Aprendizagem baseada em projeto e a formação médica: relato de experiência introduzindo questões para o debate interprofissional / Project-based learning and medical education: experience report introducing issues for interprofessional debate / El aprendizaje basado en proyecto y la formación médica: informe de experiencia que introduce cuestiones para el debate interprofesional

A aprendizagem baseada em projeto orientada pelos fundamentos da educação interprofissional é um modelo que pode contribuir para a formação de relacionamentos interpessoais, criatividade, empatia e colaboração na educação médica, por meio de uma colaboração mútua com profissionais de saúde da rede. Muito se fala da efetividade desse método no campo do ensino e aprendizagem médica, mas há a necessidade de incluir a importância do desenvolvimento de habilidades interprofissionais, com equipes colaborativas, em ações extensionistas, diante das necessidades locais no contexto da atenção primária, pensando na melhoria dos resultados de saúde. O objetivo deste trabalho é apresentar um relato de experiência de aprendizagem baseada em projeto de estudantes de Medicina no contexto da Estratégia Saúde da Família. Participaram deste trabalho estudantes do Módulo Integração Ensino, Serviço e Comunidade da Faculdade de Medicina da Universidade Federal dos Vales do Jequitinhonha e Mucuri que executaram, em colaboração com uma equipe interprofissional o projeto sobre a saúde do homem. Como resultado da análise qualitativa do feedback entre os integrantes, observaram-se mudanças no comportamento dos estudantes, com melhorias na comunicação, empatia e nas relações interpessoais, por meio do trabalho colaborativo com a equipe interprofissional. Esta experiência poderá ser adaptada para implementar o ensino e aprendizagem no projeto pedagógico orientado pela educação interprofissional na atenção primária.

Project-based learning guided by the fundamentals of interprofessional education is a model that can contribute to the formation of interpersonal relationships, creativity, empathy and collaboration within medical education, through mutual collaboration with health professionals in the health network. Much has been said about the effectiveness of this method in medical teaching and learning, but there is a need to include the importance of developing interprofessional skills, with collaborative teams, within extension actions, in view of local needs in the context of primary care, thinking about the improved health outcomes. The objective of this work was to present a report of a project-based learning experience of medical students in Family Health Strategy. Students from the Teaching, Service and Community Integration Module of the Faculty of Medicine of Universidade Federal dos Vales do Jequitinhonha e Mucuri participated in this work, executing in collaboration with an interprofessional team a project about men's health. As a result of the qualitative analysis of the feedback among the members, changes in student behavior were observed with improvements in communication, empathy and interpersonal relationships through collaborative work with the interprofessional team. This experience can be adapted to implement teaching and learning in the pedagogical project guided by interprofessional education in primary care.

El aprendizaje basado en proyectos y guiado por los fundamentos de la educación interprofesional es un modelo que puede contribuir a la formación de relaciones interpersonales, creatividad, empatía y colaboración dentro de la educación médica, a través de la colaboración mutua con los profesionales de la salud en la red de salud. Mucho se habla de la efectividad de este método dentro de la enseñanza y el aprendizaje médico, pero es necesario incluir la importancia del desarrollo de habilidades interprofesionales, con equipos colaborativos, dentro de las acciones de extensión, frente a las necesidades locales en el contexto de la atención primaria, pensando sobre los mejores resultados de salud. El objetivo de este trabajo es presentar un informe de experiencia de aprendizaje basado en proyectos de estudiantes de medicina en la Estrategia de Salud Familiar. Participaron en este trabajo estudiantes del Módulo Integración Enseñanza, Servicio y Comunidad de la Facultad de Medicina de la Universidade Federal dos Vales do Jequitinhonha e Mucuri que ejecutaron en colaboración con un equipo interprofesional el proyecto sobre la salud del hombre. Como resultado del análisis cualitativo de la retroalimentación entre los integrantes, se observaron cambios en el comportamiento de los estudiantes con mejoras en la comunicación, la empatía y las relaciones interpersonales a través del trabajo colaborativo con el equipo interprofesional. Esta experiencia puede adaptarse para implementar la enseñanza y el aprendizaje en el proyecto pedagógico guiado por la educación interprofesional en atención primaria.

Escala de alerta precoce na identificação de pacientes com risco de deterioração clínica / Early warning scale for identifying patients at risk of clinical deterioration / Escala de alerta temprana en la identificación de pacientes con riesgo de deterioro clínico

Objetivo: avaliar pontuação da National Early Warning Score (NEWS) em relação ao tipo de desfecho e perfil dos pacientes da enfermaria clínica médica de um hospital em Teresina, Piauí, Brasil. Método: estudo quantitativo realizado num hospital público, em Teresina, com 150 prontuários de pacientes internados no setor clínica médica de fevereiro de 2022 a dezembro de 2022, a partir de registros demográficos, clínicos e valores da escala na admissão e desfecho. Resultados: houve associação dos valores da escala com a faixa etária (p=0,029), tempo de internação (p=0,023) e tipo de desfecho (p < 0,001). Alto risco clínico prevaleceu entre pacientes do sexo masculino (13%), na faixa etária de 60 a 94 anos (13%), com permanência de 21 a 57 dias (19,2%) e óbito como desfecho (100%). Conclusão: implementação da referida escala evidenciou ser fundamental para prever agravos clínicos e melhorar qualidade da assistência.

