Reflexões sobre o trabalho on-line da neuropsicologia infantil numa visão histórico-cultural / Reflections on the online work of child neuropsychology from a cultural-historical perspective / Reflexiones sobre el trabajo online de la neuropsicología infantil desde una perspectiva histórico-cultural

O isolamento social provocado pela pandemia de covid-19 exigiu uma intensificação no estabelecimento de parâmetros para o trabalho do neuropsicólogo com suas especificidades. Assim, o objetivo deste artigo é levantar reflexões sobre a prática neuropsicológica infantil via internet baseada na nossa experiência prática vivenciada no período, relacionando com as referências teóricas da abordagem histórico-cutural e outros trabalhos que discorrem sobre as particularidades dessa modalidade de atendimento. Para isso, foi realizada uma pesquisa bibliográfica em fontes reconhecidas, como SciELO e Google Acadêmico, utilizando-se marcadores como "neuropsicologia on-line" e "teleneuropsicologia", entre outros, em português, inglês e espanhol. Os trabalhos encontrados foram utilizados como fundamento para discutir as ideias aqui apresentadas, a partir da experiência dos autores durante esse período. Considera-se que os neuropsicólogos precisam enfrentar a possível necessidade do trabalho on-line, considerando que as situações vividas durante a pandemia tendem a aumentar a necessidade de avaliações e intervenções neuropsicológicas. Ao mesmo tempo, se prevê que essa via de trabalho deve se intensificar após o isolamento, dentro do que se tem denominado como "o novo normal". Para isso, é essencial que haja esforço por parte da comunidade neuropsicológica para mostrar como essa área de trabalho pode ser útil para crianças, seus pais e professores. Conclui-se que é preciso ter a noção de que nenhuma via ou metodologia de trabalho é absolutamente completa, sendo essencial a instrumentalização das vantagens e desvantagens de todas elas.(AU)

The social isolation caused by the COVID-19 pandemic demanded intensification in the establishment of parameters for the neuropsychologist's work with its specificities. Thus, the aim of this article is to raise reflections on child neuropsychological practice via the internet, based on our practical experience in this period, relating to the theoretical references of the cultural-historical approach and other works that discuss the particularities of this type of care. For this, a bibliographic research was carried out in recognized sources such as SciELO and Google Scholar, using markers such as "online neuropsychology" and teleneuropsychology, among others, in Portuguese, English and Spanish. The works found were used as a basis for discussing the ideas presented here which are based on the authors' experience during this period. It is considered that neuropsychologists need to face the possible need for online work, considering that situations experienced during the pandemic tend to increase the need for neuropsychological assessments and interventions. At the same time, it is expected that this work path should intensify after isolation, within of what has been called "the new normal". For this, an effort by the neuropsychological community is essential to show how this area of work can be useful for children, their parents and teachers. It is concluded that it is necessary to have the notion that no way or work methodology is absolutely complete, being essential the instrumentalization of the advantages and disadvantages of all of them.(AU)

El aislamiento social provocado por la pandemia de Covid-19 exigió una intensificación en el establecimiento de parámetros para el trabajo del neuropsicólogo con sus especificidades. Así, el objetivo de este artículo es plantear reflexiones sobre la práctica neuropsicológica infantil a través de internet, a partir de nuestra experiencia práctica en este período, en relación con los referentes teóricos del enfoque histórico-cultural y otros trabajos que discuten las particularidades de este tipo de cuidado. Para esto, se realizó una investigación bibliográfica en fuentes reconocidas como SciELO y Google Académico, utilizando marcadores como "neuropsicología en línea" y teleneuropsicología, entre otros, en portugués, inglés y español. Los trabajos encontrados sirvieron de base para discutir las ideas aquí presentadas a partir de la experiencia de los autores durante este período. Se considera que los neuropsicólogos necesitan enfrentar la posible necesidad de trabajo en línea, considerando que las situaciones vividas durante la pandemia tienden a incrementar la necesidad de evaluaciones e intervenciones neuropsicológicas. Al mismo tiempo, se espera que esta vía de trabajo se intensifique después del aislamiento, dentro de lo que se ha denominado "la nueva normalidad". Para esto, un esfuerzo de la comunidad neuropsicológica es fundamental para mostrar cómo esta área de trabajo puede ser útil para los niños, sus padres y profesores. Se concluye que es necesario tener la noción de que ninguna vía o metodología de trabajo es absolutamente completa, siendo imprescindible la instrumentalización de las ventajas y desventajas de todas ellas.(AU)

Quality of life of people living with HIV and AIDS attending Irrua Specialist Teaching Hospital, Edo State, Nigeria

Background: With the use of highly active antiretroviral therapy (HAART), life expectancy of HIV-infected persons had increased and the disease is now managed as a chronic one, but the quality of life (QOL) of the patients is now a concern. Social support enhances QOL of patients with chronic illnesses. However, no study has been done to determine the QOL of people living with HIV and AIDS (PLWHA) in our environment. This study therefore assessed the QOL of PLWHA attending antiretroviral therapy (ART) clinic of Irrua Specialist Teaching Hospital (ISTH), Edo State of Nigeria Methodology: A descriptive cross-sectional study design was used. Two hundred and thirty PLWHA attending the ART clinic of ISTH, Irrua, Edo State, Nigeria, were systematically selected for the study. A structured questionnaire was interviewer-administered to collect data on sociodemographic and clinical profiles of selected participants, and the WHOQOL-HIV BREF questionnaire was used to collect data the QOL of each participant. Data were analyzed with IBM SPSS version 20.0. Results: The overall mean QOL score for the participants was 89.13±1.18 (95% CI=87.95-90.31). The scores in three of the six life domains in the WHOQOL-HIV BREF instrument were similar and high; spirituality/ religion/personal beliefs (16.33±0.36), physical health (15.83±0.28) and psychological health (15.07±0.24). Lower mean QOL scores were observed in the social relationships (13.49±0.28) and environment (13.45±0.20) domains. Clinical HIV stage, marital status, educational status and gender were significantly associated with mean QOL scores in bivariate analysis while only HIV stage 1 and 2 were significantly associated with good QOL in multivariate logistic regression analysis. Conclusion: It is pertinent that PLWHA are kept in early stages of HIV disease through combination of efforts such as prompt enrolment, commencement and monitoring compliance of HAART, and treatment of opportunistic infections, as well as public health measures including education, de-stigmatization, early diagnosis by extensive accessible screening/testing of at-risk population, social supports and economic empowerment, psychotherapy and social integration of affected individuals especially in a functional home.

