Atendimento psicológico ambulatorial em hospital geral: reflexões de um(a) estagiário(a) de psicologia / Ambulatory psychological care in general hospital: reflections of a psychology intern / Servicio psicológico ambulatorio en hospital general: reflexiones de una pasante de psicología

Trata-se de um relato de experiência sobre a prática de estágio curricular em psicologia realizado em um ambulatório de especialidades em um hospital geral, vinculado ao Sistema Único de Saúde. O objetivo deste artigo é apresentar reflexões sobre a prática de estágio curricular na ênfase de promoção e prevenção à saúde, a partir de um relato de experiência. Num primeiro momento, apresenta-se um delineamento histórico sobre a formação do que se conhece hoje como ambulatório em saúde mental e, posteriormente, são apresentados alguns dispositivos que podem embasar a prática do psicólogo neste contexto, fundamentados na interação entre saberes trabalhados na formação em psicologia. Os resultados apontam para a necessidade das reflexões sobre as práticas que têm sido realizadas no campo ambulatorial ­ tendo em vista a necessidade de se atualizarem as definições técnicas sobre a atuação do psicólogo nessa área ­, assim como a necessidade da criação de critérios que avaliem os métodos utilizados pelos psicólogos. Dessa forma, se constata a necessidade de atualização do ensino em psicologia e da prática profissional no atendimento em saúde mental. (AU)

This paper describes a Psychology curricular internship experience at a specialty clinic managed by the Brazilian Public Health System. The goal of this paper is to discuss the practice of curricular internship required by the curricular emphasis on health promotion and prevention, based on expe-rience report. Initially, the paper explores the historical constitution of what is currently known as mental health clinic. Then, we present some tools that may support the psychologist's practice in this context, based on the interac-tion between the distinct knowledges which students must acquire to obtain a Psychology degree. The results show a need to reflect on the practices that are currently being carried out in mental health clinics ­ given the necessity to update the technical definitions that guide psychologists' work in this field ­ as well as a need to specify criteria for the evaluation of the methods employed by psychologists. Thus, we see that there is a need to update teaching in Psychology and professional practices in the field of mental health. (AU)

Este artículo presenta un relato de experiencia sobre la pasantía curricular realizada en un ambulatorio de especialidades vinculado al Sistema Único de Salud. Tiene el fin de presentar reflexiones sobre la pasantía con énfasis en la promoción a la salud y prevención basado en un informe de experiencia. En un primer momento, el artículo presenta un diseño histórico sobre la formación de lo que hoy se conoce como ambulatorio de salud mental y, posteriormente, se presentan algunos dispositivos que pueden apoyar la práctica del psicólogo en este contexto, a partir de la interacción entre conocimientos trabajados en la formación en psicología. Los resultados apuntan la necesidad de reflexionar sobre las prácticas que se han realizado en el ámbito ambulatorio - ante la necesidad de actualizar las definiciones técnicas sobre el desempeño del psicó-logo en esta área - así como la necesidad de generar criterios que evalúen las metodologías utilizadas por los psicólogos. Por lo tanto, queda evidente la necesidad de actualizar la docencia en psicología y la práctica profesional en el cuidado de la salud mental. (AU)

Atención farmacéutica en pacientes con inmunodeficiencia adquirida y/o tuberculosis en el área ambulatoria de un hospital pediátrico / Pharmacovigilance in patients with acquired immunodeficiency and/or tuberculosis in the outpatient area of a pediatric hospital

La Atención farmacéutica (AF) ayuda a los pacientes a alcanzar objetivos terapéuticos reduciendo los problemas relacionados al medicamento (PRM). Objetivos: analizar los PRM en la práctica de la AF a pacientes con inmunodeficiencia adquirida (IDA) y/o tuberculosis (TBC) y evaluar su impacto. Método: estudio, descriptivo, observacional, en el área ambulatoria de Farmacia. Se incluyeron pacientes con IDA y/o TBC con: inicio de tratamiento, polifarmacia, reinternaciones frecuentes, regular/mala adherencia, reacciones adversas a medicamentos (RAM) previas y/o comorbilidades. Se entrevistaron pacientes o cuidadores y se registraron PRM, errores, grados de adherencia y conocimiento farmacoterapéutico, retiro oportuno de medicamentos y parámetros clínicos. Se registró la intervención farmacéutica y entregó material educativo. Se repitieron las mediciones en una segunda entrevista. Resultados: Se estudiaron 54 pacientes (28 con IDA y 26 con TBC). Se realizaron 93 intervenciones (29.9% dirigidas al prescriptor, 27.8% a otros profesionales) y se detectaron 8 RAM y 53 errores (28 IDA y 25 TBC), el principal PRM fue la mala/regular adherencia con bajo porcentaje de conocimiento farmacoterapéutico completo. Después de la AF, en IDA el grado de adherencia tuvo una mejora estadísticamente significativa (p= 0.012), también fue significativa la mejora en el retiro oportuno de la medicación (28.6% a 71.4% p=0.005 IDA). Se obtuvieron resultados favorables de carga viral (CV) en 72% pacientes con IDA y aumento de peso en 92% pacientes con TBC, aunque no fueron estadísticamente significativos. Conclusiones: mediante AF se mejoró la adherencia y la comunicación en pacientes pediátricos con IDA y/o TBC (AU)

Pharmacovigilance (PV) helps patients achieve therapeutic goals by reducing drug-related problems (DRP). Objectives: to analyze DRPs in the practice of PV in patients with acquired immunodeficiency (AIDS) and/or tuberculosis (TB) and to evaluate its impact. Methods: A descriptive, observational study was conducted in the outpatient pharmacy area. Patients with AIDS and/or TB with: treatment initiation, polypharmacy, frequent readmissions, regular/poor adherence, previous adverse drug reactions (ADR) and/or comorbidities were included. Patients or caregivers were interviewed, and DRP, errors, adherence and pharmacotherapeutic knowledge, timely drug withdrawal, and clinical parameters were recorded. The pharmaceutical intervention was recorded and educational material was delivered. Measurements were repeated in a second interview. Results: We studied 54 patients (28 with AIDS and 26 with TB). Ninety-three interventions were performed (29.9% addressed to the drug prescriber, 27.8% to other professionals) and 8 ADRs and 53 errors were detected (28 AIDS and 25 TB). The main DRP was poor/regular adherence together with a low level of complete pharmacotherapeutic knowledge. After PV, in patients with AIDS the degree of adherence statistically significantly improved (p= 0.012). The improvement in timely medication withdrawal was also significant (28.6% vs. 71.4% p=0.005 AID). Favorable viral load results were obtained in 72% of patients with AIDS and weight gain in 92% of patients with TB, although they were not statistically significant. Conclusions: PV improved adherence and communication in pediatric patients with AIDS and/or TB (AU)

