Transitional care of young people with juvenile idiopathic arthritis in Italy: results of a Delphi consensus survey.

OBJECTIVES: To present the results of a Delphi consensus survey among Italian paediatric and adult rheumatologists on transitional care (TC) of young people (YP) with juvenile idiopathic arthritis (JIA). METHODS: A taskforce of 27 paediatric and adult rheumatologists evaluated the applicability of the 2016 EULAR/PReS recommendations for TC to the Italian rheumatology practice and healthcare system and formulated additional country-specific statements aimed to increase their suitability. After a two-round discussion, applicability of EULAR/PReS recommendations and agreement with newly-proposed statements were voted on a 0-10 scale (where 0 = no applicability/agreement and 10 = total applicability/agreement). A mean level of agreement ≥8 was deemed acceptable. RESULTS: The consensus threshold was reached for only 4 of the 12 EULAR/PReS recommendations and for 25 of the 27 country-specific statements. Poor agreement with EULAR/PReS recommendations was mostly explained by paucity of centres in Italy that possess both paediatric and adult rheumatologists, disagreement about optimal time of transition start and de nition of transition coordinator, diversity between paediatric and adult clinimetric assessments, and lack of administrative and financial support. CONCLUSIONS: This consensus initiative represents an important step forward toward the establishment of a nationwide TC network for YP with JIA in Italy. The main goals established for the future are the identification of adult rheumatology centres that are willing to participate in the TC process, the education of adult rheumatology teams on childhood-onset rheumatic diseases and transition issues, and the increased awareness of public healthcare authorities and other stakeholders about the importance of good-quality TC.

Cardiometabolic risk and subclinical vascular damage assessment in idiopathic inflammatory myopathies: a challenge for the clinician.

OBJECTIVES: A high prevalence of cardiovascular disease (CVD), not fully explained by the prevalence of traditional risk factors only, is reported in patients with idiopathic inflammatory myopathies (IIMs). Thus, we investigated if novel markers of CVD risk, like carotid diameter and advanced glycated end products, can better predict increased CVD risk in IIM patients. METHODS: We studied 43 consecutive patients diagnosed with IIM. All the patients underwent a clinical and laboratory evaluation of cardiovascular risk factors and characterisation of myositis disease activity. Non-invasive instrumental examinations performed included the measurement of carotid parameters (intima-media thickness, IMT and mean arterial diameter, mAD) by ultrasonic techniques, advanced glycation end-product accumulation in the skin by autofluorescence (AF) and body composition by bioelectrical impedance analysis. The parameters were compared to those measured in 29 controls, with similar mean age, BMI, blood pressure and smoking habits. RESULTS: IIM patients showed normal carotid IMT and distensibility, but higher carotid mAD (p=0.012), higher skin AF (p<0.001), lower fat free mass (p=0.036) and increased waist circumference compared to controls. A significant correlation was observed among AF and mAD (rho=0.317 p<0.05), carotid distension (rho=0.391 p=0.036) and IMT (rho=0.627 p<0.001). CONCLUSIONS: Abnormalities of the studied parameters suggest a higher risk of CV disease in IIM patients independent of disease activity. In this population, a thorough assessment of CV risk is recommended also in absence of overt CV disease during the clinical evaluation.

Care organization in oncology / Organisation des soins en cancérologie

Care organization in oncology. The health care organization for cancer patients has been built with the passing and current cancer plans, and the coordination of all the actions against cancer by the French national cancer institute. The authors describe the several phases of a patient pathway during and after cancer treatment, underline the importance of supporting good practice guidelines for health professionals, certification criteria and cancer authorization decrees for health care institutions, as well as coordination structures, and describe the specific organizations for children and elderly patients with cancer and for patients with rare cancers. Constant adaptation of the health care organization for cancer is necessary because of the rapid evolution of the treatments, as the development of ambulatory surgery and of oral chemotherapy in outpatients.