Calidad de la formación en el postgrado de especialización en pediatría clínica de la FCM-UNA: un estudio de percepciones de sus estudiantes, actuales y graduados / Quality of training in the postgraduate specialization in clinical pediatrics of the FCM-UNA: a study of perceptions of its current students and graduates

Introducción: Los procesos de acreditación de la calidad de los programas de formación de médicos tienen importancia en cuanto al impulso que pueden dar a la formación de mejores profesionales. El reconocimiento de la calidad educativa de un determinado programa o carrera por parte de los organismos facultados, como la Agencia Nacional de Evaluación y Acreditación de la Educación Superior (ANEAES) es una garantía del cumplimiento de los criterios mínimos de calidad establecidos. Sin embargo, la calidad de un postgrado no solo es valorada por el cumplimiento de los criterios de calidad mínimos establecidos por los organismos encargados, sino por otros criterios como serían la percepción de los estudiantes, actuales y graduados sobre la calidad de la formación ofrecida por el mismo. Objetivos: El presente trabajo tiene como objetivo general estudiar la calidad de la formación en el Postgrado de Especialización en Pediatría Clínica de la FCM-UNA, a partir de las percepciones de sus estudiantes, actuales y graduados. Materiales y métodos: La metodología se enmarca en la tradición cualitativa de investigación social y en su instrumentación se incluye la realización de entrevistas semiestructuradas aplicadas a los estudiantes actuales (residentes) y graduados (egresados) del programa, así como el desarrollo, implementación y análisis de matrices, con la discusión de los resultados correspondientes a cada una de ellas. Resultados: Los resultados obtenidos muestran que la mayor parte de los estudiantes, actuales y egresados, del Postgrado de Especialización en Pediatría Clínica de la FCM UNA, perciben que la formación en este es de buena a mediana calidad. Los factores que inciden positivamente en la percepción de la calidad de la formación son: el ámbito de desarrollo del programa, el plan de estudios, las actividades académicas, la calidad de la composición y el desempeño del plantel docente, así como las relaciones interpersonales, tanto con los docentes como con sus pares; con algunas excepciones puntuales. La inclusión en el currículum de los aspectos relativos a la responsabilidad social universitaria también tuvo una incidencia positiva. Los factores que incidieron negativamente en la percepción de la calidad de la formación fueron: la carga horaria excesiva, el sistema de evaluación exigente, las falencias en la infraestructura y las tareas de asistencia social, en desmedro de la optimización del tiempo para la formación. En lo referente a la incidencia de la pandemia de COVID 19 en la calidad de la formación, las percepciones fueron dispares al interior de los casos de estudio que cursaron el postgrado durante la misma, con elementos negativos y llamativamente algunos elementos positivos. A la hora de sopesar en qué medida los factores positivos y negativos incidieron globalmente en la percepción de la calidad de la formación, se evidenció que, a pesar del reconocimiento de la existencia de varios factores negativos, los primeros primaron sobre los segundos. Esto hace que la mayoría de los estudiantes actuales y egresados manifiesten su satisfacción con el postgrado y los graduados con su desempeño autónomo al cumplir con sus expectativas. Conclusión: La mayor parte de los estudiantes, actuales y graduados del Postgrado de especialización en Pediatría Clínica de la FCM UNA, perciben que la formación en el mismo es de buena a mediana calidad, con aspectos a mejorar que son mencionados en las recomendaciones.

Introduction: The quality accreditation processes of medical training programs are important in terms of the boost they can give to the training of better professionals. Recognition of the educational quality of a certain program or career by authorized bodies, such as the National Agency for the Evaluation and Accreditation of Higher Education (ANEAES) is a guarantee of compliance with the minimum established quality criteria. However, the quality of a postgraduate course is not only assessed by compliance with the minimum quality criteria established by the bodies in charge, but by other criteria such as the perception of current and graduate students about the quality of the training offered by the same. Objectives: The general objective is to study the quality of training in the Postgraduate Specialization in Clinical Pediatrics of the FCM-UNA, based on the perceptions of its current and graduate students. Materials and methods: The methodology is part of the qualitative tradition of social research and its instrumentation includes semi-structured interviews applied to current students (residents) and graduates of the program, as well as the development, implementation and analysis of matrices, with the discussion of the results corresponding to each of them. Results: The results obtained show that most of the students, current and graduates, of the Postgraduate Specialization in Clinical Pediatrics of the FCM UNA, perceive that the training is of good to medium quality. Factors that positively affect the perception of the quality of training are: the scope of development of the program, the study plan, academic activities, quality of the composition and performance of the teaching staff, as well as interpersonal relationships, both with teachers and with their peers; with some specific exceptions. The inclusion in the curriculum of aspects related to university social responsibility also had a positive impact. Factors that negatively affected perception of the quality of training were: excessive workload, the demanding evaluation system, shortcomings in the infrastructure and the tasks of social service, to the detriment of time dedicated to optimizing training. Regarding the incidence of the COVID 19 pandemic on the quality of training, perceptions were uneven within the case studies that took the postgraduate course during it, with negative elements and strikingly some positive elements. When weighing up the extent to which the positive and negative factors had a global impact on the perception of the quality of training, it was shown that, despite the recognition of the existence of several negative factors, the former prevailed over the latter. This makes the majority of current students and graduates express their satisfaction with the postgraduate course and graduates with their autonomous performance in meeting their expectations. Conclusion: Most of the students, current and graduates of the Postgraduate specialization in Clinical Pediatrics of the FCM UNA, perceive that the training in it is of good to medium quality, with aspects to improve that are mentioned in the recommendations.

Voces de la primera infancia durante el confinamiento español por la covid-19 / Early childhood voices during the Spanish confinement by COVID-19 / Vozes da primeira infância durante o confinamento espanhol por Covid -19

Resumen (analítico) Se analiza cómo la situación creada por la covid-19, el confinamiento y la suspensión de la docencia presencial, afectó al alumnado de educación infantil. Se presenta un estudio de caso de un aula de 16 niños y niñas de tres años. A través de asambleas virtuales que combinaron conversaciones con la elaboración de dibujos se recoge su voz, mostrando en el análisis sus preferencias en la vida cotidiana durante el confinamiento y su estado emocional, los aprendizajes que dicen haber adquirido, así como los deseos de futuro ante la vuelta a su rutina diaria. Los resultados, no solo muestran la capacidad de adaptación infantil, sino también cómo llegan a identificar aspectos positivos derivados del confinamiento que inferimos como demandas de la infancia ante la vuelta a su vida diaria.

Abstract (analytical) It analyzes how the situation created by COVID-19 the confinement and the face-to-face teaching suspension affected the Early Childhood Education pupils. A case study of a classroom of 16 three-yearold boys and girls is presented. Through virtual assemblies that combine conversations with the elaboration of drawings, their voice is collected, showing in the analysis their preferences in daily life during the confinement and their emotional state are presented, the learning that they say they have acquired during this period, as well as their wishes for the future to return to their daily routine. The results not only show the child's ability to adapt themselves.

