Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles' compliance.

Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool-Kamishibai board (K-board)-during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.

Inter-observer variability with five computed tomography severity scales for COVID-19 pneumonia assessment.

INTRODUCTION: By the end 2019 there was an outbreak of pneumonia caused by a new coronavirus, a disease that was called coronavirus disease 2019 (COVID-19). Computed tomography (CT) has played an important role in the diagnosis of COVID-19 patients. OBJECTIVE: To demonstrate inter-observer variability with five scales proposed for measuring the extent of COVID-19 pneumonia on tomography. METHODS: Thirty five initial chest CT scans of patients who attended respiratory triage for suspected COVID-19 pneumonia were analyzed. Three radiologists classified the tomographic images according to the severity scales proposed by Yang (1), Yuan (2), Chun (3), Wang (4) and Instituto Nacional de Enfermedades Respiratorias-Chung-Pan (5). The percentage of agreement between the evaluators for each scale was calculated using the intra-class correlation index. RESULTS: In most patients were five pulmonary lobes compromised (77.1% of the patients). Scales 1, 2, 4 and 5 showed an intra-class correlation > 0.91 (p < 0.0001), with agreement thus being almost perfect. CONCLUSIONS: Scale 4 (proposed by Wang) showed the best inter-observer agreement, with a coefficient of 0.964 (p = 0.001).

INTRODUCCIÓN: A finales de 2019 se presentó un brote de neumonía causada por un nuevo coronavirus, enfermedad a la que se denominó COVID-19. La tomografía computarizada ha desempeñado un papel importante en el diagnóstico de los pacientes con COVID-19. OBJETIVO: Demostrar la variabilidad interobservador con cinco escalas propuestas para la medición de la extensión de la neumonía ocasionada por COVID-19 mediante tomografía. MÉTODOS: Se analizaron 35 tomografías de tórax iniciales de pacientes que asistieron al triaje respiratorio por sospecha de neumonía por COVID-19. Tres radiólogos realizaron la clasificación de las imágenes tomográficas de acuerdo con las escalas de severidad propuestas por Yang (1), Yuan (2), Chun (3), Wang (4) e INER-Chung-Pan (5). Se calculó el porcentaje de concordancia entre los evaluadores para cada escala con el índice de correlación intraclase. RESULTADOS: La mayoría de los pacientes presentó afección de cinco lóbulos pulmonares (77.1 % de los pacientes). Las escalas 1, 2, 4 y 5 mostraron una correlación intraclase > 0.91, con p < 0.0001, por lo que la concordancia fue casi perfecta. CONCLUSIONES: La escala 4 (de Wang) mostró la mejor concordancia interobservador, con un coeficiente de 0.964 (p = 0.001).

Folate- and glucuronate-functionalization of layered double hydroxides containing dysprosium and gadolinium and the effect on oxidative stress in rat liver mitochondria.

Zinc/aluminum layered double hydroxide (LDH) particles were prepared by alkaline precipitation in the presence of dysprosium and dysprosium/gadolinium cations. The particles formed were stable against exchange reactions with folate or glucuronate ions since these organic ions exclusively functionalized the external surface of the layered double hydroxides. While the dysprosium derivatives reached magnetization susceptibilities between 2.06 × 10-5 and 2.20 × 10-5 cm3/g, the samples simultaneously containing dysprosium and gadolinium decreased to a range between 1.08 × 10-5 and 1.73 × 10-5 cm3/g. This last sample was tested as a magnetic resonance imaging contrast agent and demonstrated a reduction in T1 and T2 relaxation times in a linear dependence with the LDH concentration. The oxidative stress assays in rat liver mitochondria demonstrated the low toxicity of the composition simultaneously containing dysprosium and gadolinium as well as the functionalization product with glucuronate ions, suggesting the potential of these particles to design alternative MRI contrast agents.

Influence of different light-curing units in surface roughness and gloss of resin composites for bleached teeth after challenges.

