Teleconsultation in respiratory medicine - A position paper of the Portuguese Pulmonology Society.

The COVID-19 pandemic crisis, among so many social, economic and health problems, also brought new opportunities. The potential of telemedicine to improve health outcomes had already been recognised in the last decades, but the pandemic crisis has accelerated the digital revolution. In 2020, a rapid increase in the use of remote consultations occurred due to the need to reduce attendance and overcrowding in outpatient clinics. However, the benefit of their use extends beyond the pandemic crisis, as an important tool to improve both the efficiency and capacity of future healthcare systems. This article reviews the literature regarding telemedicine and teleconsultation standards and recommendations, collects opinions of Portuguese experts in respiratory medicine and provides guidance in teleconsultation practices for Pulmonologists.

Dois Pacientes Com Sindrome De Guillian-Barre Apos Infeccao Por Sars-Cov-2

Objetivos: Descricao de dois casos de Sindrome de Guillain-Barre (SGB) possivelmente relacionados ao SARS-CoV-2. Materiais e metodos: Avaliacao dos achados clinicos e laboratoriais em pacientes que evoluiram com a SGB apos a infeccao por SARS-CoV-2. Resultados: 1degree. Homem de 56 anos, com lupus eritematoso sistemico e insuficiencia renal cronica, apresentou PCR nasofaringeo positivo para Covid-19, em 7 de setembro de 2021. Evoluiu com insuficiencia respiratoria 10 dias apos a admissao no hospital, porem com evolucao progressive, comprometimento neurologico, com parestesia dos pes/maos e abolicao dos reflexos tendinosos. O liquido cefalorraquidiano deste paciente demonstrou dissociacao albumino-citologica e o padrao eletrofisiologico foi compativel com doenca desmielinizante. O paciente nao apresentou melhora apos tratamento com esteroides e imunoglobulina intravenosa, e vinte dias apos seus primeiros sintomas neurologicos, iniciamos o tratamento com 5 plasmaferese terapetica (PFT), 1 procedimento/dia, com troca de uma volemia plasmatica. Apos 3 sessoes de PFT, houve melhora clinica significativa, inclusive no exame neurologico do paciente. 2degree. Mulher de 22 anos, previamente higida, apresentou infeccao respiratoria superior e PCR nasofaringeo positivo para Covid-19, em 10 de janeiro de 2022. Apos 3 dias do diagnostico, esta paciente apresentou parestesia ascendente progressiva simetrica. A avaliacao eletrofisiologica comprovou uma polineuropatia desmielinizante segmentar e o exame do liquido cefalorraquidiano mostrou dissociacao albumin-citologica. O tratamento com pulsoterapia com corticoides e imunoglobulina endovenosa nao mostrou resultado satisfatorio nesta paciente, que evoluiu com caracteristicas autonomicas e insuficiencia respiratoria aguda. Portanto, foi necessario iniciarmos o protocolo institucional de PFT, 1x/dia, com troca de uma volemia plasmatica. Apos a quarta PFT, o exame clinico neurologico da paciente apresentou melhora significativa, podendo inclusive ser extubada. Finalizamos o tratamento com mais quatro PFTs adicionais ate alta hopsitalar da mesma para reabilitacao. Conclusao: A SGB e uma doenca paralitica flacida aguda com fraqueza progressiva simetrica e arreflexia, geralmente ocorre apos uma infeccao respiratoria ou gastrointestinal, com apresentacao variando entre 3 e 50 dias. O suposto mecanismo fisiopatologico e uma resposta autoimune aberrante que evoca uma reacao cruzada contra os antigenos dos nervos perifericos. Nesses dois casos acima, as caracteristicas epidemiologicas, clinicas e os achados laboratoriais sugerem que a infeccao por SARS-CoV-2 pode ser mais uma infeccao viral causadora de GBS. A resposta ao tratamento com TPE em ambos os pacientes foi positiva e gratificante. Copyright © 2022

Primary care strategies and challenges in addressing the COVID-19 pandemic: an integrative review

Introduction: Sars-Cov-2 is a highly transmissible virus, with a large number of sick and occasionally infected individuals, which represents a risk of overload for the provision of care to symptomatic and more severe cases, which may have repercussions. in the strangulation of the health system and significantly increase the lethality of the disease.