Resumo (analítico) Analisa-se como a situação criada pelo Covid-19, o confinamento e a suspensão do ensino presencial afetaram os alunos da Educação Infantil. Um estudo de caso de uma sala de aula de 16 meninos e meninas de três anos de idade é apresentado. Por meio de montagens virtuais que combinam conversas com a elaboração de desenhos, sua voz é coletada, mostrando na análise das informações são apresentadas suas preferências no cotidiano durante o confinamento e seu estado emocional, os aprendizados que dizem ter adquirido nesse período, bem como seus desejos para o futuro antes de retornar à rotina diária. Os resultados mostram não apenas a adaptabilidade infantil, mas também como passam a identificar aspectos positivos decorrentes do confinamento que inferimos como as demandas da infância no retorno ao cotidiano.

Incerteza de medição associada à contagem microbiana de produtos farmacêuticos / Measurement uncertainty associated with microbial count of pharmaceutical products

A contaminação microbiana pode comprometer a eficácia e a segurança dos produtos farmacêuticos. Os testes de contagem microbiana são utilizados para avaliar a qualidade microbiológica de produtos farmacêuticos não estéreis, exigidos pela maioria dos compêndios farmacopeicos. Apesar disso, raramente é considerada a avaliação da incerteza de medição para testes de contagem microbiana, o que pode levar a falsas decisões quanto à conformidade/nãoconformidade. Neste trabalho avaliamos os efeitos de matriz nos testes de contagem microbiana e sua avaliação de incerteza top-down, e avaliamos a incerteza da medição utilizando a abordagem bottom-up, além de que estimamos os riscos do consumidor ou do produtor devido à incerteza da medição. As incertezas combinada e expandida são calculadas empregando-se a abordagem topdown consideraram a exatidão (recuperação) e a precisão como os principais componentes de incerteza. O componente de incerteza da exatidão foi o mais relevante em 59% das amostras estudadas, enquanto a precisão foi a principal fonte de incerteza em apenas 41% das amostras, sendo observado que quanto maior a interferência da matriz, maior o fator de incerteza e, consequentemente, maior a assimetria para o intervalo em torno da medida. A partir da abordagem bottom-up, foram identificadas e quantificadas três principais fontes de incerteza: fator de diluição, volume plaqueado e contagem das placas. A contribuição dessas fontes de incerteza depende do valor medido da carga microbiana em produtos farmacêuticos, a contribuição do fator de diluição e das incertezas do volume plaqueado aumentam com o aumento do valor medido, enquanto a contribuição da contagem das placas diminui com o aumento do valor medido. Foi possível avaliar o risco de decisões falsas devido à incerteza de medição, por meio das estimativas dos riscos do consumidor ou do produtor. Os riscos foram avaliados utilizando-se o método Monte Carlo. Portanto, foi demonstrado a relevância da avaliação da incerteza de medição para garantir a confiabilidade dos resultados dos testes de contagem microbiana e a apoiar a tomada de decisões quando a avaliação da conformidade/não-conformidade dos produtos farmacêuticos não estéreis

Microbial contamination can compromise the efficacy and safety of pharmaceutical products. Microbial counting tests are used to assess the microbiological quality of non-sterile pharmaceutical products required by most pharmacopoeia compendiums. Despite this, measurement uncertainty assessment for microbial count tests is rarely considered, which can lead to false compliance/non-compliance decisions. In this work we evaluated the matrix effects on microbial counting tests and their top-down uncertainty assessment, and evaluated measurement uncertainty using the bottom-up approach, inaddition to estimating the consumer's or producer's risks due to measurement uncertainty. The combined and expanded uncertainties calculated using the top-down approach considered accuracy (recovery) and accuracy as the main components of uncertainty. The uncertainty component of accuracy was the most relevant in 59% of the samples studied, while accuracy was the main source of uncertainty in only 41% of the samples, being observed that the greater the interference of the matrix, the greater the uncertainty factor and, consequently, the greater the asymmetry for the interval around the measurement. From the bottom-up approach, three main sources of uncertainty were identified and quantified: dilution factor, platelet volume and plaque count. The contribution of these sources of uncertainty depends on the measured value of microbial load in pharmaceutical products, the contribution of the dilution factor and uncertainties of the plated volume increase with the increase in the measured value, while the contribution of plate counting decreases with the increase of the measured value. It was possible to assess the risk of false decisions due to measurement uncertainty by estimating consumer or producer risks. The risks were evaluated using the Monte Carlo method. Therefore, the relevance of measuring uncertainty assessment has been demonstrated to ensure the reliability of microbial count test results and to support decision-making when assessing non-sterile pharmaceutical conformity/non-compliance

Eficacia y adaptabilidad de uso del dispositivo Shoulder Pacemaker® durante la fase de fortalecimiento en la rehabilitación de hombro. Estudio preliminar / Efficacy and adaptability of use of the Shoulder Pacemaker® Device during the strengthening phase of shoulder rehabilitation

La patología de hombro es una de las causas más comunes de atención en salas de Ortopedia, y puede deberse a múltiples entidades, como inestabilidad, lesiones del manguito rotador, artrosis, capsulitis adhesiva, que pueden provocar un sinnúmero de signos o síntomas, y requerirán un manejo integral. Uno de los pilares fundamentales en el manejo de la patología de hombro es la fisioterapia. El avance tecnológico ha permitido la incorporación de dispositivos que nos ayudan a mejorar el proceso de fisioterapia. En este estudio, compartimos nuestra experiencia con el uso del Shoulder Pacemaker®, un dispositivo diseñado para mejorar el balance muscular en pacientes con patología de hombro. Level of Evidence: III

Shoulder pathology is one of the most common causes of care in Orthopedics, being caused by multiple entities such as instability, rotator cuff injuries, osteoarthritis, adhesive capsulitis, among others, which can present several signs or symptoms, and that will require comprehensive management. One of the fundamental pillars in the management of shoulder pathology is physiotherapy. Technological advancements have allowed the advent of devices that help us improve the physiotherapy process. In this study, we share our experience with the use of the Shoulder Pacemaker®, a device designed to improve muscle balance in patients with shoulder pathology. Level of Evidence: III

Experiência do Comité Nacional de Bioética para a Saúdede Moçambique após Covid-19 / Experience of the National Bioethics Committee for Health of Mozambique after Covid-19

O Comité Nacional de Bioética para a Saúde em Moçambique (CNBS) tem como missão principal fazer a revisão, para aprovação ética, de todas as propostas de pesquisa em saúde, que envolvam seres humanos, realizadas em todo o território nacional, submetidas pelos investigadores, sejam estes nacionais ou estrangeiros. É apresentado, de forma sucinta, os objectivos do Comité Nacional de Bioética para a Saúde de Moçambique e da sua redede Comités Institucionais de Bioética paraa Saúde (CIBS ́s) e o modo do seu funcionamento para garantir o cumprimento dos procedimentos éticos na investigação para protecção do agente de pesquisa e do próprio investigador, bem como desenvolver a formação em bioética para a pesquisa, melhorando e agilizando a comunicação entre os investigadores, promotores ou financiadores destas pesquisas. Com o aparecimento da pandemia deCovid-19,e havendo necessidade destes comités, mais do que nunca, manterem-se em funcionamento, introduziram-se algumas alterações à sua actividade, nomeadamente a passagem para um regime de teletrabalho, a obrigatoriedade dos protocolos de estudo conterem um capítulo (se pertinente) sobre comoenfrentaria no terreno, a situação da Covid-19 e a avaliação expedita, entre outras. Conclui-se com o relato dos resultados desta experiência vivida num período de um ano (Janeiro a Dezembro de 2020).