Outpatient pharmaceutical office: access to medicines in public health

Abstract We evaluated the implementation of the outpatient pharmaceutical office in a teaching hospital regarding the access to medicines available in the Unified Health System - SUS. This is a descriptive-analytical study, based on secondary data analysis of 735 appointments performed by the pharmacist from 2015 to 2017. Of the drugs prescribed to patients attended at the outpatient pharmacist office, 86.39% were listed in the National List of Essential Medicines - RENAME, of which 95.43% belonged to the Specialized Component of Pharmaceutical Assistance. Evaluating the patient's diagnosis against the inclusion criteria of the Clinical Protocols and Therapeutic Guidelines (PCDT), that the most frequent pharmaceutical interventions were: adequacy of the medication request documents (56.4%) and examination requests for pharmacotherapeutic follow up (28.5%). When the prescribed drugs were not included in RENAME/PCDT, the intervention was accepted in 90.3% of the proposals for exchange with available drug in SUS. Still, it was possible to refer the patient to primary care for renewal of continuity of treatment in 95.1% of cases. In conclusion, the role of the clinical pharmacist contributes to the resolution of untreated health problems by promoting access to medicines within the scope of SUS and their rational use in accordance with the PCDT.

Conocimientos sobre donación de sangre en pacientes de un hospital de Amazonas, Perú / Knowledge about blood donation in patients of a hospital in Amazonas, Peru

RESUMEN El objetivo del estudio fue determinar el nivel de conocimientos sobre donación de sangre que tienen los pacientes externos que acuden a un hospital en Bagua Grande. Se realizó un estudio descriptivo transversal durante mayo a julio del 2019. Se elaboró y aplicó un cuestionario estructurado. Se captó a 244 personas que acudieron a consultorios externos mediante un muestreo sistemático. Los participantes obtuvieron una media de respuestas correctas de 8,90 (DE: 3,25) puntos de un total de 21. Se encontró que la edad y el grado de instrucción estaban correlacionados con el puntaje (rho = -0,21; p < 0,001 y rho = 0,38; p < 0,001, respectivamente). La procedencia y ocupación afectaron al puntaje (p < 0,001). Los conocimientos hallados en la población estudiada son bajos, pero esto no estaría relacionado con el antecedente de donación. Las intervenciones que se elaboren para mejorar la donación de sangre no solo se deben enfocar en brindar conocimientos, ya que otros factores estarían más relacionados con este resultado.

ABSTRACT This study aimed to determine the level of knowledge about blood donation among outpatients from a hospital in Bagua Grande. A descriptive cross-sectional study was conducted from May to July 2019. We developed and applied a structured questionnaire. A total of 244 outpatients were recruited through systematic sampling. Participants obtained a mean number of correct answers of 8.90 (SD: 3.25) points out of 21. Age and educational level were found to be correlated with the score (rho = -0.21; p < 0.001 and rho = 0.38; p < 0.001, respectively). Place of origin and occupation affected the score (p < 0.001). We found a low level of knowledge in the studied population, but this would not be related to previous history of donation. Interventions to improve blood donation should not only focus on providing knowledge, since other factors would be more related to this result.

Impact of COVID-19 on non-communicable disease management services at selected government health centers in Addis Ababa, Ethiopia

Background: The global pandemic of COVID-19 forced the world to divert resources and asked the public to shelter-in-place, so the diagnosis surveillance system and management of non-communicable diseases has become more challenging. Objective: To identify the impact of COVID-19 on non-communicable diseases management services at government health centers in Addis Ababa, Ethiopia. Methods: Health facility based cross-sectional study was conducted from August to September 2020. A total of 30 health centers were included in this study. Bivariate and multiple logistic regression models were used to assess association between the outcome and independent variables Results: The majority, 24 (80%), of the study participants perceived that the COVID-19 pandemic severely disrupted the non-communicable disease management services. There was a statistically significant association between a decrease in outpatient volume at non communicable disease (NCD) management services (25 (83.3%), P-value: 0.006), closure of population level screening programs of NCDs (22 (73.3%), P-value: 0.007), and closure of disease specific NCD clinics and the occurrence of the COVID-19 pandemic (23 (76.7%), P-value: 0.013). Conclusion: The most critical health-care services for non-communicable diseases management were severely disrupted by the COVID-19 pandemic. Therefore, during public health emergencies, policymakers should ensure continuation of critical clinical services and inform the public about proper service utilization

Profile of multidrug-resistant clinical bacterial isolates at the National Hospital of Zinder (NHZ), Niger Republic in 2021

Background: Today, bacterial resistance is a public health challenge throughout the world, and infections caused by resistant bacteria are associated with increased morbidity, mortality and health care costs. The objective of this descriptive study is to determine the prevalence and distribution of multi-drug resistant (MDR) clinical bacteria isolates at the National Hospital of Zinder, Niger Republic in 2021. Methodology: We conducted a descriptive cross-sectional study of in- and out-patients from whose clinical samples' bacteria were isolated at the bacteriology unit of the laboratory. Bacteria were isolated from the clinical samples following standard aerobic cultures and identified using conventional biochemical test schemes. Antibiotic susceptibility testing (AST) was performed by the agar disk diffusion technique, and categorization of the isolates into sensitive, intermediate or resistant was done according to the recommendations of the Antibiogram Committee of the French Society of Microbiology (CA-SFM) 2020 version 1.2. MDR was defined as resistance to at least one antibiotic in three or more categories, while selected MDR bacteria such as ESBL was identified using double disk synergy test, and MRSA by cefoxitin disk diffusion test. Results: Seventy-seven (6.7%) bacterial species were isolated from 1153 clinical samples processed at the bacteriology unit of the hospital laboratory between June and December 2021, of which 65.0% (50/77) were members of the order Enterobacteriales. Escherichia coli represented 40.3% (40/77) of the isolated bacteria, Staphylococcus aureus 13.0% (10/77) and Pseudomonas aeruginosa 11.7% (9/77). The overall prevalence of MDR was 44.2% (34/77), including 61.8% (21/34) ESBL-producing Enterobacteriales (ESBL-E), 26.5% (9/34) multi-resistant P. aeruginosa and 11.7% (4/34) MRSA, with 67.6% (23/34) of the MDR isolates from outpatients. Resistance rates of the Enterobacteriales to ciprofloxacin, gentamicin, amikacin and imipenem were 62.0%, 52.0%, 38.0% and 8.0% respectively. Resistance rates of P. aeruginosa were 100.0%, 88.9%, 77.8%, 33.3%, 22.2%, and 22.2% respectively to ceftazidime, ticarcillin, imipenem, ciprofloxacin, levofloxacin, and amikacin. Resistance rates of S. aureus were 100.0%, 50.0%, 40.0%, 10.0%, 0% and 0% to penicillin G,erythromycin, cefoxitin, tetracycline, fusidic acid, and chloramphenicol respectively. ESBL-E were 47.6%,85.7% and 0% resistant to amikacin, ciprofloxacin and imipenem, and MRSA resistance rates were 75.0%, 75.0%, 50.0% and 0% to erythromycin, tetracycline, gentamicin, and chloramphenicol respectively. Conclusion: This study reports high prevalence of MDR bacteria, mainly ESBL-E, with concerning high resistance to carbapenem. Rational use of antibiotics and implementation of surveillance system for MDR bacteria must be implemented in order to limit the emergence and spread of MDR bacteria in Niger Republic.