Service guarantees in an e-commerce platform: proposition of a framework based on customers' expectations, negative experiences and behavioural responses

Purpose Companies' relationship with their customers through e-commerce platforms has increased considerably in the past few years, bringing new challenges concerning service guarantees (SG). This study aims to propose a framework of the relations between customers' expectations on SG, their negative experiences and their attitudes and behavioural intentions towards an e-commerce platform. Design/methodology/approach The research had a qualitative and descriptive approach. Testimonials from clients of an online e-commerce platform were obtained through interviews via videoconference and non-participant observation on a complaints website in Brazil. The testimonies were analysed through content analysis. Findings The customer expectations regarding the SG offered by the e-commerce platform are congruent with the five categories of the theory that support this research. Customer testimonials on the complaints site show that their negative experiences with the e-commerce platform generated negative emotional, cognitive and behavioural responses towards the company. A framework was proposed, including customers' expectations regarding SG, their negative experiences and their repercussions on clients' attitudes and behavioural intentions. Originality/value This article is the only that contemplates customers' expectations about SG in an e-commerce platform, relating them to attitudes and behavioural intentions. Thus, its framework demonstrates the relationships between customer expectations about SGs, their negative experiences and attitudinal and behavioural repercussions. This article brings academic and managerial contributions for companies and managers of e-commerce platforms. It contributes to clients and consumer protection associations by revealing problems they face with SG on e-commerce platforms. This research can be used by those responsible for elaborating laws and public policies to regulate and inspect the relationships between e-commerce platforms and their customers.

Innovative Educational Approach in Healthcare-Associated Infection Prevention and Control. Results of a European Study

Prevent and control healthcare-associated infections (HAIs) is a priority in healthcare assistance, not only due to present COVID-19 pandemic. Annually, around 3.2 million patients are affected by one of these infections and it is estimated that without controlling them, by 2050, 10 million more people could die every year, with especial relevance among elderly with infectious situations representing a third of mortality in people over 65 years old. Higher Education Institutions (HEI) in healthcare area have an important role in this panorama, by preparing students to be future professionals, stimulating them to have an innovative and entrepreneurial approach to today’s real-life challenges. A mixed-methods research was conducted, at European level (in Portugal, Finland, Poland and Spain), to facilitate learning of good practices on HAIs prevention and control while developing innovative solutions. 1475 participants were enrolled, from all partner HEI: 79 professors and mentors were interviewed (individual or focus group), 1326 final year nursing students made a self-report inventory (application of InovSafeCare Scale) and 70 students participated on focus group (agile piloting of the Model). The result of this research is a pedagogical model that mixes dimensions and methods that take nursing students closer to the demands of HAIs prevention and control and capacitates them to transfer knowledge to work settings with an innovative and entrepreneurial perspective – the InovSafeCare Model. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The rescue of the culture of hand hygienization in health services in the pandemic context

The aim of this study was to identify, in the scientific literature, the strategies used by health services to influence the formation of a culture of patient safety through hand hygiene among health professionals during the Covid-19 pandemic. This is a descriptive study of an integrative literature review. An advanced search was performed in the databases that make up the Virtual Health Library (VHL), of the 700 scientific publications identified, after applying the inclusion and exclusion criteria, 11 publications were selected that made up the final sample of the study, as they were from according to the proposed theme. During the study analysis process, the following thematic categories were highlighted: "Hand hygiene and its main public policies", "Nursing and the Covid-19 pandemic" and "Consequences of the breach of the hand hygiene protocol regarding safety of the patient". The studied literature showed that the consequences in relation to breaking the hand hygiene protocol regarding patient safety, especially in the Covid-19 pandemic, are worrisome because they affect both the patient's safety and the health professional's integrity. Furthermore, an increase in hospital stay and hospital costs, increased demand for the use of broad-spectrum antibiotics and increased morbidity and mortality rates were also identified.