The main mission of the National Bioethics Committee for Health in Mozambique (CNBS) is to review for ethical approval all health research proposals involving human subjects conducted throughout the national territory submitted by national or foreign researchers. The objectives of the National Bioethics Committee for Health in Mozambique and its network of Institutional Bioethics Committees for Health (CIBS's) are briefly presented, as well as how they function to ensure compliance with ethicalprocedures in research for the protection of the research agent and the researcher himself, as well as to develop training in bioethics for research, improving and streamlining communication between researchers, promoters or funders of such research. Withthe appearance of the Covid-19 pandemic and the need for these Committees, more than ever, to remain functional, some changes were introduced to their activity, namely the change to a teleworking regime, the obligation for study protocols to contain a chapter (if relevant) on how they would deal with the Covid-19 situation in the field and the expedite evaluation, among others. We conclude with the report of the results of this experience lived in a period of one year (January to December 2020)

Compliance of patients to DOTS tuberculosis treatment strategy in a South-East Nigeria Teaching Hospital

Introduction: Tuberculosis ranks the second highest cause of adult mortality after HIV in the world. The Directly Observed Treatment Short course (DOTS) strategy is aimed at following up on patients' adherence to treatment regimen. Objectives: To assess the level of compliance of patients to the DOTS strategy. Materials and Methods: A retrospective study of patients seen at the University of Nigeria Teaching Hospital from January 2013 to April 2015. Relevant information was collected from patients' folders. Data analysis was with the SPSS and results represented in tables. Results: 111 (50%) patients were compliant with their DOTS treatment plan while 107 (41.3%) were non-compliant. Ninety-two patients (41.4%) were successfully treated and discharged home, 7 patients (3.2%) referred to other centers. The proportion of patients regarding their marital status, occupation, educational level and address that was compliant to the DOTS TB reflected varied patterns. Conclusion/ Recommendations: The study reflected poor to average compliance to DOTS. There is a need for creation of more DOTS centers; regular surveys and updates on DOTS TB strategy should be the norm rather than the exception

COVID 19: determinants and barriers to infection prevention and control practice among residents in Bonny Island, Rivers State

Background: Coronavirus disease 2019 (COVID-19) which was declared a pandemic and described as a disease of public health emergency caused worldwide disruption of business activities, education, tourism and health challenges including death. Prevention is a viable strategy to contain the pandemic, including the use of vaccines. However, evidence abound which reveals that majority of people do not comply with proposed health and safety measures recommended by World Health Organization (WHO) and their respective country health authorities. This study identified socio-demographic and other variables which may influence compliance to practice of infection prevention and control (IPC) measures. Method: This is a descriptive cross-sectional study conducted at zonal hospital Bonny. All eligible respondents who visited the hospital for Medicare were included into the study until sample size was achieved. Pretested interviewer administered questionnaire was used to elicit information from respondents. Multinomial regression analysis was used to analyze data with statistical significance set at 0.05. Ethical clearance, permission for the study and informed consent were derived from relevant authorities and respondents respectively. Result: Compliance to good IPC measures was 73.9%. There was statistically significant compliance to good practice among public servants, respondents aged 31-40 years and females. Conclusion: Good IPC measures was high among respondents, COVID 19 vaccine acceptance was poor, while factors such as inability to procure personal protective equipment and non-availability of water were responsible for poor compliance

Evaluación de los factores de riesgo vasculares convencionales en pacientes con ataque cerebrovascular isquémico en un hospital de Uruguay / Evaluation of conventional vascular risk factors in patients with ischemic cerebrovascular attack in a hospital in Uruguay

Resumen El ataque cerebrovascular es la segunda causa de muerte en adultos en el mundo occidental. Con el objetivo de conocer el estado actual de los factoresde riesgo vasculares convencionales (FRC) para el ataque cerebrovascularisquémico (ACVi) -hipertensión arterial (HTA), dislipemia, diabetes mellitus (DM), tabaquismo, arritmias, antecedentes de ataque cerebrovascular (ACV),edad y sexo- y de valorar el cumplimiento de las medidas de prevención, se analizó la distribución de éstos según etiología y topografía en un hospital público de Montevideo, Uruguay. Se estudiaron 114 pacientes de 25-97 años con ACVi. Se aplicó un protocolo para recolectar variables afines a la investigación utilizando criterios del Trial of Org 10172 in Acute Stroke Treatment y Oxfordshire Community Stroke Project para la clasificación etiológica y topográfica respectivamente. Se consideró la presencia de HTA y DM según criterios dela Organización Mundial de la Salud, de dislipemia según el Adult Treatment Panel III, de tabaquismo por haber fumado como mínimo un cigarrillo/día en el último trimestre y de arritmia a la alteración de la frecuencia cardíaca. Se observó un aumento de la frecuencia de ACVi con la edad, mayor proporción del sexo masculino respecto a la población general hasta los 64 años y frecuencia relativa etiológica y topográfica similar a la descripta en la bibliografía. La HTA fue el FRC de mayor frecuencia, tanto único como en concomitancia con otros,seguida de dislipemia y DM. Estos fueron superiores respecto de publicaciones nacionales previas. Se corroboró la implicancia de los FRC en el ACVi y la inadecuada prevención de los factores de riesgo modificables.

Abstract Stroke is the second leading cause of death in adults in the western world. Inorder to know the current status of conventional risk factors (CRF) for ischs emic stroke (IS) hypertension (HBP), dyslipidemia, diabetes mellitus, smoking, arrhythmias, history of stroke,age and sex- and to assess compliance with prevention measures, their distribution was analysed according toetiology and topography in a public hospital in Montevideo, Uruguay. One hundred fourteen IS patients aged 25-97 years were studied. A protocol was applied to collect variables related to the research using the Trial of Org 10172 in Acute Stroke Treatment and Oxfordshire Community Stroke Project criteria for etiological andtopographic classification, respectively. The presence of hypertension (HBP) and diabetes according to World Health Organization criteria, dyslipidemia according to the criteria of the Adult Treatment Panel III, smoking having smoked at least one cigarette/day in the last trimester and arrhythmia according to the alterationof the heart rate were considered. An increased in the frequency of stroke with age, a higher proportionin men compared to the general population up to 64 years of age and relative etiological and topographic frequency like bibliography were obserbed. HBP was the most frequent CRF, both alone and in concomitance with others, followed by dyslipidemia and diabetes, these being higher to than previous national publications.The implication of CRFs in stroke and the inadequate prevention of modifiable risk factors were corroborated.

