Parto domiciliar planejado no Brasil: uma revisão sistemática nacional / Planned home birth in Brazil: a systematic review

Resumo O parto domiciliar planejado (PDP) tem crescido cada vez mais no Brasil, especialmente nos grandes centros urbanos, frente à crescente insatisfação das mulheres com o sistema obstétrico hospitalar vigente. Estudos internacionais demonstram a segurança do PDP, porém a produção nacional ainda é limitada nesta área. Desta maneira, este estudo objetivou revisar a produção bibliográfica nacional acerca de parto domiciliar entre os anos de 2008 e 2018, a fim de compilar dados relacionados ao PDP no Brasil. Após levantamento, 18 estudos foram incluídos na revisão, sendo subdivididos nas seguintes categorias: "Desfechos maternos e neonatais dos PDP", "Sentimentos, motivação e perfis associados à escolha pelo PDP", "Percepção dos profissionais que atendem PDP" e "Abordagem teórica do PDP". Concluiu-se que o PDP tem crescido entre parcelas privilegiadas da população, representando importante prática de exercício da autonomia da mulher em contraponto ao modelo obstétrico vigente, apresentando-se como alternativa segura de local de parto, com alto grau de satisfação para as mulheres e famílias. Este modelo de assistência, entretanto, apresenta-se como opção limitada, uma vez que o PDP não é oferecido pelo Sistema Único de Saúde, ainda inacessível para a maioria das mulheres no país.

Abstract Planned home birth (PHB) has grown in Brazil, especially in large urban centers, in the face of women's dissatisfaction with the current obstetric system. International studies have demonstrated the security of PHB, but national production about this area is still limited. Thus, this study aimed to review the national bibliographic production about PHB between 2008 and 2018, in order to compile data related to PHB in Brazil. After survey, 18 studies were included in the review, and then subdivided into the following categories: "Maternal and neonatal outcomes of PHB", "Feelings, motivation and personal characteristics of women that choose PHB", "Perception of professionals that practice PHB" and "Theoretical approach to PHB". It was concluded that the PHB has grown between privileged portions of Brazilian population, representing the important practice of women's autonomy, presenting itself as a safe alternative place of birth, with a high degree of satisfaction of women and families. However, this model of assistance presents itself as a limited option, since the PHB is not offered by the Health System, still unaccessible to most of women in the country.

Preferências de pessoas idosas pela informação prognóstica numa situação de doença grave, com menos de um ano de vida / Older people's preferences for prognostic information in a situation of serious illness with less than a year to live

Resumo O objetivo deste estudo foi determinar as preferências de pessoas idosas, residentes na comunidade, pela divulgação de informações relativas ao tempo de vida limitado, sintomas e problemas, e opções disponíveis para cuidados numa situação de doença grave, com menos de um ano de vida; e identificar os fatores associados com a preferência pela informação sobre prognóstico de vida limitado. Foi aplicado a versão brasileira do questionário sobre Preferências e Prioridades para os Cuidados de Fim de Vida (PRISMA), por meio de entrevista face-a-face, a 400 pessoas idosas, residentes na cidade de Belo Horizonte, Minas Gerais, Brasil. Os principais resultados indicam que: 74.0% preferem ser informados sobre o tempo de vida limitado, 89.3% sobre os sintomas e problemas e 96.3% acerca das opções de cuidados. Os fatores associados à preferência pela informação sobre prognóstico de vida limitado foram: gênero (mulheres: OR=0.446, 95% IC:0.269-0.738) e local menos preferido de morte (casa de um familiar ou amigo: OR=2.423, 95% IC:1.130-5.198). Esses resultados mostram que a maioria das pessoas idosas deseja ser informada numa situação de doença avançada, com menos de um ano de vida. Os profissionais de saúde precisam estar preparados para antecipar notícias sobre o prognóstico de vida limitado e a doença.