Retrospective study of polytrauma patients's medical records that presented abdominal trauma, comperad to abdominal trauma and extra-abdominal injuries

This study sought to retrospectively assess the relationship between intra and extra-abdominal injuries in polytrauma patients undergoing laparotomy at the Regional University Hospital of Maringá between 2017 and 2018.This study was based on 111 electronic medical records from the Brazilian public health system "SUS", admitted to the hospital due to trauma and undergoing laparotomy, comparing two groups: abdominal injury without extra-abdominal injury (WoEI) and abdominal injury with extra-abdominal injury (WiEI).A total of 111 medical records were analyzed, 57 from 2017 and 54 from 2018. Of these 111records, 43 (39%) were trauma victims with only abdominal injuries and 68 (61%) trauma victims with abdominal and extra-abdominalinjuries. Most patients were male (85%), with an average age of 33 years, ranging from 14 to 87 years. In statistical analysis, according to the T-test, there was significance (p > 0.05) between the WoEI and WiEI groups for data collected regarding death rates and hospitalization days. As for the morbidity rate and difference between genders (male and female), there was no statistical significance (p < 0.05).Polytraumapatients are exposed to greater kinetic energy, with more severe conditions and therefore required more in-hospital care.

Frequência e características dos respondedores a uma intervenção educacional para redução de testes cardíacos inapropriados: um subestudo do Echo WISELY Trial / Frequency and characteristics of responders to an educational intervention to reduce inappropriate heart testing: a sub-study of the Echo WISELY Trial

Introdução: O Echo WISELY Trial é um estudo controlado, randomizado, multicêntrico, cego pelo investigador, que avaliou uma intervenção educacional com base nos critérios de uso apropriado para ecocardiografia para redução da proporção de ecocardiogramas raramente apropriados realizados ambulatorialmente. Objetivo: Descrever a prevalência e identificar preditores de responsividade de médicos respondedores submetidos à intervenção educacional no Echo WISELY Trial. Métodos: Médicos do grupo intervenção receberam um programa educacional multifacetado. O médico respondedor foi definido como aquele que apresentou redução >2,5% na média proporcional de exames raramente apropriados solicitados entre o primeiro trimestre (linha de base) e qualquer um dos seguintes trimestres (segundo ao sexto). Foram comparadas as características do médico (sexo, tempo de formação, especialidade médica e local de trabalho) com as classificações dos ecocardiogramas (apropriado, talvez apropriado e raramente apropriado) e razões clínicas para ecocardiogramas solicitados utilizando teste do qui-quadrado. A significância estatística foi indicada por p < 0,05 bicaudal. Resultados: Foram analisados 4.605 exames solicitados nos seis hospitais participantes de Ontário e randomizados para o braço intervenção. Dentre os 36 médicos incluídos, 26 (72%) foram classificados como respondedores. Entre as variáveis analisadas, não houve diferença significativa entre médicos respondedores e não respondedores à intervenção educacional. O número de exames raramente apropriados solicitados pelos respondedores foi significativamente menor que o de não respondedores (234; 8,67% versus 261; 13,8%; p < 0,0001). Conclusão: A prevalência de médicos respondedores é alta, porém não foram identificados preditores de responsividade à intervenção educacional entre as variáveis analisadas. Isso pode decorrer de aspectos psicológicos e características pessoais dos médicos, que não foram incluídos nesta pesquisa.(AU)

Introduction: The Echo WISELY Trial is a controlled randomized multicenter investigator-blinded study that evaluated an educational intervention based on the criteria for appropriate use of echocardiography to reduce the proportion of rarely appropriate outpatient echocardiograms performed. Objective: To describe the prevalence and identify predictors of the responsiveness of responding physicians subjected to an educational intervention in the Echo WISELY Trial. Methods: The intervention group physicians received a multifaceted educational program. A responding physician was defined as one who had a >2.5% reduction in the proportional mean of rarely appropriate tests requested between the first trimester (baseline) and any of the following trimesters (second to sixth). Physician characteristics (sex, time since graduation, medical specialty, and workplace) were compared to the echocardiogram ratings (appropriate, maybe appropriate, and rarely appropriate) and clinical reasons for the requested echocardiograms using the chi-square test. Statistical significance was indicated by a two-tailed p < 0.05. Results: A total of 4,605 tests requested at the six participating hospitals in Ontario were analyzed and randomized for the intervention arm Of the 36 included physicians, 26 (72%) were classified as responders. Of the variables analyzed, there was no significant difference in the outcomes of the responders versus non-responders to the educational intervention. The number of rarely appropriate tests requested by the responders was significantly lower than that of the non-responders (234 [8.67%] versus 261 [13.8%]; p < 0.0001). Conclusion: The prevalence of responder physicians was high, but predictors of responsiveness to educational intervention were not identified among the analyzed variables. This may be a result of the psychological aspects and personal characteristics of the physicians, which were not included in this research. (AU)

Integração com a Atenção Primária à Saúde: Experiência de uma Unidade de Referência em Cuidados Paliativos Oncológicos / Integration with Primary Health Care: Experience of a Referral Unit in Palliative Oncology Care / Integración con Atención Primaria de Salud: Experiencia de una Unidad de Derivación en Atención Oncológica Paliativa

O Sistema Único de Saúde (SUS) brasileiro se baseia na universalidade, equidade e integralidade, com foco na participação popular, na regionalização e hierarquização, bem como na descentralização, como seus princípios. Visa dessa forma a garantir o acesso da população à saúde em todos os níveis de atenção. O Hospital do Câncer IV (HC IV), unidade de Cuidados Paliativos do Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), tem como perfil assistencial os pacientes com câncer avançado sem possibilidade de tratamento modificador da doença oriundos das outras unidades do INCA. O HC IV/INCA tem como missão "promover e prover cuidados paliativos oncológicos da mais alta qualidade, com habilidade técnica e humanitária". Dessa maneira, pretende-se minimizar o sofrimento humano proveniente das esferas física, psíquica, social e espiritual e promover qualidade de vida

