Cooperación entre médicos del departamento de emergencias y dermatólogos por telemedicina / Cooperation between emergency department physicians and dermatologists via telemedicine

Las intercurrencias dermatológicas agudas son un motivo de consulta frecuente a las centrales de emergencias, y generalmente los médicos de atención primaria se ocupan del primer nivel de atención. Puede ser necesaria una interconsulta con expertos, aunque no siempre estén disponibles. Ante la necesidad de facilitar dicha interacción a distancia, en Julio 2022 se implementó una herramienta de teledermatología en un hospital de alta complejidad en Buenos Aires, Argentina. Este servicio se limitó a días hábiles con horario restringido, permitiendo la comunicación entre médicos del departamento de emergencias y dermatólogos, a través de WhatsApp institucional. El dermatólogo podía verificar datos de salud relacionados al paciente (ej: comorbilidades y medicación crónica) mediante revisión de la historia clínica electrónica, para decidir sobre un plan de acción. Se evaluó la perspectiva de los usuarios a través de un formulario electrónico tras 3 meses de implementación. Los resultados evidenciaron que la mayoría (85%) de los profesionales conocía la herramienta, y el 57% la había usado al menos una vez. Se obtuvo una mediana de 9 puntos (de una escala de Likert del 1 al 10) sobre la recomendación hacia otro profesional. El teletriage dermatológico resultó beneficioso y fue aceptado, tanto por médicos de guardia como por especialistas. Ante las demoras en la atención ambulatoria, ha resultado una alternativa útil para evitar derivaciones innecesarias y/o acelerar aquellas que verdaderamente lo ameritan. Sin embargo, representa una forma de comunicación informal desde el punto de vista de almacenamiento de datos. Será necesario reflexionar sobre estos tópicos pendientes de esta experiencia asistencial como legalidad, seguridad y confidencialidad (AU)

Acute skin conditions are a frequent reason for consultation in emergency departments, and primary care physicians generally handle them. They might require referrals to experts, who are not always readily available. Recognizing the need to facilitate such interactions remotely, a teledermatology triage tool was implemented in July 2022 at a high-complexity hospital in Buenos Aires, Argentina. The service was limited to business days with restricted hours, enabling communication between emergency department physicians and dermatologists through institutional WhatsApp. Dermatologists could access patient-related health data (e.g., comorbidities and chronic medication) through the electronic medical record to determine an appropriate course of action. The perspective of users was evaluated through an electronic questionnaire after three months of application. Results showed that most professionals were aware of the tool (85%), and 57% used it at least once. The median rating for recommending the tool to other professionals was 9 points (on a Likert scale from 1 to 10). Dermatological teletriage proved beneficial and was well-received by emergency physicians and specialists. In the face of delays in outpatient care, it has been a useful alternative to avoid unnecessary referrals and expedite those that are warranted. However, it represents an informal method of communication with regard to data storage. It will be necessary to rethink on improvements in pending topics such as legal limitations, security, and confidentiality of this healthcare experience (AU)

O efeito da pandemia por COVID-19 no atendimento da síndrome coronariana aguda: coorte retrospectiva / The impact of the COVID-19 pandemic on the management of acute coronary syndrome: a retrospective cohort study

OBJETIVO: avaliar a contribuição da pandemia por COVID-19 sobre os tempos de atendimento e desfechos clínicos de admissões relacionadas à Síndrome Coronariana Aguda. MÉTODO: Coorte retrospectiva. Os dados foram analisados pelo SPSS, versão 20.0, empregados em testes paramétricos e não paramétricos para comparar os grupos. Aplicado o Modelo linear generalizado para análise multivariada. RESULTADOS: Incluídos 434 pacientes no período pré-pandemia e 430 durante a pandemia. Delta-t foi maior no período durante a pandemia (p=0,003). Não encontramos diferença nos tempos de atendimento e mortalidade. Admissão no período da pandemia (RR1,56; IC95%:1,30-1,87) e ter diagnóstico de cardiopatia isquêmica prévio (RR1,82; IC95%:1,50-2,20) foram associados ao aumento do Delta-t. CONCLUSÃO: Não houve diferença no número de pacientes que acessou a emergência por Síndrome Coronariana Aguda nos períodos analisados. Apesar do Delta-t ter sido maior durante a pandemia, não foram observados piores desfechos clínicos.

OBJECTIVE: To assess the impact of the COVID-19 pandemic on response times and clinical outcomes of acute coronary syndrome admissions. METHOD: Retrospective cohort study. Data were analyzed using SPSS version 20.0 with parametric and non-parametric tests for group comparisons. Generalized linear modeling was used for multivariate analysis. RESULTS: 434 patients were included in the pre-pandemic period and 430 during the pandemic. Delta-t was higher during the pandemic period (p=0.003). There were no differences in response times and mortality. Admission during the pandemic period (RR 1.56; 95% CI: 1.30-1.87) and a previous diagnosis of ischemic heart disease (RR 1.82; 95% CI: 1.50-2.20) were associated with increased delta-t. CONCLUSIONS: There was no difference in the number of patients presenting to the emergency department with acute coronary syndrome during the periods analyzed. Despite longer Delta-t during the pandemic, no worse clinical outcomes were observed.

