Problemas éticos na prática clínica de enfermeiros do atendimento pré-hospitalar móvel: scoping review / Ethical problems in the clinical practice of mobile pre-hospital care nurses: a scoping review

OBJETIVO: Mapear na literatura os problemas éticos vivenciados por enfermeiros atuantes no Atendimento Pré-hospitalar Móvel. MÉTODO: Revisão de escopo que seguiu as recomendações do Joanna Briggs Institute (JBI), realizada de outubro a novembro de 2021, com buscas nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Web of Science, SAGE Journal, Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed) e Cumulative Index to Nursing and Allied Health Literature (CINAHL). Resultados: Nove estudos constituíram a amostra final. Os problemas éticos vivenciados na prática clínica de enfermeiros do Atendimento Pré-hospitalar Móvel foram apresentados em quatro categorias temáticas: Problemas éticos na relação equipe/usuário/família; Problemas éticos na relação entre as equipes; Problemas éticos relacionados à estrutura organizacional e gestão; e Problemas éticos relacionados aos fatores externos que interferem no cenário do Atendimento Pré-hospitalar Móvel. Conclusão: As evidências apontaram a necessidade de atenção à dimensão ética, aos valores e deveres implicados nas situações moralmente inadequadas vivenciadas por enfermeiros no cenário na rua.

OBJECTIVE: To map the ethical problems experienced by nurses in Mobile Pre-hospital Care in the literature. METHOD: A scoping review was conducted following the Joanna Briggs Institute recommendations, from October to November 2021, with searches in Latin American and Caribbean Health Sciences (LILACS), Web of Science, SAGE Journal, Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed) end Cumulative Index to Nursing and Allied Health Literature (CINAHL). Results: Nine studies comprised the final sample. Ethical problems experienced in the clinical practice of Pre-hospital Mobile Care nurses were presented in four thematic categories: Team/user/family relationship ethics, Inter-team relationship ethics, Organizational structure and management ethics, and External factors and mobile pre-hospital care ethics. Conclusion: The evidence pointed to the need for attention to the ethical dimension, to the values ​​and duties involved in morally inappropriate situations experienced by nurses in the pre-hospital setting.

The effect of honey on post-tonsillectomy pain relief: a randomized clinical trial

Abstract Objective: The study aimed to evaluate the effects of honey on the incidence of post-operative pain in patients undergoing tonsillectomy. Methods: This study is a double-blind and randomized controlled trial design. Twenty-four adult male patients underwent tonsillectomy surgery and were randomized assigned into three groups consist of honey group, placebo group, and control group. All subjects were given standard analgesia and antibiotics, also honey for the honey group and placebo for the placebo group, and only standard post-operative regimens for the control group. This study used silk-cotton tree or kapok tree honey (Ceiba pentandra). Honey was used by gargling every six hours for ten days. Likewise, the same method was applied in the placebo group. Pain scale was assessed for ten days using the Visual Analogue Scale questionnaire, and the frequency of analgesic drugs was recorded on days 1, 2, 4, 7, and 10. Result: Honey group showed significantly higher pain reduction when compared to placebo and control groups, with a significant reduction in the pain scale on day 1, 2, 4, 7 and 10 (p = 0.034; p = 0.003; p < 0.001; p = 0.001; p = 0.001) gradually; Significant differences were also observed in analgesic use, especially on day 2, 4 and 7 (p = 0.028; p = 0.001; p = 0.003). Conclusions: Administration of Kapok tree honey (C. pentandra) after tonsillectomy might reduce post-operative pain and reduce the need for analgesia. Therefore, honey can be considered a complementary medicine and can be administered routinely as adjunctive therapy for post-operative patients.

Urban Flood Relief Management in COVID-19 Pandemic

Introduction: Urban floods were addressed as a separate disaster after the historical 2005 Mumbai floods. Urban flood peaks are 2-8 times and volume 6 times when compared with rural floods. We are now handling multiple disasters simultaneously due to the Covid-19 Pandemic. The river plains of north India are prone to floods in the monsoon season and geographical location of Prayagraj doubles the damage because it faces wrath from two sides. Very few researches have been conducted on urban floods and evidence needs to be generated from the field. Methodology: This qualitative research was planned with an objective to identify the difficulties faced in operating an urban flood relief camp during superimposed burden of COVID-19 Pandemic and to suggest remedial measures from the public health aspect. We conducted in-depth interviews of nodal officers, health staff and beneficiaries of the identified camps. Informed consent was taken from participant after explaining them about the research. Results: The findings from the interviews were categorized into 3phases of flood relief i.e. before the floods, during floods and lastly post flood. The most crucial work before floods is to spread awareness about do’s and don’ts in detail. Next was identification of the local people actually affected by flood. The space and facilities at few centers was low for the population load. Urban flood management needs a major overhauling of public health infrastructure to handle such disasters in future. Conclusion: The officials were working hard to make the homeless feel as if they are on a picnic. The database of beneficiaries should be strengthened and should also include students and labourers, anyone who is a flood victim and not only local flood victims.

ANALYSIS AND COMPARATIVE STUDY OF TOPICAL CONSERVATIVEMEDICATION VERSUS OPERATIVE MANAGEMENT IN PATIENTS OFANAL FISSURE

Introduction:Anal fissures or anal ulcers are considered one of the commonest causes of severe analpain. Surgical techniques like manual anal(lords) dilatation or lateral internalsphincterotomy, effectively heal most fissures within a few weeks, but mayresult in permanently impaired anal continence. This has led to the research foralternative non-surgical treatmentAIMS AND OBJECTIVES:The present study comprises the comparative study of 2% Diltiazem gel,0.2% Glyceryl Nitrate,2%lignocaine jelly application and need of surgical intervention in the treatment of chronic fissure inano.MATERIALS AND METHODS: This is a prospective study of fissure in ano during the period from September 2020 to September2021 in Sheth Lallubhai Gordhandas Municipal General Hospital, Ahmedabad. Clinical Data ofadmitted patient were collected by their detail history after stabilizing the patient, clinicalexamination with appropriate investigations.OBSERVATION AND DISCUSSION:Anal fissure is a very common problem across the world. It causes considerablemorbidity and adversely affects the quality of life. Therefore appropriate treatment ismandatory.In this study the commonest age group affected was 31-40 years agegroup (40%) and least affected were 51-60 years age groupThe incidence of fissure in males was slightly greater than females with MaleFemale ratio being 2.2: 1 in our study.CONCLUSION:Propper clinical examination and appropriate investigations helps in management of patient eitheroperative or non-operative which leads successful treatment in these patients.