Abstract This study aimed to determine the preferences of community-dwelling older people about information disclosure regarding poor prognosis, the likely symptoms and problems, and the care options available in a situation of serious illness with less than a year to live; and to identify factors associated with a preference for information disclosure regarding poor prognosis. The Brazilian version of the Preferences and Priorities for End of Life Care (PRISMA) questionnaire was administered face-to-face to 400 older people, living in the city of Belo Horizonte, Minas Gerais, Brazil. The main results indicated that 74.0% preferred to be informed that they had limited time left, 89.3% wished to be informed about symptoms and problems, and 96.3% about available care options. The factors associated with preferences for information about poor prognosis were: gender (women: OR = 0.446, 95% CI: 0.269-0.738) and choosing the least preferred place to die (home of a relative or friend: OR = 2.423, 95% CI: 1.130-5.198. These results show that most older people want to be informed in an advanced illness situation with less than a year to live. Health care professionals need to be prepared to anticipate news about poor prognosis and the disease.

The feminization of dentistry and the perceptions of public service users about gender issues in oral health / A feminização da odontologia e as percepções dos usuários do serviço público sobre as questões de gênero em saúde bucal

Abstract It was investigated the perception of service users in relation to the professional practice of dentists, based on gender differences. The Primary Care Assessment Tool (PCATool) was applied to 900 users of the Public Service in Curitiba, PR, Brazil. Sixty clinics were selected using random sampling, divided between conventional Primary Health Care (PHC) Units and PHC with Family Health System Units. The attributes of PHC that compound the PCATool were analyzed. A question was added about user preference regarding the gender of the dental professional, thus generating four dyads derived from user gender/dentist gender (FF, FM, MM, MF). The attributes were linked to the dyads by applying the independent sample t test. Using logistic regression, the dyads were linked to 23 factors relating to scaled-up care in PHC. Many users showed a clear preference for being attended by female dentists. Users who prefer to be cared for by women tend to better evaluate PHC on issues related to "active listening", while those who prefer to be cared for by male dentists highlight the attributes of "care integration" and "community guidance". In other factors and attributes studied, there is no difference between the care given by men or women, regardless the unit.

Resumo Investigou-se a percepção dos usuários do serviço quanto à prática profissional dos dentistas, com base em diferenças de gênero. O Primary Care Assessment Tool (PCATool) foi aplicado a 900 usuários do Serviço Público de Curitiba, PR, Brasil. Sessenta clínicas odontológicas foram selecionadas usando amostragem aleatória, divididas entre unidades de Atenção Primária à Saúde (APS) convencional e unidades de APS com Estratégia Saúde da Família. Os atributos da APS no PCATool foram analisados. Uma questão foi adicionada acerca da preferência do usuário em relação ao gênero do dentista, gerando quatro díades derivadas da combinação do gênero do usuário/gênero do dentista (FF, FM, MM, MF). Os atributos foram ligados às díades pelo teste t para amostras independentes. Por regressão logística, as díades foram relacionadas a 23 fatores referentes aos cuidados ampliados na APS. Muitos usuários mostraram preferência por dentistas mulheres. Esses tendem a avaliar melhor os cuidados de saúde primários quanto à "escuta ativa e qualificada", enquanto aqueles que preferem ser atendidos por homens destacam os atributos de "integração do cuidado" e "orientação comunitária". Em outros fatores e atributos estudados, não há diferença entre o atendimento prestado por homens ou mulheres, independentemente da unidade.

Preferências dos adolescentes sobre os cuidados de saúde / Adolescents' preferences regarding health care

Resumo Os adolescentes subutilizam os serviços de saúde sobretudo para efeitos de vigilância, o que constitui uma preocupação para os profissionais. Porque a adolescência é uma fase crucial à aquisição de comportamentos saudáveis e de atitudes facilitadoras do acesso a estes serviços, por isso encontrar formas de responder às necessidades específicas dos adolescentes, através da sua participação, constitui um importante investimento no bem-estar das gerações futuras. Este estudo exploratório e descritivo, de natureza qualitativa, com duas fases, teve como objetivos identificar e analisar as ideias e preferências dos adolescentes sobre os cuidados de saúde. Realizaram-se oito entrevistas de grupo com 64 adolescentes dos 13 aos 18 anos: quatro grupos focais (fase 1) e quatro grupos nominais (fase 2). Os dados foram tratados através da análise de conteúdo. Emergiram opiniões favoráveis e desfavoráveis. Nas suas preferências destacaram-se, nas condições dos serviços, haver menos tempo de espera e ambientes mais confortáveis e menos lotados; nas atitudes dos profissionais privilegiaram as competências técnicas, como o saber e a experiência, embora associadas às competências relacionais. Os resultados suportam a necessidade de mudanças nas práticas organizacionais e sobretudo nas atitudes dos profissionais.