Profile of cardiovascular diseases and physiotherapeutic intervention in a hospital emergency service / Perfil das doenças cardiovasculares e atuação fisioterapeutica em um serviço de emergência hospitalar

Abstract Introduction Cardiovascular disease (CVD) is the lead-ing cause of death globally, with a high proportion of hospitalizations and costs. In view of this, it is essential to understand the main CVDs in patients admitted to hospital emergency services and the role of physiotherapists, in order to plan and direct health services, and to denote participation and encourage specific physiotherapy training in the context of tertiary care. Objective To outline the profile of cardiovascular emergencies and to evaluate physiotherapy in adult patients in the emergency department of a hospital in the interior of the state of São Paulo. Methods This was an observational study which analyzed 1,256 on-call records over a period of eight months. The data collected included age, gender, cardiovascular diagnostic hypothesis and physiotherapy treatment carried out. Results A total of 75 patients with cardiovascular emergencies were included, the most prevalent of which were: heart failure (n = 21), acute coronary syndrome (n = 14), acute myocardial infarction (n = 13), bradyarrhythmia (n = 6) and hypertensive crisis (n = 5). Regarding physiotherapeutic actions and their applications, the most frequent were invasive mechanical ventilation management (n = 34), lung re-expansion maneuvers (n = 17), orotracheal intubation assistance (n = 17), non-invasive mechanical ventilation (n = 14), bronchial hygiene maneuvers (n = 12), kinesiotherapy (n = 10) and sedation (n = 10). Conclusion Heart failure and acute coronary syndrome were the cardiovascular diseases that caused the most admissions to the hospital emergency department and that the procedures with an emphasis on the respiratory system were the most applied.

Resumo Introdução As doenças cardiovasculares (DCV) repre-sentam a principal causa de morte global, destacando-se em internações e gastos. Diante disso, é essencial compreender as principais DCV em pacientes admitidos em serviços de emergência hospitalar e a atuação do fisioterapeuta para planejamento e direcionamento dos serviços de saúde e para denotar a participação e incentivar formações fisioterapêuticas específicas no contexto da atenção terciária. Objetivo Traçar o perfil de emergências cardiovasculares e avaliar a atuação fisioterapêutica em pacientes adultos de serviço de emergência de um hospital no interior do estado de São Paulo. Métodos Trata-se de um estudo observacional, em que foram analisadas 1.256 fichas de passagem de plantão, no período de oito meses. Os dados coletados foram idade, sexo, hipótese diagnóstica cardiovascular e tratamento fisioterapêutico realizado. Resultados Foram incluídos 75 pacientes que apresentavam o perfil de emergências cardiovasculares, sendo as mais prevalentes: insuficiência cardíaca (n = 21), síndrome corona-riana aguda (n = 14), infarto agudo do miocárdio (n = 13), bradarritmia (n = 6) e crise hipertensiva (n = 5). Em relação à atuação fisioterapêutica e suas aplicações, as mais frequentes foram manejo da ventilação mecânica invasiva (n = 34), manobras de reexpansão pulmonar (n = 17), auxílio a intubação orotraqueal (n = 17), ventila-ção mecânica não invasiva (n = 14), manobras de higiene brônquica (n = 12), cinesioterapia (n = 10) e sedestação (n = 10). Conclusão A insuficiência cardíaca e a síndrome coronária aguda foram as doenças cardiovasculares que mais ocasionaram internação no serviço de emergência hospitalar e as condutas com ênfase no aparelho respiratório foram as mais aplicadas.

Uso dos serviços de saúde por pessoas idosas em áreas rurais e urbanas do Brasil / Health services utilization by older adults in rural and urban areas of Brazil

Resumo Objetivo Avaliar o uso dos serviços de saúde por pessoas idosas residentes em áreas urbanas e rurais do Brasil. Método Estudo transversal que analisou dados da Pesquisa Nacional de Saúde 2019, referentes aos moradores idosos (≥60 anos) selecionados nos domicílios, totalizando 22.728 entrevistas (3.300 em área rural e 19.426 em área urbana). Foram estimadas para as áreas rurais e urbanas as prevalências de cadastro na Estratégia Saúde da Família, intervalo de tempo da última consulta médica e odontológica, procura do serviço nas últimas duas semanas, última aferição da pressão arterial e da glicemia e avaliados os fatores associados à utilização dos serviços de saúde médicos e odontológicos nos últimos 12 meses. Resultados A autopercepção da saúde como 'muito boa' ou 'boa' foi maior na área urbana (47,32%), assim como a proporção de pessoas idosas que relataram consulta médica e odontológica nos últimos 12 meses (90,54%). Evidenciou-se menor frequência do acompanhamento da aferição de pressão arterial (81,30%) e da glicemia (45,83%) em áreas rurais. As pessoas idosas que possuem baixa escolaridade, residem em áreas rurais, na região Norte são as que possuem menor chance de utilização dos serviços. Conclusão A população idosa residente em área rural apresenta piores condições de saúde em relação à população residente em área urbana.

Abstract Objective To assess health services utilization by older adults in urban and rural areas of Brazil. Method A cross-sectional study was conducted analyzing data from the 2019 National Health Survey on older adults (≥60 years) selected from households based on 22,728 interviews (3,300 in rural and 19,426 in urban areas). For rural and urban areas, the prevalence of Family Health Strategy enrolment, time since last medical and dental visit, service use in past 2 weeks, and last blood pressure and blood glucose measurements were estimated. Also, the factors associated with medical and dental health services utilization in the past 12 months were explored. Results Self-rated health of "Very good" or "Good" was greater in urban areas (47.32%), as was the proportion of older adults reporting a medical or dental visit within the last 12 months (90.54%). Rates of blood pressure (81.30%) and glucose (45.83%) monitoring were lower in rural areas. Older individuals that had low education, resided in rural areas, and the North region, had a lower likelihood of using health services Conclusion The older population living in rural areas had poorer health status compared with the urban population.

Photobiomodulation for Oral Mucositis - A Microcosting and Budget Impact Analysis from a Brazilian Perspective

ABSTRACT Objective: To measure the costs of preventive and therapeutic protocols of Photobiomodulation (PBM) for oral mucositis (OM) and their budgetary impact on Brazil's Ministry of Health (BMH). Material and Methods: A partial economic analysis was performed to estimate the costs using a bottom-up approach from a social perspective. Monetary values were assigned in Brazilian reais (BRL). The costs of the preventive protocol were calculated for five, 30, and 33 consecutive PBM sessions, depending on the antineoplastic treatment instituted. The costs of the therapeutic protocol were calculated for 5 or 10 sessions. The annual financial and budgetary impact was calculated considering the groups of oncologic patients with a higher risk of development of OM, such as those with head and neck and hematological cancer and pediatric patients. Results: The cost of a PBM session was estimated at BRL 23.75. The financial impact of providing one preventive protocol per year for all oncologic patients would be BRL 14,282,680.00, 0.030% of the estimated budget for hospital and outpatient care of the BMH in 2022. The financial and budgetary impacts of providing one treatment for OM for all patients in one year would be BRL 2,225,630.31 (0.005%, most optimistic scenario) and BRL 4,451,355.63 (0.009%, most pessimistic scenario). Conclusion: The budgetary impact of implementing PBM protocols in the Brazilian Healthcare System is small, even in a pessimistic scenario.