The aim of this study evaluates the surface roughness and gloss of resin composites for bleached teeth, using different modes of light curing and photoinitiators after challenges. Eighty discs were made with Filtek Z350XT (camphorquinone) and Vit-l-escence (camphorquinone, amine and lucerin-TPO). Forty disks were light cured by a monowave LED and forty with a polywave LED. Roughness and gloss analysis were made. The specimens were exposed to brushing and hydrochloric acid (HCl) and analyzed again. The data were analyzed by two-way ANOVA analysis of variance for repeated measures, considering each challenge separately. Afterwards, Tukey test was applied for multiple comparisons (p ≤ 0.05). All resins had a significant increase in roughness after brushing with polywave device and only Vit-l-escence presented significant increased after HCl. Regarding the surface gloss, no influence on light-curing units was found for all resins after toothbrushing and after HCl for Vit-l-escence. All resins showed significant decrease in gloss after the challenges. The type of LED device did not influence the roughness and surface gloss of resin composites for bleached teeth after the challenges.

Decreased short-interval intracortical inhibition correlates with better pinch strength in patients with stroke and good motor recovery.

BACKGROUND: Deeper short-interval intracortical inhibition (SICI), a marker of GABAA activity, correlates with better motor performance in patients with moderate to severe hand impairments in the chronic phase after stroke. OBJECTIVES: We evaluated the correlation between SICI in the affected hemisphere and pinch force of the paretic hand in well-recovered patients. We also investigated the correlation between SICI and pinch force in controls. METHODS: Twenty-two subjects were included in the study. SICI was measured with a paired-pulse paradigm. The correlation between lateral pinch strength and SICI was assessed with Spearman's rho. RESULTS: There was a significant correlation (rho = 0.69, p = 0.014) between SICI and pinch strength in patients, but not in controls. SICI was significantly deeper in patients with greater hand weakness. CONCLUSIONS: These preliminary findings suggest that decreased GABAA activity in M1AH correlates with better hand motor performance in well-recovered subjects with stroke in the chronic phase.

Potencialidades e fragilidades dos núcleos de segurança do paciente em serviços hospitalares / Potentials and weaknesses of the patient safety centers in hospital services