El eucalipto utilizado como alternativa de tratamiento para afecciones respiratorias en la población de Barranca / Eucalyptus used as an alternative treatment for respiratory diseases in the population of Barranca / Eucalipto usado como alternativa de tratamento para doenças respiratórias na população de Barranca

Las hojas de eucalipto por muchos años se han empleado para aliviar las afecciones respiratorias; durante la pandemia su consumo se ha incrementado significativamente Objetivo. Determinar los efectos del consumo de eucalipto mediante diversas preparaciones caseras para el alivio de las afecciones respiratorias. Método. Se basa en la investigación descriptiva; pues se empleó cuestionario sobre que plantas se consumen para las afecciones respiratorias, con qué frecuencia se consume eucalipto y si el consumo de eucalipto alivia las afecciones respiratorias. Obtenidos los datos se procesaron con estadísticas básicas y análisis de correlación. Resultados. Se determinó que los pobladores encuestados utilizan plantas medicinales para el tratamiento de afecciones respiratorias, destacándose el uso de las hojas de eucalipto que consume el poblador con una frecuencia promedio de 2 veces por día de infusión de eucalipto. El porcentaje de alivio de los signos y síntomas de las afecciones respiratorias fue 80 %; la correlación del porcentaje de consumo de eucalipto con respecto al porcentaje de las personas que registraron alivio de sus afecciones respiratorias, alcanzó un valor de r= 0.989 y el análisis de varianza del porcentaje del consumo de eucalipto con relación al porcentaje que aliviaron las afecciones respiratorias, determinó un efecto significativo. Conclusión. Que el consumo de medicina natural a base de hojas de eucalipto se puede considerar como un tratamiento complementario y beneficioso para la salud; puesto que su composición tiene componentes activos tales como Cineol, α y ß-pineno, y limoneno, que tienen propiedades antibacterianas y antivirales.

Eucalyptus leaves have been used for many years to relieve respiratory conditions; during the pandemic its consumption has increased significantly Objective. To determine the effects of eucalyptus consumption through various home preparations for the relief of respiratory conditions. Method. It is based on descriptive research; since a questionnaire was used on which plants are consumed for respiratory conditions, how often eucalyptus is consumed and if the consumption of eucalyptus relieves respiratory conditions. Once the data was obtained, it was processed with basic statistics and correlation analysis. Results. It was determined that the surveyed residents use medicinal plants for the treatment of respiratory conditions, highlighting the use of eucalyptus leaves consumed by the population with an average frequency of 2 times per day of eucalyptus infusion. The percentage of relief of signs and symptoms of respiratory conditions was 80%; the correlation of the percentage of consumption of eucalyptus with respect to the percentage of people who reported relief from their respiratory conditions, reached a value of r= 0.989 and the analysis of variance of the percentage of consumption of eucalyptus with respect to the percentage that relieved respiratory conditions, determined a significant effect. Conclution. That the consumption of natural medicine based on eucalyptus leaves can be considered as a complementary and beneficial treatment for health; since its composition has active components such as Cineol, α and ß-pinene, and limonene, which have antibacterial and antiviral properties.

As folhas de eucalipto são usadas há muitos anos para aliviar problemas respiratórios; durante a pandemia seu consumo aumentou significativamente Objetivo. Determinar os efeitos do consumo de eucalipto através de diversas preparações caseiras para o alívio de problemas respiratórios. Método. Baseia-se em pesquisa descritiva; uma vez que foi aplicado um questionário sobre quais plantas são consumidas para condições respiratórias, com que frequência o eucalipto é consumido e se o consumo de eucalipto alivia as condições respiratórias. Uma vez obtidos os dados, estes foram processados com estatística básica e análise de correlação. Resultados. Constatou-se que os moradores pesquisados utilizam plantas medicinais para o tratamento de afecções respiratórias, destacando-se o uso de folhas de eucalipto consumidas pela população com frequência média de 2 vezes ao dia de infusão de eucalipto. O percentual de alívio dos sinais e sintomas de afecções respiratórias foi de 80%; a correlação do percentual de consumo de eucalipto com o percentual de pessoas que relataram alívio de suas condições respiratórias, atingiu um valor de r= 0,989 e a análise de variância do percentual de consumo de eucalipto com relação ao percentual que aliviou condições respiratórias, determinou um efeito significativo. Conclusão. Que o consumo de medicamentos naturais à base de folhas de eucalipto pode ser considerado um tratamento complementar e benéfico para a saúde; uma vez que sua composição possui componentes ativos como Cineol, α e ß-pineno e limoneno, que possuem propriedades antibacterianas e antivirais.

Development and Utilization of "One-Stop Finance Service" forRelief Fund for Hemophilia Patients / 罕见病研究

The economic burden of medication for hemophilia patients is heavy. Charitable donation is a key way to supplement relief funds for the patients. In order to explore the appropriate and efficient usage of the relief funds, Nanfang Hospital was one of the earliest ones that launched the "one-stop finance service" of relief funds. The practice and experience of the service have been widely referred to and applied in other places, and achieved good results. This article reviews the practice and cases, and discusses the significance in reducing the burden of patients and in improving the efficiency of hemophilia relief.