Consultas tardías en los servicios de emergencias pediátricas durante la pandemia por COVID-19 en Uruguay, entre el 13 de marzo y el 29 de julio de 2020

En diciembre de 2019, en Wuhan, China, se detectaron los primeros casos de SARS-CoV-2. En Uruguay, desde el 16 de marzo de 2020 se suspendieron las actividades de enseñanza, deportivas y espectáculos públicos. Varios países reportaron una marcada disminución de las visitas a urgencias. Algunos niños presentaron enfermedades ocasionales o descompensaciones de enfermedades crónicas, consultando en forma tardía con el riesgo que ello implica. El objetivo de este trabajo es realizar una descripción de las consultas tardías durante la pandemia. Se realizó un estudio multicéntrico y descriptivo entre el 13 de marzo y el 29 de julio de 2020. Se definió consulta tardía como los ingresos por injurias agudas con más de 6 horas de evolución, fiebre mayor a 72 horas de evolución, dificultad respiratoria con más de 12 horas de evolución, síntomas agudos, como dolor abdominal, de más de 24 horas de evolución, síntomas de más de 12 horas de evolución en niños con enfermedades crónicas que determinaron descompensación e ingreso. Se incluyeron 27 centros. Se registraron un total de 34.260 consultas en urgencia, se incluyeron 189 niños para el estudio. El promedio de edad fue de 6 años; 17 pacientes requirieron ingreso a unidad de cuidados intensivos (UCI). Predominó la apendicitis entre los diagnósticos al alta. Esta investigación puso en evidencia la existencia de consultas tardías en nuestro país. Esto contribuye a ponderar el impacto negativo de la pandemia en la población pediátrica.

Summary: In December 2019, the first cases of SARS-CoV-2 were detected in Wuhan. In Uruguay, since March 16, teaching, sports and public entertainment activities were suspended. Several countries reported a marked decrease in emergency room visits. Some children presented occasional illnesses or decompensations from chronic illnesses, consulting late with the risk that this implies. The objective of the work is to make a description of late consultations during the pandemic. A multicenter and descriptive study was carried out between March 13 and July 29, 2020. "Late consultation" was defined as admissions for: Acute injuries with more than 6 hours of evolution, fever greater than 72 hours of evolution, difficulty respiratory disease with more than 12 hours of evolution, acute symptoms such as abdominal pain of more than 24 hours of evolution, symptoms of more than 12 hours of evolution in children with chronic diseases that determined decompensation and admission. 27 centers were included. A total of 34260 emergency consultations were registered, 189 children were included for the study. The average age was 6 years. 17 patients required admission to the ICU. Appendicitis predominated among the diagnoses at discharge. This research revealed the existence of late consultations in our country. This helps to weigh the negative impact of the pandemic on the pediatric population.

Em dezembro de 2019, em Wuhan, foram detectados os primeiros casos de SARS-CoV-2. No Uruguai, desde 16 de março, as atividades de ensino, esporte e entretenimento público foram suspensas. Vários países relataram uma diminuição acentuada nas visitas ao pronto-socorro. Algumas crianças apresentavam doenças ocasionais ou descompensações de doenças crônicas, consultando tardiamente os riscos que isso implica. O objetivo do trabalho é fazer uma descrição das consultas tardias durante a pandemia. Um estudo multicêntrico e descritivo foi realizado entre 13 de março e 29 de julho de 2020. Consulta tardia foi definida como internações por: Lesões agudas com mais de 6 horas de evolução, febre maior que 72 horas de evolução, dificuldade respiratória com mais de 12 horas de evolução, sintomas agudos como dor abdominal com mais de 24 horas de evolução, sintomas com mais de 12 horas de evolução em crianças com doenças crônicas que determinaram descompensação e internação. 26 centros foram incluídos. Um total de 34.260 consultas de emergência foram registradas, 189 crianças foram incluídas no estudo. A idade média era de 6 anos. 17 pacientes necessitaram de internação na UTI. Apendicite predominou entre os diagnósticos na alta. Esta pesquisa revelou a existência de consultas tardias em nosso país. Isso ajuda a pesar o impacto negativo da pandemia na população pediátrica.

Desafios para o suporte à amamentação em homens transgêneros sob à luz da interseccionalidade / Intersectionality and challenges in support for chest-feeding transgender men

Resumo O objetivo deste artigo é apreender os desafios nas vivências dos usuários e profissionais de Banco de Leite Humano no atendimento a homens transgêneros no contexto da amamentação sob à luz da Interseccionalidade. Estudo qualitativo descritivo-exploratório a partir de entrevistas realizadas com seis profissionais do Banco de Leite Humano, que atenderam previamente homens trans no contexto de amamentação, e dois homens trans bissexuais, que amamentaram ao peito. Os dados foram tratados pela Análise Temática com auxílio do software Atlas.ti versão 9.0. Observam-se lacunas nas esferas educacionais, institucionais e na gestão, associadas a questões pessoais e sociais, que reproduzem um modelo pré-concebido normativo, desconsiderando as singularidades requeridas no atendimento à população trans no contexto da amamentação. A cisheteronormatividade e a supremacia do profissional operam em âmbitos pessoais, sociais e institucionais para a segregação de homens transgêneros nos serviços de suporte à amamentação. A análise interseccional destes desafios permite uma visão global dos fatores de segregação e a implementação de políticas públicas promotoras da justiça social.

