Paciente com câncer colorretal em quimioterapia adjuvante: evidências para os cuidados com estoma e equipamentos coletores / Patient with colorectal cancer in adjuvant chemotherapy: evidence for the stoma care and collectors equipment

A Quimioterapia antineoplásica (QtA) adjuvante para câncer colorretal (CCR) traz consequências fisiológicas e psicossociais como os eventos adversos (EA) gastrintestinais e dermatológicos, que podem trazer dificuldades na utilização de equipamentos para os pacientes com estomia intestinal. Este estudo teve por objetivos analisar a produção científica nacional e internacional sobre os EA gastrintestinais e dermatológicos para pacientes com CCR em QtA adjuvante; e estabelecer as recomendações em relação à indicação de equipamentos coletores e adjuvantes para os pacientes com estomia intestinal por CCR, assim como para os cuidados com a estomia intestinal e o manejo destes equipamentos durante a QtA, com base nas evidências científicas. Trata-se de uma Revisão Integrativa, fundamentada na Prática Baseada em Evidências, cuja pergunta formulada foi: Quais os EA gastrintestinal e dermatológico decorrentes da quimioterapia adjuvante em pacientes com câncer colorretal? Os descritores utilizados para as buscas foram Neoplasias Colorretais, Quimioterapia, Toxicidade, Efeitos adversos, nas bases de indexação eletrônica PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cumulative Index to Nursing and Allied Health (CINAHL), e Excerpta Médica (EMBASE), mediante os critérios de inclusão: estudos que abordassem a ocorrência e o tratamento de EA gastrintestinais ou dermatológicos em pacientes com CCR em QtA adjuvante; e estudos publicados em inglês, português ou espanhol, sem corte temporal de publicação; obtidos na íntegra via Biblioteca Central do Campus de Ribeirão Preto da Universidade de São Paulo; e os critérios de exclusão que foram estudos em modelo animal e modelo in vitro; estudos sobre metástases associadas ao tumor primário colorretal. Do total de 4.021 artigos científicos, resultantes das buscas, foram selecionados mediante os critérios de inclusão e exclusão, 20 estudos que constituíram a amostra final, sendo que todos foram publicados em inglês, com níveis de evidência pouco fortes em 65% (IV e VI) e cujos aspectos abordados foram categorizados em quatro temáticas: Diarreia e demais EA gastrintestinais; Diarreia e EA Gastrodermatológicos; EA Gastrintestinais; e EA Dermatológicos. No tema Diarreia e demais EA gastrintestinais evidenciou-se diarreia, náusea, perda de apetite e constipação, vinculados à QtA adjuvante com 5-FU, capecitabina e irinotecano. No tema Diarreia e EA Gastrodermatológicos evidenciou-se síndrome palmar-plantar, outras afecções cutâneas (eritema, úlcera, descamação, prurido, eritema, bolha), estomatite, edema das mãos/face/boca, e hipersensibilidade por capecitabina e oxaliplatina. No tema EA Gastrintestinais verificamos que náusea e vômito foram mais frequentes e relacionados à oxaliplatina. No tema EA Dermatológicos, evidenciou-se rash cutâneo, rubor, prurido, reações alérgicas, síndrome palmar-plantar nos esquemas com 5-FU, capecitabina, oxaliplatina e irinotecano. Considerando estas evidências e a necessidade de utilização de equipamentos coletores do paciente com estomia intestinal por CCR em QtA adjuvante, a assistência de enfermagem especializada deve assegurar a demarcação de estoma, ensino do autocuidado sobre EA e seu manejo, indicação e fornecimento de equipamentos coletores e adjuvantes, que atendam as suas necessidades, assim como o desenvolvimento de protocolos para avaliação dos EA gastrintestinais e dermatológicos durante a QtA adjuvante

