SEOM-GG clinical guidelines for the management of germ-cell testicular cancer (2023).

Testicular germ cell tumors are the most common tumors in adolescent and young men. They are curable malignancies that should be treated with curative intent, minimizing acute and long-term side effects. Inguinal orchiectomy is the main diagnostic procedure, and is also curative for most localized tumors, while patients with unfavorable risk factors for recurrence, or those who are unable or unwilling to undergo close follow-up, may require adjuvant treatment. Patients with persistent markers after orchiectomy or advanced disease at diagnosis should be staged and classified according to the IGCCCG prognostic classification. BEP is the most recommended chemotherapy, but other schedules such as EP or VIP may be used to avoid bleomycin in some patients. Efforts should be made to avoid unnecessary delays and dose reductions wherever possible. Insufficient marker decline after each cycle is associated with poor prognosis. Management of residual masses after chemotherapy differs between patients with seminoma and non-seminoma tumors. Patients at high risk of relapse, those with refractory tumors, or those who relapse after chemotherapy should be managed by multidisciplinary teams in experienced centers. Salvage treatment for these patients includes conventional-dose chemotherapy (TIP) and/or high-dose chemotherapy, although the best regimen and strategy for each subgroup of patients is not yet well established. In late recurrences, early complete surgical resection should be performed when feasible. Given the high cure rate of TGCT, oncologists should work with patients to prevent and identify potential long-term side effects of the treatment. The above recommendations also apply to extragonadal retroperitoneal and mediastinal tumors.

The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer.

Lung cancer is a major cause of cancer deaths worldwide. Non-small-cell lung cancer (NSCLC) represents most lung cancer cases, and approximately one-third of patients present with stage III disease at diagnosis. As multiple treatment plans can be adopted for these patients depending on tumor size and nodal staging, stage III NSCLC management is challenging. Over the past decades, multidisciplinary teams (MDTs) have been implemented in healthcare services to coordinate actions among the different health care professionals involved in cancer care. The aim of this review was to discuss real-world evidence of the impact of MDTs on stage III NSCLC management, survival, and quality of life. Here, we performed a literature review to investigate the role of nutrition and navigational nursing in NSCLC care and the influence of MDTs in the choice of treatment plans, including immunotherapy consolidation, and in the management of chemotherapy and radiotherapy-related adverse events. We also performed a mapping review to identify gaps in the implementation of cancer care MDTs in healthcare services around the world.

Avances en tumores del estroma gastrointestinal: ¿hacia dónde vamos?

Gastrointestinal Stromal Sarcomas (GIST) are mesenchymal neoplasms whose incidence accounts for 1-2% of digestive tumors, being located in the stomach (55-60%) and small intestine (30%). The advances in its knowledge and management succeeded in the last years have being spectacular. This review aims to summarize the most important of them for surgeons. We identified four areas of interest: molecular oncology, laparoscopic approach, management of GIST located at unusual locations, and management of advanced GIST. Advances in the field of molecular oncology lead to the discovery of new oncogenic mutations making the term Wil Type GIST obsolete. Moreover, these advances allow for the development of 2 new drugs: Avapritinib and Ripretinib, that added to the previous 3 commercially available drugs (imatinib, sunitinib and regorafenib) make possible the management of GIST with resistant mutations. The principles of the surgical management of primary GIST are well stablished which laparoscopic approach must accomplish. This approach is limited by 2 main factors: location and size. The diagnosis of GIST in unusual locations as esophagus, duodenum, rectum of out of the gastrointestinal tract (EGIST), implies an extraordinary therapeutic challenge, being imperative to manage them by surgeons and oncologist among others in the setting of a multidisciplinary team. The management of advanced/metastatic GIST has changed in a revolutionary fashion because surgery is now part of its treatment as adjuvant to tyrosine kinase inhibitors.