Abstract This article tried, from an intersectional standpoint, to grasp the challenges experienced by health professionals and service users of human milk banks in provision of care for transgender men chestfeeding. This exploratory, descriptive qualitative study drew on interviews of six human milk bank staff, who had previously assisted trans men in relation to chestfeeding and two bisexual trans men, who chestfed. The data was treated by thematic analysis, supported by Atlas.ti software, version 9.0. Lacunas in the educational, institutional and management spheres, associated with personal and social issues, reproduce a pre-conceived normative model and disregard the special demands of providing chestfeeding care for the trans population. Cisheteronormativity and "professional supremacy" operate in personal, social and institutional respects to segregate transgender men in lactation support services. Intersectional analysis of these challenges affords an overall view of segregative factors and enables public policies to be introduced to promote social justice.

Torsades de pointes and myocardial infarction following reversal of supraventricular tachycardia with adenosine: a case report

ABSTRACT Adenosine is an antiarrhythmic drug that slows conduction through the atrioventricular node and acts as a coronary blood vessel dilator. This case report highlights two unusual life-threatening events following the use of adenosine to revert supraventricular tachycardia in a structurally normal heart: non-sustained polymorphic ventricular tachycardia and myocardial infarction. A 46-year-old woman presented to the emergency department with a two-hour history of palpitations and was diagnosed with supraventricular tachycardia. Vagal maneuvers were ineffective, and after intravenous adenosine administration, the patient presented with chest pain and hypotension. The rhythm degenerated into non-sustained polymorphic ventricular tachycardia and spontaneously reverted to sinus rhythm with ST elevation in lead aVR and ST depression in the inferior and anterolateral leads. The patient spontaneously recovered within a few minutes. Despite successful arrhythmia reversal, the patient was admitted to the intensive care unit because of an infarction without obstructive atherosclerosis. This report aims to alert emergency physicians about the potential complications associated with supraventricular tachycardia and its reversal with adenosine.

Centros de Atenção Psicossocial e formação profissional para oferta das Práticas Integrativas e Complementares: estudo com profissionais ofertantes dos serviços / Psychosocial care centers and professional training for the provision of integrative and complementary practices: a study with professionals offering these services / Centros de Atención Psicosocial y formación profesional para oferta de las Prácticas Integradoras y Complementarias: estudio con profesionales ofertantes de los servicios

Estudos sobre a formação em Práticas Integrativas e Complementares têm se concentrado na análise curricular dos cursos da Saúde e as pesquisas abrangendo as percepções dos profissionais a respeito dos processos formativos devem ser mais elucidadas. O estudo objetiva identificar os processos de formação e capacitação dos profissionais ofertantes de Práticas Integrativas e Complementares nos Centros de Atenção Psicossocial de uma região metropolitana. Trata-se de um estudo descritivo, exploratório, de abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 45 profissionais, as quais foram posteriormente analisadas segundo a Análise de Conteúdo Temática. As pós-graduações, graduação, formações em serviço e o ensino privado foram as trajetórias adotadas pelos profissionais, revelando a existência de uma formação difusa para a oferta no cenário investigado. Esses resultados podem subsidiar o planejamento de estratégias educacionais para a ordenação dos recursos humanos em Práticas Integrativas e Complementares.

Studies of training in integrative and complementary practices have concentrated on the analysis of the curriculums of health courses and further more in-depth research into professionals' perceptions about training processes is needed. This study aimed to identify training processes and capacity building for professionals who offer integrative and complementary practices in psychosocial care centers in a metropolitan region. We conducted an exploratory descriptive study involving semi-structured interviews with 45 professionals. The interview transcripts were analyzed using content analysis. The most common routes taken by the professionals were post-graduate qualifications, degrees, in-service training and private education. The results reveal that training in this area was diffuse. Our results can inform the development of educational strategies for the organization of human resources in the area of integrative and complementary practices.

Los estudios sobre la formación en Prácticas Integradoras y Complementarias se han concentrado en el análisis curricular de los cursos de la salud y las investigaciones que incluyen las percepciones de los profesionales con relación a los procesos de formación deben elucidarse más. El objetivo del estudio es identificar los procesos de formación y capacitación de los profesionales ofertantes de Prácticas Integradoras y Complementarias en los Centros de Atención Psicosocial de una región metropolitana. Se trata de un estudio descriptivo, exploratorio, de abordaje cualitativo. Se realizaron entrevistas semiestructuradas con 45 profesionales que fueron posteriormente analizadas según el Análisis de Contenido Temático. Los postgrados, graduación, formaciones en servicio y la enseñanza privada fueron las trayectorias adoptadas por los profesionales, revelando la existencia de una formación difusa para la oferta en el escenario investigado. Esos resultados pueden subsidiar la planificación de estrategias educativas para la ordenación de los recursos humanos en las Prácticas Integradoras y Complementarias.

Aprendizaje servicio virtual: prácticas profesionales de terapia ocupacional a través de la telesalud en contexto de confinamiento / Aprendizagem em serviço virtual: práticas profissionais de terapia ocupacional através da telessaúde no contexto do confinamento / Virtual service learning: professional practices of occupational therapy through telehealth in the context of confinement

El objetivo de este estudio es analizar los aportes y desafíos que se presentan en la formación y en la intervención cuando estudiantes de terapia ocupacional realizan su práctica profesional a través de la telesalud, durante el periodo de confinamiento por pandemia Covid-19. Se utiliza como enfoque metodológico una sistematización de experiencia de tipo cualitativa. Se produce la información por medio de cuatro grupos focales y diez entrevistas semiestructuradas. Se realiza un análisis del contenido temático. Se establecen cuatro temas: 1) vínculo terapéutico y Aprendizaje-Servicio por telesalud, 2) aprendizajes alcanzados por telesalud, 3) lo que no se aprende fácilmente por telesalud y 4) prácticas pedagógicas de apoyo al aprendizaje en telesalud. Esta modalidad se potenciaría si se cuenta con la tecnología adecuada, si las atenciones son frecuentes y si se prepara a los cuidadores-familiares para apoyar los procesos de atención.