The antineoplastic chemotherapy for adjuvant colorectal cancer (ACC) brings physiological and psychosocial consequences such as gastrointestinal and dermatologic adverse events (AE), which can cause difficulties in using equipment for patients with ostomy. This study aimed to analyze the national and international scientific literature on the gastrointestinal and dermatological EA for patients with CRC in adjuvant chemotherapy; and establish recommendations regarding the indication of equipment supplies and also aid for patients with ostomy by CRC, as well as for ostomy care and management of this equipment during the chemotherapy, based on scientific evidence. This is an integrative review, based on the evidence-based practice, whose question was: What are the gastrointestinal and dermatological EA resulting from adjuvant chemotherapy in patients with colorectal cancer? The descriptors used for the search were Colorectal neoplasms, Drug therapy, Toxicity, and Adverse effects, in electronics PubMed indexing bases, Latin American and Caribbean Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health (CINAHL) and Excerpta Medical (EMBASE) by the inclusion criteria: studies that addressed the occurrence and treatment of gastrointestinal or dermatological EA in patients with CRC in adjuvant chemotherapy; and studies published in English, Portuguese or Spanish, without temporal cutting time publication; obtained in entirety at Ribeirão Preto Campus Central Library of the University of São Paulo; and the exclusion criteria were studies in animal models and in vitro model; studies on colorectal metastases associated with primary tumor. Of the total of 4,021 scientific articles resulting from the searches, they were selected by the inclusion and exclusion criteria, 20 studies which formed the final sample, all of which have been published in English, with little strong evidence levels 65% (IV and VI) and whose addressed aspects were categorized into four themes: Diarrhea and other gastrointestinal EA; Diarrhea and gastrointestinal and dermatologic EA; Gastrointestinal EA; Dermatologic EA. In the subject Diarrhea and other gastrointestinal EA became evident diarrhea, nausea, loss of appetite and constipation linked with adjuvant 5-FU, capecitabine, and irinotecan. On the topic diarrhea and Gastrointestinal and dermatologic EA showed up hand-foot syndrome, other skin disorders (erythema, ulcers, peeling, itching, erythema, and bubble), and stomatitis, swelling of the hands / face / mouth, and hypersensitivity oxaliplatin and capecitabine. On the topic Gastrointestinal EA were found that nausea and vomiting were more frequent and related to oxaliplatin. On the topic of Dermatological EA, evidence of skin rash, redness, itching, allergic reactions and palmar-plantar syndrome in the schemes with 5-FU, capecitabine, oxaliplatin and irinotecan. Considering this evidence and the need for equipment supplies in patients with ostomy by CRC in chemotherapy, specialized nursing care to ensure the demarcation of stoma, self-care education on EA and its management, display and supply collectors equipment and adjuvants that meet their needs, as well as the development of protocols for evaluation of gastrointestinal and dermatological EA during adjuvant chemotherapy

Impacto colateral del COVID-19 en la salud ambiental derivado de la disposición inadecuada de mascarillas / Collateral impact of COVID-19 on environmental health derived from improper disposition of masks

El uso de mascarillas por parte de la población general como elemento de protección personal frente al COVID-19 se mantuvo en ascenso durante la primera mitad del 2020, en medio de constantes actualizaciones de la OMS acerca del público objetivo, su correcto uso y posibles beneficios, pero donde no se definieron protocolos para el manejo del desecho resultante. Durante el segundo semestre del 2020 la población mundial usaba diariamente 4.300 millones de mascarillas, de las cuales el 78,5% se descartaban de forma incorrecta, llegando a generar un volumen de 2,61 (2,26-2,94; IC=95%) millones de toneladas de desecho diseminadas en el medio ambiente. Los componentes plásticos incorporados en la fabricación de mascarillas como PP, PE y PET pueden tardar 400 años en degradarse en condiciones ambientales, fragmentándose paulatinamente en microplásticos, que afectan a la flora, fauna, agua y suelos de su entorno. Adicionalmente, algunos aditivos sintéticos antioxidantes (AO) usados en la fabricación de plásticos pueden retardar aún más las reacciones de degradación de las mascarillas descartadas hacia el ambiente, aumentando su daño potencial. Se calculó que 216,9 (188,5-245,3; IC=95%) toneladas de AO168, 190 (165,2-214,9; IC=96%) toneladas de AO168O y 442,7 (384,8-500,6; IC=95%) toneladas de AO1010 fueron expuestas al medio ambiente debido a la disposición incorrecta de mascarillas en la segunda mitad de 2020. Aunque la masa conjunta de estos componentes sintéticos sólo representa el 0,017% de las mascarillas desechadas en el mismo lapso, su concentración resulta suficiente para acrecentar el riesgo de daño al ambiente(AU)

The use of masks by the general population as an element of personal protection against COVID-19 continued to rise during the first half of 2020, amid constant updates from the WHO about the target audience, their correct use and possible benefits, but where no protocols were defined for the management of the resulting waste. During the second half of 2020, the world population used 4.3 billion masks daily, of which 78.5% were discarded incorrectly, generating a volume of 2.61 (2.26-2.94; IC = 95%) million tons of waste disseminated in the environment. The plastic components incorporated in the manufacture of masks such as PP, PE and PET can take 400 years to degrade under environmental conditions, gradually fragmenting into microplastics, which affect the flora, fauna, water and soils of their environment. Additionally, some synthetic antioxidant additives (OA) used in the manufacture of plastics can further delay the degradation reactions of discarded masks into the environment, increasing their potential damage. It was calculated that 216.9 (188.5-245.3; IC = 95%) tons of AO168, 190 (165.2-214.9; IC = 96%) tons of AO168O and 442.7 (384.8 -500.6; IC = 95%) tons of AO1010 were exposed to the environment due to the incorrect disposal of masks in the second half of 2020. Although the combined mass of these synthetic components only represents 0.017% of the masks discarded in the same period, its concentration is sufficient to increase the risk of damage to the environment(AU)