Resumo O acidente vascular-cerebral é a segunda causa de morte em adultos no mundo ocidental. Para conhecer ostatus atual dos fatores de risco vasculares convencionais (FRC) para acidente vascular-cerebral isquêmico(ACVi) -hipertensão arterial (HTA), dislipidemia, diabetes mellitus (DM), tabagismo, arritmias, antecedentesde ACVi, idade e sexo- e para avaliar o cumprimento das medidas de prevenção, sua distribuição foi analisadade acordo com a etiologia e a topografia em um hospital público de Montevidéu, Uruguai. Foram estudados114 pacientes com ACVi com idades entre 25 e 97 anos. Um protocolo foi aplicado para coletar variáveis vinculadas à pesquisa usando os critérios do Trial of Org 10172 in Acute Stroke Treatment e Oxfordshire Community Stroke Project para classificação etiológica e topográfica, respectivamente. Considerou-se apresença de HTA e DM de acordo com os critérios da Organização Mundial da Saúde, dislipidemia de acordocom o Adult Treatment Panel III, tabagismo tendo fumado pelo menos um cigarro/dia no último trimestree arritmia conforme a alteração da frequência cardíaca. Observa-se aumento da frequência de AVCi com aidade, maior proporção de homens em relação à população geral até 64 anos e frequência relativa etiológicae topográfica semelhante à bibliografia. A HTA foi o FRC mais frequente, tanto única quanto em concomitância com outras, seguida de dislipidemia e DM. Eles foram superiores às publicações prévias. O envolvimentodos FRCs no ACVi e a prevenção inadequada dos fatores de risco modificáveis foram confirmadas.

Knowledge and compliance to standard precautions and general self efficacy among nurses in a tertiary hospital

Purpose@#This study aimed to evaluate the level of knowledge on Standard Precautions, level of compliance to Standard Precautions, and General self-efficacy of nurses in a tertiary hospital. Also, this study aimed to identify the relationship between those variables.@*Design and Methods@#A descriptive correlational research design was utilized in the study. 168 nurses from the tertiary hospital from Nueva Ecija, Philippines were recruited to complete a questionnaire about their knowledge and compliance to Standard Precautions and their General self-efficacy. The data was coded, encoded, and statistically analyzed using PSPP 1.2.0 (GNU Project. New York City, New York, USA).@*Results@#Findings indicated that nurses have good knowledge and high compliance concerning standard precautions; also, findings showed that nurses have a moderate level of general self-efficacy. However, there was no remarkable relationship between the level of knowledge, level of compliance in Standard Precautions, and general self-efficacy.@*Conclusions@#Although the researcher concluded a high level of knowledge among nurses, statistical analysis showed no relationship when correlated with compliance. This concluded that knowledge of Standard Precautions does not necessarily influence compliance and its application. Also, findings inferred that a moderate level of general self-efficacy did not act upon the level of compliance of nurses to Standard Precautions.

Career Adaptability in the 9th Year: Efficacy of an Intervention in Two Consecutive School Years / Adaptabilidade de Carreira no 9º ano: Eficácia da Intervenção em Dois Anos Letivos Consecutivos / Adaptación Escolar en el 9º año: Eficacia de la intervención en dos años Escolares Consecutivos

Abstract The program Eu Pertenço ao Meu Futuro! (I Belong to My Future!) has evidence of effectiveness in the career adaptability of 9th-year Portuguese students. This study evaluates its effectiveness in two consecutive school years, 2015/16 and 2016/17 - a period with a series of government changes that impacted school educational projects. This study was conducted with 2,376 students (1201 (50.5%) boys; age M = 14.53 years; SD = .836), 1138 of whom were randomized into the experimental group and 816 in the control group. Data were collected by means of the Adaptability Scale, administered in a pre- and posttest with a seven-weeks interval, and treated using the MANOVA. The intervention achieved the expected results regarding confidence and control in 2016/17. The program had different effects in the two school years, reaching more favorable outcomes in the second year, which may be explained by contextual factors and the intervention process.

Resumo O programa Eu Pertenço ao Meu Futuro! tem evidências de eficácia na adaptabilidade de carreira de alunos/as portugueses do 9.º ano escolar. Contudo, variações desta eficácia, nunca foram analisadas. Este estudo teve por objetivo avaliar a eficácia daquele em dois anos letivos consecutivos, 2015/16 e 2016/17, período de mudanças governamentais, com impacto nos projetos educativos das escolas. Participaram 2376 alunos/as [1201 (50.5%) rapazes; idade M = 14.53 anos; DP = .836], 1138 do grupo experimental e 816 do grupo de controlo. Respostas à Escala sobre Adaptabilidade, num pré e pós-teste, intervalados sete semanas, foram tratadas por meio da MANOVA. Os resultados indicam que a intervenção atingiu resultados esperados, na confiança e no controlo, em 2016/17. O programa teve efeitos distintos nos dois anos letivos, mais favoráveis no segundo ano. Torna-se necessário considerar os fatores contextuais e do processo da intervenção que possam explicar tais efeitos.

Resumen El programa Eu Pertenço ao Meu Futuro! ("¡Pertenezco a mi futuro!") tiene evidencia de eficacia en la adaptación de los/las estudiantes portugueses/as del 9.º año. Pero todavía no se han estudiado las variaciones de esta eficacia. Este estudio pretende evaluar la eficacia de esta adaptación en dos años escolares consecutivos, 2015/16 y 2016/17, un período de cambios de gobierno con impactos en los proyectos educativos escolares. Participaron 2.376 estudiantes [1.201 (50,5%) niños; edad M = 14,53 años; DE = .836], 1.138 del grupo experimental y 816 del grupo control. Las respuestas a la Escala de Adaptabilidad, en un pre-test y post-test, con un intervalo de siete semanas, se trataron con MANOVA. Los resultados indican que la intervención logró los resultados esperados en confianza y control en el 2016/17. El programa tuvo diferentes efectos en los años escolares, más favorables en el segundo año. Es necesario considerar los factores contextuales y el proceso de intervención que pueden explicar tales efectos.

