Preoperative scale proposal based on clinical outcome for elderly patients with ruptured intracranial aneurysms undergoing microsurgery.

INTRODUCTION: Life expectancy in individuals has increased in recent years. There is no consensus in the literature on the best treatment for a ruptured aneurysm in the elderly (> 60 years), but some places only have microsurgery as a therapeutic strategy. This work aims to develop a prognostic scale for ruptured intracranial aneurysms in the elderly. MATERIAL AND METHODS: Two thousand five hundred thirty patients with subarachnoid hemorrhage were retrospectively evaluated in the last ten years, and 550 of them were elderly. We developed a prognostic scale from the analysis of medical records, clinical and tomographic features that had statistical significance. Glasgow Coma Outcome (GOS) was the outcome of interest and p value < 0,05 was considered statistically significant. RESULTS: Five hundred fifty patients were evaluated, and the comorbidities that were independent variables for poor prognosis were smoking and arterial hypertension; clinical variables were Hunt-Hess, modified Rankin and Glasgow Coma Scale; tomographic was Fisher scale. Poor outcome was defined as GOS ≤ 3. Poor surgical outcomes were more remarkable in the high-risk factor categories, being 6.41 times higher among individuals who had 3 to 4 risk factors and 8.80 times higher among individuals with 5 to 6 risk factors. CONCLUSION: In some vascular neurosurgery services worldwide, microsurgery is the only therapeutic option. This scale aimed at the elderly patient individualizes the treatment and can predict the clinical outcome in ruptured intracranial aneurysms.

Avaliação do programa de controle do câncer do olo do útero e de mama sob a óttica das usuárias / Evaluation of cervical and breast cancer control program from the user perspective

Avaliar o Programa de Controle do Câncer do Colo do Útero e de Mama a partir do relato das usuárias da unidade básica, estabelecendo, em alguns momentos, comparações entre unidades de maior e menor cobertura dos exames citopatológicos. Estudo quantitativo, amostra intencional de quatro unidades básicas de saúde. Realizou-se entrevistas com perguntas fechadas. Das 51 usuárias entrevistadas, 64,7% relata fazer o exame preventivo anualmente, 67% iniciaram com menos de 25 anos, sendo que 91,8% fizeram o exame preventivo por orientação da unidade básica, 82,3% conseguiram agendamento para coleta em menos de um mês, 92,1% receberam orientações de retorno. Quanto à prevenção dos cânceres, apenas 47,0% receberam as orientações durante as consultas. Este estudo demonstra que a realização do exame citopatológico pela equipe está integrada às rotinas de atendimento nas unidades de saúde, no entanto, atividades de prevenção do câncer de mama são pouco relatadas pelas usuárias.

This paper has the objective of evaluating the cervical and breast cancer control program from the user perspective, establishing, at times, comparisons among units with greater and lesser coverage of cervical screening tests. This is a quantitative study, with a purposive sample of four basic health units. Interviews with close-ended questions were performed. From the 51 users interviewed, 64.7% reported doing an anual cytopathological exam, 67% started with less than 25 years of age, and 91.8% had a cytopathological exam following advice from the basic health unit, 82.3% succeeded in scheduling it within the same month, 92.1% received instructions to return. Regarding cancer prevention, only 47% received advice during consultations. This study demonstrates that the performance of cytopathological exam by the health team is integrated into the routine care in health units; however, activities for the prevention of breast cancer are scarcely reported by the users.

Profissionais de saúde e o programa de controle do câncer do colo uterino e mama / Health professionals and cervic and breast cancer control program

Objetivo: compreender a percepção dos profissionais de saúde em relação ao Programa de Controle e Prevenção do Câncer de Colo de Útero e Mama. Método: estudo avaliativo com 15 trabalhadores de saúde. Utilizou-se um roteiro de entrevistas com perguntas fechadas. Resultados: nas unidades investigadas, pode ser verificado que a cobertura maior ou menor de exames citopatológicos não foi influenciada pela adequação da estrutura física para a coleta do exame preventivo de câncer ginecológico. Já a capacitação e o envolvimento de todos os profissionais lotados na unidade, a divulgação do programa e a rotina com que a mulher realiza anualmente o exame influenciaram em maior cobertura. Considerações: é essencial incluir na formação profissional instrumentosde avaliação da efetividade das ações e melhor compreensão da importância da atenção primária na qualidade de vida das mulheres.

Objective: to understand the perception of the health professionals on the Cervic and Breast Cancer Control Program. Method: descriptive study with 15 health professionals. A guideline with closed questions was used to collect the data. Results: it could be observed that the higher and the lower covering of cytopathological exams don’t seem to be influenced by adaptation of the physical structure. The way of spreading in the program at its own unit, the involvement of all the professionals booked up the unit, the routine in which the woman accomplish her yearly exam, among others facts, shows to influence the high covering. Considerations: it is essential include in the professional formation instruments of evaluation of the effectiveness of their actions and better understanding of the importance of the primary health care in the quality of life of women.

Objetivo: investigar la percepción de los profesionales de la salud en relación al Programa de Control y Prevención del Cáncer de Cuello Uterino y de Mama. Método: estudio evaluativo, con 15 trabajadores de la salud. Se utilizó un instrumento con preguntas cerradas. Resultados: en las unidades investigadas, se puede verificar que la cobertura de mayor o menor de exámenes de citopatología no fue influenciada por la adecuación de la estructura física para la recogida de la prevención del cáncer ginecológico. Ya, la formación y la participación de los profesionales de la unidad, la divulgación del programa y la rutina que las mujeres realizan la prevención anual influencia de una mayor cobertura. Consideraciones finales: es fundamental incluir herramientas de formación profesional para evaluar la eficacia de las acciones y la comprensión de la importancia de la atención primaria sobre la calidad de vida de las mujeres.