Escovas de limpeza em centrais de materiais e esterilização: características e cuidados / Cleaning brushes in Central Materials and Sterilization

A limpeza é a primeira e mais essencial etapa antes que qualquer processo de desinfecção ou esterilização possa ocorrer. Nesta etapa ocorre a fricção manual dos materiais com escovas apropriadas a fim de eliminar sujidades. A depender das características, estas escovas podem ter um custeio elevado para os serviços de saúde, especialmente em países com recursos limitados como o Brasil. Elucidar, em tempo oportuno, o que traz a literatura sobre as características necessárias às escovas de limpeza em Centrais de Materiais e Esterilização (CME), especialmente sobre a necessidade de serem autoclavadas.

Qualidade e segurança no uso da insulinoterapia pela população idosa / Calidad y seguridad en el uso de la insulinoterapia por parte de la población de edad avanzada / Quality and safety in the use of insulin therapy by the aged population

Objetivo: avaliar a qualidade e segurança individual e coletiva no uso de insulina pela população idosa em um município de grande porte do sul do Brasil. Método: estudo transversal de base populacional realizado em 2016-2017 com idosos de 68 anos ou mais. As entrevistas foram realizadas nos domicílios dos idosos. O desfecho foi medido pela forma de utilização e descarte das seringas e agulhas. Realizou-se análise descritiva mediante cálculo das proporções e projeções dos dados para os idosos do município. Resultados: foram entrevistados 735 idosos. A prevalência de diabetes foi de 20,0%, e 13,8% faziam uso de insulina injetável. A reutilização das seringas e agulhas foi relatada por 55,0% e 65,0% referiram descartar o material direto no lixo comum. Conclusões: a qualidade e a segurança dos idosos em insulinoterapia estão comprometidas, sendo necessário implementar estratégias de educação em saúde que visem melhorar o conhecimento e acesso as orientações adequadas.

Objective: to evaluate individual and collective quality and safety in the use of insulin by the aged population in a large city of southern Brazil. Method: a cross-sectional population-based study conducted in 2016-2017 with older adults aged 68 and over. The interviews were conducted in the older adults' homes. The outcome was measured by the way in which syringes and needles were used and disposed of. Descriptive analysis was performed by calculating the data proportions and projections for the older adults in the municipality. Results: 735 older adults were interviewed. The prevalence of diabetes was 20.0%, and 13.8% made use of injectable insulin. Syringes and needle reuse was reported by 55.0%, and 65.0% mentioned discarding the material directly in regular garbage. Conclusions: the quality and safety of the older adults in insulin therapy are compromised, and it is necessary to implement health education strategies aimed at improving knowledge and access to the appropriate guidelines.

Objetivo: evaluar la calidad y la seguridad individual y colectiva en el uso de insulina por parte de la población de edad avanzada en un importante municipio del sur de Brasil. Método: estudio transversal de base poblacional realizado en 2016-2017 con ancianos de al menos 68 años de edad. Las entrevistas se realizaron en los domicilios de las personas de edad avanzada. El resultado se midió considerando la forma de utilización y descarte de las jeringas y agujas. Se realizó un análisis descriptivo mediante el cálculo de las proporciones y proyecciones de los datos para los ancianos del municipio. Resultados: se entrevistó a un total de 735 personas de edad avanzada. La prevalencia de diabetes fue del 20,0%, y el 13,8% utilizaba insulina inyectable. El 55,0% indicó que reutilizaba las jeringas y agujas y el 65,0% mencionó que desechaba el material directamente en la basura común. Conclusiones: la calidad y la seguridad de las personas de edad avanzada sometidas a insulinoterapia están en riesgo, por lo que resulta necesario implementar estrategias de educación en salud que tengan por objetivo mejorar el conocimiento y el acceso a las pautas adecuadas.

Reúso de dispositivos médicos de uso único e implicações para a segurança do paciente / Reuse of single use medical devices and implications for patienty safety / Reutilización de dispositivos médicos de uso individual e implicaciones para la seguridad del paciente

Objetivo: Descrever aspectos do reúso dos dispositivos médicos de uso único e as implicações dessa prática para a segurança do paciente. Método: Ensaio acadêmico, utilizando dados de revisão integrativa e expertise da autora. Resultados: O reúso de produtos de uso único é realidade mundial e ocasiona debates regulatórios, técnicos, econômicos, éticos e de segurança do paciente, denotando diversos interesses dos distintos atores envolvidos: Estado, fabricantes, serviços de saúde, academia, profissionais e usuários. Embora haja risco teórico, dados não identificam relação causal entre evento adverso e reúso desses produtos. Existem argumentos a favor e contra que compreendem riscos e benefícios e justiça distributiva e social. O rótulo desses produtos representa nó crítico e elemento fomentador dos dilemas que permeiam essa prática. Conclusão: Há consenso de que o reúso de um produto médico deve ter o mesmo padrão de segurança, independentemente se rotulado como de uso único ou de multiuso. Alguns produtos ditos de uso único podem ser seguramente reusados, mas essa prática requer condições organoestruturais dos serviços de saúde, além de expertise, adoção de protocolos e supervisão dessas atividades.