A busca da qualidade do sistema de serviços de saúde é uma exigência cada vez mais presente na sociedade moderna e um dever do próprio sistema. No ambiente hospitalar, esta exigência torna fundamental a criação de normas e mecanismos de avaliação e controle da qualidade assistencial. Neste cenário, a qualidade é definida a partir das necessidades e do interesse dos clientes, que desejam adquirir produtos e serviços com excelência em todos os aspectos. Com base na premissa de que a segurança do paciente é parte integrante da prestação de cuidados de qualidade, os locais de atendimento à saúde devem estabelecer programas abrangentes voltados para a melhoria continua da segurança do paciente. A adesão das iniciativas da Aliança Mundial para Segurança do Paciente da Organização Mundial de Saúde (OMS), promovidas pelo Ministério da Saúde e a Agência Nacional de Vigilância Sanitária (ANVISA) por parte dos serviços é baixa, justamente por não terem uma cultura institucional voltada para a segurança do paciente. O reflexo disso está na alta ocorrência de eventos adversos (EA) evitáveis em hospitais brasileiros, que corresponde a cerca de 67% de todos os EA. A segurança do paciente é enfoque central das discussões na área da saúde em quase todo o mundo. O tema é para o campo da avaliação em saúde, um dos atributos da qualidade proposto por Donabedian. No Brasil, em 2013, foi editada a Portaria n. 529, de 01 de abril que instituiu a Política Nacional de Segurança do Paciente, definindo ações e metas. No mesmo ano, foi criada a Resolução da Diretoria Colegiada n. 36, de 25 de julho de 2013 que estabeleceu a obrigatoriedade de implantação de um Núcleo de Segurança do Paciente (NSP) nos hospitais, visando reduzir a ocorrência de danos e eventos adversos na assistência aos pacientes, melhorar a qualidade dos serviços prestados, promover o registro e aprimorar a sua qualidade. Certo que resoluções não são suficientes para modificar práticas, este estudo teve como objetivo analisar a implementação de Núcleos de Segurança do Paciente em serviços hospitalares. Trata-se de pesquisa quantitativa, transversal do tipo Survey, por meio da aplicação de questionário estruturado. Para o desenvolvimento da pesquisa, as seguintes etapas foram percorridas: elaboração do questionário, validação de face e conteúdo do mesmo e coleta de dados nos hospitais selecionados utilizando o questionário, composto por 20 itens relacionados ao processo de criação, formação e atuação do NSP nos serviços hospitalares. A pesquisa foi desenvolvida em 11 hospitais de um município do interior do Estado de São Paulo e demonstrou que a maioria dos hospitais 81% (n=9) participam de programa de melhoria da qualidade. Todos os respondentes informaram uma composição multiprofissional do NSP. Quanto ao Plano de Segurança do Paciente (PSP), a maioria dos respondentes indicou a existência (91%; n = 10) e o único hospital que não tem um PSP justificou que não conseguiu elaborar. Todos os hospitais notificam e comunicam os incidentes e eventos adversos, sendo esse procedimento feito tanto na forma eletrônica (82%) como na forma manual (73%) e os dados são analisados, na maioria das vezes, pelo NSP (63,6%) e pelo escritório da qualidade (54,5%). Os respondentes indicaram que 64% dos hospitais informam os pacientes e familiares sobre o acontecimento da ocorrência do EA. Aproximadamente 27% dos hospitais reportaram que não envia à ANVISA a ocorrência de EA. Todos os hospitais realizam a abordagem e devolutiva sobre o EA com o colaborador e adotam os protocolos do Ministério da Saúde referentes ao Programa Nacional de Segurança do Paciente. A dificuldade de aceitação das equipes, a falta de envolvimento dos profissionais das diversas áreas, a falta de adesão dos setores envolvidos apareceu permeando a dificuldades de implantação do NSP. Percebe-se que há NSP atuantes nos serviços hospitalares, bem como um fluxo bem estabelecido para a notificação dos EA, porém, faz-se necessário expandir estas informações coletadas no processo de notificação. Diante do exposto, acredita-se que os resultados encontrados possam oferecer subsídios e acrescentar evidências que contribuam para as reformulações que se fizerem necessárias no processo de formação e implantação dos NSP

The search for the quality of the health service system is a requirement increasingly present in modern society and a duty of the system. In the hospital environment, this requirement makes the creation of care quality evaluation and control standards and mechanisms of fundamental importance. In that context, quality is defined based on the clients' needs and interest, who want to purchase products and services of excellence in all aspects. Based on the premise that patient safety is a part of quality service provision, the healthcare establishments should establish comprehensive programs for the continuous improvement of patient safety. The services' compliance rates with the initiatives of the World Health Organization's (WHO) Global Patient Safety Alliance, promoted by the Brazilian Health Department and the Brazilian National Health Surveillance Agency (ANVISA) is low, exactly because they do not have an institutional patient safety culture. That is reflected in the high rates of avoidable adverse events (AE) in Brazilian hospitals, corresponding to about 67% of all AE. Patient safety is the main focus of discussions in health almost everywhere in the world. In the field of health assessment, the theme is one of the quality attributes proposed by Donabedian. In Brazil, Decree 529 was enacted on April 1st, 2013, which established the National Patient Safety Policy, setting actions and targets B. In the same year, the Collegiate Directorate Resolution 36 was created on July 25th, 2013, which established the compulsory implementation of a Patient Safety Center (PSC) in hospitals, aiming to reduce the occurrence of damage and adverse events in patient care, to improve the quality of the service provided, to promote the registration and improve its quality. As resolutions are insufficient to modify practices, the objective of this study Analyze the implementation of Patient Safety Centers in hospital services. A quantitative and cross-sectional survey was undertaken through the application of a structured questionnaire. To develop the research, the following steps were executed: elaboration of the question, face and content validation and data collection at the selected hospitals using the questionnaire, which consisted of 20 items related to the creation, constitution and activity process of the NSP in the hospital services. The research was developed in 11 hospitals from an interior city in the State of São Paulo and demonstrated that most of the hospitals, 81% (n=9), participate in a quality improvement program. All of the respondents informed that the PSC consists of multiple professions. As regards the Patient Safety Plan (PSP), most respondents indicated that such a plan exists (91%; n = 10) and the only hospital that does not have a PSP justified that it did not manage to elaborate one. All hospitals report and inform about the incidents and adverse events. This procedure takes place electronically (82%) and/or manually (73%) and, in most cases, the data are analyzed by the PSC (63.6%) and the quality service (54.5%). The respondents indicated that 64% of the hospitals inform the patients and relatives about the occurrence of the AE. Approximately 27% of the hospitals reported that they do not forward the AE report to ANVISA. All hospitals discuss and give feedback to the collaborator about the AE and adopt the Health Department's protocols of the National Patient Safety Program. The teams' acceptance difficulties, the lack of involvement among professionals from different areas and the lack of compliance of the sectors involved permeated difficulties to implement the PSC. As noticed, Patient Safety Centers are active in the hospital services, with a well-established flow for the reporting of AE. Nevertheless, this information collected during the reporting process needs further expansion. In view of the above, we believe that the results found can offer support and add evidence that contributes to any reformulations needed in the development and implementation process of the PSC