The future of higher education: How to move forward

This article reflects on possible and necessary transformations, based on the experiences lived by teachers, students, and educational institutions throughout the year 2020, as they survived, learned and adapted to the COVID-19 pandemic. Teaching should be based on pedagogical evidence, collaborative practices, educational technology, supported by computer infrastructure and evaluative practices that foster learning, through feedback and a closer interaction between learner and teacher. The direction pointed in the future includes and is based on blended education to help students to achieve competence for professional practice. The development of interpersonal skills will be fundamental, especially in the training of health professionals. Offering opportunities for faculty development and creating communities of practice for collaborative learning will also be essential. The greater flexibility of curricula and the technological mediation of the teaching and learning process should favor exchanges and the internationalization of institutions. In this way, both undergraduate, graduate and stricto-sensu education tends to expand its scope and will no longer be limited to its original niches, expanding to national and international agreements. University spaces and face-to-face moments will be adapted to a new reality, which allows the student to acquire essential clinical and relational skills, and which require activities in the professional practice settings. In the HPE, ensuring these training moments will continue to be a fundamental requirement. Thus, classrooms, laboratories and internship fields must be safe, allowing direct guidance and supervision by teachers and preceptors. It is possible and probable that, for a long time, it will still be necessary to maintain some social distance, use of personal protective equipment, hand and environment hygiene so that students are not deprived of these experiences during their training. In the health area, it will be necessary to reaffirm that there is no dilemma between the training of health professionals and patient safety, as we experienced with the interruption of most practical activities in the HPE undergraduate courses in Brazil, during the first semester of 2020. Training health professionals, in a context of a health & sanitary emergency, is equivalent to caring for people in any context or setting. It is the same if we are talking about access to personal protective equipment or access to vaccines. The challenges are launched and the possibilities for advancement emerge and need to be taken advantage of from a cohesive work between university managers, faculty, administrative staff and students.

Think up to teach well: Instructional design for remote learning

The pandemic caused by the new coronavirus (SARS-CoV-2) imposed a worldwide scenario of social isolation and suspension of face-to-face teaching activities at all levels of education. It has forced the emergency adoption of remote teaching strategies to maintain the continuity of the didactic activities, even though in a limited way. On the other hand, most teachers, at all levels of education, had barely or no knowledge and experience with remote teaching. Although the educational institutions offered support, to some degree or another, it was up to individual teachers to do most of theirselves training, prepare, and deliver their subjects. Also, many courses were migrated to the virtual learning environment without the proper adaptations, which may result in worse learning outcomes. Although there are different methodologies for planning and implementing e-learning, the ADDIE model is largely popular and relatively simple to implement, and for this reason, it was chosen for the development of this article. Thus, we present the steps of analysis, design, development, implementation, and evaluation of a remote course. Additionally, we include practical elements such as an indication of equipment, software, links, and suggestions to accomplish these steps.

Editorials about the coronavirus pandemic: The facultative modality

This work aims to describe and analyse the facultative modality as a resource and argumentative strategy in the opinionated journalistic genre, the editorial. For that, we resort to studies related to the discursive modalization and the typology of the modalities of Hengeveld (2004), which defines the facultative modality as that referring to the intrinsic and acquired abilities and skills. Therefore, 60 editorials were selected and made available online on the website of the newspaper O Diário do Nordeste, whose content addressed the effects of the coronavirus pandemic. After the analysis of the facultative modality in the editorials, it was found that the speaker does not preferably include [-inclusion] in the incidence of modal value, choosing modal orientations for the Event, making the installed option less emphatic [-categorical] and with positive modalized statements [+ positive]. When introducing the facultative modality, the editorialist mostly used modal auxiliaries, inflected in the present indicative, which brings the facultative modality closer to the realis aspect, or in the subjunctive present, which brings it closer to the unrealis aspect. Finally, the relevance of the facultative modality as a resource and argumentative strategy was concluded, in which it is engendered in the discourse in view of the editorialist's intentions and communicative purposes. © 2021 Universidade do Vale do Rio dos Sinos. All rights reserved.

THE DEONTIC MODALITY IN HEALTH DISCOURSE: AN ANALYSIS OF THE DEONTIC SEMANTIC VALUES IN THE TREATMENT AND PREVENTION AGAINST THE CORONAVIRUS

This work aims to describe and analyze, based on Hengeveld (2004), the expression of deontic semantic values (deonticity) in the health discourse on the treatment and prevention of coronavirus on Spanish-language web pages. In this sense, we aim that the current context in which Spanish and Hispanic-American society finds itself in relation to this new pandemic allows health professionals to codify the deontic modality in a different way, seeking, through the appropriate choice of linguistic expressions, to differentiate the deontic semantic values. After the qualitative analysis of the cases, we found that deonticity differs based on the polarity of deontic modalization, in this case, positive (recommendation, permission and obligation) and negative (not necessary, not permission/obligation and prohibition), considering the tense and grammatical mode (present, simple future and simple conditional of the indicative), in addition to modal orientation (Participant and Event) and forms of expression (modal auxiliaries, verbs and adjectives in a predicative function).