Organisation des soins en cancérologie. L'organisation des soins en cancérologie s'est structurée au fil des Plan cancer successifs et de la coordination par l'Institut national du cancer de toutes les actions de lutte contre le cancer. Sont décrits ici les différents temps du parcours d'un malade atteint de cancer, pendant et au décours de son traitement, l'encadrement des pratiques des professionnels de santé par les référentiels nationaux de bonne pratique, l'encadrement règlementaire des établissements de santé délivrant les traitements des patients, les structures de coordination, les organisations spécifiques pour les enfants, les sujets âgés et les patients ayant des cancers rares. L'évolution rapide des traitements du cancer nécessite une adaptation constante de l'organisation des soins en cancérologie. C'est le cas pour la chirurgie ambulatoire et le développement des traitements médicaux du cancer (chimiothérapie et thérapie ciblée) par voie orale.

Rheumatic manifestations of scurvy.

This paper reviews the rheumatological manifestations of scurvy, based on articles published in English from 1965 until October 2014, with a particular focus on rheumatological manifestations. Scurvy is a rare, uncommon disease in developed countries. Due to its clinical heterogeneity, the disease can easily mimic rheumatologic conditions leading to a delay in diagnosis and treatment.

Epidemiology and management of neuropsychiatric disorders in Behçet's syndrome.

Behçet's syndrome (BS) is a systemic, chronic, relapsing vasculitis, typically characterized by recurrent orogenital ulcers, ocular inflammation and skin manifestations; articular, vascular, gastroenteric and neurological involvement may also occur. Besides the other clinical features of BS, it seems relatively frequent that patients with BS develop a neurobehavioural syndrome, characterized by euphoria, bipolar disorders and paranoid attitudes, loss of insight/disinhibition, and indifference to their disease, defined as 'neuro-psycho-BS'. To date, the pathogenetic mechanism underlying neuro-psycho-BS has not been determined. It may be secondary to organic neurological involvement, or it may be related to poor quality of life and the relapsing course of the disease. Another engaging theory suggests that it could be related to the frequent observation of psychiatric symptoms during relapses or, in some cases, in the phases preceding reactivation of the disease; these elements suggest that psychiatric disorders in BS could represent a crucial element, whether a psychiatric subset or a distinct clinical feature of the disease. Moreover, it has been reported that cognitive impairment in BS can be seen with or without central nervous system involvement. Globally, psychiatric symptoms have been described as being multifaceted, ranging from anxiety disorders to depressive-bipolar disorders or to psychotic ones. In addition, some psychological characteristics of BS patients seem to predispose them to maladaptive stress management, which may lead to stress-related disorders, including anxiety and depression. Therefore, the aims of this review are to explore the epidemiology of neuro-psycho-BS by evaluating the relationship between the stress system and the multifaceted psychiatric manifestations in BS, and to summarize the therapeutic strategy used.

Isolated aortitis versus giant cell arteritis: are they really two sides of the same coin?

OBJECTIVES: The aim of the study was to compare epidemiological data, clinical findings and results of investigations in patients with isolated aortitis and those with giant cell arteritis (GCA) to establish whether patients with isolated aortitis differ from those with GCA. METHODS: We reviewed the medical notes of all patients consecutively seen in two Rheumatology centres in the last two decades with a suspicion of GCA, searching for cases characterised by abnormal [18F] fluorodeoxyglucose (FDG) PET uptake of the aorta. 'Isolated aortitis' was defined as increased FDG uptake in the aorta not explained by atherosclerosis in the absence of FDG uptake in other large vessels. RESULTS: Comparing the epidemiological and clinical data of patients with isolated arteritis with those with GCA, we observed many statistical significant differences. First of all, the male/female ratio was reversed, with a predominant male involvement in isolated arteritis. Moreover, the mean age of patients with isolated arteritis was significantly lower than that of GCA patients (62 vs. 78.4 yrs; p<0.0001). None of the patients with isolated aortitis presented at any time of the disease course the typical symptoms of GCA, while in a low percentage of cases constitutional symptoms represented the only clinical features. Beside the aortic arch, the sites more frequent involved were the thoracic and abdominal tracts, in all cases without an uptake of the aortic branches. CONCLUSIONS: It is not known whether our patients with isolated aortitis represent variants of GCA or TA, nor is it known how they will evolve, but we can certainly conclude that these patients have a different epidemiologic and clinical profile, and do not necessarily represent two sides of the same coin.

[Waiting times for cancer care in four most frequent cancers in several French regions in 2011 and 2012]. / Délais de prise en charge des quatre cancers les plus fréquents dans plusieurs régions de France en 2011 et 2012.