Abstract Adolescents underutilize health services, especially for monitoring purposes, which represents a concern for professionals. Since adolescence is a crucial phase in acquiring healthy behaviors and attitudes that facilitate access to these services, finding ways to respond to the specific needs of adolescents through their participation is an important investment in the well-being of future generations. This is an exploratory, descriptive and qualitative study with two phases, seeking to identify and analyze adolescents' ideas and preferences about healthcare. Eight group interviews were conducted with 64 adolescents aged 13 to 18 years: four focus groups (phase 1) and four nominal groups (phase 2). The data was submitted to content analysis. The adolescents revealed both favorable and unfavorable opinions, highlighting a set of preferences regarding service conditions, such as short waiting periods, more comfortable and less crowded settings. Concerning the professionals' attitudes, they emphasized their technical competencies, such as knowledge and experience, although combined with interpersonal skills. These findings support the need for changes in organizational practices, and particularly in the attitudes of the professionals.

Users' perceptions and preferences towards maxillary removable orthodontic retainers: a crossover randomized clinical trial

Abstract The aim of this study was to assess, correlate, and compare users' perceptions and preference related to maxillary removable retainers. Volunteers were recruited to use four retainer types: conventional wrap-around (CWA), wrap-around with an anterior opening (OWA), "U" wrap-around (UWA), and clear thermoplastic retainer (CT). The main outcomes were the volunteers' perceptions, evaluated with a 100-mm visual analogue scale, and their preferred retainer. The retainers were used for 21 days each (washout intervals of 7 days). Nineteen volunteers (27 ± 4.53 years) were randomly divided into four groups that used the four retainers, but with a different sequence. Perceptions were evaluated immediately after the use of each retainer and the preference at the end of the research. Repeated measures ANOVA and Friedman tests with post-hoc Tukey's test (intergroup comparisons), and Pearson and Spearman analyses (correlations between perceptions) were applied. The WA retainers did not significantly differ among themselves. The CT was rated significantly worse in speech (p ≤ 0.001), discomfort (p < 0.001), and occlusal interference (p < 0.001), and did not significantly differ from the others in esthetics. Users preferred significant more the WA retainers in comparison with the CT retainers. The occlusal interference caused by the CT was positively correlated to other perceptions, such as changes in speech and discomfort. WA retainers presented similar preference and perceptions, but were significantly better than the CT. The CT occlusal coverage appeared to be the primary cause of its rejection.

Do Otolaryngology Patients Show Gender Preference When Choosing a Surgeon? — A Quantitative and Qualitative Analysis

Abstract Introduction Otorhinolaryngology has always been considered a gender-neutral specialty, whereas in several other specialties, such as obstetrics, gynecology and urology, gender preference has been consistently shown by patients when choosing their treating surgeon. To date, no study has been performed to analyze whether this practice of gender preference is prevalent in otorhinolaryngology patients too. Objectives To identify if gender preference exists in the field of otorhinolaryngology, specifically in its four subspecialties, namely otology, pediatric otolaryngology, laryngology and head and neck surgery. Methods Patients attending our outpatient department were asked to complete a preformed proforma. The pro forma consisted of two parts, demographic details of the subjects and gender preference in the following subspecialties: otology, pediatric otolaryngology, laryngology and head and neck oncosurgery. Results A total of 1,112 subjects took part in the study, out of which 1,089 subjects were included in the final analysis. Female gender preference was highest in the field of pediatric otolaryngology, while male preference was highest for head and neck oncosurgery. Conclusion Though otorhinolaryngology and head and neck surgery has been considered a gender-neutral field, subspecialties of this field show considerable gender preference.