The principles of the National Health System (SUS) are based in the universality, equity, and integrality, targeted to the participation of the individuals, regionalization and hierarchy and decentralization. It attempts to ensure the population the access to health across all levels of attention . The "Hospital do Câncer IV (HC IV)" Palliative Care Unit of the National Cancer Institute José Alencar Gomes da Silva (INCA), provides care to patients with advanced cancer without possibility of disease modifying treatment referred from other INCA units. HC IV/ INCA's mission is to "promote and provide high quality palliative oncologic care with technical and humanitarian proficiency" . Following this logic, it endeavors to minimize the human suffering of physical, psychic, social and spiritual nature, and improve the quality of life

Fatores de riscos psicossociais e dimensões do trabalho em profissionais de Enfermagem de ambulatório universitário / Psychosocial risk factors and dimensions of work in Nursing professionals at a university outpatient clinic

Objetivo: Analisar as dimensões do trabalho que constituem fatores de risco psicossocial e suas repercussões no sofrimento e adoecimento das profissionais de enfermagem de ambulatório de hospitais universitários. Método: Estudo quantitativo, transversal, realizado nos 11 ambulatórios dos hospitais universitários localizados no município do Rio de Janeiro. Foram participantes da pesquisa 388 profissionais atuantes na assistência de enfermagem dessas unidades. O instrumento de coleta de dados contemplou um questionário para caracterização sociodemográfica, ocupacional e de saúde e o Protocolo de Avaliação dos Riscos Psicossociais Relacionados ao Trabalho. Os dados foram organizados, processados e analisados com o auxílio do programa Statistical Package for the Social Sciences, versão 21.0. As análises bivariadas foram realizadas utilizando a razão de chances, odds ratio (OR), com intervalo de confiança de 95%, com um nível de significância de 5% para verificar a associação entre as variáveis. A coleta de dados orientou-se pela obediência aos princípios éticos da pesquisa com seres humanos, sendo aprovado por oito comitês de Ética em Pesquisa. Resultados: A equipe de enfermagem ambulatorial aponta para um perfil de feminilidade maior que em outras unidades, profissionais mais velhas, casadas, com filhos, negras e com qualificação superior às exigidas para o cargo. Dentre as características ocupacionais, destacou-se o vínculo permanente, sendo um percentual significativo com mais de um vínculo, exercendo uma carga horária superior a 30 horas semanais. A maioria era de técnicas de enfermagem e já havia trabalhado em outro setor dentro da instituição, sendo no turno diurno independente do vínculo. Em relação ao tempo de trabalho, a média foi de 23,7 anos na enfermagem, 17,8 anos na instituição e 8,3 anos no ambulatório. No que diz respeito às características relacionadas à saúde, a maioria apresentou autoavaliação positiva da saúde, não apresentou afastamento por doença no último ano, possuía problema de saúde relacionado ao trabalho e apresentava doenças crônicas. A organização do trabalho em ambulatórios de hospitais universitários foi avaliada como risco médio pelos respondentes, o que significa um estado de alerta/situação limite para os riscos psicossociais no trabalho dos profissionais de enfermagem. Para esses profissionais há presença moderada dos estilos de gestão gerencialista e coletivo nos ambulatórios universitários. Em relação ao sofrimento patogênico, os fatores falta de sentido no trabalho e falta de reconhecimento apresentaram baixo risco psicossocial, enquanto o fator esgotamento mental apresentou risco médio. Os danos físicos foram avaliados como risco médio, já os danos psicológicos e sociais apresentaram resultado positivo, representando baixos riscos psicossociais. Conclusões: A partir do entendimento de que a natureza do trabalho da enfermagem não é passível de mudanças, e que esta, por si, já expõe o trabalhador a riscos com potencial de causar danos à sua saúde, medidas interventivas devem ser realizadas nas dimensões do trabalho que se constituem fatores de risco psicossocial e se apresentaram nesta pesquisa relacionados à organização do trabalho e gestão dessas unidades, a fim de minorar o sofrimento e os danos dos profissionais de enfermagem que atuam nos ambulatórios universitários. Contribuições para a enfermagem: A partir desses resultados, pretende-se sensibilizar os gestores das unidades para a necessidade de implementar ações que foquem nas condições desfavoráveis de trabalho, visando sua adequação, possibilitando melhoria no desempenho da equipe de enfermagem, com vista à prestação de serviços de qualidade, mas também à preservação de sua saúde. Atenção deve ser dada aos modelos hierarquizados, hegemônicos nos serviços de saúde, que impedem a autonomia no trabalho da enfermagem, dificultam o estabelecimento de relações cooperativas e o sentimento de valorização e reconhecimento, essenciais para a transformação do sofrimento em prazer no trabalho.

Objective: To analyze the work dimensions that represent psychosocial risk factors and their repercussion in the suffering and illness of the Nursing professionals working in outpatient clinics of university hospitals. Method: A quantitative and cross-sectional study conducted in the 11 outpatient services of the university hospitals located in the city of Rio de Janeiro. The research participants were 388 professionals working in the Nursing assistance sector of these units. The data collection instrument included a questionnaire for sociodemographic, occupational and health characterization, as well as the Protocol for the Evaluation of the Work- Related Psychosocial Risks. The data were organized, processed and analyzed with the aid of the Statistical Package for the Social Sciences program, version 21.0. The bivariate analyses were performed using Odds Ratio (OR), with a 95% confidence interval and a 5% significance level to verify the association between the variables. Data collection was guided by observance of the ethical principles of research with human beings, being approved by eight Research Ethics committees. Results: The outpatient Nursing team points to a greater female profile than in other units, older professionals, married, with children, black-skinned and with higher qualifications than those required for the position. Among the occupational characteristics, permanent employment contract stood out, with a significant percentage of people having more than one contract, representing an hour load of over 30 hours a week. Most of the participants were nursing technicians and had already worked in another sector within the institution, in the day shift regardless of the contract. In relation to the working time, the mean values were 23.7 years in Nursing, 17.8 years in the institution, and 8.3 years in the outpatient service. Regarding the characteristics related to health, most of them presented a positive health self- assessment, did not take medical leaves in the past year, had some work-related health problem, and presented chronic diseases. Work organization in the outpatient services of university hospitals was assessed as with medium risk by the respondents, which means a state of alert/borderline situation for the psychosocial risks in the Nursing professionals' work. For these professionals, there is moderate presence of the managerial and collective management styles in the university outpatient services. In relation to pathogenic suffering, the "lack of meaning in work" and "lack of recognition" factors presented low psychosocial risk, while the "mental exhaustion" factor presented medium risk. The physical harms were assessed as with medium risk; on the other hand, the psychological and social harms presented a positive result, representing low psychosocial risks. Conclusions: Based on the understanding that the nature of the Nursing work is not subjectable to changes, and that such nature per se already exposes workers to risks with the potential to cause harms to their health, intervention measures must be implemented in the work dimensions that constitute psychosocial risk factors and were presented in this research as related to the work organization and management of these units, in order to mitigate distress and harms in the Nursing professionals working in the outpatient services of university hospitals. Contributions to Nursing: Based on these results, the intention is to sensitize the units' managers regarding the need to implement actions focused on the unfavorable working conditions, aiming at their adaptation, enabling an improvement in the performance of the Nursing team, with a view to quality in the provision of services, but also to preserving their health. Attention must be paid to the hierarchical models, hegemonic in the health services, which preclude autonomy in the Nursing work, hinder the institution of cooperative relationships and of a feeling of appreciation and recognition, essential to transform suffering into pleasure at work.