Increase in Short-Interval Intracortical Facilitation of the Motor Cortex after Low-Frequency Repetitive Magnetic Stimulation of the Unaffected Hemisphere in the Subacute Phase after Stroke.

Low-frequency repetitive transcranial magnetic stimulation of the unaffected hemisphere (UH-LF-rTMS) in patients with stroke can decrease interhemispheric inhibition from the unaffected to the affected hemisphere and improve hand dexterity and strength of the paretic hand. The objective of this proof-of-principle study was to explore, for the first time, effects of UH-LF-rTMS as add-on therapy to motor rehabilitation on short-term intracortical inhibition (SICI) and intracortical facilitation (ICF) of the motor cortex of the unaffected hemisphere (M1UH) in patients with ischemic stroke. Eighteen patients were randomized to receive, immediately before rehabilitation treatment, either active or sham UH-LF-rTMS, during two weeks. Resting motor threshold (rMT), SICI, and ICF were measured in M1UH before the first session and after the last session of treatment. There was a significant increase in ICF in the active group compared to the sham group after treatment, and there was no significant differences in changes in rMT or SICI. ICF is a measure of intracortical synaptic excitability, with a relative contribution of spinal mechanisms. ICF is typically upregulated by glutamatergic agonists and downregulated by gabaergic antagonists. The observed increase in ICF in the active group, in this hypothesis-generating study, may be related to M1UH reorganization induced by UH-LF-rTMS.

Translational neurorehabilitation research in the third world: what barriers to trial participation can teach us.

BACKGROUND AND PURPOSE: Most stroke rehabilitation studies have been performed in high-income countries. The aim of this study was to identify the main barriers for patient inclusion in a research protocol performed in Brazil. METHODS: We evaluated reasons for exclusion of patients in a pilot, randomized, double-blinded clinical trial of stroke rehabilitation. Descriptive statistical analysis was performed. RESULTS: Only 5.6% of 571 screened patients were included. Recurrent stroke was responsible for exclusion of 45.4% of potentially eligible patients. CONCLUSIONS: Recurrent stroke represented a big barrier to enroll patients in the protocol. External validity of rehabilitation trials will benefit from definition of study criteria according to regional characteristics of patients, including rates of recurrent stroke. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01333579.