UNLABELLED: Measuring waiting times is a good indicator of quality of cancer care and could reveal inequalities in cancer care access. AIMS: To determine the most representative waiting times in breast, lung, colon and prostate cancer care in several regions of France. To analyze the influence of individual, medical or health care system factors on those waiting times. METHODS: This study was piloted by the French Cancer Institute in partnership with the National Federation of the Regional Health Observatories and was driven by the Regional Oncology Networks and the Regional Health Observatories. In 2011, 2,530 women with breast cancer and 1,945 patient with lung cancer were included in eight regions, and in 2012, 3,248 patients with colon cancer and 4,207 men with prostate cancer were included in 13 regions, two of which were overseas departments. Data were analyzed from multidisciplinary discussion reports and from medical records. RESULTS: The mean time intervals (± standard deviation) for the various components of access to care were as follows in breast cancer: mammography to pathologist diagnosis, 17,7 days (±15,9); diagnosis (or treatment proposal) to surgery, 22,9 days (±13,9). In lung cancer: first suspect medical image to pathologist diagnosis, 21,5 days (±17,6); diagnosis to treatment proposal, 13,5 days (±10,7). In colon cancer: coloscopy to pathologist diagnosis, 4,5 days (±4,1); diagnosis to surgery, 18,9 days (±14,9). In prostate cancer: pathologist diagnosis to treatment proposal, 36,5 days (±26,5); treatment proposal to surgery, 45,2 days (±30,1). Data collection was particularly difficult because of very heterogeneous way in medical records filling by care centers, so the data collection method used in the study could not be used in routine procedures. Waiting times measured in the four cancers had an important variability. In fact, age, circumstance of diagnosis, tumor stage and category of care center had an influence. After considering those different factors, differences between regions remained from range 2 to 4. Those regional differences could be explained by organizational factors but were not explored in our study. In the same way, data on individual factors (social vulnerability, category of employment) were not available to measure their effects on this study. Besides, our results were comparable to those in international publications or national recommendations in other countries. CONCLUSION: These results suggest that waiting times could be good indicators and could reveal inequalities in cancer care access. Measuring them would lead to characterize those inequalities and to propose actions to improve access to cancer care whose impact could be measured.

Evaluation of effectiveness of training of nursing professionals: a correlational study

Aiming to evaluate the professional training programs, this study wants to evaluate the effectiveness of training about contact precautionary steps, run to nursing professional. This is a correlational design research. The material of analysis is composed by the pre- and post-training learning evaluations (n=248), performed in the University Hospital of the São Paulo University, which were submitted to a descriptive and inferential statistical analysis. This study was approved by the Ethics in Research Committee of the institution. The main results showed that, if compared the pre- and post-training periods, there was a significant rise on the post moment, of the average grade, in 10 out of 14 questions from the evaluation chart. Despite the fact the training was considered effective, it was observed there is a necessity to improve the diagnosing method of educational actions, as well as the evolution of a deeper evaluation methodology that embraces the observation of the results of training in assisting care.

Avaliação do treinamento "Prevenção e Tratamento de Úlcera por Pressão" ministrado à equipe de enfermagem / Evaluation of the "Pressure Ulcer Prevention and Treatment" training program given to the nursing team / Evaluación de la capacitación Úlcera por Presión administrada al equipo de enfermería

Considerando a importância da assistência de enfermagem e a avaliação de ações educativas, este estudo quantitativo, do tipo exploratório-descritivo, teve como objetivo avaliar a reação e aprendizagem dos participantes do treinamento "Prevenção e Tratamento de Úlcera por Pressão", ministrado a auxiliares e técnicos de enfermagem do Hospital Universitário da Universidade de São Paulo. Por meio de estatística descritiva e inferencial, foram analisados 96 avaliações de reação e da aprendizagem. Dentre os principais resultados, observamos que os participantes ficaram satisfeitos com o treinamento e que houve aumento significante do conhecimento no momento pós-treinamento. Não foi encontrada relação entre as variáveis nota e unidade de trabalho e foi constatada a relação entre turno e participação. Este estudo recomenda a ampliação da metodologia de avaliação de treinamento e oferece informações para análise de critérios e identificação de variáveis preditoras de resultados das ações educativas...