Objetivo: Analizar las dimensiones del trabajo que constituyen factores de riesgo psicosocial y sus repercusiones en el sufrimiento y las enfermedades de los profesionales de Enfermería de los servicios ambulatorios de hospitales universitarios. Método: Estudio cuantitativo y transversal realizado en los 11 servicios ambulatorios de los hospitales universitarios situados en el municipio de Rio de Janeiro. Los participantes del estudio de investigación fueron 388 profesionales de Enfermería de estas unidades. El instrumento para la recolección de datos incluyó un cuestionario para la caracterización sociodemográfica, ocupacional y de salud y el Protocolo de Evaluación de los Riesgos Psicosociales Relacionados con el Trabajo. Los datos se organizaron, procesaron y analizaron con la ayuda del programa Statistical Package for the Social Sciences, versión 21.0. Los análisis bivariados se realizaron utilizando Odds Ratio (OR), con intervalo de confianza del 95% y nivel de significancia del 5% para verificar la asociación entre las variables. La recolección de datos se basó en la obediencia de los principios éticos de la investigación con seres humanos. Resultados: El equipo de Enfermería ambulatoria apunta a un perfil femenino mayor que en otras unidades, profesionales de más edad, casadas, con hijos, de raza negra y con calificaciones superiores a las exigidas para el cargo. Entre las características ocupacionales, se destacó el vínculo permanente, donde un porcentaje significativo de las profesionales poseía más de un vínculo laboral, con una carga horaria superior a 30 horas semanales. La mayoría de las participantes eran técnicas de Enfermería y ya habían trabajado en otro sector de la institución, en el turno diurno e independientemente del vínculo laboral. En relación con el tiempo de trabajo, los valores medios fueron 23,7 años en Enfermería, 17,8 años en la institución y 8,3 años en el servicio ambulatorio. Con respecto a las características relacionadas con la salud, la mayoría presentó una autoevaluación positiva de la salud, no tuvo que tomar licencia por enfermedad durante el último año, tuvo problemas de salud relacionados con el trabajo y presentó enfermedades crónicas. Las entrevistadas evaluaron la organización del trabajo en los servicios ambulatorios de hospitales universitarios como de riesgo medio, lo que significa un estado de alerta/situación límite para los riesgos psicosociales en el trabajo de los profesionales de Enfermería. En el caso de estos profesionales, se registra una moderada presencia de los estilos de gestión gerencialista y colectivo en los servicios ambulatorios universitarios. En relación con el sufrimiento patogénico, los factores «falta de sentido en el trabajo¼ y «falta de reconocimiento¼ presentaron un riesgo psicosocial reducido, mientras que el factor «agotamiento mental¼ presentó riesgo medio. Los perjuicios físicos se evaluaron como de riesgo medio, mientras que los psicológicos y sociales presentaron un resultado positivo, representando así riesgos psicosociales reducidos. Conclusiones: Sobre la base de comprender que la naturaleza del trabajo de Enfermería no es pasible de mudanzas y que, de por sí, dicha naturaleza ya expone al trabajador a riesgos con potencial de causar daños a su salud, deben implementarse medidas de intervención en las dimensiones del trabajo que representan factores de riesgo psicosocial y que, en esta investigación, se presentan relacionados con la organización del trabajo y la gestión de estas unidades, a fin de mitigar el sufrimiento y los perjuicios de los profesionales de Enfermería que se desempeñan en los servicios ambulatorios de hospitales universitarios. Contribuciones para la Enfermería: A partir de estos resultados, se pretende sensibilizar a los gerentes de las unidades con respecto a la necesidad de implementar acciones enfocadas en las condiciones desfavorables del trabajo, en pos de su adecuación, posibilitando así una mejora en el desempeño del equipo de Enfermería, con vistas a una prestación de servicios de calidad, como así también a preservar su salud. Debe prestarse atención a los modelos jerarquizados, hegemónicos en los servicios de salud, que impiden la autonomía en el trabajo de Enfermería, dificultan el establecimiento de relaciones de cooperación y el sentimiento de valorización y reconocimiento, esenciales para transformar el sufrimiento en placer laboral.

Differentiating irritable mood and disruptive behavior in adults

Abstract Introduction Irritability has both mood and behavioral manifestations. These frequently co-occur, and it is unclear to what extent they are dissociable domains. We used confirmatory factor analysis and external validators to investigate the independence of mood and behavioral components of irritability. Methods The sample comprised 246 patients (mean age 45 years; 63% female) from four outpatient programs (depression, anxiety, bipolar, and schizophrenia) at a tertiary hospital. A clinical instrument rated by trained clinicians was specifically designed to capture irritable mood and disruptive behavior dimensionally, as well as current categorical diagnoses i.e., intermittent explosive disorder (IED); oppositional defiant disorder (ODD); and an adaptation to diagnose disruptive mood dysregulation disorder (DMDD) in adults. Confirmatory factor analysis (CFA) was used to test the best fitting irritability models and regression analyses were used to investigate associations with external validators. Results Irritable mood and disruptive behavior were both frequent, but diagnoses of disruptive syndromes were rare (IED, 8%; ODD, 2%; DMDD, 2%). A correlated model with two dimensions, and a bifactor model with one general dimension and two specific dimensions (mood and behavior) both had good fit indices. The correlated model had root mean square error of approximation (RMSEA) = 0.077, with 90% confidence interval (90%CI) = 0.071-0.083; comparative fit index (CFI) = 0.99; and Tucker-Lewis index (TLI) = 0.99, while the bifactor model had RMSEA = 0.041; CFI = 0.99; and TLI = 0.99 respectively). In the bifactor model, external validity for differentiation of the mood and behavioral components of irritability was also supported by associations between irritable mood and impairment and clinical measures of depression and mania, which were not associated with disruptive behavior. Conclusions Psychometric and external validity data suggest both overlapping and specific features of the mood vs. disruptive behavior dimensions of irritability.