Adherencia terapéutica en pacientes hipertensos del consultorio de Clínica Médica del Hospital de Clínicas / Therapeutic adherence in hypertensive patients of the Internal Medicine office at the Hospital de Clínicas

Introducción: La adherencia al tratamiento de la hipertensión arterial constituye uno de los principales factores para la obtención de un buen control de la tensión arterial y la disminución de complicaciones crónicas que la misma condiciona. Objetivos: El objetivo de este estudio fue determinar la adherencia terapéutica en pacientes hipertensos que acuden al Consultorio Externo de Clínica Médica del Hospital de Clínicas de la Universidad Nacional de Asunción. Materiales y métodos: diseño observacional, descriptivo, de corte transversal. Se incluyó a pacientes adultos con diagnóstico de hipertensión arterial que acudieron al consultorio externo de Clínica Médica del Hospital de Clínicas en el mes de octubre de 2019. Se les aplicó el cuestionario de Morisky de adherencia a la medicación de ocho ítems (MMAS-8) para valorar el cumplimiento terapéutico y se recabaron datos sociodemográficos. Los datos fueron analizados mediante estadística descriptiva. Resultados: se incluyeron 80 sujetos, la media de edad fue de 56,4±12,6 años, 56 (70%) fueron mujeres. Más de la mitad presentó alta adherencia terapéutica (56,25%). Se encontró un nivel de adherencia similar en ambos sexos (57,14% en mujeres y 54,17% en varones). Pacientes en el rango de 18 a 40 años fueron los de mayor cumplimiento (62,5%). La mayoría procedía del Área Metropolitana (71%). La ocupación predominante fue el de quehaceres domésticos (51,25%). La mayor parte de la población presentaba algún grado de formación académica (85%). Se encontró mayor adherencia en pacientes con hipertensión de menos de 5 años de evolución (65%), solteros (66%) y en pacientes que recibían una dosis diaria de la medicación (68,75%). Conclusión: más de la mitad de los hipertensos tiene buen apego terapéutico. Se encontró mayor adherencia en pacientes solteros, menores de 40 años, con algún grado de formación académica, con hipertensión de menos de 5 años de evolución y tratados con monodosis de fármacos.

Introduction: Adherence to the treatment of arterial hypertension constitutes one of the main factors for obtaining a good control of blood pressure and the reduction of chronic complications that it conditions. Objectives: The objective of this study was to determine therapeutic adherence in hypertensive patients who attend the Outpatient Clinic of the Medical Clinic of the Hospital de Clínicas of the National University of Asunción. Materials and methods: observational, descriptive, cross-sectional design. Adult patients with a diagnosis of hypertension who attended the outpatient clinic of the Clínica Médica del Hospital de Clínicas in October 2019 were included. The Morisky questionnaire of adherence to medication of eight items (MMAS-8) was applied. to assess therapeutic compliance and sociodemographic data were collected. The data were analyzed using descriptive statistics. Results: 80 subjects were included, the mean age was 56.4 ± 12.6 years, 56 (70%) were women. More than half had high therapeutic adherence (56.25%). A similar level of adherence was found in both sexes (57.14% in women and 54.17% in men). Patients in the range of 18 to 40 years were those with the highest compliance (62.5%). The majority came from the Metropolitan Area (71%). The predominant occupation was that of housework (51.25%). Most of the population had some degree of academic training (85%). Greater adherence was found in patients with hypertension of less than 5 years of evolution (65%), single (66%) and in patients who received a daily dose of the medication (68.75%). Conclusion: more than half of hypertensive patients have good therapeutic adherence. Greater adherence was found in single patients, under 40 years of age, with some degree of academic training, with hypertension of less than 5 years of evolution and treated with single doses of drugs.

Spatial variation and level of compliance on COVID-19 prevention strategies in Amhara region, Ethiopia: observational survey

Background: The novel Coronavirus was first detected in Wuhan, China in December 2019. In Ethiopia, The COVID-19 pandemic was expanding geopgraphically overtime. Understanding the spatial variation of the pandemic and the level of compliances towards COVID-19 prevention strategies is important to guide focused prevention and control efforts. Aim: This study aimed to explore the level of compliance and spatial variation in COVID-19 prevention strategies in major cities and towns in the Amhara region, Ethiopia. Methods: A community based observational survey was conducted from June 25 to August 10, 2020, in 16 selected cities and towns of the Amhara region. The level of compliance with hand hygiene, physical distancing and mask utilization as per the WHO recommendations were observed from 6,002 individuals and 346 transport services. Getis-Ord Gi* statistics were used to identify hot spot areas with a low level of compliance with COVID19 preventive strategies. Spatial interpolation was performed to predict the level of compliance for un-sampled areas in the region. Results: The practice of hand hygiene, physical distancing and mask utilization were 12.0%, 13% and 26%, respectively. COVID-19 prevention strategies were found to be spacially non-random in Amhara region (Global Moran's I = 0.23, z-score = 9.5, P-value < 0.001). Poor (Hot Spot Areas) COVID-19 Prevention practices were spatially clustered at Northern Amhara (Metema, Gondar, and Woghemira town) and Western Amhara (Moarkos, Enjibara, And Bahir Dar town).Southern (Shewa Robit, and Kemissie Twon) and Eastern (Dessie, Kombolcha, Wolidiya, and Kobo) parts of the Amhara region were spatially clustered as cold spots (better practice) for COVID19 prevention strategies. With regards to the practice of COVID19 prevention strategies, practices were low in northern and northwestern parts of the region ( 5%), whereas this was found to be much higher in the southern part of the region (41%). Conclusion: The level of compliance with regards to hand hygiene, physical distancing and mask utilization exhibit spatial variation across the region. Continuous community-based education using different modalities are necessary to increase the practice of hand hygiene, physical distancing and mask utilization

Desarrollo psicomotor en la infancia temprana y funcionalidad familiar / Psychomotor development in early childhood and family functionality

Resumen Se investigó el desarrollo psicomotor temprano y si existían diferencias significativas en las diversas áreas de este desarrollo según la funcionalidad familiar (cohesión y adaptabilidad familiar) desde la percepción materna. Se trabajó con un diseño no experimental de alcance descriptivo. La muestra estuvo compuesta por 32 diadas madre- hijo de entre 12 y 27 meses de edad. Se administró el Instrumento de Observación del Desarrollo Infantil (IODI), la Prueba Nacional de Pesquisa (PRUNAPE) y FACES III. Se encontraron diversas diferencias significativas entre tipo de cohesión-adaptabilidad familiar y áreas de la PRUNAPE (p<.05) y del IODI (p<.05). Se observó un desarrollo infantil temprano más favorable en las áreas personal social, lenguaje y socioemocional, en aquellas familias conectadas y flexibles.