Objective: to describe aspects of the reuse of single-use medical devices and implications for patient safety. Method: academic essay, using integrative review data and author's expertise. Results: the reuse of single-use products is a worldwide reality and causes regulatory, technical, economic, ethical and patient safety debates, denoting several interests of the different actors involved: State, manufacturers, health services, academia, professionals and users. Although there is a theoretical risk, data do not identify a causal relationship between adverse events and reuse of these products. There are arguments for and against and are involved: risks and benefits, distributive and social justice. The label of these products represents a critical node and fomenting element of the dilemmas that permeate this practice. Conclusion: There is consensus that the reuse of a medical product should have the same safety standard, regardless of whether labeled as single-use or multipurpose. Some so-called single-use products can be safely reused, but this practice requires organo-structural conditions of health services, as well as expertise, adoption of protocols and supervision of these activities.

Objetivo: Describir aspectos de la reutilización de dispositivos médicos de un solo uso e implicaciones para la seguridad del paciente. Método: ensayo académico, utilizando datos de revisión integradores y la experiencia del autor. Resultados: La reutilización de productos de un solo uso es una realidad mundial y provoca debates regulatorios, técnicos, económicos, éticos y de seguridad del paciente, que denotan diversos intereses de los diferentes actores involucrados: Estado, fabricantes, servicios de salud, academia, profesionales y usuarios. Aunque existe un riesgo teórico, los datos no identifican una relación causal entre el evento adverso y la reutilización de estos productos. Hay argumentos a favor y en contra y están involucrados: riesgos y beneficios, justicia distributiva y social. La etiqueta de estos productos representa un nodo crítico y un elemento que fomenta los dilemas que impregnan esta práctica. Conclusión: Existe un consenso de que la reutilización de un producto médico debe tener el mismo estándar de seguridad, independientemente de si está etiquetado como de uso único o multipropósito. Algunos de los llamados productos de un solo uso pueden reutilizarse de manera segura, pero esta práctica requiere condiciones organoestructurales para los servicios de salud, además de experiencia, adopción de protocolos y supervisión de estas actividades.

Study on Testing Methods of Pen-injector's Dosing Accuracy / 中国医疗器械杂志

OBJECTIVE@#An accuracy test method is proposed to reduce the amount of reagents used in the test and reduce the cost of spot checks and self-tests.@*METHODS@#According to the requirements of dose accuracy test in standard atmospheric conditions in ISO 11608-1:2014, dose accuracy test is carried out for the same batch of reusable pen injector samples by using the test method proposed in this paper and the test method in relevant foreign research, and the data measured by the two methods are processed.@*RESULTS@#After experimental testing and analysis, the data measured by the two methods did not exceed the dose accuracy limit specified in the ISO standard. There was no significant difference between the two methods when the dose of 60 U and 30 U were tested, but there was significant difference when the dose of 1 U was tested.@*CONCLUSIONS@#Both methods can be used to evaluate dose accuracy, however, the method proposed in this paper can reduce the usage of drugs by 2/3, so it can reduce cost of supervised test.

Application Study of Medical Consumables Supply Chain Reengineering in Hospitals Based on SPD / 中国医疗器械杂志

The supply chain management of medical consumables in hospitals is an important guarantee for the improvement of clinical diagnosis and treatment. It requires continuous re-engineering and optimization on procurement and supplier management, costs and efficiency of daily operation. Based on the practical case of Shanghai Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital, the study discusses the practical path and key points as well as improvement results in hospital medical consumables supply chain re-engineering via SPD model. Also, the research can provide references on medical consumables supply chain management to large and medium-size hospitals.