Ablacao de Fibrilacao Atrial por Mapeamento Eletroanatomico: Eficacia e Fatores de Recorrencia / Atrial Fibrillation Ablation by Use of Electroanatomical Mapping: Efficacy and Recurrence Factors

Fundamento: A ablação por cateter de radiofrequência guiada por mapeamento eletroanatômico é, atualmente, uma importante opção terapêutica para o tratamento da fibrilação atrial. A complexidade do procedimento, as diferentes técnicas e a diversidade de pacientes dificultam a reprodução dos resultados bem como a indicação do procedimento. Objetivo: Avaliar a eficácia e os fatores relacionados à recorrência de fibrilação atrial. Métodos: Estudo de coorte prospectivo com pacientes consecutivos submetidos ao tratamento de fibrilação atrial por ablação e mapeamento eletroanatômico. Foram incluídos os seguintes pacientes: idade acima de 18 anos; portadores de fibrilação atrial paroxística, persistente ou persistente de longa duração; com registro de fibrilação atrial em eletrocardiograma, Holter ou ergometria (duração > 15 minutos); com sintomas associados aos episódios de fibrilação atrial; e apresentando refratariedade a, pelo menos, duas drogas antiarrítmicas (entre elas amiodarona) ou impossibilidade do uso de drogas antiarrítmicas. Resultados: Foram incluídos 95 pacientes (idade 55 ± 12 anos, 84% homens, CHADS2 médio = 0,8) que realizaram 102 procedimentos com seguimento mediano de 13,4 meses. A taxa livre de recorrência após o procedimento foi de 75,5% após 12 meses. Os pacientes portadores de fibrilação atrial paroxística e fibrilação atrial persistente apresentaram recorrência de 26,9% versus 45,8% dos pacientes portadores de fibrilação atrial persistente de longa duração (p = 0,04). Das variáveis analisadas, o tamanho do átrio esquerdo demonstrou ser preditor independente de recorrência de fibrilação atrial após ...

Background: Radiofrequency catheter ablation guided by electroanatomical mapping is currently an important therapeutic option for the treatment of atrial fibrillation. The complexity of the procedure, the several techniques used and the diversity of the patients hinder the reproduction of the results and the indication for the procedure. Objective: To evaluate the efficacy and factors associated with recurrence of atrial fibrillation. Methods: Prospective cohort study with consecutive patients submitted to atrial fibrillation ablation treatment guided by electroanatomical mapping. The inclusion criteria were as follows: minimum age of 18 years; presence of paroxysmal, persistent or long-standing persistent AF; AF recording on an electrocardiogram, exercise testing or Holter monitoring (duration longer than 15 minutes); presence of symptoms associated with AF episodes; AF refractoriness to, at least, two antiarrhythmic drugs, one of which being amiodarone, or impossibility to use antiarrhythmic drugs. Results: The study included 95 patients (age 55 ± 12 years, 84% men, mean CHADS2 = 0.8) who underwent 102 procedures with a median follow-up of 13.4 months. The recurrence-free rate after the procedure was 75.5% after 12 months. Atrial fibrillation recurred as follows: 26.9% of patients with paroxysmal and persistent atrial fibrillation; 45.8% of patients with long-standing persistent atrial fibrillation (p = 0.04). Of the analyzed variables, the increased size of the left atrium has proven to be an independent predictor of atrial fibrillation recurrence after the procedure (HR = 2.58; 95% CI: 1.26-4.89). Complications occurred in 4.9% of the procedures. Conclusion: Atrial fibrillation ablation guided by electroanatomical mapping has shown good efficacy. The increase in left atrium size was associated with atrial fibrillation recurrence. .

Atrial fibrillation ablation by use of electroanatomical mapping: efficacy and recurrence factors.