Pain and Satisfaction Levels upon Removal of External Fixator at an Outpatient Facility / Nível de satisfação e dor na retirada de fixador externo em um ambulatório

Abstract Objective To quantify the levels of satisfaction and pain of patients submitted to external fixation removal without anesthesia at an outpatient facility. Methods The present was a prospective study involving 28 patients using external fixators who answered 3 questionnaires associated with the Visual Analogue and Numerical Pain Scale during different moments of the removal. Results The average pain prior to fixator removal was of 3.61. Shortly after the procedure, the patients reported that, on average, the most intense pain scored 6.68, and the least intense pain, 2.25 points. The average pain variation was of 4.43 points, and pain after 1 week scored, on average, 2.03 points. The recollection of the pain after fixator removal scored lower than the pain reported immediately after the procedure (mean value: 5.29). Most patients were middle-aged men, and 89.3% used circular external fixators. The main limb segment involved was the leg, and most patients (71.4%) had never used an external fixator before; they preferred the removal at an outpatient facility because it was faster (75%), and to avoid hospitalization (25%). The most intense pain was felt during the removal of Schanz pins (60.7%), being worse in the extremities of the limbs for 75% of the patients. An absolute majority of 85.7% was satisfied with the removal, and 82.1% stated that they would undergo the procedure again. Conclusion External fixator removal at an outpatient facility without anesthesia is a well-tolerated option for patients, with good levels of approval and satisfaction.

Resumo Objetivo Quantificar os níveis de satisfação e dor dos pacientes submetidos a retirada ambulatorial de fixadores externos sem anestesia. Métodos Estudo prospectivo envolvendo 28 pacientes usando fixadores externos submetidos a três questionários associados à Escala Visual Analógica e Numérica da dor durante diferentes etapas da retirada. Resultados A média de dor prévia à retirada foi de 3,61. Logo após o término do procedimento, encontramos média de 6,68 para a dor mais intensa, e de 2,25 para a dor menos intensa. A variação da dor média foi de 4,43, e a dor após uma semana teve média de 2,03. A lembrança dolorosa da retirada foi menor do que a dor referida imediatamente após a retirada (média de 5,29). A predominância no estudo foi de pacientes do sexo masculino de meia-idade, e 89,3% usavam fixador externo do tipo circular. O principal segmento dos membros envolvido foi a perna, e a maior parte dos pacientes não havia feito uso de fixador externo previamente (71,4%); eles optaram pela retirada ambulatorial por se tratar de opção mais rápida (75%), e para evitar internação hospitalar (25%). O momento de dor mais intensa ocorreu durante a retirada dos pinos de Schanz (60,7%), sendo pior nas extremidades dos membros para 75% dos entrevistados. Uma maioria absoluta de 85,7% mostrou-se satisfeita após a retirada, e 82,1% afirmaram que se submeteriam novamente ao procedimento. Conclusão A retirada ambulatorial de fixadores externos sem anestesia é uma opção bem tolerada pelos pacientes, tratando-se de um procedimento com bons níveis de aceitabilidade e satisfação.

Sala de espera: educação em saúde em um ambulatório de gestação de alto risco / The waiting room: health education in a high risk pregnancy clinic

O objetivo deste trabalho foi identificar as necessidades das gestantes referentes a assuntos que possam ser abordados em atividades de educação em saúde, no momento de espera, em um ambulatório de referência de gestação de alto risco. Trata-se de um estudo descritivo, qualitativo e de campo, utilizando a análise de conteúdo temática de Bardin. Participaram 35 gestantes presentes no dia da consulta de pré-natal. Emergiram então seis categorias: Percepção de desconforto durante o momento de espera; Sentimento de abandonado no momento de espera e preocupação com o retorno ao trabalho; Referência a sintomas de ordem física e emocional; Participação (ou não) de educação em saúde; Sugestão de desenvolvimento de atividades educativas no momento de espera; Proposição de oferta oportuna de lanches durante o momento de espera. Assim, a partir das necessidades identificadas, sugere-se a prática de educação em saúde como forma de otimizar o tempo de espera para a consulta de pré-natal deste serviço.

Current paper identifies the needs of pregnant females with regard to themes within health education when they are waiting in a high-risk hospital outpatient clinic. Through a descriptive, qualitative and field studies and employing Bardin´s thematic contents, thirty-five pregnant females participated on the occasion of their pre-natal visit to the doctor. Six categories emerged: perception of discomfort while waiting; feeling of abandonment while waiting; concern on return to work; reference to physical and emotional symptoms; participation or not in health education; suggestion to the development of educational activities while waiting; offering of meals while waiting. When needs are identified, health education should optimize waiting time prior to pre-natal service.

Fatores associados à demência em idosos / Factors associated with dementia in elderly

Resumo Analisar os fatores associados à demência em idosos atendidos em um ambulatório de memória da Universidade do Sul de Santa Catarina (Unisul). Estudo transversal com análise de dados de prontuário no período de 01/2013 a 04/2016. O desfecho foi o diagnóstico clínico de demência. As variáveis de controle foram: nível sérico de vitamina D na época do diagnóstico, sexo, cor da pele, escolaridade, idade, diabetes tipo 2, hipertensão arterial e depressão. Foi realizada análise bruta e ajustada com regressão logística. Amostra de 287 idosos, com predominância de idade entre 60 e 69 anos (48,78%), sexo feminino (79,09%), cor da pele branca (92,33%). A média de anos de estudo foi de 6,95 anos (DP ± 4,95) e da vitamina D 26,09 ng/mL (DP ± 9,20). A prevalência de idosos com demência foi de 16,72%. Dentre as morbidades a depressão foi a de maior prevalência seguida pela hipertensão arterial. Estiveram independentemente associadas à demência: vitamina D (OR = 0,92 IC 95% 0,88;0,97), depressão (OR = 4,09 IC95% 1,87;8,94), hipertensão arterial (OR = 2,65 IC95% 1,15;6,08) e indivíduos com idade igual e maior que 80 anos. A prevalência de demência foi alta, e houve associação de níveis mais baixos de vitamina D com diagnóstico de demência. Sendo a vitamina D um fator modificável, abrindo importantes perspectivas para políticas de saúde pública.