Los tumores del estroma gastrointestinal (GIST) suponen el 1-2% de los tumores digestivos, siendo su localización más frecuente el estómago (55-60%) y el intestino delgado (30%). Los avances más importantes sucedidos en los últimos años se centran en cuatro áreas: biología molecular, abordaje quirúrgico laparoscópico, manejo técnico del GIST en localizaciones inusuales y tratamiento e integración de la cirugía en el manejo del GIST avanzado. Los avances en el conocimiento de la biología molecular del GIST han dado lugar a la progresiva identificación de nueva mutaciones oncogénicas que hacen del concepto wild type obsoleto. Estos avances han permitido el desarrollo de dos nuevos fármacos, avapritinib y ripretinib, lo que permite el tratamiento de pacientes con mutaciones resistentes a las tres líneas terapéuticas clásicas. El tratamiento quirúrgico del GIST se rige por unos principios técnicos bien establecidos que el abordaje laparoscópico debe cumplir, abordaje que queda limitado por dos factores clave: localización y tamaño. El GIST de localización infrecuente (esófago, duodeno o recto, o extradigestivo) supone un reto terapéutico. Estos pacientes deben ser manejados en un contexto multidisciplinario. La cirugía queda integrada en el manejo del GIST avanzado, considerándose como adyuvante a los inhibidores de la tirosina cinasa.

Manejo interdisciplinario de pacientes quemados. Pilar fundamental para la reducción de secuelas funcionales / Multidisciplinary management of burned patients: Fundamental pillar for reduction of functional sequelae

Las secuelas de quemaduras representan una patología muy frecuente en nuestro medio y su impacto en la calidad de vida de los pacientes que las padecen es muy importante. El objetivo del trabajo fue demostrar la eficacia del manejo interdisciplinario en pacientes con quemaduras AB y B de zonas funcionales para reducir las secuelas. Se realizó un estudio retrospectivo que incluyó 53 pacientes tratados en nuestro servicio, detectando 15 pacientes secuelados; en el 90% de los casos la causa fue el incumplimiento de la terapia indicada luego del alta y el 10% la cicatrización patológica rebelde al tratamiento. Los pacientes con secuelas funcionales por abandono del tratamiento kinesiológico indicado fueron: cinco con retracción en la región cervical anterior, cuatro con retracción en la articulación del codo y cuatro con retracción axilar. Se detectaron dos pacientes que a pesar del tratamiento instaurado sufrieron cicatrices retráctiles, uno de ellos en cuello y el otro paciente en axila.

Sequels of burns represent a very frequent pathology in our environment and its impact on the quality of life of patients suffering from them is very important. The objective of the study was to demonstrate the effectiveness of the interdisciplinary management in patients with burns AB and B of functional areas to reduce the consequences. This is a retrospective study that included 53 patients treated in our service. Fifteen patients with sequelae were detected. In 90% of the cases the cause was a failure in following the prescriptions ordered in hospital discharge, and in10% it was due to rebel to treatment scarring. The patients with functional sequelae due to the absence of the indicated kinesiological treatment were: five with retraction in the anterior cervical region, four with retraction in the elbow joint and four with axillary retraction. Two patients were detected that in spite of the established treatment they suffered retractile scars, one of them in neck and the other patient in armpit.

Psicólogo intensivista: reflexões sobre a inserção profissional no âmbito hospitalar, formação e prática profissional / El psicólogo intensivista: reflexiones acerca de la inserción en el ámbito hospitalario, formación y práctica profesional / Intensive care psychologist: reflections about professional insertion, professional qualification and practice at the hospital

Esta pesquisa buscou analisar o perfil do psicólogo hospitalar atuante em Unidades de Terapia Intensiva em hospitais públicos e privados de Porto Alegre, conhecer sua formação, as principais intervenções psicológicas utilizadas no atendimento ao paciente e seus familiares, as possibilidades de intervenção com a equipe assistencial atuante em terapia intensiva e identificar possíveis carências na formação do psicólogo que sejam consideradas essenciais pelas participantes para atuação neste campo. Os dados foram coletados através de um questionário sociodemográfico e uma entrevista semi dirigida. Foram entrevistadas sete psicólogas intensivistas de dois hospitais de Porto Alegre-RS, atuantes em unidades de atenção a pacientes adultos, pediátrica e neonatal. As informações obtidas nas entrevistas foram submetidas à análise de conteúdo, e dela emergiram categorias temáticas para posterior interpretação dos resultados. Foi percebida uma carência nos cursos de Psicologia de conteúdos que capacitem os alunos para as especificidades da atuação em saúde e sua inserção em equipes multiprofissionais. A pesquisa também evidenciou a necessidade de adaptação das técnicas já utilizadas na clínica, tanto no que diz respeito à avaliação psicológica quanto nos atendimentos a pacientes, familiares e intervenções em grupo. Evidencia-se a carência de estudos sobre Psicologia Intensivista, destacando a necessidade de mais pesquisas nesta área.