Route of birth delivery preferred by mothers and their motivations / Vía de nacimiento elegida por puérperas y sus motivaciones / Via de parto preferida por puérperas e suas motivações

Abstract Objective: Identify the route of birth delivery preferred by mothers and their motivations. Method: Cross-sectional study with 361 mothers from a university hospital. Data were obtained using a structured questionnaire from February to April 2013. Descriptive analysis was performed and the Chi-square test was used to verify association among the variables. Results: 77.6% of the women preferred vaginal delivery and the reason reported by 81.8% of them was easier recovery postpartum; 20.5% believed they took part in the decision-making concerning the type of delivery; 64.5% believed the type of delivery they experienced did not involve risk for themselves, while 21.9% believed it involved risk for the newborn. Statistical association was found between number of deliveries and type of previous delivery with the preferred route of delivery. Conclusion: Women did not have adequate knowledge regarding the risks and benefits of different types of delivery and for this reason were not empowered to exert their autonomy in regard to this decision.

Resumen Objetivo: Conocer la preferencia y la motivación de las mujeres en cuanto a vía de parto. Método: Estudio transversal con 361 puérperas de un hospital universitario. Datos obtenidos entre febrero y abril de 2013 a partir de cuestionario estructurado. Se realizó un análisis descriptivo y, para verificación de las variables, el Test Chi-Cuadrado. Resultados: El 77,6% de las mujeres prefirieron el parto vaginal, el 81,8% de estas por la recuperación postparto. El 20,5% creen haber participado en la decisión del tipo de parto. El 64,5% creían que el parto al cual fueron sometidas no involucraba riesgos para ellas y 21,9% pensaron que implicaba riesgos para el recién nacido. Hubo asociación estadística positiva entre paridad y tipo de parto anterior con la vía preferida. Conclusión: Las mujeres no tenían conocimiento adecuado sobre riesgos y beneficios de los tipos de parto y, por ello, no creen estar empoderadas para ejercer su autonomía.

Resumo Objetivo: Conhecer a via de parto preferida pelas puérperas e suas motivações. Método: Estudo transversal, com 361 puérperas de um hospital universitário. Os dados foram obtidos por meio de questionário estruturado, de fevereiro a abril de 2013. Realizou-se análise descritiva e, para a verificação da associação entre as variáveis, o Teste de Quiquadrado. Resultados: 77,6% das mulheres preferiram o parto vaginal, e o motivo, para 81,8% destas, foi melhor recuperação pós-parto; 20,5% acreditaram ter participado da decisão sobre o tipo de parto; 64,5% acreditavam que o parto ao qual foram submetidas não envolveu riscos para si e 21,9% acharam que envolvia riscos para o recém-nascido. Houve associação estatística entre paridade e tipo de parto anterior com a via de parto preferida. Conclusão: As mulheres não demonstraram conhecimento adequado sobre os riscos e benefícios dos tipos de parto e, por isso, acredita-se não estarem empoderadas para exercer sua autonomia nessa decisão.

¿La imagen importa? Influencia de la vestimenta del traumatólogo en la elección y confianza del paciente / The impact of the orthopedic surgeons' attire on patient preferences

Background: The formal appearance of health care professionals may influence their trustworthiness. Aim: To determine the effect of the orthopedic surgeon's attire on patients' perceptions of credibility and reliability of professionals. Material and Methods: In a cross-sectional design, 351 patients (mean age 43 ± 17 years, 62% males) from the Department of Orthopedics and Traumatology of a Chilean regional hospital in southem of Chile were chosen to complete a questionnaire of attire preferences, in which five photographs with male and female orthopedic surgeons appeared (executive, formal attire, informal attire, scrubs and casual clothing). The influence of attire in the perception of physicians' trustworthiness to resolve medical situations was analyzed. Results: Forty four percent of patients had no physician gender predilection (p = 0.32). Forty three percent of male and 38% of female patients preferred the use of formal attire. In situations of credibility or confidence, all patients chose mostly the use of white coats with formal attire by professionals. The probability of choosing an orthopedic surgeon with a formal attire was significantly higher among patients who considered the attire and appearance of the professional to be very important (Odds ratio = 3.74; p < 0.01). Conclusions: Patients prefer orthopedic surgeons wearing white coats and formal attire, which improves credibility of these professionals to correctly solve medical situations.