International cooperation of hospital ship SS HOPE in Natal (1972): health care and education / Cooperación internacional del buque hospital SS HOPE en Natal (1972): salud y educación / Cooperação internacional do navio-hospital SS HOPE em Natal (1972): assistência e educação em saúde

ABSTRACT Objective: to analyze the activities developed by hospital ship SS HOPE in Natal. Method: this is a qualitative, socio-historical study, elaborated from documentary sources and 16 interviews with health professionals. Thematic Oral History was used for data treatment and analysis. Results: the empirical material identified a wide schedule of courses and lectures as well as made it possible to elaborate the following categories: Health education on hospital ship SS HOPE; Legacy of international cooperation of hospital ship SS HOPE; Statements about the season of hospital ship SS HOPE. Final considerations: the arrival and stay of this hospital ship, for ten months, is the result of negotiations between the University, the State Government and the People to People Foundation. During their stay, education and health care actions were carried out, with the joint participation of health professionals, Potiguares and Americans.

RESUMEN Objetivo: analizar las actividades desarrolladas por el buque hospital SS HOPE en Natal. Método: estudio cualitativo, sociohistórico, basado en fuentes documentales y 16 entrevistas a profesionales de la salud. Se utilizó la Historia Oral Temática para el tratamiento y análisis de los datos. Resultados: el material empírico identificó un amplio programa de cursos y conferencias, además de posibilitar el desarrollo de las siguientes categorías: Educación para la salud en el buque hospital SS HOPE; Legado de la cooperación internacional del buque hospital SS HOPE; Declaraciones sobre la temporada del buque hospital SS HOPE. Consideraciones finales: la llegada y permanencia de este buque hospital, por diez meses, es el resultado de negociaciones entre la Universidad, el Gobierno del Estado y el People to People Foundation. Durante su estadía se realizaron acciones de educación y salud, con la participación conjunta de profesionales de la salud, potiguares y estadounidenses.

RESUMO Objetivo: analisar as atividades desenvolvidas pelo navio-hospital SS HOPE em Natal. Método: estudo qualitativo, sócio-histórico, elaborado a partir de fontes documentais e da realização de 16 entrevistas com profissionais de saúde. Utilizou-se a História Oral Temática para o tratamento e a análise dos dados. Resultados: o material empírico identificou uma vasta programação de cursos e palestras, assim como possibilitou a elaboração das seguintes categorias: Educação em saúde no navio-hospital SS HOPE; Legado da cooperação internacional do navio-hospital SS HOPE; Enunciados sobre a temporada do navio-hospital SS HOPE. Considerações finais: a vinda e permanência desse navio-hospital, por dez meses, é fruto da negociação entre a Universidade, o Governo do estado e a People to People Foundation. Durante sua estadia, foram realizadas ações de educação e assistência à saúde, com a participação conjunta de profissionais de saúde, potiguares e estadunidenses.

Humanización en los servicios de urgencia: Revisión narrativa / Humanization in emergency services: Narrative review

INTRODUCCIÓN: En Colombia, el tema de la humanización de los servicios de salud se encuentra estrechamente ligado a los aspectos normativos, los cuales datan de la conceptualización de la Constitución Política del país y otras normas anteriores que reglamentan la conducta médica y del personal que presta servicios de salud. OBJETIVO: Describir los aspectos relacionados con la humanización en los servicios de urgencia, en publicaciones científicas, mediante una revisión narrativa. MÉTODO: Se realizó una búsqueda bibliográfica, de artículos originales de acceso abierto publicados entre 2010 y 2020 en inglés, español y portugués. La búsqueda se concentró en los meses de marzo a julio de 2020 en cinco bases de datos disponibles en el servicio de biblioteca de la Universidad de Cartagena. RESULTADOS: Se recuperaron 17 artículos que aportaron significativamente al análisis y comprensión de la situación; el 100% en idioma inglés, de estudios desarrollados en cuatro continentes (América, Europa, Asia y Oceanía); los profesionales de enfermería cuentan con mayor número de publicaciones orientadas al conocimiento de la humanización de los servicios de salud. CONCLUSIÓN: Los resultados demuestran un necesario cambio de actitudes frente a la humanización, capacitación y reconocimiento del otro como ser humano. Es frecuente que se normalice la violencia en los servicios de urgencia, situación que es contraria a los criterios de humanización de los servicios de salud.

INTRODUCTION: In Colombia, the issue of the humanization of health services is closely linked to the normative aspects, which date from the conceptualization of the Political Constitution of the country and other previous norms that regulate the medical conduct and of the personnel who provide health services. OBJECTIVE: To describe the aspects related to humanization in emergency services, in scientific publications, through a narrative review. METHOD: A bibliographic search was carried out for original open access articles published between 2010 and 2020 in English, Spanish and Portuguese. The search was concentrated in the months of March to July 2020 in five databases available in the library service of the University of Cartagena. RESULTS: 17 articles were retrieved that contributed significantly to the analysis and understanding of the situation; 100% in English, from studies carried out on four continents (America, Europe, Asia and Oceania); Nursing professionals have a greater number of publications aimed at understanding the humanization of health services. CONCLUSION: The results show a necessary change in attitudes towards the humanization, training and recognition of the other as a human being. Violence in emergency services is often normalized, a situation that is contrary to the criteria of humanization of health services.

Enfermeiros no atendimento de urgência em presídios: explorando razões do chamado e local da assistência / Enfermeras en atención de urgencia en cárceles: explorando razones de la llamada y local de la asistencia / Nurses in urgent care in prisons: exploring reasons for the call and place of assistance

RESUMO Objetivo: analisar as percepções dos enfermeiros do Serviço de Atendimento Móvel de Urgência (SAMU) em atendimentos realizados em penitenciárias perante as razões das demandas e o local da assistência. Método: trata-se de um estudo exploratório e descritivo de abordagem qualitativa. Realizaram-se entrevistas nos meses de agosto a dezembro de 2017, individuais e audiogravadas, seguindo roteiro semiestruturado com 91 enfermeiros que atuavam no SAMU de cidades do estado da Paraíba, Brasil. Aplicou-se o referencial metodológico da Análise de Conteúdo proposta por Bardin para categorização dos dados obtidos. Resultados: das análises das falas dos participantes emergiu a presença de dificuldades como demandas não pertinentes ao serviço, local inadequado para assistência, falta de privacidade durante os atendimentos e de escolta para transporte quando necessário. Considerações finais: os problemas relatados evidenciam a necessidade do estabelecimento de estratégias para melhorar as condições da assistência potencializando a capacidade de resolutividade do serviço e para problemas que não podem ser resolvidos em uma única visita de profissionais do SAMU no ambiente prisional, que seja garantido a continuidade da assistência em outros serviços articulados a ele e para isso são necessários fortes laços intersetoriais.

