Malignant phyllodes tumor of the breast in ayoung patient ­ case report

Phyllodes tumor (PT) is an uncommon form of breast tumor. It occurs most commonly in women aged 35 to 65 years. The benign form represents about 85­90% of cases and only 10­15% of PTs are malignant. Clinically and radiologically, malignant phyllodes tumor (MPT) presents as regular, well-delimited, mobile nodules that are difficult to distinguish from fibroadenomas of the breast. The most important differential diagnoses of MPT include fibroadenoma, metaplastic carcinoma, and sarcoma. The prognosis of MPT exhibits a higher frequency of local recurrence and metastatic rate with larger tumors and inadequate surgical margins. The case presented here refers to a 24-year-old female patient, with a vast tumor in the right breast, with rapid and progressive growth, associated to local pain, and histological diagnosis of MPT. Surgery was the initial treatment, followed by adjuvant chemotherapy and radiotherapy. The purpose of this article was to report an atypical case of MPT of the breast in a very young woman as well as to make a brief literature review on this infrequent and dangerous disease. (AU)

Teaching strategies to develop skills to address social inequalities in nursing education: A scoping review.

OBJECTIVES: to identify teaching strategies for developing skills to address social inequalities in nursing education. DESIGN: Following the Joanna Briggs Institute and PRISMA-ScR guidelines, a scoping review was performed to answer the following research question: "What are the teaching strategies employed to develop nurses' skills to address social inequalities?" DATA SOURCES: Bibliographical search was conducted seven electronic databases until December 29, 2020, and updated on March 25, 2022. Papers published in Portuguese, English, and Spanish on competence and professional practice, social inequality, education/training, and nursing were included. REVIEW METHODS: Seven reviewers screened the articles by reading titles and abstracts. Studies on teaching strategies used to develop nurses' skills to address social inequalities were included. Of the 1137 articles found, 61 were selected by the first screening, and 23 were included in the final sample. Data were analyzed and summarized as a narrative. RESULTS: The included papers were published between 2000 and 2020, predominantly in the United States. Curricular and learning strategies, including service, experience, and interactive, were the most common, followed by university programs and civil society initiatives. Courses, classes, debates, and practical activities predominated as teaching activities. Teaching techniques focus on resources such as posters, videos, workshops, and seminars. CONCLUSIONS: This review identified teaching strategies used to develop nurses' skills to address social inequalities. Curricular initiatives, learning strategies, university programs and civil society initiatives can expand students' understanding of social inequalities and be used to develop skills.

Evaluation of clinical, pathological and epidemiological profile of patients with breast cancer in the microregion of Lavras ­ MG

Breast cancer is associated with high frequency and mortality in Brazilian women. There have been limited studies portraying the characteristics of breast cancer cases in the countryside of the state of Minas Gerais for a long period of time, a fact that will allow us to better understand the epidemiology of these tumors. This descriptive study aims to analyze the epidemiology and clinical features of patients with breast cancer treated at a public health service facility in Lavras, MG. Methods: This is a transversal study with 299 women diagnosed with breast cancer between 2002 and 2022, based on data collection from medical records and subsequent descriptive analysis. Results: There were a total of 317 cases, and 299 were eligible for the study. The mean age at diagnosis was 54.2 years, and 36.1% of the patients were under 50 years old at diagnosis. Positive family history was found in 17.0% of the patients. The diagnosis was made by clinical alteration detected on physical examination in 71.5% of cases, and lump was the most frequent type of lesion (89.0%). Invasive carcinoma was 93.1% of the cases, and the mean tumor size was 28.6 mm. The average time between first medical appointment and diagnosis was 63.2 days, and between diagnosis and beginning of treatment was 39.6 days. Conclusions: This study showed that a significant number of cases occurred in women outside the recommended age for screening in Brazil. Diagnosis was predominantly performed by clinical examination, with delays in obtaining the histological diagnosis, and the stage at diagnosis was high, and these facts were associated with the health system limitations (AU)

[Professional practices in situations of violence in home care: an integrative review]. / Práticas profissionais em situações de violência na atenção domiciliar: revisão integrativa.

This article aims to describe the practices of health professionals in situations of violence in the provision of home care. It involved an integrative review of the literature conducted between December 2016 and December 2017 in the LILACS, BDENF and MEDLINE databases. The sample was composed of 15 articles, organized and characterized by author, publication journal, country, year, title, method, main idea, category and level of evidence. The violent situations found most often were abuse of elderly and children and domestic violence towards women and children. Different practices were adopted during violent situations against patients, like interventions, notifications, orientation, and professional qualification. Practices of health professionals in home care focuses on actions of patient care,seek to minimize the effects of violence.