Purchase of prescription and OTC medicines in Slovakia: factors influencing patients' expectations and satisfaction

ABSTRACT Slovakia is a country where the purchase of OTC (over the counter) medicines outside the pharmacy is not allowed by the government. This study aimed at evaluating patients' satisfaction and acceptance of community pharmacists. Customer's behaviour and expectations influencing the purchase of prescription and OTC medicines were analyzed. A structured questionnaire having 15 multiple-choice questions was used to analyze the descriptive parameters. Data collection lasted from January to February 2014. The sample size consisted of 357 high-school educated individuals under 40 years of age. The survey showed that the prescription and OTC medicines were bought equally. The participants reported a 96.0%, 96.3% and 90.2% satisfaction rate with willingness and approach of the community pharmacist, pharmacy services and provision of drug information respectively. As for the OTC medicines, 89.5% people considered the pharmacist an expert: 88.2% purchased medicines with pharmacist's recommendation, 97.8% needed a professional counselling and 97.2% required a pharmacist's guidance. As for the prescription drugs, only 72.1% considered the pharmacist an expert: 96.3% suggested that physician's prescription was significant and 88.3% considered pharmacist's guidance in the process of selection of prescription medicines nonessential. A comprehensible and respectable conversation was highly expected in regards to both the OTC and prescription medicines.

Criterios de médicos tratantes para indicar instalación de gastrostomía en pacientes con demencia avanzada / A survey about the criteria for the indication of a gastrostomy in patients with advanced dementia

Background: Decision making concerning patients with advanced dementia is complicated. The indication of a gastrostomy is among these hard decisions, especially considering that there is no consensus about its real benefit. Aim: To explore the criteria used by Chilean physicians to indicate a gastrostomy in patients with advanced dementia. Material and Methods: A questionnaire about the decision making to indicate a gastrostomy was delivered to 72 physicians working in public and private hospitals. Results: The survey was answered by 43 physicians. Fifty one percent had indicated a gastrostomy to patients with advanced dementia in the last year, 79% believed that gastrostomy reduces the risk of aspiration pneumonia, 50% thought that gastrostomy helps in bed sore healing and 74% believed that gastrostomy improves survival. Conclusions: The majority of physicians who answered the survey think that gastrostomy will improve the health status of patients with advanced dementia.

Egalitarian Health Policy Preference and Its Related Factors in Korea: National Representative Sample Survey

Recently in Korea, the commercialization of health services has come to the fore, and the issue of egalitarianism/universal coverage in health is a matter for debate. This study explored the extent of Korean citizen's preference for egalitarian health policies focusing on the provision of health care service, financing and related factors. The data came from the 2011 Korean General Social Survey (KGSS) and the International Social Survey Program (ISSP). The preference for an egalitarian health policy (dependent variable) was divided into a preference for an egalitarian health services provision (ES) and a willingness to contribute (WC) to it. Each index was linearly regressed with demographic factors, socioeconomic status, ideology, and health-related factors. ES was significantly associated with an individual's egalitarianism and political liberalism, having illness/disability, having no additional private health insurance, and their perception of health insurance coverage. WC was associated with age, sex, household income, education, egalitarianism, and their perception of health insurance coverage. There were evidently different factors between ES and WC, mainly socioeconomic factors. WC was strongly influenced by socioeconomic status, whereas ES seemed to be linked more closely to economic affordability. Moreover, the results showed that Korean citizens prefer ES but do not like WC. These results deserve great attention, and the authorities should keep it in perspective. If the government wants to make a successful attempt to change the healthcare system through public policy, it will need to take public preferences into account.