Abstract We analyzed the factors associated with dementia in the elderly attended at a memory outpatient clinic of the University of Southern Santa Catarina (UNISUL). This is a cross-sectional study with data analysis of medical records from January 2013 to April 2016. The outcome was the clinical diagnosis of dementia. The control variables were: serum vitamin D level at the time of diagnosis, gender, skin color, schooling, age, type 2 diabetes, hypertension, and depression. We performed a crude and adjusted analysis with logistic regression. The sample consisted of 287 elderly, with the predominance of age between 60 and 69 years (48.78%), female (79.09%) and white (92.33%). The mean number of years of study was 6.95 years (SD ± 4.95) and mean vitamin D was 26.09 ng/mL (SD ± 9,20). The prevalence of elderly with dementia was 16.72%. Depression was the most prevalent (42.50%) among the morbidities, followed by hypertension (31.71%). The following were independently associated with dementia: vitamin D (OR = 0.92, 95%CI, 0.88;0.97), depression (OR = 4.09, 95%CI, 1.87;8.94), hypertension (OR = 2.65, 95%CI, 1.15;6.08) and individuals aged 80 years and over (OR = 3.97 95%CI, 1.59;9.91). Dementia prevalence was high and diagnosed dementia was associated with lower levels of vitamin D. Vitamin D is a modifiable factor, opening up essential perspectives for public health policies.

Perfil da equipe de enfermagem de unidades ambulatoriais universitárias: considerações para a saúde do trabalhador / Perfil del equipo de enfermería de unidades ambulatorias universitarias: consideraciones para la salud del trabajador / Profile of the nursing team of university outpatient units: worker health considerations

RESUMO Objetivo identificar o perfil sociodemográfico, laboral e de saúde da equipe de enfermagem de unidades ambulatoriais especializadas. Método Estudo quantitativo, descritivo, realizado com 388 profissionais de enfermagem de ambulatórios de universidades públicas no município do Rio de Janeiro. Os dados foram coletados por equipe de auxiliares capacitados. A análise foi realizada por meio do software SPSS. Resultados houve predomínio do sexo feminino, idade acima de 50 anos, profissionais casados e com filhos. Percentual maior de trabalhadores possuía Pós-Graduação Lato Sensu, vínculo permanente, um vínculo empregatício e carga horária laboral de 31 a 60 horas semanais. Prevaleceram aqueles que autoavaliaram o estado de saúde como bom. Dentre as doenças crônicas com diagnóstico médico, destacaram-se o estresse, as doenças osteoarticulares e as varizes. Conclusões e implicações para a prática os resultados mostraram, além de dados que corroboram com a realidade nacional e internacional, uma realidade que não é prerrogativa apenas da enfermagem, como o duplo vínculo e uma alta prevalência de estresse associado a outros problemas de saúde. Observa-se um cenário preocupante no mundo do trabalho da equipe de enfermagem ambulatorial, o qual traz à tona concepções e práticas negativas potencialmente causadoras de insatisfações, riscos, danos, inseguranças e adoecimentos no trabalho.

RESUMEN Objetivo identificar el perfil sociodemográfico, laboral y de salud del equipo de enfermería de unidades ambulatorias especializadas. Método estudio cuantitativo, descriptivo, realizado con 388 profesionales de enfermería de ambulatorios de universidades públicas del município de Rio de Janeiro. Los datos fueron recolectados por auxiliares capacitados. El análisis se realizó utilizando software SPSS. Resultados se observó predominio del sexo feminino, edad superior a 50 años, profesionales casados ​​y con hijos. Un porcentaje mayor de trabajadores poseía Posgrado Lato Sensu, vínculo permanente, vínculo de empleo y carga horaria laboral de 31 a 60 horas semanales. Prevalecerán aquellos que auto validarán el estado de salud como bueno. Entre las enfermedades crónicas con diagnóstico médico se destacan estrés, las enfermedades osteoarticulares y varices. Conclusiones e implicaciones para la práctica los resultados mostraron, además de datos que corroboran con la realidad nacional e internacional, una realidad que no es prerrogativa apenas de la enfermería, como el doble vínculo y alta prevalencia de estrés asociados a otros problemas de salud. Esto demuestra un escenario preocupante en el mundo del trabajo del equipo de enfermería ambulatoria, el cual trae a tono concepciones y prácticas negativas potencialmente causantes de insatisfacciones, riesgos, daños, inseguridades y enfermedades en el trabajo.

ABSTRACT Objective to identify the sociodemographic, occupational and health profile of nursing staff working at specialized outpatient units. Method a descriptive study with a quantitative approach, conducted with 388 nursing professionals from outpatient clinics of public universities in the city of Rio de Janeiro. Data were collected by trained auxiliary team. Analysis was performed using SPSS software. Results there was a predominance of females, aged over 50 years, married professionals, and with children. A higher percentage of workers had Lato Sensu Graduate studies, permanent employment, an employment relationship and workload of 31 to 60 hours per week. Those who self-rated health prevailed as good. Chronic diseases with medical diagnosis, that stand out, include stress, osteoarticular diseases and varicose veins. Conclusions and implications for the practice the results showed, in addition to data that corroborate the national and international reality, a reality that is not only prerogative of nursing, such as the double bond and a high prevalence of stress associated with other health problems. This shows a worrying setting in the outpatient nursing staff work world, which brings out negative conceptions and practices potentially causing dissatisfaction, risk, damage, insecurity, and illness at work.

Application of three-in-one intelligent screening in outpatient department of children's hospital during COVID-19 epidemic / 浙江大学学报·医学版

OBJECTIVE@#To evaluate the application of three-in-one intelligent screening in outpatient pre-inspection in children's hospital.@*METHODS@#We randomly enrolled 100 children pre-screened by traditional method in the outpatient department of Children's Hospital of Zhejiang University from February 6th to 16th, 2020, and another 100 children by the intelligent three-in-one mode from February 17th to 27th, 2020. The traditional triage was conducted by nurses based on face-to-face, one-by-one interview of the epidemiological history and consultation department, and the temperature was measured before manual triage. The intelligent three-in-one model combined online rapid pre-inspection and triage, on-site manual confirmation, as well as synchronized online health education system. For on-line registered patients, the system automatically sent the COVID-19 epidemiological pre-screening triage questionnaire one hour before the appointment, requiring parents to complete and submit online before arriving at the hospital. The on-site registered patients were controlled at 100 m away from the hospital entrance. The nurses guided the parents to scan the QR code and fill in the COVID-19 epidemiological pre-examination triage questionnaire. At the entrance of the hospital, the nurse checked the guidance sheet and took the temperature again. The children with red guidance sheet were checked again and confirmed by pre-examination nurses, and accompanied to the isolation clinic through COVID-19 patients-only entrance. The children with yellow guidance sheet were guided to fever clinic. The children with green guidance sheet could go with their parents to the designated area, and then went to the corresponding consultation area. Health education was carried out throughout the treatment, and the system automatically posted the corresponding outpatient instructions and education courses. Parents would read the courses on their mobile phones and counsel online. The time of pre-examination and the coincidence rate of triage were compared between the two groups.@*RESULTS@#The three-in-one intelligent pre-inspection mode took an average of (25.6±8.0) s for each child, which was significantly shorter than the traditional pre-inspection mode (74.8±36.4) s (@*CONCLUSIONS@#The three-in-one intelligent pre-inspection model can effectively shorten the patient pre-check time, with similar triage coincidence rate to traditional model.