Taking into consideration the importance of nursing care and the evaluation of educational activities, the objective of this quantitative, exploratory-descriptive study was to evaluate the reaction and learning of the participants in the "Pressure Ulcer Prevention and Treatment" training course provided to nursing aides and technicians of the University of São Paulo University Hospital. Using descriptive and inferential statistics, 96 reaction and learning evaluations were analyzed. Among the main results, we observed that the participants were satisfied with the training and that there was a significant increase in their knowledge post-training. No relationship was found between the scores and work unit variables, but a relationship wasfound between the shift worked and level of participation. This study recommends the improvement of the evaluation methodology and provides information regarding the analysis of criteria and the identification of variables that predict the outcomes of educational activities...

Considerando la importancia de la atención de enfermería y la evaluación de acciones educativas, este estudio cuantitativo, exploratorio y descriptivo objetivó evaluar la reacción y aprendizaje de participantes de la capacitación "Prevención y Tratamiento de Úlceras por Presión", administrado a auxiliares y técnicos de enfermería del Hospital Universitario de la Universidad de São Paulo. Mediante estadística descriptiva e inferencial, fueron analizadas 96 evaluaciones de reacción y aprendizaje. Entre los resultados principales, observamos que los participantes quedaron satisfechos con la capacitación y que existió significativo aumento del conocimiento con posterioridad al entrenamiento. No se encontró relación entre las variables nota y unidad de trabajo, y se constató relación entre turno y participación. Este estudio recomienda ampliar la metodología de evaluación de capacitación y ofrece informaciones para análisis de criterios e identificación de variables predictivas de resultados de las acciones educativas...

Large- and small-vessel vasculitis: a critical digest of the 2010-2011 literature.

The last two years have been marked by significant achievement in the identification of the basic mechanisms of systemic vasculitis and in the translation of these mechanisms into targeted therapies. More specifically, new insights into the environmental, cellular, and genetic factors involved in the pathogenesis of systemic vasculitis have been provided. Consequently, several studies focused on the development of novel strategies to achieve and maintain clinical remission in small- and large-vessel vascultis, including relevant large multicentre trials, have been promoted. The highlights of these studies, their potential clinical implications and the unmet needs, which are still to be addressed, are summarised in this review.

Pop-cola acids and tooth erosion: an in vitro, in vivo, electron-microscopic, and clinical report.

Introduction. Manufactured Colas are consumed universally as soft drinks. Evidence about the acid contents of Cola-beverages and its effects on teeth is rare. Aim. To assess (i) cola acidity and buffering capacity in vitro, (ii) tooth erosion after swishing with colas in vivo (iii) scanning electron microscopic effects on teeth of colas, and tooth-brush abrasion, and (iv) report a clinical case of erosion from cola consumption. Materials and Methods. (i) We measured six commercially available pop "Cola beverages", pH, and buffering capacities using a pH-Mettler Automatic Titrator, with weak solution of Sodium Hydroxide (ii) two cohorts, one with teeth, the second without teeth rinsed with aliquots of Cola for 60 seconds. Swished cola samples tested for calcium and phosphorus contents using standardized chemical analytical methods (iii) enamel, dentine, and the enamel-cemental junction from unerupted extracted wisdom teeth were examined with a scanning electron microscope after exposure to colas, and tested for tooth-brush abrasion; (iv) a clinical case of pop cola erosion presentation, are all described. Results. Comparisons among pop colas tested in vitro reveal high acidity with very low pH. Buffering capacities in millilitres of 0.5 M NaOH needed to increase one pH unit, to pH 5.5 and pH 7 are reported. Rinsing in vivo with pop cola causes leeching of calcium from teeth; SEM shows dental erosion, and pop-cola consumption induces advanced dental erosion and facilitates abrasion. Conclusions. (i) Pop-Cola acid activity is below the critical pH 5.5 for tooth dissolution, with high buffering capacities countering neutralization effects of saliva; (ii) calcium is leeched out of teeth after rinsing with pop colas; (iii) SEM evidence explains why chronic exposure to acid pop colas causes dental frangibles; (iv) a clinical case of pop-cola erosion confirms this.

Muscle modifications in fibromyalgic patients revealed by surface electromyography (SEMG) analysis.