Preferencias de los pacientes sobre la información de su enfermedad / Patients' preferences for information in health care decision-making

Se realizó una encuesta a pacientes que concurrían a servicios de cardiología para conocer cómo preferían ser informados sobre su estado de salud, y las características sociodemográficas asociadas con estas preferencias, considerando los siguientes ítems: conocimiento sobre la enfermedad, información sobre opciones terapéuticas y toma de decisiones. De 770 encuestados, 738 (95.8%) respondieron completamente el formulario. Se observó una tendencia a confiar sólo en el médico para obtener información (81.7%), a querer conocer las opciones de tratamiento y poder opinar (85.9%) y en menor medida, a la participación de la familia en las decisiones (63.2%). El 9.6% deseaba recibir la información mínima necesaria o "no saber nada" sobre una presunta enfermedad grave. Los varones fueron menos proclives a solicitar opciones y dar opinión (OR: 0.64), dando menos libertad a la participación familiar (OR: 1.31). Los de menor nivel socioeconómico reclamaron menos opciones (OR: 0.48) y dieron menor participación familiar (OR: 1.79). Los provenientes de otros países de Sudamérica tuvieron una menor tendencia a reclamar opciones y manifestar opinión (OR: 0.60); y los de menor nivel educativo confiaron menos en el conocimiento del médico (OR: 1.81), exigieron menos opciones (OR: 0.45) y prefirieron no conocer la gravedad de la enfermedad (OR: 0.56). El análisis de las variables demográficas permitió definir distintas preferencias de información asociadas a la edad, sexo, procedencia, educación, religión y estado de salud. Se concluye que, aunque es imperativo promover la autonomía del paciente, se deben conocer las preferencias individuales antes de informar y comprometer al paciente en el proceso de toma de decisiones sobre su enfermedad.

A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely. A trend to trust only in the doctor's knowledge to obtain information (81.7%), in wanting to know the options of treatment and express one's point of view (85.9%), and to involve the family in the decisions (63.2%) was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (OR: 0.64), giving less freedom to family involvement (OR: 1.31). People with a lower social and economical level claim fewer options (OR: 0.48) and gave less family participation (OR = 1.79). Natives from other South American countries had a minor tendency to demand for options and express their thoughts (OR: 0.60); and the ones with lower education level trusted less in the doctor's knowledge (OR: 1.81), demanded fewer options (OR: 0.45) and chose not to know the severity of the disease (OR: 0.56). The analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patient's autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.

Problemas y decisiones al final de la vida en pacientes con enfermedad en etapa terminal / Terminally-ill patients' end of life problems and related decisions

Objetivos Describir preferencias en las decisiones al final de la vida en pacientes y familiares, problemas que subyacen y motivos que los llevan a solicitar apoyo. Métodos Estudio descriptivo, exploratorio de fuentes secundarias de una ONG que brinda apoyo a los pacientes al final de la vida. Resultados La opción más frecuente fue la muerte digna en 43 % seguida de la eutanasia en un 12 %. Un 22 % de las personas solicitaban orientación sobre aspectos éticos y legales y además referentes a la atención adecuada para enfermos terminales. Las patologías que ocuparon el 75 % de los diagnósticos fueron Enfermedad Crónica Degenerativa, Cáncer y Estado de Coma. La agudización de síntomas fue el principal motivo por el cual solicitaron apoyo y el dolor incontrolable llevó con más frecuencia a la opción por la eutanasia. Sólo 14 % de los pacientes habían formalizado sus voluntades anticipadas respecto al final de la vida. La opción de muerte digna se relacionó con el rechazo a medidas fútiles y al encarnizamiento terapéutico. La eutanasia se percibió como acción intencional y autónoma de poner fin al sufrimiento. La familia juega un papel esencial en la toma de decisiones. Conclusiones Las decisiones al final de la vida son motivadas por la percepción de unas condiciones no dignas debidas al deterioro progresivo, dolor mal controlado, abandono del paciente crónico, encarnizamiento terapéutico y uso de medidas innecesarias que posponen la muerte. Se toman en un contexto complejo de dilemas religiosos, éticos y legales.