RESUMEN Objetivo: analizar las percepciones de los enfermeros del Servicio de Atención Móvil de Urgencia (SAMU) en atenciones realizadas en prisiones ante las razones de las demandas y el lugar de la asistencia. Método: se trata de un estudio exploratorio y descriptivo de enfoque cualitativo. Se realizaron entrevistas en los meses de agosto a diciembre de 2017, individuales y audiograbadas, siguiendo guion semiestructurado con 91 enfermeros que actuaban en el SAMU de ciudades del estado de Paraíba, Brasil. Se aplicó el referencial metodológico del Análisis de Contenido propuesto por Bardin para categorización de los datos obtenidos. Resultados: de los análisis de los relatos de los participantes surgió la presencia de dificultades como demandas no pertinentes al servicio, local inadecuado para asistencia, falta de privacidad durante las atenciones y de escolta para transporte cuando necesario. Consideraciones finales: los problemas relatados evidencian la necesidad de que se establezcan estrategias para mejorar las condiciones de la asistencia, perfeccionando la capacidad de resolución del servicio y para problemas que no pueden ser resueltos en una sola visita de profesionales del SAMU en el ambiente carcelario, que se garantice la continuidad de la asistencia en otros servicios articulados a él y para ello son necesarios fuertes lazos intersectoriales.

ABSTRACT Objective: to analyze the perceptions of nurses from the Mobile Emergency Care Service (SAMU) in care provided in penitentiaries regarding the reasons for the calls and the place where care is provided. Method: this is an exploratory and descriptive study with a qualitative approach. Individual and audio-recorded interviews were carried out from August to December 2017 following a semi-structured script with 91 nurses who worked in the SAMU in cities in the state of Paraíba, Brazil. The methodological framework of Content Analysis proposed by Bardin was applied to categorize the data obtained. Results: the presence of difficulties emerged from the analysis of the speeches of the participants. They included calls for reasons not relevant to the service, inadequate place for assistance, lack of privacy during consultations, and lack of escort for transport when necessary. Final considerations: the reported problems highlight the need to establish strategies to improve the conditions of care provision so as to enhance the service's ability to solve problems that cannot be solved in a single visit by SAMU professionals in the prison environment, which guarantees the continuity of assistance in other services articulated to it, making strong intersectoral links necessary.

Epidemiologia das vítimas de trauma atendidas por serviço pré-hospitalar / Epidemiology of trauma victims served by prehospital service / Epidemiología de las víctimas de trauma atendidas por servicio prehospitalario

Objetivo: caracterizar os aspectos epidemiológicos das vitimas de trauma atendidas por um Serviço de Atendimento Móvel de Urgência 192. Método: estudo exploratório, descritivo e quantitativo, realizado no pronto socorro de um hospital de referencia. A população alvo foram as vitimas de trauma atendidas pelo Serviço de Atendimento Móvel de Urgência, transportadas para o referido hospital. Resultados: observou-se que 5,9% deram entrada na urgência por Ferimentos por Arma de Fogo, 4,9% por Ferimento por Arma Branca, 23,8% por queda, e 60,4% por acidentes de transito. Conclusão: o perfil identificado foi de homens, vitimas de acidente de transito, nas idades de 18 a 35 anos, com segundo grau completo, sendo o tórax a região mais atingida. Esse estudo pode subsidiar a elaboração de estratégias para enfrentamento desses agravos, pois a grande quantidade de óbitos por causas externas são considerados um problema de saúde publica, causando sequelas irreparáveis

Objective: to characterize the epidemiological aspects of the victims of trauma treated by a Mobile Emergency Care Service 192. Method: an exploratory, descriptive and quantitative study, carried out in the first aid hospital of a reference hospital. The target population was the victims of trauma treated by the Mobile Emergency Care Service, transported to the referred hospital. Results: It was observed that 5.9% were admitted to the emergency due to Firearm Injuries, 4.9% to White Weapon Injury, 23.8% to fall, and 60.4% due to trafficaccidents. Conclusion: the identified profile was of men, victims of traffic accident, in the ages of 18 to 35 years, with full second degree, being the thorax the most affected region. This study may support the development of strategies to deal with these diseases, since the large number of deaths from external causes are considered a public health problem, causing irreparable sequelae

Objetivo: caracterizar los aspectos epidemiologicos de las victimas de trauma atendidas por un Servicio de Atencion Movil de Urgencia 192. Método: estudio exploratorio, descriptivo y cuantitativo, realizado en el pronto socorro de un hospital de referencia. La poblacion objetivo fueron las victimas de trauma atendidas por el Servicio de Atencion Movil de Urgencia, transportadas al referido hospital. Resultados: se observo que el 5,9% ingreso en la urgencia por Feridas por Arma de Fuego, 4,9% por Lesion por Arma Blanca, 23,8% por caida, y 60,4% por accidentes de transito. Conclusión: el perfil identificado fue de hombres, victimas de accidente de transito, en las edades de 18 a 35 anos, con segundo grado completo, siendo el torax la region mas afectada. Este estudio puede subsidiar la elaboracion de estrategias para enfrentar esos agravios, pues la gran cantidad de muertes por causas externas son consideradas um problema de salud publica, causando secuelas irreparables

Vivências da deliberação moral de enfermeiras no atendimento pré-hospitalar móvel / Experiencias de la deliberación moral de las enfermeras en la atención móvil pre-hospitalaria / Experiences of the moral deliberation of nurses in mobile pre-hospital care