Resumen La investigación buscó cono cer las especificidades de la práctica del psicólogo intensivista, analizando aspectos de su rutina profesional, dificultades y potencialidades, principales intervenciones con familiares y equipos de salud, además de investigar sobre su formación profesional y como esta repercute sus acciones en la actualidad. Los datos fueron recogidos a través de cuestionario sociodemográfico y entrevista semidirigida. Fueron entrevistadas siete psicólogas intensivistas, de dos hospitales de la ciudad de Porto Alegre-RS, actuantes en unidades de atención a pacientes adultos, pediátrica y neonatal. Las informaciones obtenidas en las entrevistas fueron sometidas a un análisis de contenido y emergieron categorías temáticas para la posterior interpretación de los resultados. Fue percibida una carencia en los cursos de Psicología de contenidos que capaciten los alumnos para las especificidades de la actuación en salud y su inserción en equipos multiprofesionales en el actual contexto brasilero. Además de esto, la investigación evidenció la necesidad de adaptación de las técnicas ya utilizadas en la clínica, tanto en lo que se refiere a la evaluación psicológica como en la atención a pacientes, familiares e intervenciones en grupo. Evidenciase la carencia de estudios sobre Psicología Intensivista, destacando la necesidad de un mayor número de investigaciones en el área.

Abstract This research aimed to investigate the specifities of the work of intensive care psychologists, analyzing aspects of their professional routines, difficulties and potential, major interventions with patients, families and healthcare teams, and also investigate their training and how it affects the professional actions that have been explored nowadays. The data was collected through a sociodemographic questionnaire and a semistructured interview. Seven intensive care psychologists were interviewed, active in two hospitals in Porto Alegre-RS, both in care units to adult patients, and in areas such as pediatric and neonatal. Information obtained from the interviews was subjected to content analysis from which emerged some topics for the subsequent interpretation of the results. From this analysis, a shortage in Psychology courses that enables students to the specifics of performance in healthcare and its role in multi-professional teams in the current Brazilian context was perceived. In addition, the survey also highlighted the need to adapt the techniques that these pofessionals already used in clinical care, both in terms of psychological assessment as in the care to patients and family and group interventions. The lack of studies on Intensive Psychology was overt, highlighting the need for more research in this area.

Primary Health Care That Works: The Costa Rican Experience.

Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica's innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica's experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented.

Processos formativos em álcool e outras drogas para trabalhadores da rede pública do município de São Paulo: a experiência do CRR-DIMESAD-UNIFESP / Training courses on addiction issues to workers from the public sector of São Paulo city: the experience of CRR-DIMESAD-UNIFESP / Procesos de formación en alcohol y otras drogas para trabajadores de la red pública del municipio de São Paulo: la experiencia del CRR-DIMESAD-UNIFESP

Este artigo descreve a experiência de implementação e avaliação de cursos de capacitação sobre a temática do álcool e outras drogas para profissionais da rede pública do município de São Paulo, organizados pelo CRR-DIMESAD-UNIFESP, apoiados por edital da Secretaria Nacional de Políticas sobre Drogas. A partir de metodologia mista de pesquisa, envolvendo abordagem qualitativa e quantitativa, são descritos os desafios metodológicos enfrentados na primeira edição dos cursos e a trajetória de mudanças que culminou na reestruturação dos cursos em módulos temáticos, a partir da avaliação dos processos formativos vigentes em 2014 e do diálogo com as secretarias parceiras, acerca das demandas dos profissionais. A reestruturação, em curso desde meados de 2016, pautou-se ainda nos pressupostos ético-políticos do paradigma da Educação Permanente, enfatizando o processo ensino-aprendizagem em sua dimensão emancipatória e política.

This article describes the implementation and evaluation of training courses on addiction issues to workers from the public sector in São Paulo city. It was conducted by the Regional Reference Center of the Federal University of São Paulo. The restructuring process of the courses, since their first edition, held in 2014, as well as their methodological challenges and the series of changes that led to their restructuring into thematic modules are described.. This changing process was based on the evaluation of the existing training courses in 2014 and on the dialogue, related to the worker's demands, with different public departments. The evaluation research conducted was based on qualitative and quantitative approach. Such restructuring, ongoing since mid-2016, was also marked by ethical and political assumptions of the Brazilian Permanent Education paradigm, emphasizing the teaching-learning process in its emancipatory and political dimension.