Práticas profissionais em situações de violência na atenção domiciliar: revisão integrativa / Professional practices in situations of violence in home care: an integrative review

Resumo O objetivo deste artigo é descrever as práticas de profissionais de saúde em situações de violência nos cuidados da Atenção domiciliar. Trata-se de uma revisão integrativa da literatura realizada entre dezembro de 2016 e dezembro de 2017 nas bases de dados LILACS, BDENF e MEDLINE. A amostra foi composta por 15 artigos, organizados e caracterizados de acordo com autor, periódico de publicação, país, ano, título, método, ideia central, categoria e nível de evidência. As situações de violência mais encontradas foram abuso em idosos e crianças e violência doméstica em mulheres e crianças. Práticas distintas foram adotadas nas situações de violência contra os pacientes, como intervenções, notificações, orientação, e capacitação profissional. As práticas dos profissionais na atenção domiciliar focalizam ações de cuidado dos pacientes, buscando minimizar os efeitos da violência.

Abstract This article aims to describe the practices of health professionals in situations of violence in the provision of home care. It involved an integrative review of the literature conducted between December 2016 and December 2017 in the LILACS, BDENF and MEDLINE databases. The sample was composed of 15 articles, organized and characterized by author, publication journal, country, year, title, method, main idea, category and level of evidence. The violent situations found most often were abuse of elderly and children and domestic violence towards women and children. Different practices were adopted during violent situations against patients, like interventions, notifications, orientation, and professional qualification. Practices of health professionals in home care focuses on actions of patient care,seek to minimize the effects of violence.

O cotidiano de trabalho na enfermagem: uma reflexão sobre práticas profissionais / The daily work in nursing: a reflection on professional practices

Objective: To reflect on the daily routineof nursing work practices, taking into account the daily ways of doing in which Certeau proposes, focusing on historical aspects and professional performance in health services. Methods: This is a reflection based on the studies on the daily life of Michel de Certeau. Results: The application of the arts of doing about the daily life of the profession proposes the need for discussions about the daily practices of nursing and critical reflection on the reality of health services. Strategies and tactics are used in the daily work of nursing, as a dimension of the real. Final considerations: Practices in health services include several ways of doing the work; and in the nursing routine these actions become multiple and intermittent. Nursing uses pre-established aspects of the work and a creative dimension of the professionals' work.

Objetivo: Refletir sobre o cotidiano das práticas de trabalho de enfermagem, levando em consideração as maneiras de fazer no cotidiano propostas por Certeau, focalizando aspectos históricos e de atuação profissional em serviços de saúde. Métodos: Trata-se de uma reflexão fundamentada nos estudos sobre o cotidiano de Michel de Certeau. Resultados: A aplicação das artes de fazer sobre o cotidiano da profissão propõe a necessidade de discussões sobre as práticas cotidianas da enfermagem e reflexão crítica sobre a realidade dos serviços de saúde. As estratégias e táticas são utilizadas no cotidiano de trabalho da enfermagem, como uma dimensão do real. Considerações finais: As práticas nos serviços de saúde contemplam diversas maneiras de fazer o trabalho; e no cotidiano da enfermagem essas ações se tornam múltiplas e intermitentes. A enfermagem utiliza aspectos preestabelecidos do trabalho e uma dimensão criativa do fazer dos profissionais.

Interrupções no trabalho do enfermeiro e suas interferências na segurança do paciente / Interruptions in nurses' work and their interference in patient safety