The objective of this study is to analyze the contributions and challenges that arise in training and intervention when occupational therapy students carry out their professional practice through telehealth, during the period of confinement due to the Covid-19 pandemic. A qualitative systematization of experience is used as a methodological approach. The information is produced through four focus groups and ten semi-structured interviews. An analysis of the thematic content is carried out. Four themes are established: 1) therapeutic link and Service-Learning through telehealth, 2) learning achieved through telehealth, 3) what is not easily learned through telehealth and 4) pedagogical practices to support learning in telehealth. This modality would be enhanced if there is adequate technology if care is frequent and if family caregivers are prepared to support the care processes.

O objetivo deste estudo é analisar as contribuições e desafios que surgem na formação e intervenção quando os estudantes de terapia ocupacional realizam a sua prática profissional através da telessaúde, durante o período de confinamento devido à pandemia de Covid-19. Uma sistematização qualitativa da experiência é utilizada como abordagem metodológica. As informações são produzidas por meio de quatro grupos focais e dez entrevistas semiestruturadas. É realizada uma análise do conteúdo temático. São estabelecidos quatro temas: 1) vínculo terapêutico e aprendizagem-serviço por meio da telessaúde, 2) aprendizagem alcançada por meio da telessaúde, 3) o que não se aprende facilmente por meio da telessaúde e 4) práticas pedagógicas de apoio à aprendizagem em telessaúde. Essa modalidade seria potencializada se houvesse tecnologia adequada, se o cuidado fosse frequente e se os cuidadores familiares estivessem preparados para apoiar os processos de cuidado.

Cuidado compartilhado em Saúde Mental: o que dizem os trabalhadores? / Shared Mental Health care: what do worker say? / Cuidado compartido en Salud Mental: ¿qué dicen los trabajadores?

A conjunção da Reforma Psiquiátrica e da Reforma Sanitária torna o Brasil um cenário único na superação do Paradigma Biomédico hegemônico e na radicalidade da desinstitucionalização no território. Este artigo objetiva analisar a percepção dos trabalhadores da Atenção Básica e da Atenção Especializada sobre o compartilhamento do cuidado em Saúde Mental em um município paulista de médio porte. Constitui-se como uma pesquisa qualitativa, de abordagem hermenêutico-dialética, cujos dados foram produzidos por narrativas de grupos focais narrativo-hermenêuticos realizados em 2022, com 15 trabalhadores. A Educação Permanente, a formação profissional, a integração da rede, a Saúde Mental do trabalhador e o enfrentamento das políticas de desmonte foram considerados fundamentais para o cuidado compartilhado. Mostra-se imperativo que o campo da Saúde Mental seja priorizado e não faltem recursos para que, cada vez mais, as práticas possam se orientar pelo Paradigma Psicossocial.

The conjunction of the mental health reform and health reform make Brazil a unique setting in overcoming hegemonic biomedical paradigm and in the radicality of deinstitutionalization across the territory. The aim of this study was to analyze the perceptions of primary and specialist care workers about sharing mental health care in a medium-sized municipality in the state of São Paulo. We conducted a qualitative study using the hermeneutic-dialectic method of inquiry based on data from the narratives of focus group meetings with 15 workers held in 2022. Permanent education, professional training, network integration, worker's mental health and confronting the dismantling of policies were considered essential to shared care. It is imperative that the field of mental health is prioritized and sufficient resources are made available so that practices are increasingly oriented towards the psychosocial paradigm.

La conjunción de la Reforma Psiquiátrica y de la Reforma Sanitaria hace que Brasil sea un escenario único en la superación del Paradigma Biomédico hegemónico y en la radicalidad de la desinstitucionalización en el territorio. El objetivo de este artículo es analizar la percepción de los trabajadores de la Atención Básica y de la Atención Especializada sobre la compartición del cuidado en salud mental en un municipio de mediano porte del estado de São Paulo. Se constituye como una investigación cualitativa, de abordaje hermenéutico-dialéctico, cuyos datos se produjeron a partir de narrativas de grupos focales narrativos-hermenéuticos realizados en 2022 con quince trabajadores. La educación permanente, la formación profesional, la integración de la red, la salud mental del trabajador y el enfrentamiento de las políticas de desmonte se consideraron fundamentales para el cuidado compartido. Se muestra imperativo que se priorice el Campo de Salud Mental y que no falten recursos para que, cada vez más, las prácticas puedan orientarse hacia el Paradigma Psicosocial.

Os caminhos do entrincheiramento no serviço público: uma análise longitudinal em multigrupos / Los caminos de atrincheramiento en el servicio público: un análisis longitudinal en multigrupos / The paths of entrenchment in the public service: a longitudinal analysis in multigroups

Resumo Pouco mais de uma década separa este estudo da primeira proposição acadêmica do entrincheiramento organizacional, e, até o momento, pesquisas longitudinais não foram realizadas, apesar da importância reconhecida desse método para enriquecer os estudos no campo comportamental. Este artigo objetivou identificar características do entrincheiramento organizacional entre servidores de instituições federais de ensino no Brasil, com base na avaliação longitudinal dos perfis latentes. Realizou-se uma pesquisa quantitativa e longitudinal com 1060 participantes na primeira coleta. Foram feitas análises descritivas, de comparação de médias e análise de transição latente. Os servidores da amostra apresentaram baixos níveis de entrincheiramento. Entre os principais achados, está a estabilidade dos perfis formados pelos servidores, tendo as médias mais altas sido encontradas nas dimensões "ajustamentos à posição social" e "arranjos burocráticos impessoais", o que reforça alguns achados teóricos transversais. Os resultados desta pesquisa contribuem para orientar gestores sobre a importância dos fatores internos para o entrincheiramento dos servidores e sobre como a atenção aos itens da dimensão "ajustamentos à posição social" pode favorecer o trabalho com esse vínculo. O presente estudo encontrou que, ao longo do tempo, o entrincheiramento é um vínculo estável.