BACKGROUND: Several studies have been carried out in order to investigate surface electromyography (SEMG) response on fibromyalgic (FM) patients. Some studies failed to demonstrate differences between FM patients and healthy individuals while others found differences in SEMG parameters. Different muscular region have been analyzed in FM patients and heterogeneity is also produced because of the different ways in which the SEMG technique is used. The aims of this study were to evaluate muscle modifications by SEMG analysis in FM women with respect to a sample of healthy controls and to investigate the relationships between SEMG parameters and the clinical aspects of the disease. METHODS: SEMG was recorded in 100 FM women (48.10 +/- 11.96 yr) and in 50 healthy women (48.60 +/- 11.18 yr), from the tibialis anterior and the distal part of vastus medialis muscle during isometric contraction. Initial values and rate of change of median spectral frequency (MDF) and conduction velocity (CV) of the SEMG signal were calculated.The clinical parameters "Fibromyalgia Impact Questionnaire", pain, tender points, tiredness were evaluated and the relationships between these data and the SEMG results were also studied. For the statistical analysis Mann-Whitney test, chi-square test and Spearman correlation were used. RESULTS: MDF absolute values and the so-called Fatigue Index (FI) were significantly lower (p < 0.001) in both muscles studied in FM patients (MDF: 93.2 microV; FI: 1.10, 0.89) with respect to healthy controls (MDF: 138.2 microV; FI: 2.41, 1.66) and a smaller reduction in the percentage values of MDF was observed in FM patients vs controls (22% vs 38%). A significant correlation was found between the SEMG parameter decrement of normalized median frequency (MNF) (%) and seriousness of FM (evaluated by means of tender points). CONCLUSION: We have found some interesting muscle modifications in FM patients with respect to healthy controls, regarding MDF, CV and FI values which resulted significantly lower in FM. Patients might have a different fiber recruitment or a possible atrophy of type II fibers suggesting that they are not able to reach muscle relaxation.

Calibration and validation of a dynamic water model in agricultural scenarios.

A dynamic aquatic model (DynA model) was previously developed to predict the fate of a chemical in aquatic scenarios characterized by daily or periodic changes in several input parameters. DynA model is here calibrated with data obtained from the literature in specific unsteady state scenarios, such as those of rice fields. The results obtained for two herbicides (cinosulfuron and pretilachlor) in rice paddy scenarios revealed the capability of the model to accurately predict water and sediment concentrations, as shown by some statistical indicators. Modelling efficiency (EF) values of 0.86-0.99 for the water compartment and of 0.77-0.84 for sediment show the good agreement between predicted and measured concentrations. An "external validation" was performed using measured data for a different herbicide (molinate) applied in a Portuguese paddy rice scenario. A sensitivity analysis for this volatile chemical revealed the influence of some climatic parameters (e.g. temperature) to the model outcomes, such as water and sediment concentrations. This confirmed the capability of DynA model as an efficient tool for the pesticide risk assessment in dynamic scenarios.

Development of a dynamic aquatic model (DynA Model): estimating temporal emissions of DDT to Lake Maggiore (N. Italy).

BACKGROUND, AIMS AND SCOPE: Most existing models used to describe the fate of chemicals in surface water and sediment generally consider a 'static scenario', in which a contaminant is discharged at a constant rate and environmental input parameters do not change during the simulation time. This approach is not suitable in environmental scenarios characterized by daily or periodic changes of several input parameters. The aim of this study is to estimate approximate emissions of DDT lo Lake Maggiore using a new surface water model, (DynA Model) that describes the fate of a chemical in a dynamic scenario. METHODS: The model is developed on the grounds of an existing and validated model (QWASI). A numerical solution was adopted to build the fully dynamic version of the model. RESULTS AND DISCUSSION: The model was applied to Lake Maggiore emitting DDT at a constant rate until steady-state was reached. Emissions were stopped and later sporadic 'pulse' emissions were added. This was done to calculate the amount of DDT needed to simulate concentrations close to those measured in water and sediments. This allowed the evaluation of the order of magnitude of emissions. An uncertainty analysis for sediment resuspension was also performed, given the lack of measured resuspension rates. CONCLUSION: The model showed the time response of the Lake Maggiore system to varying emission scenarios and provided what are regarded as reasonable estimates of DDT emissions. The model demonstrated the importance of sediment-water exchange. RECOMMENDATION AND OUTLOOK: In order to better calculate DDT concentrations the model should be run with different discharge scenarios to clarify the time trends of concentrations, possibly with the use of different sets of measured data (such as biota and sediment deposition/resuspension rates).