BACKGROUND: Radiofrequency catheter ablation guided by electroanatomical mapping is currently an important therapeutic option for the treatment of atrial fibrillation. The complexity of the procedure, the several techniques used and the diversity of the patients hinder the reproduction of the results and the indication for the procedure. OBJECTIVE: To evaluate the efficacy and factors associated with recurrence of atrial fibrillation. METHODS: Prospective cohort study with consecutive patients submitted to atrial fibrillation ablation treatment guided by electroanatomical mapping. The inclusion criteria were as follows: minimum age of 18 years; presence of paroxysmal, persistent or long-standing persistent AF; AF recording on an electrocardiogram, exercise testing or Holter monitoring (duration longer than 15 minutes); presence of symptoms associated with AF episodes; AF refractoriness to, at least, two antiarrhythmic drugs, one of which being amiodarone, or impossibility to use antiarrhythmic drugs. RESULTS: The study included 95 patients (age 55 ± 12 years, 84% men, mean CHADS2 = 0.8) who underwent 102 procedures with a median follow-up of 13.4 months. The recurrence-free rate after the procedure was 75.5% after 12 months. Atrial fibrillation recurred as follows: 26.9% of patients with paroxysmal and persistent atrial fibrillation; 45.8% of patients with long-standing persistent atrial fibrillation (p = 0.04). Of the analyzed variables, the increased size of the left atrium has proven to be an independent predictor of atrial fibrillation recurrence after the procedure (HR = 2.58; 95% CI: 1.26-4.89). Complications occurred in 4.9% of the procedures. CONCLUSION: Atrial fibrillation ablation guided by electroanatomical mapping has shown good efficacy. The increase in left atrium size was associated with atrial fibrillation recurrence.

Sonolência diurna excessiva entre acadêmicos de psicologia / Excessive daytime sleepiness among students of psychology

A sonolência compreende um processo biológico de homeostase do organismo, que quando em excesso se configura em uma patologia. O objetivo deste trabalho consistiu avaliar a prevalência de sonolência diurna excessiva em acadêmicos do curso de psicologia de uma universidade. Foram entrevistados 286 estudantes e utilizou-se a Escala de Sonolência de Epworth (ESE) e um questionário sociodemográfico. A Escala de Sonolência de Epworth constitui valores do cotidiano que inclinem para algum tipo de sonolência, tal como estar sentado e lendo; vendo televisão; sentado em lugares públicos; andando uma hora sem parar; deitando-se para descansar à tarde, quando as circunstâncias permitem; sentado e conversando; sentado calmamente depois do almoço sem álcool; enquanto estiver dirigindo, quando parar por alguns minutos. Observou-se que 54,44% dos acadêmicos apresentaram sonolência diurna excessiva, sendo que apenas o fator idade teve significância (P = 0,004); quanto menor a idade, tanto maior tendência à sonolência. Outras variáveis como, turno frequentado, sexo, estado civil, ano de curso, nível de dependência e o fator trabalho não tiveram associação significativa. (AU)

The sleepiness comprises a biologic process of homeostasis, that when in excess is configured in a pathology. The objective of this work consists to evaluate the prevalence of excessive daytime sleepinessin academics of psychology of a university. In this way 286 students. Utilizing the Epworth Sleepiness Scale (ESS) and a sociodemographic questionnaire. The Epworth Sleepiness Scale constitutes daily values of academics that inclinates to some kind of sleepiness, such as being sitting and reading; watching TV; sitting in a public place; lying down to rest in the afternoon when the circumstances permit; sitting and talking to someone; sitting quietly after a lunch without alcohol; in acar, while stopped for a few minutes in a traffic. It was observed that 54,44% of the students presented excessive daytime sleepiness, and only the age factor was significant (P = 0,004), how much lower the age, greater the tendency to sleepiness. Other variables such as shift frequented, gender, marital status, year of study, level of dependence and labor factor are not significantly associated with the ESS. (AU)

Home-based nerve stimulation to enhance effects of motor training in patients in the chronic phase after stroke: a proof-of-principle study.