Resumen Ha transcurrido poco más de una década entre la primera propuesta académica de atrincheramiento organizacional y el presente estudio y, hasta la fecha, no se ha llevado a cabo ninguna investigación longitudinal, a pesar de la reconocida importancia de este método para enriquecer los estudios en el campo del comportamiento. Esta investigación tuvo como objetivo identificar las características del atrincheramiento organizacional entre funcionarios de instituciones federales de enseñanza en Brasil, a partir de una evaluación longitudinal de perfiles latentes. Se realizó una encuesta cuantitativa y longitudinal con 1060 participantes. Se realizaron análisis descriptivos, comparación de medias y análisis de transición latente. Los funcionarios de la muestra presentaron bajos niveles de atrincheramiento. Entre los principales hallazgos están la estabilidad de los perfiles formados por los funcionarios, con las medias más altas encontradas en las dimensiones ajustes a la posición social y arreglos burocráticos impersonales, lo que refuerza algunos hallazgos teóricos transversales. Los resultados de esta investigación ayudan a orientar a los gestores sobre la importancia de los factores internos para el atrincheramiento de los funcionarios y sobre cómo la atención a los ítems de la dimensión ajustes a la posición social puede favorecer el trabajo con ese vínculo. Esta investigación constató que el atrincheramiento es un vínculo estable a lo largo del tiempo.

Abstract Little more than a decade separates this research from the first academic proposition of organizational entrenchment. To date, no longitudinal research has been carried out despite the recognized importance of this method for enriching studies in the behavioral field. This research aimed to identify characteristics of organizational entrenchment among civil servants at federal educational institutions in Brazil based on a longitudinal assessment of latent profiles. A quantitative and longitudinal survey was carried out with 1060 participants in the first collection. Descriptive analysis, comparison of means, and latent transition analysis were carried out. The civil servants in the sample showed low levels of entrenchment. Among the main findings are the stability of the profiles formed by the civil servants and the higher averages found in the dimensions of adjustments to social position and impersonal bureaucratic arrangements, reinforcing some cross-sectional theoretical findings. The results help to guide managers on the importance of internal factors for the entrenchment of civil servants and how attention to the items in the dimension of adjustments to social position can favor working with this bond. This research found that, over time, entrenchment is a stable bond.

Noncardiac Surgery in Patients with Left Ventricular Assist Devices: A 11-Year Institutional Experience

ABSTRACT Introduction: Limited options in the end-stage treatment of heart failure have led to increased use of left ventricular assist devices. For this reason, the rate of non-cardiac surgeries in patients with left ventricular assist devices is also increasing. Our study aims to analyze surgical rate, anesthesia management, and results by reviewing our 11-year experience with patients who underwent non-cardiac surgery receiving left ventricular assist devices support. Methods: We retrospectively evaluated 57 patients who underwent non-cardiac surgery and 67 non-cardiac surgical procedures among 274 patients who applied between January 2011 and December 2022 and underwent left ventricular assist devices implantation with end-stage heart failure. Results: Fifty (74.6%) patients with left ventricular assist devices admitted to the hospital for non-cardiac surgery were emergency interventions. The most common reasons for admission were general surgery (52.2%), driveline wound revision (22.3%), and neurological surgery (14.9%). This patient group has the highest in-hospital mortality rate (12.8%) and the highest rate of neurological surgery (8.7%). While 70% of the patients who underwent neurosurgery were taken to surgery urgently, the International Normalized Ratio values of these patients were between 3.5 and 4.5 at the time of admission to the emergency department. Conclusion: With a perioperative multidisciplinary approach, higher morbidity and mortality risks can be reduced during emergencies and major surgical procedures.

Análise comparativa da percepção de pessoas idosas e adultos hospitalizados sobre a qualidade da dieta hospitalar / Comparative analysis of older adults and hospitalized adults' perception of hospital diet quality

Resumo Objetivo analisar e comparar a percepção da qualidade da dieta hospitalar entre pessoas idosas e adultos hospitalizados. Método pesquisa quali-quantitativa, desenvolvida em um hospital público do interior paulista, com pessoas idosas (n=185) e adultos (n=185), hospitalizados há pelo menos três dias, recebendo dieta via oral geral/branda e distribuídos segundo o tipo de dieta prescrito: sem restrição de alimentos (GSR), para controle glicêmico (GDM) ou hipossódica (GHSS). Os dados foram coletados por entrevistas individuais, empregando-se questionário validado. A qualidade da dieta foi avaliada por meio da escala Likert, considerando-se as categorias sabor, temperatura, quantidade, aparência, horário das refeições, higiene e disponibilidade para substituição de alimentos. Os dados qualitativos foram submetidos à análise de conteúdo temática e, os quantitativos à análise descritiva e estatística pelos testes Kruskal-Wallis (variáveis quantitativas) e qui-quadrado (variáveis qualitativas). Resultados independentemente da dieta prescrita (p≥0,05), pessoas idosas e adultos hospitalizados consideraram a qualidade da dieta hospitalar satisfatória (Bom/Ótimo) entre as categorias de satisfação avaliadas, exceto o sabor, que para as pessoas idosas, apresentou associação significativa com a dieta prescrita (p=0,05). Três categorias temáticas emergiram dos relatos, mostrando que pessoas idosas e adultos compreendem a importância da dieta hospitalar para recuperação da saúde, mas ainda se vê a expectativa negativa quanto à refeição ofertada. Conclusão a dieta hospitalar com restrição influencia a percepção de sabor em pessoas idosas. Conhecer essa particularidade pode auxiliar na criação de estratégias de adequação e melhor aceitação da dieta hospitalar para esse grupo etário.