Objetivo: Trata-se de uma pesquisa quantitativa observacional de corte transversal, que teve como objetivo analisar as interrupções nas atividades primárias dos enfermeiros de uma unidade de Pronto Atendimento (PA) de um hospital universitário de Minas Gerais. Método: Os participantes foram 40 enfermeiros, dos turnos diurno e noturno, que atuavam na unidade. A coleta de dados foi realizada de 8 de junho a 23 de julho de 2018, por meio da observação direta não participante das interrupções nas atividades primárias dos enfermeiros, após aprovação do Comitê de Ética em Pesquisa e do hospital. A análise descritiva foi feita utilizando planilha eletrônica da plataforma Microsoft Excel e realizada distribuição de frequência absoluta e relativa. Resultados: Durante as 113,2 horas de coleta de dados, foram observadas 736 atividades primárias, sendo 277 (37,6%) de cuidado indireto ao paciente; 211 (28,7%) de cuidado direto; 144 (19,6%) de atividades administrativas; 99 (13,5%) de atividades pessoais; e 5 (0,7%) de atividades de ensino e pesquisa. Quanto ao tempo das interrupções, constatou-se que os enfermeiros gastaram mais tempo durante o cuidado indireto (34,9%). Das 736 atividades, 426 (57,9%) foram interrompidas, com média de 1,8 interrupções por atividade primária, totalizando 1.334 ocorrências (11,8 por hora). O cuidado indireto foi o mais interrompido (53,5%), seguido pelo cuidado direto (29,8%), atividade administrativa (13,2%) e atividade pessoal (3,5%). A atividade com maior número de interrupções foi registro de enfermagem (28,1%), seguida da avaliação do paciente (13,7%) e realização de procedimentos ou cuidado ao paciente (10,6%). As interrupções corresponderam a 41% do tempo de trabalho dos enfermeiros durante o período de observação. A mediana da duração das atividades primárias interrompidas foi de oito minutos e as não interrompidas foi de 2,5 minutos. O número de interrupções foi maior no turno da manhã (36%), mas a duração das interrupções foi maior no horário noturno (4,1%). As principais fontes de interrupções foram a equipe de enfermagem (40,6%) e a autointerrupção (13,3%), sendo as fontes que mais demandaram o tempo do enfermeiro, 41,2% e 12,3%, respectivamente. Os motivos de interrupções mais frequentes foram os relacionados ao paciente (31%), administrativo (24%), pessoal (18%), ajuda (17%), ambiente (8%) e ensino e pesquisa (2%). Os principais motivos foram fornecer e receber informações relacionadas ao paciente (18,1%), conversa paralela (12,5%) e alarmes (6,1%). O motivo que mais consumiu o tempo do enfermeiro foi conversa paralela (32,3%). Após as interrupções, os enfermeiros não retornaram à atividade primária em 1,8% dos casos, sendo necessário atender de uma a 30 interrupções antes de retornar à atividade inicial. Ao comparar a frequência das interrupções do PA Subunidades e PA Unidade de Terapia Intensiva, notou-se que o segundo correspondeu a 54% das interrupções, representando 61,5% do tempo total das interrupções. Conclusão: O conhecimento das interrupções no trabalho do enfermeiro pode contribuir para se elencar interrupções que propiciam a segurança do paciente e aquelas que geram problemas para a concentração e interferem na qualidade da assistência e na segurança do paciente. O profissional deve ater-se à atividade em execução e avaliar a pertinência da intervenção de acordo com a situação.(AU)

Objective: This is a cross-sectional, observational quantitative study, whose objective was to analyze the interruptions in the primary activities of nurses at an Emergency Care Unit at a university hospital in Minas Gerais. Method: There were 40 nurses participating in the study, from both day and night shifts, who worked in the unit. Data collection was performed from June 8th to July 23rd, 2018, through the direct non-participant observation of interruptions in nurses primary activities, after approval of the Research Ethics Committee and the hospital. The descriptive analysis was done using Microsoft Excel. In addition to that, it was performed absolute and relative frequency distribution. Results: During the 113.2 hours of data collection, 736 primary activities were observed, being: 277 (37.6%) of indirect care to the patient; 211 (28.7%) of direct care; 144 (19.6%) of administrative activities; 99 (13.5%) of personal activities; and 5 (0.7%) of teaching and research activities. Regarding the time of interruptions, it was found that nurses spent more time during indirect care (34.9%). Of the 736 activities, 426 (57.9%) were interrupted, with an average of 1.8 interruptions per primary activity, at a total of 1,334 occurrences (11.8 interruptions per hour). The indirect care was the most interrupted (53.5%), followed by direct care (29.8%), administrative activity (13.2%) and personal activity (3.5%). The activity with the highest number of interruptions was the nursing record (28.1%), followed by patient evaluation (13.7%), and procedures or patient care (10.6%). The interruptions corresponded to 41% of nurses' work time during the observation period. The median duration of interrupted primary activities was eight minutes and the non-interrupted was 2.5 minutes. The number of interruptions was higher in the morning shift (36%), but the duration of interruptions was higher at the night shift (34.1%). The main sources of interruptions were the nursing team (40.6%) and self-interruption (13.3%), being the sources that most demanded the nurses' time, 41.2% and 12.3%, respectively. Regarding the reasons for the interruptions, the most frequent were those related to the patient (31%), administrative (24%), personal (18%), help (17%), environment (8%) and teaching and research (2%). The main reasons were providing and receive information related to the patient (18.1%), parallel conversation (12.5%) and alarms (6.1%). The reason that most consumed the nurse's time was the parallel conversation (32.3%). After the occurrence of interruptions, the nurses did not return to primary activity in 1.8% of the cases, being necessary to attend from one to 30 interruptions before returning to the initial activity. When comparing the frequency of interruptions of the Emergency Care Subunits and the Intensive Care Unit of the Emergency Care Unit, it was observed that the second corresponded to 54% of the interruptions, besides representing 61.5% of the total time of the interruptions. Conclusion: The knowledge of the interruptions in the work of the nurse can contribute to list interruptions that promote patient safety and those that generate problems for concentration and interfere in the quality of care and in the patient safety. The professional should stick to the activity in execution and evaluate the pertinence of the intervention according to the situation.(AU)