Abstract The early psychomotor development was investigated and whether there were significant differences in the various areas of this development according to the maternal perception of family functionality (family cohesion and adaptability). A non-experimental descriptive design was carried out. The sample was comprised of 32 mothers with their children between 12 and 27 months old. Data was collected regarding The Child Development Observation Instrument (IODI), The National Research Test (PRUNAPE) and FACES III. Significant differences between cohesion and adaptability types and areas of development from PRUNAPE (p <.05) and IODI (p <.05) were observed. A more favorable early childhood psychomotor development was observed in the personal social area, as well as in A more favorable early the language and socioemotional area, in those families connected and flexible.

Programa Gestão Pessoal da Carreira para Universitários: Análise Qualitativa do Processo / Career Self-Management Program for College Students: Qualitative Analysis of the Process / Programa de Gestión Personal de la Carrera para Universitarios: Análisis Cualitativa del Proceso

A avaliação do processo das intervenções de carreira é uma lacuna da investigação vocacional. Este estudo apresenta a avaliação qualitativa do processo de um programa de gestão pessoal da carreira para universitários, com seis sessões semanais de 120 minutos cada, realizadas com oito grupos distintos. Participaram 42 estudantes, três psicólogas e uma supervisora. Analisou-se o conteúdo das respostas a questões abertas, no início, durante e final do processo de intervenção. As expectativas dos estudantes foram satisfeitas, sobretudo, quanto ao fomento do apoio e à adaptabilidade de carreira. As primeiras sessões satisfizeram expectativas de maior conhecimento de si, do meio e de certeza vocacional e, as últimas, de projeção futura e planejamento. A avaliação do processo demonstra o impacto do programa.

The evaluation of the career intervention process is a research gap. This study presents the qualitative evaluation of the process of a career self-management program for university students, with six weekly sessions of 120 minutes each, held with eight distinct groups. Forty-two students, three psychologists and one supervisor participated. The content of the answers to open questions at the beginning, during and at the end of the intervention process was analyzed. The students’ expectations were met, above all, in terms of fostering support and career adaptability. The first sessions satisfied expectations of greater knowledge of oneself, of the environment and of career certainty, and the last ones of future projection and planning. The evaluation of the process demonstrates the impact of the program.

La evaluación del proceso de intervenciones en la carrera es una laguna en la investigación vocacional. Este estudio presenta la evaluación cualitativa del proceso de un programa de gestión personal de la carrera para estudiantes universitarios, con seis sesiones semanales de 120 minutos cada una, celebradas con ocho grupos distintos. Participaron 42 estudiantes, tres psicólogos y un supervisor. Se analizó el contenido de las respuestas a las preguntas abiertas al principio, durante y al final del proceso de intervención. Las expectativas de los estudiantes se cumplieron, sobre todo, en lo que respecta a la promoción del apoyo y la adaptabilidad de la carrera. Las primeras sesiones satisficieron las expectativas de un mayor conocimiento de sí mismo, del entorno y de la certeza vocacional, y las últimas de proyección y planificación futuras. La evaluación del proceso demuestra el impacto del programa.

Ingesta alimentaria y presbifagia en adultos mayores activos de la comunidad de Chillán, Chile / Food intake and presbyphagia in active elderly adults in Chillán, Chile

RESUMEN El propósito del presente estudio fue determinar la prevalencia de presbifagia en adultos mayores que viven en la comunidad y estudiar el estado nutricional e ingesta alimentaria. Material y métodos: Estudio de caso-control con personas mayores de 65 años, pertenecientes a clubes de adultos mayores de Chillán, Chile. La ingesta alimentaria se evaluó a través de la encuesta de tendencia de consumo cuantificada y encuesta de modificación alimentaria creada y validada para este estudio. La presencia de presbifagia se diagnosticó mediante el cuestionario EAT-10 y el diagnóstico de disfagia por MECV-V realizado por fonoaudiólogo. El estado nutricional se evaluó a través del índice de masa corporal. Resultados: La prevalencia de presbifagia fue de 29,5% y disfagia 14,5%. El 74% de los adultos mayores con presbifagia tenía malnutrición por exceso versus 48% de los con disfagia, el 55,5% tenía un cumplimiento insuficiente de energía, situación que no coincide con el estado nutricional predominante de malnutrición por exceso. Las calorías consumidas fueron en base a carbohidratos y proteínas. Tenían una baja ingesta de agua, fibra, calcio y vitamina D y alto consumo de sodio. Los adultos mayores con disfagia demoran más tiempo en comer y han dejado de consumir alimentos que dificultan la deglución como frutas, carnes y arroz. Conclusión: La prevalencia de adultos mayores que viven en la comunidad con presbifagia fue de 29,5%, con malnutrición por exceso en el 74%, para facilitar el proceso deglutorio los adultos mayores con disfagia realizan modificaciones alimentarias a los sólidos.

ABSTRACT The purpose of the present study was to determine the prevalence of presbyphagia in community-living elderly persons and to study nutritional status and dietary intake. Material and methods: We conducted a case-control study with persons over 65 years of age, belonging to clubs for the elderly in Chillán, Chile. Dietary intake was evaluated through a food frequency questionnaire and food modification survey created and validated for this study. Presbyphagia was diagnosed by means of the EAT-10 questionnaire and dysphagia by a speech therapist with MECV-V. The nutritional status was evaluated through the body mass index. Results: The prevalence of presbyphagia was 29.5% and dysphagia 14.5%. 74% of those with presbyphagia had excess malnutrition versus 48% of those with dysphagia, 55.5% had insufficient energy compliance, a situation that does not coincide with the prevailing nutritional status of excess malnutrition. The calories consumed were based on carbohydrates and proteins. They had a low intake of water, fiber, calcium and vitamin D and high sodium in-take. Elderly persons with dysphagia took longer to eat and reported having stopped eating foods difficult to swallow such as fruits, meats and rice. Conclusion: The prevalence of community-living elderly persons with presbyphagia was 29.5% and, among those with presbyphagia, 74% had excess malnutrition. To facilitate the swallowing process, active elderly persons with dysphagia make food modifications to solid food intake.

Nivel de conocimiento sobre prevención radiológica en escenarios de formación profesional práctica de Odontología / Level of knowledge on radiological prevention in scenarios of practical professional training in Dentistry

La presente investigación tuvo como propósito de determinar el nivel de conocimientos sobre prevención radiológica en estudiantes y tutores de la carrera Odontología de la Universidad Nacional de Chimborazo, que participaron en la formación práctica en clínicas integrales de convenio. El estudio fue observacional, descriptivo y de corte transversal. La población estuvo conformada por los 169 estudiantes y 19 docentes tutores de ese entorno de enseñanza; a partir de un muestreo no probabilístico intencional se estableció una muestra de 118 alumnos y 17 profesores. Las técnicas aplicadas fueron la observación y la medición, se diseñó un test de conocimientos sobre prevención radiológica, a través de constructo y compuesto por 10 preguntas, que arrojó un alfa de Cronbach de 0,81. Entre los estudiantes que participaron en el estudio, la mayoría mostró un nivel de conocimiento de prevención radiológica catalogado como No aceptable (62,7%), mientras que entre los docentes primó Aceptable (60%). En relación con el cumplimiento de las medidas de protección radiológica se observaron los mejores resultados en las clínicas III y IV, con valores típicos de 0,43 y 0,40 respectivamente. Existieron diferencias significativas entre el cumplimiento de las medidas de protección radiológica y los conocimientos mostrados a través del test aplicado.