Abstract Objective To analyze and compare the perception of hospital diet quality between older adults and hospitalized adults. Method Quali-quantitative research conducted at a public hospital in the state of São Paulo, Brazil, involving older adults (n=185) and adults (n=185) who have been hospitalized for at least three days, receiving a general/soft oral diet, and classified according to the prescribed diet type: unrestricted diet (GSR), for glycemic control (GDM), or low-sodium (GHSS). The data were collected through individual interviews, utilizing a validated questionnaire. Diet quality was assessed using a Likert scale, considering the categories of taste, temperature, quantity, appearance, meal timing, hygiene, and availability for food substitution. The qualitative data were subjected to thematic content analysis, while the quantitative data underwent descriptive and statistical analysis using Kruskal-Wallis tests (for quantitative variables) and chi-square tests (for qualitative variables). Results Regardless of the prescribed diet (p≥0.05), both older adults and hospitalized adults considered the quality of hospital food satisfactory (Good/Excellent) across the assessed satisfaction categories, except for taste, which showed a significant association with the prescribed diet for older adults (p=0.05). Three thematic categories emerged from the reports, indicating that both older adults and adults understand the importance of hospital diet for health recovery, yet a negative expectation regarding the offered meal is still prevalent. Hospital diets with restrictions influence taste perception in older adults. Understanding this particularity can assist in the creation of strategies for adaptation and better acceptance of hospital diets for this age group.

Nursing technicians' proxemic behaviors during transfusions in hospitalized clients / Comportamientos proxémicos de técnicos de enfermería durante transfusiones en clientes internados / Comportamentos proxêmicos de técnicos de enfermagem durante o ato transfusional em clientes hospitalizados

ABSTRACT Objective: to describe nursing technicians' proxemic behaviors during transfusions in hospitalized clients. Method: a qualitative, descriptive and exploratory study based on non-participant observation, recorded in an instrument prepared from the Theory of Proxemic Behavior. The participants were 18 nursing technicians from a reference hospital for Hematology and Hemotherapy in the Brazilian Southeast Region, from April to December 2022. Data analysis prioritized thematic content. Results: the following stood out: eye contact; instrumental touch; normal tone of voice; and intimate and personal distances. These indicate welcoming, attention and technical vigilance when carrying out the transfusions. Conclusion: there is a need to raise nursing technicians' awareness regarding proxemic behaviors when welcoming clients. That is: expanding listening, bonding and effective interpersonal coexistence, and favoring the reach of comprehensive health care in Hematology and Hemotherapy.

RESUMEN Objetivo: describir los comportamientos proxémicos de técnicos de Enfermería durante transfusiones en clientes internados. Método: estudio cualitativo, descriptivo y exploratorio, basado en la observación no participante y registrado en un instrumento elaborado a partir de la Teoría del Comportamiento Proxémico. Los participantes fueron 18 técnicos de Enfermería de un hospital que es referencia en Hematología y Hemoterapia de la Región Sudeste de Brasil, entre abril y diciembre de 2022. En el análisis de los datos se priorizó el contenido temático. Resultados: se destacó lo siguiente: contacto visual; toque instrumental; tono de voz normal; y distancias íntima y personal; los cuales indican buen recibimiento, atención y vigilancia técnica al realizar las transfusiones. Conclusión: es necesario generar conciencia en los técnicos de Enfermería con respecto a los comportamientos proxémicos al recibir a los clientes. Eso implica: prestar más atención al escuchar y ampliar los vínculos y la convivencia interpersonal efectiva, además de favorecer el alcance de las medidas de atención en integrales en Hematología y Hemoterapia.

RESUMO Objetivo: descrever os comportamentos proxêmicos de técnicos de enfermagem durante o ato transfusional em clientes hospitalizados. Método: estudo qualitativo, descritivo e exploratório, pautado em observação não participante, registrado em instrumento elaborado a partir da teoria do comportamento proxêmico. Participaram 18 técnicos de enfermagem de um hospital referência em hematologia e hemoterapia da Região Sudeste do Brasil, de abril a dezembro de 2022. A análise de dados priorizou o conteúdo temático. Resultados: destacaram-se o contato visual; o toque instrumental; o tom de voz normal e as distâncias íntima e pessoal. Estes, indicativos de acolhimento, atenção e vigilância técnica à realização do ato transfusional. Conclusão: há necessidade de despertar a consciência dos técnicos de enfermagem em relação aos comportamentos proxêmicos durante o acolhimento aos clientes. Isto é: ampliar a escuta, o vínculo, a efetiva convivência interpessoal e favorecer o alcance dos cuidados em saúde integral na hematologia e hemoterapia.

Facteurs associés à la survenue du diabète chez les patients admis dans les services d' accueil des urgences de deux hôpitaux de Dakar en 2018 (Sénégal): Étude transversale / NA

Introduction :Au Sénégal, le profil épidémiologique en termes de diabète n'est pas clairement établi chez les patients reçus dans les services d'accueil des urgences (SAUs). L'objectif était de déterminer les facteurs associés à la survenue du diabète chez les patients admis dans les SAUs de deux hôpitaux de Dakar.Méthodes : L'étude était transversale et analytique. La collecte des données a eu lieu du 25 janvier au 05 mars 2018. La taille de l'échantillon était de 615 patients. L'entretien en face en face était réalisé. Les facteurs de risque étaient identifiés à l'aide d'une régression logistique. Les résultats étaient exprimés à l' aide de l'odds ratio ajusté (ORa) et entouré de son intervalle de confiance à 95% (IC95%) Résultats : Les patients étaient des hommes, âgés de moins de 40 ans, mariés et sans emploi dans respectivement 52,4%, 44,5%, 64,5% et 53,3% des cas. En outre, la consommation des fruits et légumes et la pratique du sport étaient insuffisantes chez respectivement 96,4% et 72% des patients. Par ailleurs, 16,9% des sujets interrogés étaient diabétiques. Les facteurs de risque de la survenue de la maladie étaient l'âge avancé, le statut sans emploi et l'obésité: patients âgés entre 40 et 69 ans (ORa=21,184; IC95%=[6,11-73,41]), patients âgés d'au moins 70 ans (ORa=12,62; IC95%=[3,29-48,28]), patients sans travail (ORa=3,47; IC95%=[1,69-7,10]) et patients obèses (ORa=3,17; IC95%=[1,35-7,45]).Conclusion : La fréquence du diabète est élevée chez les patients admis en consultation dans les SAUs des hôpitaux de Dakar. Cette étude montre que recherche du diabète chez cette catégorie de patients devrait être une pratique courante et qu'il urge de mettre en place des actions de promotion de la santé.