Objetivo compreender como as enfermeiras vivenciam a ação de deliberação moral no cenário de prática. Método pesquisa fenomenológica fundamentada no referencial de Alfred Schutz realizada mediante entrevistas com 12 enfermeiras de um Serviço de Atendimento Móvel de Urgência. Da análise ideográfica e nomotética foram obtidas as categorias concretas do vivido. Resultados emergiram três categorias: significados da ação da deliberação moral das enfermeiras no atendimento pré-hospitalar móvel de urgência que se referem ao contexto do atendimento; o conhecimento técnico-científico como fundamento para a ação da deliberação moral; e a dimensão social das relações estabelecidas entre as equipes como fonte de problemas éticos. Conclusão foram desvelados fatores que incidem na prática, revelando elementos que favorecem a deliberação, como as experiências do vivido, o compartilhamento das situações e os conflitos que demandam a tomada de decisão. Emerge, assim, um novo olhar para a prática das enfermeiras pautada em um agir ético, responsável e prudente.

Objetivo entender cómo las enfermeras experimentan la acción de la deliberación moral en el escenario de práctica. Método investigación fenomenológica basada en la referencia de Alfred Schutz realizada a través de entrevistas con 12 enfermeras de un Servicio de Atención Móvil de Urgencia. A partir del análisis ideográfico y nomotético, se obtuvieron las categorías concretas de los vividos. Resultados surgieron tres categorías: significados de la acción de la deliberación moral de las enfermeras en la atención pre-hospitalaria móvil de urgencia que se refieren al contexto de la atención; conocimiento técnico-científico como base para la acción de la deliberación moral; y la dimensión social de las relaciones establecidas entre los equipos como fuente de problemas éticos. Conclusión se revelaron factores que afectan a la práctica, revelando elementos que favorecen la deliberación, como las experiencias de los vividos, el intercambio de situaciones y conflictos que requieren la toma de decisiones. Así, surge un nuevo aspecto para la práctica de las enfermeras basada en una acción ética, responsable y prudente.

Objective to understand how nurses experience the action of moral deliberation in the practice scenario. Method phenomenological research based on Alfred Schutz's reference conducted through interviews with 12 nurses from a Mobile Urgency Care Service. From the idiographic and nomothetic analysis, the concrete categories of the lived were obtained. Results three categories emerged: meanings of the action of nurses' moral deliberation in the mobile pre-hospital emergency care that refer to the care context; technical-scientific knowledge as the basis for the action of moral deliberation; and the social dimension of the relationships established between the teams as a source of ethical problems. Conclusion factors that affect practice were revealed, unveiling elements that favor deliberation, such as experiences of the lived, the sharing of situations and conflicts that require decision-making. Thus, a new look emerges for the practice of nurses based on an ethical, responsible and prudent action.

Evaluating the Pilot Usability for Telenursing-based Cancer Pain Monitoring System

The purpose of this study was to evaluate the pilot usability used in a telenursing-based cancer pain monitoring system. Health care providers and advanced cancer patients who visited a hospital as outpatients (n=10/group) used and evaluated the system using a Web Usability Scale (WUS) and free description. Of the WUS seven factors, “comprehensibility” and “content reliability” received good evaluation, and “ease of operation”, “visual effects”, “responsiveness”, “usefulness”, and “acceptablity” didn’t received good evaluation. In the free description, the system was evaluated to enhance self-management of cancer pain, a request for expansion of operation, and social issues were shown. Improving patient usability is an issue, and sufficient orientation is required to verify the effects.

The impact of serving in disaster relief among volunteers in Malaysia / 中华创伤杂志(英文版)

PURPOSE@#Malaysian disaster relief volunteers have a long and proud history of participating in relief missions within and outside the country. Despite of a plethora of researches into the various areas of disaster relief, there has been a little scholarly activity looking into the experiences of the medical volunteers worldwide and even less research on the experiences of the relief volunteers in Malaysia. Therefore, the purpose of this study is to identify the effect of disaster relief works on volunteers in Malaysia.@*METHODS@#This is a non-experimental cross-sectional design study, which was conducted using survey questionnaire to examine the incidence of burnout, posttraumatic stress disorder (PTSD) symptoms and the quality of life (QOL) among the disaster relief volunteers. And the study also examined the socio-demographic variables of the participants. In addition, the association between the sociodemographic variable and the preferred coping strategies was also investigated through self-reporting checklist.@*RESULTS@#The findings of this study revealed that 90.9% volunteers (n = 312) experienced some levels of recurring stress throughout their lives, which led to burnout. Also, 96.8% (n = 332) of the participants were categorized as having at least some symptoms of PTSD. However, self-reporting QOL measurements indicated that the participants are, in general, satisfied with their lives. Significant associations between the incidence of burnout, incidence of PTSD and QOL were identified. Both positive coping measures and behavioral or avoidant coping measures were also identified. Furthermore, a number of socio-demographic factors were also seen to interact significantly with burnout, PTSD and QOL.@*CONCLUSION@#This study provides some insights into the psychological challenges of disaster relief volunteers in Malaysia, and this impact can last a long time after the volunteers return to their hometowns. Several recommendations including practice development, policy and research were discussed in the study.

Analysis of Decision-making Data for Payment of Adverse Drug Reaction Relief System to Over-the-counter Drugs to Promote Their Proper Use / 社会薬学

Adverse Drug Reaction Relief System is intended for people who suffer adverse health effects from drugs despite their proper use, including over-the-counter (OTC) drugs. The decision-making data for the payment of relief benefits associated with OTC drugs and the instructions-for-use provided by community pharmacists and registered retailers were investigated. The results showed that the relief benefit nonpayment rate for OTC drugs was 3.9% and the number of cases was 9, of which 5 were due to improper use. Among the OTC drugs covered by relief benefits, the most common were schedule II pharmaceuticals, which were sometimes used in combination with prescription drugs. These results suggest that pharmacists and registered retailers should check for the use of concomitant drugs (e.g., with drug notebooks) at the time of the OTC drug sale. Pharmacists and registered retailers should provide a detailed explanation of the drugs to consumers and confirm that the information is understood, especially when schedule II pharmaceuticals or psychotropic drugs are sold. Additionally, information on the initial symptoms of an adverse drug reaction and treatment should be provided to prevent serious reactions. Follow-up with consumers during OTC drug use may also reduce the risk of misuse.