Cantidad de descarte de materiales endodónticos contenidos en jeringas dispensadoras: un informe técnico / Discarded quantity of endodontic materials contained within dispenser syringes: a technical report

La presente comunicación tiene como objetivo informar sobre la cantidad de material que se pierde junto con las puntas dispensadoras descartables durante el uso de materiales endodónticos contenidos en jeringas y comprobar si esa cantidad es significativa en comparación con el contenido total original (15 g). Se procedió a pesar en una balanza de precisión 12 puntas dispensadoras descartables vacías, pertenecientes a dos materiales de uso endodóntico: 2Seal EasyMix (VDW) y Activa BioActive-Base/Liner (PulpDent Corp.). La sumatoria del peso (masa) en las 12 puntas pertenecientes a cada uno de los materiales ensayados fue considerada como peso total de las puntas vacías. Posteriormente, las puntas se llenaron completamente con los materiales, se almacenaron durante 48 horas para permitir el fraguado y finalmente se las pesó nuevamente. La diferencia entre el peso de las 12 puntas vacías y llenas fue considerada como la cantidad de material remanente que se descarta con ellas. La diferencia entre los totales de masa contenida en las puntas llenas de cada material y el contenido original de las jeringas representó la proporción de material que se descarta sin haber sido utilizado. Cuando el porcentaje de material descartado fue menor o igual al 20%, el resultado se consideró aceptable. Se observó que la proporción de ambos materiales fue mayor al 20% (2Seal EasyMix=44,36%; Activa BioActive-Base/Liner=36,87%). Se concluyó que el empleo de materiales endodónticos contenidos en jeringas dispensadoras produce la pérdida de una importante proporción de material durante los procedimientos operatorios (AU)

In order to inform about the amount of material that is lost along with the disposable dispensing tips during the use of endodontic materials contained in deliver syringes and check if that amount is significant compared to the total original content (15 g) of them. 12 empty disposable dispensing tips belonging to two endodontic materials: 2Seal EasyMix (VDW) and ActivaBioactive Base/liner (PulpDent Corp.), were weighed on a precision scale. The sum of the weight (mass) of each of the 12 tips belonging to each of the materials tested was considered as the total weight of the empty tips. Subsequently, the tips were completely filled with the materials, stored for 48 hours to allow them to set and finally weighed again. The difference between the weight of the 12 empty and full tips was considered as the amount of material remaining within them that is discarded. The difference between the total mass contained in 12 filled tips of each material and the original syringe content represented the proportion of material discarded without being used. It was considered that if the % of discarded material was ≤20% this would be considered acceptable. It was observed that the proportion of both materials was >20% (2Seal EasyMix = 44.36%; ActivaBioactive Base/liner = 36.87%). The use of endodontic materials contained in dispensing syringes causes the loss of a significant proportion of material during the operative procedures (AU)

Zoonosis and veterinary waste disposal in rural practice / Zoonosis y disposición de desperdicios veterinarios en la práctica rural

The objectives of this study were to estimate: (a) the frequency of zoonoses in large animal veterinarians from rural areas of the province of Buenos Aires, Argentina, and (b) to describe the use and disposal of personal protective equipment (PPE) and selective veterinary clinical waste. A cross-sectional study was carried out on large animal veterinary practitioners in the Province of Buenos Aires (n = 106). One third (29.2%) of them had been diagnosed with a zoonosis by laboratory-methods, being brucellosis the most frequent (22.6%). The more years passed since their graduation, the greater the chances of becoming ill (p < 0.001). Gloves were the most adopted PPE; however, other elements had little or no use at all. Older and experienced professionals used PPE less frequently than young inexperienced practitioners. Some PPE was frequently reused and the final disposal of veterinary waste was often inappropriate. A change in behavior is an urgent need to preserve not only the veterinarians' health but also their families' wellbeing and to ensure proper disposal of potentially hazardous waste.

Los objetivos de este trabajo fueron los siguientes: a) estimar la frecuencia de zoonosis en veterinarios de grandes animales que desarrollan su labor en la provincia de Buenos Aires; b) describir el uso y la disposición de los elementos de protección personal (EPP) y otros residuos generados durante el trabajo de estos veterinarios. Para ello se realizó un estudio transversal en una muestra de 106 profesionales. En un tercio de ellos (29,2%) se había sido diagnosticado por métodos de laboratorio alguna zoonosis; la brucelosis fue la más frecuente (22,6%). Se encontró que a mayor tiempo transcurrido desde la graduación, mayor era la probabilidad de enfermarse (p< 0,001). Sobre la base de las respuestas obtenidas en cuestionarios estructurados, se determinó lo siguiente: que los guantes fueron el EPP más adoptado, mientras que otros elementos tuvieron escasa o nula adopción; que los profesionales de mayor edad y experiencia usaron EPP con menos frecuencia que los practicantes más jóvenes e inexpertos; y que algunos EPP se reutilizaban con frecuencia y que la eliminación final de los desechos veterinarios fue a menudo inapropiada. Considerando estos hallazgos, es claro que se requiere un cambio de comportamiento para preservar no solo la salud de los veterinarios, sino también para asegurar el bienestar de sus familias y garantizar la eliminación adecuada de los residuos potencialmente peligrosos.