Objectives Describing terminally-ill patients and their relatives' preferences regarding end of life decisions, the underlying problems and reasons leading to them requesting support. Methods This was a descriptive, exploratory analysis of the secondary sources in an NGO providing support for patients at the end of their lives. Results The most frequent choice was dying with dignity (43 %), followed by euthanasia (12 %). Some people asked for guidance on legal and ethical aspects regarding appropriate care for the terminally-ill. The pathologies accounting for 75 % of the diagnoses were chronic degenerative diseases, cancer and coma. The worsening of symptoms was the main reason for requesting support and uncontrollable pain more often led to the choice of euthanasia. Only 14 % of the patients had formalised their wills regarding their end of life decisions. The choice of dying with dignity was related to rejecting futile measures and therapeutic cruelty. Euthanasia was seen as an autonomous intentional action to end suffering. The family plays an essential role in making end of life decisions. Conclusions End of life decisions are motivated by a perception of undignified conditions for patients due to progressive deterioration, poorly controlled pain, abandoning of chronic patients, therapeutic obstinacy and unnecessary measures that postpone death. They are taken within a complex context concerning religious dilemmas and ethical or legal concerns.

Patient positioning during digital rectal examination of the prostate: preferences, tolerability, and results

PURPOSE: To evaluate the preferred position used by Brazilian Urologists to perform DRE, the position that Brazilian patients prefer or think it is less embarrassing to have a DRE, and to evaluate the results of DRE with patients in left lateral decubitus, modified lithotomy, standing-up, or the physician will have them place their elbows on the table and squat down slightly. MATERIALS AND METHODS: Brazilian Urologists were contacted by e-mail, and 200 patients answered a questionnaire while undergoing prostate cancer screening. RESULTS: The preferred position was modified lithotomy position reported by 63.4 percent of Urologists, and left lateral position reported by 42.7 percent of the patients. Total DRE time was lower in the standing-up position. Pain and urinary urgency scores were similar regardless of the position used, and bowel urgency score was higher in patients squatting down. Patients were similar in terms of age and PSA level, but there was a significant difference between the standard deviations of estimated prostate weight in left lateral position. There were no differences in prostate asymmetry, positive DRE, or incomplete palpation of the prostate rates among different examination positions. CONCLUSIONS: Despite individual subjective preferences, a faster examination time in the standing-up position, and higher bowel urgency scores in patients with their elbows placed on the table and squatting down slightly, there were similar rates of prostate asymmetry, positive DRE, and incomplete palpation of the prostate, and comparable patient tolerability among different examination techniques.

Avaliação da glicemia capilar na ponta de dedo versus locais alternativos: valores resultantes e preferência dos pacientes / Analysis of fingerstick capillary glycemia versus alternative site: results and patients preferences

O trabalho visa avaliar eficácia e a preferência dos pacientes na monitorização da glicemia capilar em locais alternativos: lóbulo de orelha, antebraço e panturrilha em relação à ponta de dedo. Foram avaliados 89 pacientes (39 M/50 F) com diabetes melito tipo 2 (DM2). A monitorização foi feita com glicosímetro digital (ACCU - CHEK Performa, Roche), lancetador ACCU-CHEK Multiclix, em grau 5 na face palmar da falange distal do 3º dedo da mão direita, porção inferior do lóbulo da orelha direita, antebraço direito e região superior da panturrilha direita. Não houve diferença da glicemia capilar na ponta de dedo em relação aos locais alternativos. A ponta de dedo foi o local mais doloroso. Quanto ao local de preferência, a orelha e a ponta de dedo foram os preferidos. A monitorização glicêmica em locais alternativos é simples, segura e eficaz, como a glicemia de ponta de dedo.

This paper evaluate the efficacy and patients preferences of glucose monitoring in alternatives sites: ear lobe, forearm and calf against conventional fingerstick. We studied 89 patients (39 M/ 50 F) with type 2 diabetes mellitus (DM2). Glucose monitoring was measured using a digital glucosimeter (ACCU - CHEK Performa, Roche), and ACCU-CHEK Multiclix lancetador, with grade 5 on the distal phalange on the right hand's third finger, inferior part of right ear lobe, right forearm and right calf. There was not statistical significance on the comparative analyzes of fingerstick and alternatives sites. There was more pain in fingerstick. The patients preferred the fingerstick and the ear lobe. Glucose monitoring in alternative sites is as simple, safe and efficient as fingerstick.