Let ′Rare Disease′ Been Seen: Delving into the Building up of Resource and Information Service in Medical Libraries for Rare Diseases / 罕见病研究

With the development of the diagnosis and treatment for rare diseases and the promotion of the construction of ′Double First-Class′ Universities in China, the libraries of medical schools have to make full use of their strengths to better face new challenges in discipline construction proactively. This article refers to resource and information service practices related to the rare disease carried out by medical libraries in China and in other countries; explores the possibilities of building up the resource and information in the future, aiming at improving the awareness of rare diseases among medical students, researchers, and the general public. The article also focuses on the need for strengthening the support for teaching and research into rare diseases, hoping to contribute to the overall improvement of the diagnosis, treatment, and educational research in rare diseases in China.

Application of FMEA model and 6S management method in reducing dispensing errors in PIVAS of children’s hospitals / 中国药房

OBJECTIVE To reduce dispensing errors in pharmacy intravenous admixture service （PIVAS） of children’s hospitals. METHODS The risk of dispensing procedures in our PIVAS was identified by applying failure mode and effect analysis （FMEA） model. Potential failure modes that might lead to dispensing errors in each link were determined， and failure causes were analyzed. The severity， incidence and detection degree of potential failure modes were quantitatively scored， and their risk priority number （RPN） was calculated to screen failure modes that needed to be improved in priority； the corresponding improvement measures were developed by 6S management method from six aspects， namely， finishing （seiri）， rectifying （seiton）， sweeping （seiso）， sanitation （seiketsu）， literacy （shitsuke） and safety. The effect of intervention before and after rectification was evaluated. RESULTS Based on the RPN， 32 potential failure modes were selected， of which a total of 18 critical failure modes that needed to be improved in priority. After implementing corresponding measures according to 6S management method， the RPN of 18 critical failure modes decreased. The total RPN decreased from 497 to 142 with a decrease rate of 71.43%. The error rates of 15 critical failure modes were significantly lower than before implementation （P＜0.05）. CONCLUSIONS Applying FMEA model and 6S management method to the risk control of all aspects of PIVAS workflow can effectively reduce the risk of PIVAS dispensing errors and ensure the safety of children’s intravenous medication.

2022 Country Report on Medical Rehabilitation Services, Quality and Safety in Health Care System / 中国康复理论与实践

ObjectiveTo analyze the medical services, quality and safety of rehabilitation medicine departments in general hospitals and rehabilitation hospitals in 2021 in perspectives of structure, segment and outcome quality. MethodsWe analyzed the data from National Clinical Improvement System of the National Health Commission, involving 9 328 hospitals, including all secondary and above general hospitals and rehabilitation hospitals, as well as traditional Chinese Medicine hospitals and integrated traditional Chinese and Western medicine hospitals in 2021. A total of 2 513 sampling hospitals that equipped with rehabilitation wards were included. ResultsAmong the 9 328 general hospitals surveyed this year, only 2 713 had rehabilitation wards. In general hospitals, the average number of physicians per bed in 56.77% hospitals, the average number of rehabilitation therapists per bed in 80.36% hospitals, and the average number of nurses per bed in 53.53% hospitals did not meet the national requirements, and the average number of rehabilitation medical personnel per bed in rehabilitation medicine departments in different regions was significantly different. The rates of early rehabilitation intervention were 13.45%, 20.67% and 29.74% respectively in department of orthopedics, department of neurology and intensive care units in general hospitals. The average improvement rate of activities of daily living of discharged patients was 77.87% in rehabilitation department of general hospitals, and 69.01% in rehabilitation hospitals. ConclusionIn 2021, professional medical services, quality and safety of rehabilitation medicine in China have improved steadily. However, most general hospitals in China still have not configured the rehabilitation wards, and there are problems such as the total number of rehabilitation medical personnel in the country does not meet the requirements, early rehabilitation intervention is significantly insufficient, and the implementation of important evaluation and therapies is deficient. The effect of rehabilitation still needs to improve. It is necessary to continuously promote capacity building of the medical rehabilitation to improve the quality of medical rehabilitation services.

Assistive technology application in educational contexts: policy framework and core areas / 中国康复理论与实践

ObjectiveTo study domestic and international policies and core areas related to assistive technology services for children with disabilities, to explore the application of assistive technology for children with special needs in the educational context. MethodsBased on the relevant policies and theoretical frameworks of policies on assistive technology services of United Nations, World Health Organization (WHO) and China, the policy frameworks and core areas of assistive technology in the educational context were analyzed using the theories of the six elements of the WHO assistive technology service system and the 5P service model, as well as the international and domestic classifications and directory lists of assistive technologies. ResultsInternational Classification of Functioning, Disability and Health (ICF) gave the definition and classification of assistive technology in educational scenarios. With the Convention on the Rights of Persons with Disabilities (CRPD) as the core and the Assistive Technology for Children with Disabilities (ATD) strategy as the centerpiece of the international policy, the core areas of assistive technology application in educational settings were established with the 5P Model, consisting of five related areas, namely individuals, policies, products, practitioners and service delivery, based on the six elements of the WHO assistive technology service system, namely leadership and governance, financing, human resources for health, service delivery, medical technology and health information system. The ecosystem focused on people, policies, products, practitioners and services that promote access to and use of assistive technology. ConclusionThe policy and core areas for the application of assistive technology in educational contexts are formed on the basis of ICF, with the CRPD at the core, and the strategy of ATD, to define scientifically the definition; and promote assistive technology services for children with disabilities from the perspective of the right to comprehensive, efficient, and child-centered development, to provide usable, accessible, affordable, adaptable, acceptable and quality assistive technology services to ensure that children with disabilities enjoy equal and quality education, and to improve the quality of life and well-being. A human-centered assistive technology ecosystem can be established using 5P Model, to innovate and develop assistive technology services for children with disabilities.