Avaliaçäo de um curso técnico de enfermagem: um olhar dos egressos / Evaluation of a technical nursing course. Some egress students point of view

Este estudo teve como objetivos avaliar um curso técnico de enfermagem e analisar o processo de avaliaçäo desenvolvido no campo de estágio, sob a ótica dos egressos. Tratou-se de uma pesquisa de caráter exploratório, na perspectiva qualitativa; os sujeitos foram onze egressos da turma de 2001 de uma escola técnica de enfermagem, localizada em um hospital de ensino do município de Säo Paulo. Os dados foram coletados por meio de entrevistas semi-estruturadas e analisados pelo referencial Bardin, abrangendo as categorias: fatores facilitadores e dificultadores, formando um aluno crítico-reflexivo, sugestöes para o curso e fatores relacionados ao processo de avaliaçäo do aluno no estágio. Verificamos pelos resultados, que o curso facilitou a aprendizagem por meio de estágios e que os mesmos foram considerados momentos de maior aproveitamento. Ainda em relaçäo aos estágios, constatamos que ao proporcionar um campo acolhedor e com possibilidade de autonomia para o aluno, existem maiores chances de aprendizagem significativa e entender o processo de trabalho. O conteúdo teórico foi considerado satisfatório e a recuperaçäo paralela apontada como positiva. Por outro lado, em relação às dificuldades nos estágios, os egressos revelaram alguns sentimentos como medo do desconhecido, sofrimento e sentimento de impotência diante de uma certa realidade, sentimentos que podem dificultar a aprendizagem. Emergiram outras dificuldades como rigor excessivo por parte da equipe, medo dos profissionais em delegar a assistência de enfermagem ao aluno, desconfiança. Os sujeitos revelaram satisfaçäo na descoberta e utilizaçäo do saber e que aprenderam quando tiveram a chance de fazer conhecendo o porque desse saber. Deixaram claro também que o processo de avaliaçäo de estágio aconteceu de maneira justa, dialogada, objetiva, participativa, contínua, transmitindo segurança ao aluno. O professor foi visto como aquele que conhece o aluno, observa seu crescimento e interfere quando necessário; portanto a avaliaçäo desenvolvida no estágio foi realizada na abordagem de competência humana, pois foi feita por meio de observaçäo crítica, sistematizada, criteriosa e processual. Foi evidenciado que os estudos de casos foram essenciais para estimular o processo reflexivo em qualquer fase do curso, inclusive como estratégia para avaliaçäo. Constatamos em apenas dois depoimentos certas dificuldades relacionadas ao processo avaliativo no estágio,...

Avaliação de um curso técnico de enfermagem: um olhar dos egressos / Evaluation of a Technical Nursing Course: some egress students point of view

Este estudo teve como objetivos avaliar um curso técnico de enfermagem e analisar o processo de avaliação desenvolvido no campo de estágio, sob a ótica dos egressos. Tratou-se de uma pesquisa de caráter exploratório, na perspectiva qualitativa; os sujeitos foram onze egressos da turma de 2001 de uma escola técnica de enfermagem, localizada em um hospital de ensino do município de São Paulo. Os dados foram coletados por meio de entrevistas semi-estruturadas e analisados pelo referencial Bardin, abrangendo as categorias: fatores facilitadores e dificultadores, formando um aluno crítico-reflexivo, sugestões para o curso e fatores relacionados ao processo de avaliação do aluno no estágio. Verificamos pelos resultados, que o curso facilitou a aprendizagem por meio de estágios e que os mesmos foram considerados momentos de maior aproveitamento. Ainda em relação aos estágios, constatamos que ao proporcionar um campo acolhedor e com possibilidade de autonomia para o aluno, existem maiores chances de aprendizagem significativa e entender o processo de trabalho. O conteúdo teórico foi considerado satisfatório e a recuperação paralela apontada como positiva. Por outro lado, em relação às dificuldades nos estágios, os egressos revelaram alguns sentimentos como medo do desconhecido, sofrimento e sentimento de impotência diante de uma certa realidade, sentimentos que podem dificultar a aprendizagem. Emergiram outras dificuldades como rigor excessivo por parte da equipe, medo dos profissionais em delegar a assistência de enfermagem ao aluno, desconfiança. Os sujeitos revelaram satisfação na descoberta e utilização do saber e que aprenderam quando tiveram a chance de fazer conhecendo o porque desse saber. Deixaram claro também que o processo de avaliação de estágio aconteceu de maneira justa, dialogada, objetiva, participativa, contínua, transmitindo segurança ao aluno. O professor foi visto como aquele que conhece o aluno, ) observa seu crescimento e interfere quando necessário; portanto a avaliação desenvolvida no estágio foi realizada na abordagem de competência humana, pois foi feita por meio de observação crítica, sistematizada, criteriosa e processual. Foi evidenciado que os estudos de casos foram essenciais para estimular o processo reflexivo em qualquer fase do curso, inclusive como estratégia para avaliação. Constatamos em apenas dois depoimentos certas dificuldades relacionadas ao processo avaliativo no estágio, como medo, excesso de controle do professor e desconhecimento dos critérios de avaliação, sendo que essa última dificuldade ocorreu em estágios em que o professor não acompanhou diretamente o aluno. Os resultados demonstraram que o curso possibilitou a construção de competências sócio-políticas e pessoais, estimulou o egresso a assumir uma postura crítico-reflexiva, a aprendizagem contínua e ao questionamento. O estudo apontou ainda para a continuidade do projeto pedagógico desenvolvido pela escola e contribuirá para transformação da realidade escolar, no sentido de aperfeiçoar o processo educativo