Tramadol versus placebo for labor analgesia in low risk women: a randomized controlled trial

Background: In low- and middle-income countries epidural analgesia is generally not available and practically no form of labor analgesia is given to the majority of the parturient. The purpose of study was to evaluate the safety and efficacy of tramadol as a labor analgesic during first stage of labor.Methods: Pregnant women admitted in the labor room satisfying the eligibility criteria were randomized to receive intramuscular injection of either 100 mg tramadol or 2 ml distilled water. Visual analogue score (VAS) was assessed at the beginning and every hour till 4 hours. Pain satisfaction, duration of second stage of labor, fetal heart rate, mode of delivery, and any maternal side effects of the study drug were recorded. Neonatal evaluation using Apgar score at 1 and 5 minutes was done. For statistical analysis Student t-test, Chi Square test and Fisher’s exact test were used.Results: Total of 86 women were included in the study. The VAS scores were significantly lower in the tramadol group at 1, 2 and 3 hours after the administration. Pain relief satisfaction was significantly higher in the tramadol group. Rate of cervical dilatation, duration of the second and the third stage, need for instrumental delivery or lower segment caesarean section, rate of fetal distress and Apgar score at one and five minutes were comparable in both the groups. Nausea was significantly higher in tramadol group.Conclusions: Tramadol is a safe and efficacious drug which is inexpensive, easily available and easy to administer with few minor side effects. It can be used as a labour analgesic as an alternative to epidural analgesia in settings where epidural analgesia is not available. Trial registration: Clinicaltrials.gov PRS registration number: NCT02999594.

Acolhimento e classificação de risco: percepção de profissionais de saúde e usuários / User embracement and risk classification: health professionals' and users' perceptions / Acogida y clasificación de riesgo: percepción de profesionales sanitarios y usuarios

Objetivo: Conhecer a percepção de profissionais de saúde e usuários em relação ao acolhimento com classificação de risco em um serviço de urgência/emergência. Métodos: Estudo exploratório descritivo, com abordagem qualitativa, realizado em uma unidade de urgência/emergência de um hospital do interior do Rio Grande do Sul, Brasil. A coleta de dados ocorreu em agosto e setembro de 2017, através de entrevista semiestruturada realizada com 15 profissionais de saúde e nove usuários do serviço. A análise obedeceu aos pressupostos da análise de conteúdo, emergindo três categorias temáticas: O cotidiano de trabalho dos profissionais em relação ao acolhimento e classificação de risco; Dificuldade do usuário em compreender a classificação de risco estabelecida pelos profissionais; Importância da capacitação para atuação em equipe no acolhimento com classificação de risco. Resultados: Os usuários possuem pouco conhecimento sobre o acolhimento com classificação de risco, assim como sobre o funcionamento do mesmo. Os profissionais não se sentem preparados para trabalhar com esse sistema em função da falta de treinamento adequado, por vezes classificando os usuários de forma inadequada, o que pode agravar o quadro clínico e o prognóstico, além de dificultar a efetivação da integralidade do cuidado. Conclusão: Evidenciou-se que os usuários não têm clareza a respeito dos critérios utilizados para a realização do Protocolo de acolhimento com classificação de risco, gerando conflitos entre profissionais e usuários. Há necessidade de se repensar as formas de esclarecer os usuários quanto à importância desse sistema.

Objective: To know health professionals' and users' perceptions of user embracement and risk classification in an urgency/emergency service. Methods: A qualitative exploratory descriptive study was conducted in an urgency/emergency center of a hospital in the countryside of Rio Grande do Sul, Brazil. Data were collected in August and September 2017 through semi-structured interviews with 15 health professionals and nine service users. The analysis followed the assumptions of content analysis and three thematic categories emerged: Professionals' daily work in relation to user embracement and risk classification; User's difficulty in understanding the risk classification made by professionals; Importance of training for teamwork in user embracement with risk classification Results: The users have little knowledge about user embracement with risk classification and its functioning. The professionals do not feel prepared to work with this system due to lack of adequate training and sometimes end up inappropriately classifying the users, which may worsen the clinical picture and prognosis in addition to hindering the delivery of comprehensive care. Conclusion: The users do not understand clearly the criteria adopted to carry out the user embracement with risk classification protocol, which generates conflicts between professionals and users. There is a need to rethink ways to inform users about the importance of this system.

Objetivo: Conocer la percepción de profesionales sanitarios y usuarios respecto la acogida con la clasificación de riesgo de un servicio de urgencia/emergencia. Métodos: Estudio exploratorio descriptivo de abordaje cualitativo realizado en una unidad de urgencia/emergencia de un hospital de Rio Grande do Sul, Brasil. La recogida de datos se dio entre agosto y septiembre de 2017 a través de entrevista semiestructurada realizada con 15 profesionales sanitarios y nueve usuarios del servicio. El análisis obedeció a los presupuestos del análisis de contenido del cual emergieron tres temáticas: El cotidiano de trabajo de los profesionales respecto la acogida y la clasificación de riesgo; Dificultad del usuario de comprender la clasificación de riesgo establecida por los profesionales; Importancia de un equipo preparado para la acogida con clasificación de riesgo. Resultados: Los usuarios tienen poco conocimiento sobre la acogida con clasificación de riesgo así como el funcionamiento del mismo. Los profesionales no están preparados para trabajar con ese sistema por no tener entrenamiento adecuado, algunas veces clasificando los usuarios de manera inadecuada lo que puede empeorar el cuadro clínico y el pronóstico además de dificultar la efectuación de la integralidad del cuidado. Conclusión: Se ha evidenciado que los usuarios no están seguros de los criterios utilizados para la realización del protocolo de acogida con clasificación de riesgo lo que genera conflictos entre profesionales y usuarios. Hay la necesidad de repensar las formas de aclarar los usuarios sobre la importancia de ese sistema.

