRs should be reported. There was no significant difference in the knowledge and attitude between interns and nurses but few questionnaires show significant variations between post graduate and staff nurse. The practice of ADR reporting was significantly higher in postgraduate compared to nurses.Conclusions: This study concluded that post graduate, intern and staff nurse had good knowledge and positive attitude towards pharmacovigilance and ADR reporting, but unfortunately the actual practice of ADR reporting is still deficient among staff nurse and intern. This can be improved by adequate training and motivation.

Knowledge, attitudes, and practices of kangaroo mother care among Health care professionals in Keetmanshoop District, Namibia

Background: Kangaroo mother care (KMC) refers to the practice of providing continuous skin-to-skin contact between motherand baby, exclusive breast feeding, and early discharge from hospital. The study aim to assess the knowledge, attitude, andpractices surrounding kangaroo mother care (KMC) among health care professional (HCPs) in Keetmanshoop District; to assessthe extent to which HCPs practice KMC in the care of low birth weight (LBW) babies; and to identify challenges in theimplementation of KMC among HCPs. Materials methods: This quantitative, cross-sectional descriptive study was conducted at6 health facilities in Keetmanshoop district. A self-reported questionnaire consisting of Closed-ended questions and 5-point Likertscale was used for data collection. Statistical Package for Social Sciences (SPSS), Version 24 was used to analyze data. Results:Demographic data revealed that, 79% of participants were females and 21% were males, 30% of participants were between theage of 20 to 30, while 20% were aged between 51 to 60 years. It was discovered that 99% of the respondents believed that KMCpromotes bonding between the mother and her baby. Only 39% of health care professionals underwent training on KMC. Themajority of HCP 87% agreed that, the policy on kangaroo mother care practice is not displayed in their facilities, while 65% statedthat KMC is not effectively implemented in their facilities. Conclusion: The result revealed that, lack of policy, guidelines, andspace to accommodate mothers are the major obstacles to the successful implementation of Kangaroo Mother Care.

Adverse drug reactions observed in treatment of gastro intestinal and respiratory tract infections: a prospective analysis

Background: The aim of the study was to observe common adverse drug reactions in treatment of gastro intestinal and respiratory tract infections in a tertiary care hospitals.Methods: A prospective observational study was conducted by Departments of Pharmacology for a period of one year from prescriptions and case sheets of medical record section. Adverse drug reaction reporting forms and alert cards were used for reporting.Results: The drugs most commonly used for gastrointestinal tract and respiratory diseases are tablets norflox 400 mg, norflox-tz, taxim 200 mg, IV amikacin and iv amoxicillin (500 mg) and clavulanic acid (125 mg) combination. Systems affected by use of above drugs were skin and gastrointestinal tract. Urticaria on skin, abdominal pain, itching in genital area, ulcer on oral mucosa are the common adverse drug reactions observed.Conclusions: Drugs used for common gastrointestinal tract and respiratory tract infections alert cards should be issued to patients when prescribing and adverse drug reactions should be reported to higher centres. Brand names causing adverse reactions should be monitored regularly and their further usage should be based on signals from other centres. All tertiary care hospitals should have antimicrobial guidelines policy to reduce adverse drug reactions.

Analysis of spontaneous individual case safety reports reported at adverse drug reaction monitoring centre: tertiary care teaching hospital in South India

Background: Drugs are double edged weapons, they are used in treatment of the patients but in return can harm as well. The safety of drug prescribing has become a need of the hour topic in medicine. Safety monitoring of patients via Pharmacovigilance tool has become an integral part of pharmacotherapy. This study has been undertaken to analyze the various individual case safety reports including the Special situation cases of medicational error and over dose and to promote the reporting of adverse drug reactions (ADRs) among the healthcare professionals (HCPs).Methods: A retrospective non-interventional observational study was done for indexed period of six months at AMC-PvPI under Osmania Medical College and General Hospital. The reported individual case safety reports (ICSRs) are evaluated on basis of demographics of age and gender, seriousness criteria, outcome parameters and causality assessment of suspected drug (s) and suspected ADR/AE (s) as per the ICH guidelines and WHO causality assessment scale.Results: A total of 177 ICSRs are reported out of that 137 were ADRs, 36-medication error cases and 4-cases of over dose. The incidence of ADRs in females are high compared with males was identical. The occurrence of ADRs in adult patients (61%) was significantly higher than other age groups. Of total ADRs, most of them were with analgesics (26%) and highly reported system organ classification was CNS. Overall, 79% patients were recovered from ADRs.Conclusions: The results depicted an insight to the HCPs on the importance of monitoring and reporting of ICSRs. Our study results emphasized need to roll out a pharmacovigilance practice tool to ensure the safe use of drugs for better Pharmacotherapy and development of pharmacogenomic studies.