Development of a Safe Syringe Disposal System Moving towards Automated Syringe Data Collection / 대한의료정보학회지

OBJECTIVES: An automatic needle destroyer (ANDY) was developed to prevent needlestick injuries, and usability tests were conducted in several hospitals. The addition of extra features to the ANDY is in progress, such as data collection and automatic identification of used syringes. Thus, this report describes how the ANDY can be used to track the data of used syringes. METHODS: The motor torque required for barrel separation differs according to syringe diameters. By monitoring the electric current which is consumed for the motor torque, the type of syringe can be identified. Twelve prototypes were produced, and five usability tests were conducted in hospitals. RESULTS: After use, a syringe is inserted into the proposed device, and the needle portion is then cut and separated from the syringe body (barrel) and discarded. The needles are collected in a sharps container for hygienic disposal, and the barrel is dropped into a general medical waste container. CONCLUSIONS: The ANDY can be used to track the syringe used for each patient. The barcode can be read while the syringe rotates in the main body of the ANDY with a built-in omnidirectional scanner. Collection of information during syringe disposal can facilitate stock management. This system could also be extended to other types of consumable medical devices, although it would still be a challenge to differentiate each medical device.

Study on the Migration Resistance of Additives in Disposable Photophobic Infusion Set / 中国医疗器械杂志

The disposable photophobic infusion was used to simulate clinical infusion under different conditions. The simulated liquid was collected every 30 min (total 4 h),and detected the additives (Fe, MDA and antioxidant 1076) in simulated liquid by spectroscopic method and chromatography method. The method is simple and stable, and can be used for the technical monitoring of the disposable photophobic infusion set in the future.

Surgical plane positioning with a disposable circumcision suture device for the treatment of phimosis and redundant prepuce / 中华男科学杂志

<p><b>Objective</b>To investigate the clinical effects of circumcision by surgical plane positioning with a disposable circumcision suture device in the treatment of phimosis and redundant prepuce.</p><p><b>METHODS</b>From September 2016 to June 2017, we treated 250 patients with phimosis or redundant prepuce, 127 by conventional circumcision (the control group) and the other 123 by surgical plane positioning with a disposable circumcision suture device (the observation group). We compared the operation time, intra-operative bleeding, preputial frenulum alignment, postoperative ecchymosis, and postoperative penile appearance between the two groups of patients.</p><p><b>RESULTS</b>Compared with the controls, the patients in the observation group showed significantly longer operation time (［4.48 ± 1.18］ vs ［7.17 ± 1.42］ min, P<0.05), lower rates of intra-operative frenulum bleeding (15.0% ［19/127］ vs 4.1% ［5/123］, P<0.05) and frenulum misalignment (26.8% ［34/127］ vs 0.8% ［1/123］, P<0.05), higher incidence of postoperative ecchymosis (41.7% ［53/127］ vs 21.1% ［26/123］, P<0.05), and higher satisfaction of the patients with the postoperative penile appearance (92.9% ［18/127］ vs 98.4% ［121/123］, P<0.05). However, no statistically significant difference was found between the control and observation groups in intra-operative non-frenulum bleeding (4.7% ［6/127］ vs 1.6% ［2/123］, P = 0.164).</p><p><b>CONCLUSIONS</b>Circumcision by surgical plane positioning with a disposable circumcision suture device can effectively avoid preputial frenulum misalignment, reduce intra-operative bleeding, and improve postoperative penile appearance.</p>

Ficha clínica de atendimento ao cliente com diabetes mellitus do tipo 1 / Type 1 diabetes mellitus customer clinical care history sheet

Diabetes Mellitus é um dos principais problemas de saúde pública, sendo a Diabetes Mellitus tipo 1 (DM1) o distúrbio endócrino-metabólico mais comum na infância. Durante o atendimento ambulatorial ao cliente com DM1, foi observado que o registro da consulta era feito em uma folha pautada apenas, sem qualquer orientação para seu preenchimento, mesmo diante de uma patologia complexa, com inúmeros dados e informações. A questão norteadora foi à necessidade de uma sistematização para um registro adequado do atendimento. O objetivo deste estudo foi elaborar uma Ficha Clínica (FC) padronizada para acompanhamento ambulatorial do cliente com DM1, com o intuito de melhorar a assistência e a segurança dos dados coletados. Ao mesmo tempo, teve o propósito de servir como instrumento facilitador para acadêmicos e profissionais de saúde para melhor aprendizagem e a avaliação dos casos. O método utilizado foi à revisão narrativa do assunto para selecionar dados e parâmetros de avaliações essenciais para compor a referida FC. Foram selecionados artigos de revisão e consensos publicados na base de dados PUBMED, LILACS, Cochrane e Scielo, produzidos no Brasil e no exterior, com a utilização dos descritores "Diabetes Mellitus tipo 1", "Guideline", além de livros atualizados sobre o tema, publicados entre os anos de 1988 a 2016. Da mesma forma, foi realizada outra revisão narrativa da literatura para aprofundar conhecimentos sobre as orientações e leis que regem o descarte correto dos resíduos sólidos perfurocortantes em domicílio, devido à extrema relevância que o tema demonstrou na assistência ao cliente com DM1. Além da elaboração de artigos sobre os temas estudados, os produtos dessas duas revisões foram: (1) "Folheto educativo (FC) para profissionais de saúde sobre destinação ambientalmente correta de perfurocortantes em domicílio" e (2) o produto principal "Ficha Clínica de atendimento ao cliente com diabetes Mellitus Tipo 1" e seu instrutivo para preenchimento. Conclusão: O estudo atingiu o objetivo proposto, com a elaboração não só de uma FC sistematizada para consulta inicial, mas também para acompanhamento da evolução clínica do diabético. Além disso, o Folheto explicativo dirigido aos profissionais de saúde sobre o descarte de resíduos perfurocortantes domiciliares complementa essa ficha clínica e possibilita uma assistência mais completa ao portador de DM1