This research aimed to determine the level of knowledge on radiological prevention in students and tutors that participated in practical training of clinics in the dentistry school of Universidad Nacional de Chimborazo. The study was observational, descriptive, and cross-sectional. The population was made up of 169 students and 19 tutors from that teaching environment. A sample of 118 students and 17 teachers was established based on an intentional non-probability sampling. The applied techniques were observation and measurement, a knowledge test on radiological prevention was designed, through a construct and made up of 10 questions, which showed a Cronbach's alpha of 0.81. Among the students who participated in the study, the majority presented a level of knowledge of radiological prevention cataloged as Not acceptable (62.7%), while among the teachers it was acceptable (60%). In relation to compliance with radiological protection measures, the best results were observed in clinics III and IV, with typical values of 0.43 and 0.40, respectively. There were significant differences between compliance with radiological protection measures and the knowledge shown through the applied test.

Desarrollo e implementacion de un proyecto de comunicacion efectiva de valores criticos en un laboratorio publico pediatrico / Development and implementation of an effective communication project of critical values in a pediatric public laboratory / Desenvolvimento e implementação de um projeto de comunicação efetiva de valores críticos em um laboratório público pediátrico

Los valores criticos (VC) son resultados de laboratorio que deben comunicarse inmediatamente al profesional responsable, representan una amenaza para la vida del paciente y requieren atencion clinica urgente. La deteccion y comunicacion efectiva de valores criticos (CEVC) impacta directamente en la seguridad del paciente y es responsabilidad del laboratorio. Entes acreditadores y la International Organization of Standardization (ISO- 15189:2012) incluyen los VC entre sus requisitos. En 2017 se desarrollo un proyecto para garantizar la CEVC en el Hospital Garrahan. Se reviso el proceso de CEVC documentado en 2015. Se realizaron encuestas y reuniones dentro del laboratorio que evidenciaron falta de adherencia al mismo. Los VC no se comunicaban de la forma estandarizada y frecuentemente no se registraban. Se evaluaron las causas utilizando el diagrama de Ishikawa, lo que reflejo ausencia de consenso para elaborar el documento inicial. Se realizaron encuestas y reuniones intralaboratorio y con los servicios medicos, para consensuar aspectos relacionados con la CEVC y umbrales para diferentes analitos. Se acordo un nuevo listado de VC y otro de valores de informe inmediato en los que era necesario garantizar la comunicacion efectiva, aunque no requirieran intervencion medica urgente. Se protocolizo la CEVC: informe telefonico al medico tratante registrado en un formulario estandar. Se redacto y difundio un nuevo procedimiento. Se desarrollo un sistema de monitoreo con indicadores de calidad. Promover la mejora continua y desarrollar proyectos interdisciplinarios favorece la atencion centrada en el paciente y su familia. El trabajo mancomunado de diferentes servicios permitio consensuar la lista de VC y un protocolo de comunicacion acorde a las necesidades de esta institucion pediatrica.

The critical values (CV) are laboratory results that should be reported immediately to the responsible professionals, representing a threat to the patient's life and being required for urgent clinical attention. Detection and effective communication of the critical values (ECCV) impacts directly on the patient's College of Americans Pathologists (CAP), Joint Commission on Accreditation of Health Care Organizations (JCAHO), Clinical Laboratory Improvements Amendments (CLIA) e safety and it is the laboratory's responsibility. Accrediting bodies and the International Organization of Standardization (ISO 15189:2012) include CV among their mandatory requisites. In 2017, a project was developed to guarantee the ECCV at the Hospital Garrahan. The ECCV process documented in 2015 was reviewed. Surveys and assemblies were carried out within the laboratory, finding evidence of the lack of compliance with standard procedures. The CV were neither reported according to the expected standardized rules nor registered regularly. The causes were evaluated using the Ishikawa diagram, which reflected the absence of consensus to elaborate the initial document. Surveys and intra-laboratory assemblies were performed alongside with medical Departments staff, in order to come to terms on aspects related to the ECCV as well as thresholds for different analytes. Agreement was reached on a new CV list and another list for immediate reporting, in which it is essential to guarantee effective communication, even though they do not require urgent medical intervention. The ECCV was standardized through a telephone report to the treating physician registered in standard forms. A new operation procedure was edited and shared. A monitoring system with quality indicators was developed. Promoting continuous improvements as well as developing interdisciplinary projects enhance patient and family-centred care. The joint work of different Service Departments made it possible to issue the CV list and a communication protocol according to the needs of this pediatric institution.

Os valores críticos (VC) são resultados laboratoriais que devem ser imediatamente comunicados ao profissional responsável, representam uma ameaça para a vida do paciente e requerem atenção clínica urgente. A detecção e comunicação efetiva de valores críticos (CEVC) é de responsabilidade do laboratório e impacta diretamente na segurança do paciente. Organismos de acreditação e a Organização Internacional de Padronização (ISO-15189: 2012) incluem os VC entre seus requisitos. Em 2017, um projeto foi desenvolvido para garantir a CEVC no Hospital Garrahan. O processo do CEVC documentado em 2015 foi revisado. Pesquisas e reuniões foram realizadas dentro do laboratório, evidenciando a falta de adesão a ele. VC não se comunicavam de maneira padronizada e frequentemente não se registravam. As causas foram avaliadas, usando o diagrama de Ishikawa, refletindo a ausência de consenso para preparar o documento inicial. Pesquisas e reuniões foram realizadas dentro do laboratório e com os serviços médicos, para acordar aspectos relacionados à CEVC e limiares para diferentes analitos. Uma nova listagem de VC foi acordada e outra de valores de relatório imediato nas quais era necessário garantir a comunicação efetiva, mesmo que não exijissem intervenção médica urgente. O CEVC foi registrado: relatório telefônico para o médico responsável pelo tratamento registrado em um formulário padrão. Um novo procedimento foi escrito e divulgado. Um sistema de monitoramento com indicadores de qualidade foi desenvolvido. Promover a melhoria contínua e desenvolver projetos interdisciplinares favorece o cuidado centrado no paciente e sua família. O trabalho conjunto de diferentes serviços permitiu chegar a um consenso sobre a lista de VC e um protocolo de comunicação de acordo com as necessidades dessa instituição pediátrica.