This study was targeted at the evaluation of a technical nursing course and analyse the evaluation process in the field of traineeship, according to the viewpoint of egress students. It was an exploratory research of qualitative approach. The selected personnel were eleven students enrolled in a technical nursing school that took place in a school hospital in São Paulo city in 2001. The Bardin theoretical reference was used to analyse the data collected through semi-structured interviews, including the categories, factors that facilitate or make it difficult, contribute to educate a critical-reflexive student, suggestions to the course besides factors related to the evaluation process of the traineeship student. According to the results, the course has facilitated the learning by traineeships and they were also considered situations of great improvement it was also possible to realize that when working in a warm and friendly atmosphere, which provides the student autonomy to choose the prodecures, the learning and working process become more effective and meaningful. The theoretical contents were considered satisfying and the parallel recuperation pointed as positive. On the other hand, in relation to the difficulties faced during the traineeship, the egress students showed some feelings related to fear of the unknown, suffering and feelings of impotence when facing certain facts. Those feelings can make learning more difficult. Some other difficulties came up during the course such as inflexibility of the staff, the professionals lack of confidence to allow the students to take care of the nursery - mistrust. The students were satisfied by the acquisition of this knowledge. They also considered the evaluation criteria as fair, dialogical, strict to the point, participative, and continuous leading the student to feelings of self-confidence. The teacher was considered as a professional who cares about his own student's development, so the evaluation was based upon the human competences since it was performed by means of critical and step by step observation. The study of real cases were crucial to aware the reflexive process in any stage of the course and as an evaluation strategy. We checked out that only two students had some difficulties related to the evaluation process in the traineeship, as fear, a very strict teacher and unawareness of the evaluation criteria, but this situation only occurred in stages when the teacher hasn't followed the student directly. The results demonstrated that the course has allowed the build up of personal and social-political competences, has stimulated the egress student to assume a critical - reflexive behaviour, the continuous process of learning and questioning. This study has also pointed to the continuity of the pedagogical project developed by the school and will contribute to transform the school reality and improve the educational process.

Transformación maligna de la papilomatosis laringea juvenil / Malignant changes in juvenile laryngeal papillomatosis

La papilomatosis laríngea juvenil es una entidad generalmente benigna que debe ser considerada, no sólo por su eventual malignización, sino por su impredecible evolución local con compromiso respiratorio y séptico que pueden conducir a la muerte. Presentamos un paciente de sexo masculino con diagnóstico de esta enfermedad a los 9 meses de vida, que a los 15 años es internado con deterioro del estado general y alteraciones radiológicas pulmonares y vertebrales, lesiones que son biopsiadas com diagnóstico histopatológico de carcinoma epidermoide bien diferenciado con metástasis óseas. Este caso se suma a las escasas publicaciones de transformación carcinomatosa sin antecedentes de radioterapia (AU)