Avaliação da capacidade funcional de pacientes atendidos em um ambulatório perioperatório do Distrito Federal / Evaluation of the functional capacity of patients attended in a perioperative outpatient clinic of the Federal District / Evaluación de la capacidad funcional de pacientes atendidos en un ambulatorio perioperatorio del Distrito Federal

Objetivo: Identificar a capacidade funcional de pacientes atendidos no ambulatório de avaliação perioperatória do Hospital Regional do Gama (APA-HRG), no Distrito Federal, bem como estabelecer relação com as estratificações cardíacas utilizadas. Método: Estudo observacional, descritivo, retrospectivo, com coleta de dados dos registros nos prontuários das consultas pré-operatórias de 292 pacientes triados como alto risco, executadas por equipe de médicos anestesiologistas e enfermeiros, realizadas no APA-HRG no período de junho de 2014 a junho de 2016. Resultados: O perfil da amostra constituiu-se, em sua maioria, por indivíduos do gênero feminino (78,77%), maiores de 60 anos (48,35%), não obesos (69,44%), encaminhados principalmente pela clínica ginecológica (39,79%), diagnosticados com hipertensão arterial sistêmica (44,17%) e tabagistas (12,67%). A capacidade funcional foi classificada como excelente em 63,18% (>10 equivalentes metabólicos) dos pacientes. Foi constatada associação significativa entre os equivalentes metabólicos e as estratificações da American Society of Anesthesiologists, do Índice de Risco Cardíaco Revisado e da Classificação Funcional da New York Heart Association. Conclusão: A maioria dos prontuários analisados era de pacientes com excelente capacidade funcional, apresentando associação significativa com as estratificações estudadas.

Objective: To identify the functional capacity of patients attended at the perioperative evaluation outpatient clinic of the Regional Hospital of Gama (APA-HRG), Federal District, as well as establish relationship with the cardiac stratifications employed. Method: Observational, descriptive, retrospective study with data collection of records from preoperative consultations of 292 patients screened as high risk, performed by a team of medical anesthesiologists and nurses, performed in the APA-HRG in the period from June 2014 to June 2016. Results: The sample profile consisted, for the most part, of female subjects (78.77%), of over 60 years of age (48.35%), not obese (69.44%), referred mainly by the gynecological clinic (39.79%), diagnosed with systemic arterial hypertension (44.17%) and smokers (12.67%). Functional capacity was classified as excellent in 63.18% (>10 metabolic equivalents) of patients. There was a significant association between the metabolic equivalents and the stratification of the American Society of Anesthesiologists, the Revised Cardiac Risk Index and the Functional Classification of the New York Heart Association. Conclusion: Most of the charts analyzed were of patients with excellent functional capacity, presenting a significant association with the stratifications studied.

Objetivo: Identificar la capacidad funcional de pacientes atendidos en el ambulatorio de evaluación perioperatoria del Hospital Regional do Gama (APA-HRG), en el Distrito Federal, así como establecer relación con las estratificaciones cardíacas utilizadas. Método: Estudio observacional, descriptivo, retrospectivo, con colecta de datos de los registros en los historiales médicos de las consultas preoperatorias de 292 pacientes seleccionados como alto riesgo, ejecutadas por equipo de médicos anestesistas y enfermeros, realizadas en el APA-HRG en el período de junio de 2014 a junio de 2016. Resultados: El perfil de la muestra se constituye, en su mayoría, por individuos del género femenino (78,77%), mayores de 60 años (48,35%), no obesos (69,44%), encaminados principalmente por la clínica ginecológica (39,79%), diagnosticados con hipertensión arterial sistémica (44,17%) y tabaquistas (12,67%). La capacidad funcional fue clasificada como excelente en un 63,18% (>10 equivalentes metabólicos) de los pacientes. Fue constatada asociación significativa entre los equivalentes metabólicos y las estratificaciones de la American Society of Anesthesiologists, del Índice de Riesgo Cardíaco Revisado y de la Clasificación Funcional de la New York Heart Association. Conclusión: La mayoría de los historiales médicos analizados era de pacientes con excelente capacidad funcional, presentando asociación significativa con las estratificaciones estudiadas.

O fenômeno psicossomático na neurose obsessiva em ambulatório hospitalar: um estudo de caso / The psychosomatic phenomena in obsessive neurosis in a hospital outpatient clinic: a case study

O presente trabalho teve por objetivo investigar as repercussões subjetivas de um paciente acometido por miastenia gravis (MG), uma doença neuromuscular de origem autoimune, em contexto de ambulatório hospitalar, orientado pela abordagem psicanalítica. Durante a análise com o paciente, levantou-se a hipótese diagnóstica de uma estrutura neurótica, e o tipo clínico sendo a neurose obsessiva. A partir do relato da história de vida do paciente, verificou-se que a impossibilidade de elaborar um evento traumático pode se tornar origem de uma angústia com repercussões no corpo, a ver, os fenômenos psicossomáticos (FPS). Em tais casos, o psicólogo hospitalar, orientado pela teoria psicanalítica, necessita intervir de modo que o sofrimento relatado não fique restrito à dimensão do corpo, e se faça presente pela via da fala, buscando trazer à tona a subjetividade que lhe é encoberta pelo discurso médico.

This study aimed to investigate the subjective repercussions of a patient affected by myasthenia gravis, a neuromuscular disease of autoimmune origin, in the context of a hospital outpatient clinic, guided by the psychoanalytic approach. During the analysis with the patient, the diagnostic hypothesis of a neurotic structure was raised, and the clinical type being the obsessive neurosis. From the report of the patient's life story, it was found that the impossibility of working through a traumatic event could become the source of an anguish with repercussions in the body, that is, the psychosomatic phenomena. In such cases, the health psychologist guided by the psychoanalytic theory needs to intervene so that the suffering is not restricted to a bodily dimension