Esteartículodescribe la experiencia de implementación y evaluación de cursos de capacitación sobre la temática de alcohol y otras drogas para profesionales de la red pública del municipio de São Paulo, organizados por el Centro Regional de Referencia de la Universidad Federal de São Paulo. A partir de la metodología de investigación mixta, con enfoque cualitativo y cuantitativo, describiremos el trayecto de la reestructuración de los cursos, partiendo de la primera edición (2014) y planteada por la convocatoria de la Secretaria Nacional de Políticas sobre Drogas. Serán descritos los desafíos metodológicos enfrentados en la primera edición de los cursos y la trayectoria de los cambios que culminó en la reestructuración de los cursos en módulos temáticos, a partir de la evaluación de los procesos formativos vigentes en 2014 y del diálogo con las secretarías que trabajan en conjunto. Tal reestructuración se pautó en los supuestos ético-políticos del programa de Educación Permanente, enfatizando el proceso de enseñanza-aprendizaje en su dimensión emancipadora y política.

Management framework paradigms for disorders of sex development

Until 2005, questions regarding medical treatment and diagnostic information on Disorders of Sex Development (DSD) were not systematically discussed with both the patients and their families; however, the way these patients are currently treated have been changing with time. Interventional changes in the clinical-psychotherapeutic-surgical areas of DSD determine not only different medical recommendations but also help to place the patient and the family into the decisional process of therapy. We must consider two paradigmatic periods that have influenced and transformed the clinical management framework of patients with DSD: a) The "Money era" (1955), which emphasized the role of the gonads as the diagnostic criterion, having the environment as determinant of the sex identity; and b) The Chicago Consensus (2005) phase, in which the role of genetics and molecular biology was critical for an early identification, as well as in building a proper sex identity, emphasizing ethical questions and the "stigma culture". In addition, recent data have focused on the importance of interdisciplinarity and statements on questions concerning Human Rights as key factors in treatment decision making. Despite each of these management models being able to determine specific directions and recommendations regarding the clinical handling of these patients, we verify that a composite of these several models is the clinical routine nowadays. In the present paper, we discuss these several paradigms, and pinpoint clinical differences and their unfolding regarding management of DSD patients and their families.

Evaluación de un protocolo para valorar situaciones de desprotección infantil: la opinión de los técnicos / Evaluation of a protocol to assess situations where a child is in need of protection from the child protection workers' point of view

El objetivo de este trabajo es conocer la valoración que los técnicos municipales hacen de un protocolo cuyo objetivo es unificar, en los diferentes municipios de la isla de Tenerife, el procedimiento de valoración de los casos de desprotección infantil. 126 técnicos respondieron a un cuestionario en el que se les pedía su opinión sobre tres aspectos diferentes: el contenido del protocolo, los efectos de su aplicación y los recursos que facilitan su implementación. Los resultados indican que los profesionales valoran positivamente el contenido y los efectos del protocolo, sobre todo los referentes a las condiciones en las que realizan su labor, la unificación de criterios y la coordinación horizontal. Los recursos más valorados en la implementación del protocolo son el acompañamiento de técnicos especializados durante el proceso de implementación, la existencia de espacios de encuentro y una buena dinámica de trabajo en equipo. Se encontraron algunas diferencias en la valoración, en función del perfil profesional. Se concluye que es adecuada la creación de este tipo de instrumentos, a través de procesos participativos, y que su implementación se ve mediatizada por algunas variables ajenas al instrumento.

The aim of this study is to find out council child protection officers' assessment of a protocol that unifies the different evaluation procedures in district councils on the island of Tenerife in cases where a child is in need of protection. 126 child protection officers answered an ad hoc questionnaire in which their opinions on three aspects were requested: the content of the protocol, the effects of its application and the resources to facilitate its implementation. Results indicate that professionals value positively the content and effects of the protocol, above all in regard to the conditions in which they carry out their work, the unification of criteria and horizontal co-ordination. The resources most valued in the implementation of the protocol are: being accompanied by specialists during the implementation processes; the existence of opportunities for meetings and a good teamwork dynamic. There were some differences in the assessment of the professional's profile. In conclusion, the creation of this type of instrument through participative processes and its implementation when influenced by some variables not directly connected to the instrument is considered appropriate.