Diabetes Mellitus is one of the main public health problems, with Diabetes Mellitus type 1 (DM1) being the most common endocrine-metabolic disorder in childhood. During ambulatory care with the DM1 client, it was observed that the registration of the consultation was done on a standardized sheet only, without any orientation for its completion, even in the face of a complex pathology, with numerous data and information. The guiding question was the need for systematization for an adequate record of care. The objective of this study was to develop a standardized Clinical Record (CR) for outpatient follow-up of patients with DM1, in order to improve the care and safety of the data collected. At the same time, it was intended to serve as a facilitating tool for academics and health professionals for better learning and case assessment. The method used was the narrative review of the subject to select data and evaluation parameters essential to compose said clinical record. We selected articles of review and consensus published in the PUBMED, LILACS, Cochrane and Scielo database, produced in Brazil and abroad, using the descriptors "Diabetes Mellitus type 1", "Guideline", and updated books on the subject , published between 1988 and 2016. In the same way, another narrative review of the literature was carried out to deepen knowledge about the guidelines and laws that govern the correct disposal of solid residues at home, due to the extreme relevance that the topic demonstrated in customer service with DM1. In addition to the elaboration of articles on the subjects studied, the products of these two reviews were: (1) "Educational brochure for health professionals about the environmentally correct destination of sharps at home" and (2) the main product "Clinical file with Type 1 Diabetes Mellitus" and it's instructive to fill. Conclusion: The study reached the proposed goal, with the elaboration not only of a systematized CR for initial consultation, but also for monitoring the clinical evolution of the diabetic. In addition, the explanatory brochure addressed to health professionals on the disposal of household hazardous waste complements this clinical file and enables a more complete assistance to the DM1 patient

A novel disposable circumcision device versus conventional surgery in the treatment of redundant prepuce and phimosis / 中华男科学杂志

Objective@#To compare the clinical effect of a novel disposable circumcision device Ring with that of conventional circumcision in the treatment of redundant prepuce and phimosis.@*METHODS@#Totally, 750 patients with redundant prepuce or phimosis underwent Ring circumcision (group A, n = 450) or conventional circumcision (group B, n = 300). We recorded the operation time, intraoperative blood loss, Visual Analogue Scale (VAS) intraoperative pain scores, postoperative complications, wound healing time, and patients' satisfaction with postoperative penile appearance, followed by comparison of the collected data between the two groups of patients.@*RESULTS@#All the operations were successfully completed. Group A, as compared with B, showed significantly shorter operation time (［3.78 ± 0.42］ vs ［26.24 ± 3.99］ min, P 0.05) or the postoperative incidence rate of edema (0.89% ［4/450］ vs 2.33% ［7/300］, P >0.05). There were no significant postoperative infections or delayed incision healing except for 1 case of wound dehiscence in each group.@*CONCLUSIONS@#Ring circumcision, with its advantages of shorter operation time, less blood loss and pain, higher safety, and better postoperative penile appearance, is easily accepted by the patients and deserves wide clinical application.

A novel disposable ring versus the suture device in circumcision / 中华男科学杂志

Objective@#To investigate the clinical effect of a novel disposable ring versus that of the suture device in circumcision for redundant prepuce and phimosis.@*METHODS@#We randomly assigned 470 male patients with redundant prepuce or phimosis to receive circumcision with a novel disposable ring (the DR group, n = 235) or the suture device (the SD group, n = 235) and compared the operation time, intraoperative blood loss, pain scores, wound healing time, and postoperative complications and penile appearance between the two groups of patients.@*RESULTS@#All the operations were completed smoothly. Compared with the SD group, the DR group showed significantly shorter operation time (［7.49 ± 1.84］ vs ［3.83 ± 0.42］ min, P 0.05) or while the staples scraping the underpants or at the ring removal (3.49 ± 1.22 vs 3.36 ± 1.41, P >0.05). No obvious postoperative infection or delayed healing was observed except for 3 cases of wound dehiscence (1 in the DR and 2 in the SD group) and 8 cases of delayed removal of the staples in the SD group.@*CONCLUSIONS@#The novel disposable ring, with its advantages of short operation time, less bleeding and pain, good penile appearance, high safety, and simple operation, is obviously superior to the suture device in circumcision and deserves to be applied and popularized clinically. .