BACKGROUND: Somatosensory stimulation in the form of repetitive peripheral nerve stimulation (RPSS) is a promising strategy to improve motor function of the upper limb in chronic stroke. Home-based RPSS may be an alternative to hospital-based RPSS. OBJECTIVES: To investigate the feasibility and safety of an innovative program of home-based RPSS combined with motor training and to collect preliminary data on the efficacy of this program to enhance hand motor function in patients in the chronic phase after stroke. METHODS: Twenty patients were randomized to either active or sham RPSS associated with daily motor training performed at home over 4 consecutive weeks. All the patients were able to perform tasks of the Jebsen-Taylor Test (JTT). The primary outcome measures were feasibility, evaluated by self-reported compliance with the intervention, and safety (adverse events). Secondary outcomes comprised improvements in hand function in the JTT after end of treatment and after a 4-month follow-up period. RESULTS: There were no relevant adverse events. Compliance with RPSS and motor training was significantly greater in the active group than in the sham group. Upper extremity performance improved significantly more in the active group compared with the sham group at the end of treatment. This difference remained significant 4 months later, even when differences in compliance with motor training were considered. CONCLUSIONS: Home-based active RPSS associated with motor training was feasible, was safe, and led to long-lasting enhancement of paretic arm performance in the chronic phase after stroke for those who can perform the JTT. These results point to the need for an efficacy trial.

Qualidade de vida em estudantes de psicologia / Quality of life in students of psychology

A grande expectativa nos dias de hoje para se ter uma vida saudável, tanto nos aspectos físicos, psicológicos, quanto nas relações sociais, é possuir uma boa qualidade de vida (QV). Entretanto, o conceito de QV pode ser encontrado na literatura a partir de diversos pontos de vista. Dessa forma, com a intenção de analisar o seu meio cultural e seus sistemas de valores, em que diariamente é acompanhado pelo ser humano em relação aos seus objetivos, expectativas, padrões e preocupações, colocamos o conceito de QV em três níveis: avaliação total do bem-estar, domínio global (físico, psicológico, econômico, espiritual e social) e os componentes de cada domínio (Físico, Psicológico, Relações Sociais e Meio Ambiente). Assim, a presente pesquisa tem o objetivo de avaliar a qualidade de vida dos acadêmicos de Psicologia da Universidade Católica Dom Bosco. No total, 285 estudantes responderam a dois questionários anônimos: o WHOQOL-breve de Qualidade de Vida e um questionário sociodemográfico. O cruzamento de dados dos questionários apresentou várias características. Percebeu-se que os homens obtiveram melhor desempenho do que as mulheres em relação à qualidade de vida, principalmente os do sétimo semestre. Além disso, foi observado que quanto maior a idade, tanto melhor a Qualidade de Vida nos domínios: Físico, Psicológico, Relações Sociais e Meio Ambiente. (AU)

The great expectation nowadays in order of a healthy life, either in psychological and physical aspects or social relationships is a high quality of life (QOL). However, the concept of QOL can be found in the literature from different points of view. In order to assess culture and value systems which is daily followed by humans in relation to their personal goals, expectations, standards and concerns we haveused the concept of quality of life in three levels: globalwell-beingevaluation, broad domains (physical health, psychological health, economic, personal´s believes and social relationships) and each component of the domain (physical health, psychological state, social relationships and features of the environment). The goal of thisresearch is to evaluate quality of life among undergraduate Psychologystudents from Dom Bosco Catholic University. In total, 285 studentsanswered two anonymous questionnaires: the WHOQOL-bref quality of life instrument and a sociodemographic questionnaire. The crossing of data from the questionnaires showed several characteristics. It´s hasbeen noticed that men had the best performances when comparing togirls in relation to quality of life, especially the ones in the seventh semester. Besides, it´s been shown that as older a person is, better is the quality of life in domains: physical health, psychological state, social relationships and features of the environment. (AU)

Recaída sistémica con compromiso de SNC de linfoma Hodgkin y respuesta al esquema Gemcitabina/Vinorelbina / Systemic Relapse with involvement of the CNS by Hodgkin's Lymphoma: response to gemcitabine/Vinorelbine Scheme

El compromiso del sistema nervioso central (SNC) por Linfoma de Hodgkin es infrecuente. El tratamiento con Gemcitabina/Vinorelbina es efectivo y bien tolerado en pacientes con Linforma de Hodkgin recaídos/refractarios.