Avaliação de aplicativo móvel sobre acidentes com múltiplas vítimas para profissionais do SAMU / Evaluation of a mobile application related to multiple victim accidents for SAMU professionals

Introdução: Nos serviços de atendimento pré-hospitalar no Brasil e no mundo, os Acidentes com Múltiplas Vítimas, que são aqueles oriundos de acidentes de trânsito, atos terroristas, incidentes de massa e desastres naturais, continuam ocorrendo e sobrecarregando os serviços médicos em nível global. O aumento significativo na última década exigiu processos de capacitações especiais para atuação nessas condições. As Tecnologias da Informação e Comunicação, sobretudo os aplicativos móveis educacionais, podem auxiliar nesse sentido, pois essas ferramentas possibilitam o ensino e a atualização de conhecimentos. Objetivo: avaliar um aplicativo móvel educacional sobre Acidentes com Múltiplas Vítimas para os profissionais do Sistema de Atendimento Móvel de Urgência - SAMU. Método: trata-se de um estudo descritivo e exploratório fundamentado pelo referencial metodológico do Modelo Evolucionário, que faz parte do Ciclo de vida de desenvolvimento de sistemas. O processo de planejamento e construção do aplicativo ocorreu em pesquisa anterior. A pesquisa foi realizada em etapas que envolveram o mapeamento sistemático da literatura e o processo de avaliação do aplicativo móvel com experts em desenvolvimento de sistemas e profissionais especialistas em urgência e emergência e sua implementação. Na primeira avaliação participaram seis profissionais e foi utilizado um instrumento para análise de violação de heurísticas. Na segunda avaliação participaram 54 profissionais e foi utilizado o instrumento de avaliação de qualidade de aplicativos educacionais - MOLEVA, avaliando aspectos pedagógicos e técnicos que contemplaram critérios de aprendizagem, conteúdo, usabilidade, funcionalidade, desempenho e portabilidade. O período de coleta de dados foi de outubro de 2019 a fevereiro de 2020. Resultados: o mapeamento sistemático da literatura evidenciou a escassez de tecnologias móveis desenvolvidas para o processo de educação permanente aos serviços de emergência. A avaliação heurística mostrou aspectos fundamentais para reorganização e adequação do aplicativo. A avaliação da qualidade se mostrou satisfatória, obtendo escore de 86,85%, demonstrando que o sistema se mostrou preciso e eficaz no que se propôs, comprovando sua qualidade técnica e funcional. O aplicativo SAMUV® foi implementado mediante o registro de software junto ao Instituto Nacional de Propriedade Intelectual - INPI e disponibilizado gratuitamente no banco de aplicativos móveis da Google. Conclusão: o mapeamento sistemático da literatura possibilitou a identificação de estudos correlatos. O objetivo da pesquisa de avaliar o SAMUV® foi alcançado: o aplicativo móvel pode ser uma ferramenta educacional na educação permanente em saúde. Espera-se que a ferramenta inspire outros pesquisadores para que possam elaborar novas ferramentas de qualidade que auxiliem no processo de ensino e aprendizagem e de atualização dos profissionais nas diversas áreas da saúde

Introduction: In pre-hospital care services in Brazil and worldwide, Multiple Victim Accidents, which result from traffic accidents, terrorist acts, mass incidents and natural disasters, continue to occur and overburden medical services. A significant increase in the last decade has required special training processes to operate in these contexts. Information and Communication Technologies, especially educational mobile applications, can help in this regard, as these tools enable teaching and the updating of knowledge. Objective: to evaluate an educational mobile application related to Multiple Victim Accidents for professionals in the Mobile Emergency Care System - SAMU. Method: this was a descriptive and exploratory study based on the Evolutionary Model methodological framework, which is part of the systems development life cycle. The process of planning and construction of the application occurred in a previous study. The present study was carried out in stages that involved the systematic mapping of the literature and the evaluation process of the mobile application with experts in systems development and professionals specialized in urgent and emergency care and its implementation. In the first assessment, six professionals participated, with an instrument used to analyze the violation of heuristics. In the second evaluation, 54 professionals participated and the instrument for evaluating the quality of educational applications (MOLEVA) was used, evaluating pedagogical and technical aspects that included learning criteria, content, usability, functionality, performance and portability. The data collection period was from October 2019 to February 2020. Results: the systematic mapping of the literature evidenced the scarcity of mobile technologies developed in relation to the process of continuous education for the emergency services. The heuristic evaluation showed fundamental aspects for the reorganization and suitability of the application. The quality assessment was satisfactory, obtaining a score of 86.85%, demonstrating that the system was found to be accurate and effective for what it proposed, proving its technical and functional quality. The SAMUV® application was implemented by registering the software with the National Institute of Intellectual Property - INPI and made available for free in Google's mobile application database. Conclusion: the systematic mapping of the literature made it possible to identify related studies. The aim of the research, to evaluate the SAMUV® , was achieved: the mobile application can be an educational tool in continuous health education. It is hoped that the tool will inspire other researchers to develop new quality tools that assist in the teaching and learning process and updating professionals in different areas of health.