Interrupções no trabalho do enfermeiro e na segurança do paciente / Interruptions in the nurse's work and patient safety

Objetivo: identificar os efeitos das interrupções na rotina de trabalho do enfermeiro e na segurança do paciente. Método: trata-se de estudo bibliográfico, descritivo, tipo revisão integrativa de literatura, com a coleta de dados nas bases de dados MEDLINE, CINAHL, Web of Science e LILACS, em artigos indexados de 2013 a 2017, analisando-os de forma descritva, após a apresentação em figuras. Resultados: encontraram-se 17 artigos e se percebeu que revelaram aspectos negativos em relação à interrupção na rotina de trabalho do enfermeiro e na segurança do paciente e 76,5% mostraram, também, pontos positivos. Salienta-se que os resultados analisados não apoiaram consistentemente a relação negativa entre as interrupções e as suas implicações na rotina de trabalho do enfermeiro e na segurança do paciente. Conclusão: evidenciaram-se aspectos que favorecem a ocorrência de interrupções na prática do enfermeiro, entretanto, há poucos estudos que descrevem o impacto das interrupções na prática e na segurança do paciente. Fazse necessária uma ampla compreensão dos fatores que ocasionam as interrupções e colocam em risco a segurança do paciente.(AU)

Objective: to identify the effects of disruptions on the nurse's work routine and patient safety. Method: this is a bibliographical, descriptive, type-integrative review of literature, with the collection of data in the MEDLINE, CINAHL, Web of Science and LILACS databases, in indexed articles from 2013 to 2017, analyzing them in a descriptive way, after the presentation in figures. Results: 17 articles were found and it was noticed that they revealed negative aspects regarding interruption in the nurse's work routine and patient safety, and 76.5% also showed positive points. It should be noted that the results analyzed did not consistently support the negative relationship between the interruptions and their implications in the nurse's work routine and patient safety. Conclusion: aspects that favor the occurrence of interruptions in nurses' practice were evidenced, however, there are few studies that describe the impact of interruptions on the practice and safety of the patient. There is a need for a broad understanding of the factors that cause disruption and jeopardize patient safety. (AU)

Objetivo: identificar los efectos de las interrupciones en la rutina de trabajo del enfermero y en la seguridad del paciente. Método: se trata de un estudio bibliográfico, descriptivo, tipo revisión integradora de literatura, con la recolección de datos en las bases de datos MEDLINE, CINAHL, Web of Science y LILACS, en artículos indexados de 2013 a 2017, analizándolos de manera descriptiva, después de la presentación en figuras. Resultados: se encontraron 17 artículos y se observó que revelaron aspectos negativos relacionados con la interrupción en la rutina de trabajo del enfermero y en la seguridad del paciente, y el 76.5% mostraron también puntos positivos. Cabe señalar que los resultados analizados no apoyaron de manera consistente la relación negativa entre las interrupciones y sus implicaciones en la rutina de trabajo del enfermero y en la seguridad del paciente. Conclusión: se evidenciaron aspectos que favorecen la ocurrencia de interrupciones en la práctica del enfermero, sin embargo, existen pocos estudios que describan el impacto de las interrupciones en la práctica y en la seguridad del paciente. Se hace necesaria una amplia comprensión de los factores que causan las interrupciones y ponen en riesgo la seguridad del paciente.(AU)