Central nervous system involvement by Hodgkin is rare. Gemcitabine/Vinorelbine is an effective and well tolerated regimen for patients with relapsed and refractory Hodgkin's lymphoma.

Linfoma gástrico primario / The conservative treatment with anthracycline containing chemotherapy has replaced gastrectomy as a standard approach against primary gastric lymphoma

El estómago constituye la localización más frecuente del linfoma no-Hodgkin extranodal. El linfoma difuso de células grandes B es el tipo histológico predominante. Es un linfoma agresivo que inicialmente se presenta como enfermedad localizada asociada o no a la infección con Helicobacter pylori. El tratamiento conservador con regímenes quimioterápicos con antraciclina seguidos o no por radioterapia en campos comprometidos ha reemplazado a la gastrectomía como tratamiento de primera línea.

The stomach is the extranodal site most commonly involved by non-Hodgkin lymphomas. Diffuse large B-cell lymphoma is the most common histotype category arising in this organ. This is an aggressive lymphoma usually presenting as limited disease, being associated or not to Helicobacter pylori infection. Conservative treatment with anthracycline-containing chemotherapy, followed or not by involved-field radiotherapy has replaced gastrectomy as standard approach against this malignancy.

A importância do preparo da amostra para o sucesso da análise de alimentos / The importance of sample preparation for success in food analysis

A amostragem constitui um conjunto de operações executadas dentro de uma especificação, assegurando que a amostra coletada contenha todas as características da matriz. É uma série de etapas executadas com as quais se obtém do material em estudo, uma porção pequena de tamanho apropriado para o trabalho em laboratório. Em experimentos com alimentos, os métodos analíticos são compatíveis com o tipo do produto a ser estudado. Portanto, deve-se obedecer a uma seqüência analítica, tais como: definição do problema, escolha do método, amostragem, pré-tratamento da amostra e separação, medição, calibração de equipamentos, avaliação e a ação, onde qualquer falha em uma das etapas pode comprometer os resultados do estudo em desenvolvimento. O objetivo deste trabalho é apresentar de forma abrangente, informações quanto à importância do preparo da amostra, visando obter um resultado preciso para o sucesso nas análises de composição centesimal e mineral de alimentos.

Avaliação da inserção da odontologia no Programa Saúde da Família de Pompéu ( MG ): a satisfação do usuário / The evaluation of the dental service inclusion in the Family Health Program of Pompéu ( MG ): the user satisfaction

Para avaliar a inserção da odontologia no Programa Saúde da Família (PSF) do município de Pompéu, Minas Gerais, pelo olhar do usuário, foi entrevistado um grupo de 120 usuários do PSF do bairro Volta do Brejo (estimativa de proporção, grau de confiança de 90 por cento). Como instrumento de coleta de dados, foi utilizado um questionário. As principais queixas dos usuários foram relacionadas à presteza no atendimento e à resolutividade do serviço. Como fatores positivos, elucidaram a presença dos agentes comunitários de saúde (ACS) e a proximidade da unidade de saúde das suas residências. Os "problemas de boca" ficam, assim, sem solução como os observados na saúde: desigualdades no acesso, ausência de integralidade, insuficiência de pessoal, insuficiência de recursos financeiros.

Manifestações bucofaciais da hanseníase / Oral manifestations of leprosy

A hanseníase é uma doença crônica granulomatosa causada pelo Mycobacterium leprae, que afeta primariamente o sistema nervoso periférico e, secundariamente, a pele e alguns outros tecidos e órgãos. A via de infecção mais provável é o trato respiratório, através da inalação de gotículas eliminadas pelos doentes das formas infectantes. As alterações faciais e bucais da hanseníase são descritas e discutidas neste trabalho. O reconhecimento dos sinais e sintomas da doença devem ser de interesse do cirurgião-dentista