Choosing a hospital assistance ship to fight the covid-19 pandemic / Escolha de navio de assistência hospitalar no combate à pandemia da covid-19

ABSTRACT OBJECTIVE: To apply the THOR 2 multi-criteria support system to select the Brazilian navy's most suitable hospital care vessel (NAsH) to support the fight against the covid-19 pandemic. METHODS: We used the first three stages of the Soft Systems Methodology for structuring and modeling of the problem. For the evaluation and ordering of alternatives, we used the Thor 2 multi-criteria support system, comparing four classes of NAsH in the light of their operational and hospital criteria: "Dr. Montenegro," "Soares Meirelles," "Oswaldo Cruz" and "Tenente Maximiano." The chosen ship would support the amazon hospital system, which has an increasing number of cases of covid-19. RESULTS: After the application of the methods, we analyzed three distinct scenarios of ordering the alternatives, which allowed a robust sensitivity analysis, conferring greater transparency and reliability to the decision-making process. The NAsH "Oswaldo Cruz" was selected to be used in the fight against the pandemic. CONCLUSIONS: This study brings valuable contribution to academia and society, since it represents the application of a multi-criteria decision-aid method in the state of the art to contribute to the solution of a real problem that affects millions of people in Brazil and worldwide.

RESUMO OBJETIVO: Aplicar o método multicritério THOR 2 para selecionar o navio de assistência hospitalar (NAsH) da Marinha do Brasil mais indicado para apoiar o combate à pandemia de covid-19. MÉTODOS: Para a estruturação e modelagem do problema, foram usados os três primeiros estágios da Soft Systems Methodology. Já para a avaliação e ordenação das alternativas, foi utilizado o método de análise multicritério Thor 2, comparando quatro classes de NAsH à luz de seus critérios operativos e hospitalares: "Dr. Montenegro", "Soares Meirelles", "Oswaldo Cruz" e "Tenente Maximiano". O navio escolhido apoiaria o sistema hospitalar do Amazonas, que apresenta número cada vez maior de casos de covid-19. RESULTADOS: Após a aplicação dos métodos, foi possível analisar três cenários distintos de ordenação das alternativas, o que permitiu uma análise de sensibilidade robusta, conferindo maior transparência e confiabilidade ao processo decisório. O NAsH "Oswaldo Cruz" foi selecionado para ser empregado no combate à pandemia. CONCLUSÕES: Este trabalho traz valiosa contribuição para academia e sociedade, uma vez que representa a aplicação de um método de auxílio à decisão multicritério no estado da arte para contribuir com a solução de um problema real que afeta milhões de pessoas no Brasil e no mundo.

Experimental Study on Enhancing the Antitussive Efficacy and Reducing the Toxicity of Dioscorea bulbifera L. by the Processing Technology / 中国药学杂志

OBJECTIVE: To investigate the effects of different processing methods on antitussive and hepatotoxicity of Dioscorea bulbifera L.. METHODS The raw and processed products of Dioscorea bulbifera L., fried Dioscorea bulbifera L. (FD), wine-fried Dioscorea bulbifera L. (WD), liquorice liquid-fried Dioscorea bulbifera L. (LD) and angelicae liquid-fried Dioscorea bulbifera L. (AD) were administered to mice at a dose of 1.7 g•kg-1 for 7 d. The effects of processing on the cough relief of Dioscorea bulbifera L. were evaluated by the cough test induced by concentrated ammonia water. The detoxification effect and the preliminary mechanism of processing on Dioscorea bulbifera L. were evaluated by the detection and analysis of the relevant indicators. RESULTS: Compared with the RD group, LD and AD group had longer cough latency (P0.05). Compared with the AD group, there were more coughing times in LD group (P0.05) in mice induced by concentrated ammonia water. The intervention of WD only had significant reversal effect on the low GST level of liver (P0.05). CONCLUSION: Processing with Angelica sinensis and licorice could enhance the antitussive effect of Dioscorea bulbifera L. and reduce its hepatotoxicity. The mechanism of attenuation may be related to the inhibition of lipid peroxidation and the enhancement of antioxidant level in liver. The antitussive effect of two kinds of processing, stir-fried and wine-fried, is only effective, but no synergistic effect, no toxic effect and no attenuation effect are found.

Digital evaluation of finite element model for percutaneous kyphoplasty with bone cement injection / 中国组织工程研究

BACKGROUND: The treatment principle, long-term therapeutic effects, and complications of percutaneous kyphoplasty are closely related to blomechanlcs. Its blomechanlcs have attracted wide attention. OBJECTIVE: To establish a virtual digital evaluation system for biomechanical changes and bone cement leakage after percutaneous kyphoplasty and bone cement injection. METHODS: Percutaneous kyphoplasty with bone cement injection was performed based on previously established three-dimensional model of L3-L5. The model was processed using the software Abaqus2016 for finite element analysis. The effects of bone cement injection model, injection pressure, and injection volume on the stress of fractured L4 vertebral endplate were analyzed. RESULTS AND CONCLUSION: (1) After simulated percutaneous kyphoplasty with bone cement injection, the stress of L4 fractured vertebral endplate decreased significantly under the partial pressure of cement. Different injection methods had no significant effect on the stress of fractured L4 vertebral endplate (P > 0.05), but bilateral injection made the distribution of bone cement more uniform and produced the best effect. (2) Different injection pressures had no significant effect on the stress of fractured L4 vertebral endplate (P > 0.05), but with the increase of injection pressure, the distribution of bone cement was more dispersed and leakage was more likely to occur. (3) With increase in bone cement injection dose, the stress of fractured L4 vertebral endplate gradually decreased (P < 0.05). The physiological stiffness of the vertebral body could not be restored when 2 mL of bone cement was injected. The distribution of bone cement was more concentrated when 4 mL of bone cement was injected. The breakdown point was reached when 8 mL of bone cement was injected. (4) After injection of bone cement, the upper endplate of the lower vertebral body was more prone to suffer from fracture than the lower endplate of the upper vertebral body. (5) These results suggest that the stress of L4 vertebral endplate shifted obviously after simulated surgery compared with before surgery, that is, the stress of L4 upper endplate increased and that of L4 lower endplate decreased. Different injection methods had little effect on the surgical results, but the distribution of bone cement injected bilaterally was more uniform, which reduced the incidences of re-fracture and collapse. Lower injection pressure could reduce the risk of cement leakage after surgery. Injection of 4 mL bone cement can restore good stiffness and physiological curvature of the diseased vertebra, without reaching the yield point or causing refracture.