Frenulum identification positioning with a disposable suture device in circumcision to prevent postoperative penile frenulum malposition / 中华男科学杂志

Objective@#To investigate the effect of the frenulum identification positioning method with a disposable suture device in circumcision for the prevention of postoperative penile frenulum malposition.@*METHODS@#Totally 212 patients with phimosis or redundant prepuce underwent circumcision from March 2015 to September 2016, including 109 cases of conventional circumcision (the control group) and 103 cases treated by frenulum identification positioning with a disposable suture device (the observation group). We observed the postoperative position of the penile frenulum and median raphe and compared the deviation angles of the frenulum between the two groups of patients.@*RESULTS@#The median of penile frenulum deviation angle (interquartile range) was 0 (3.56) in the observation group, significantly smaller than 12.41 (19.59) in the control (P <0.001, P = 0.000). And the rate of frenulum deviation was remarkably lower in the former (8.74% ［9/103］) than in the latter group (66.06% ［72/109］) (P <0.01).@*CONCLUSIONS@#Circumcision using the frenulum identification positioning method with a disposable suture device can effectively avoid postoperative penile frenulum malposition. With the advantages of safety and easy operation, it deserves clinical application and popularization.

Biossegurança em serviço de embelezamento: conhecimento e práticas em uma capital do nordeste brasileiro / Bioseguridad en los centros de embellecimento: conocimientos y prácticas en una capital del nordeste brasileño / Biosafety in beauty centers: knowledge and practices in a state capital in Northeast Brazil

Resumo OBJETIVO Avaliar o conhecimento e as práticas de biossegurança adotadas por profissionais do segmento da beleza. MÉTODOS Pesquisa descritiva do tipo survey. Foram entrevistados 238 profissionais de serviços de embelezamento entre agosto de 2014 e 2015. As variáveis foram apresentadas por meio de frequências absolutas e relativas, bem como média e desvio padrão. RESULTADOS 62,6% dos profissionais tiveram contato com sangue de clientes sem uso de luvas; instrumentais para o atendimento e 32,8% dos entrevistados não utilizaram equipamentos de proteção individual durante suas atividades laborais. CONCLUSÕES As doenças mais citadas quanto ao risco de contágio e de transmissão na prática laboral foram as hepatites virais, HIV e fungos. Quanto aos procedimentos de biossegurança adotados, o autoclave é o equipamento menos usado na esterilização dos instrumentos.

Resumen OBJETIVO Evaluar el conocimiento y las prácticas de bioseguridad adoptadas por profesionales del segmento del embellecimiento. MÉTODOS Evaluar el conocimiento y las prácticas de bioseguridad adoptadas por profesionales del segmento del embellecimiento. RESULTADOS: 62,6% de los profesionales tuvieron contacto con sangre de clientes sin el uso de guantes; el 74,4% higienizaban las manos entre los atendimientos, el 16,8% reutilizaban materiales desechables. Ningún profesional informó la cantidad adecuada de instrumentos y el 32,8% de los entrevistados no utilizaban equipos de protección individual durante sus actividades laborales. CONCLUSIONES Las enfermedades más citadas con respecto al riesgo de contagio y de transmisión en la práctica laboral fueron las hepatitis virales, el VIH y los hongos. Acerca de los procedimientos de bioseguridad adoptados, el autoclave fue el aparato menos utilizado en la esterilización de los instrumentos.

Abstract OBJECTIVE To evaluate the knowledge and biosafety practices adopted by professionals of the beauty segment. METHODS Descriptive study, of survey type. 238 professionals of the beauty segment were interviewed between August 2014 and 2015. The variables were expressed by means of absolute and relative frequencies, as well as average and standard deviation. RESULTS 62.6% of the interviwed professionals reported having had contact with blood from customers when they were not wearing gloves; 74.4% said they washed their hands before and after each service, and only 16.8% of the respondents reported reusing nonsterilizable materials. None of them was able to inform the correct number of sets of tools needed , and 32.8% of the respondents did not use Personal Protective Equipment during their work activities. CONCLUSIONS The most frequently reported diseases associated with the risk of infection and transmission in the work activities were viral hepatitis, HIV and fungi. Regarding the biosafety procedures adopted, autoclave is the least used method for sterilizing devices. Keywords: Beauty and aesthetics centers. Exposure to biological agents. Prevention of diseases.