Objective: to evaluate the National Early Warning Score (NEWS) in relation to the type of outcome and profile of patients in the medical clinical ward of a hospital in Teresina, Piauí, Brazil. Method: a quantitative study conducted in a public hospital in Teresina, with 150 medical records of patients admitted to the medical clinic sector from February 2022 to December 2022, based on demographic and clinical records and scale values at admission and outcome. Results: there was an association between the scale values and the age group (p=0.029), length of stay (p=0.023) and type of outcome (p < 0.001). High clinical risk prevailed among male patients (13%), aged between 60 and 94 years (13%), with a stay of 21 to 57 days (19.2%), and death as an outcome (100%). Conclusion: implementation of the aforementioned scale proved to be fundamental for predicting clinical problems and improving care quality.

Objetivo: evaluar el puntaje de la National Early Warning Score (NEWS) con respecto al tipo de desenlace y el perfil de los pacientes de la enfermería clínica médica de un hospital en Teresina, Piauí, Brasil. Método: estudio cuantitativo realizado en un hospital público en Teresina, con 150 historiales médicos de pacientes internados en el sector de clínica médica desde febrero de 2022 hasta diciembre de 2022, a partir de registros demográficos, clínicos y valores de la escala en la admisión y desenlace. Resultados: hubo asociación de los valores de la escala con la edad (p=0,029), tiempo de internación (p=0,023) y tipo de desenlace (p < 0,001). El alto riesgo clínico prevaleció entre los pacientes del sexo masculino (13%), en la franja de edad entre 60 y 94 años (13%), con una estancia de 21 a 57 días (19,2%) y fallecimiento como desenlace (100%). Conclusión: la implementación de dicha escala demostró ser fundamental para prever agravios clínicos y mejorar la calidad de la asistencia.

Multidisciplinary team training in postpartum hemorrhage: impact on the use of blood products.

Objective: Compare the number of puerperal women submitted to blood transfusion before and after the implementation of a care protocol for postpartum hemorrhage (PPH) with multidisciplinary team training. Methods: Cross-sectional study in a university hospital, analyzing births from 2015 to 2019, compared the use of blood products before and after the adoption of a PPH protocol with multidisciplinary training. Results: Between 2015 and 2019, there were 17,731 births, with 299 (1.7%) postpartum women receiving blood products and 278 postpartum women were considered for this analysis, 128 (0.7%) at Time 1 and 150 (0.8%) at Time 2. After the multiprofessional team training (T2), there was a difference in the complete use of the PPH protocol (use of oxytocin, misoprostol and tranexamic acid) (T1 = 5.1% x T2 = 49.5%, p≤0.0001). An individual categorized analysis revealed that, in the T2 period, there was lower use of blood component units per patient compared to T1 (Mann-Whitney, p=0.006). It should be noted that at T1 and T2, 54% and 24% respectively received two units of blood products. It is important to highlight that after the multidisciplinary team training for the PPH protocol, the goal of zero maternal death due to hemorrhage was reached. Conclusion: The adoption of a specific protocol for PPH, combined with the training of a multidisciplinary team, had an impact on the ability to identify women at high risk of hemorrhage, resulting in a decrease in the use of blood components.

Description of the etiological factors behind acute moderate and severe malnutrition in children under 5 years hospitalized at two high-complexity referral centers: Case series.

BACKGROUND: Acute malnutrition in children <5 years of age has a direct relationship with medical complications and mortality. We aimed to describe the etiologic factors in children with moderate and severe non-illness-related acute malnutrition who required hospitalization for treatment of malnutrition in two high-complexity hospital centers in Bogotá, Colombia. METHODS: This is a multicenter case series (December 2016 to December 2020) including patients aged 1-59 months with a weight/height indicator less than -2 SD. Electronic health records were reviewed, and demographic (sex, age, city of origin, and socioeconomic status) and clinical data (gestational age at birth, edema, and nutrition status) were collected. Descriptive analysis of information was performed. An exploratory bivariate analysis by diagnostic categories of moderate and severe acute malnutrition vs days of hospitalization was also performed. RESULTS: Forty-five patients were included, 62.2% of whom were male, with a median age of 14 months (Q1-Q3: 7-24). The main etiologic factors of malnutrition were related to problems with total food intake (33.3%), transition in consistency of feeding (31.1%), and breastfeeding technique (22.2%). Only 13.3% had problems related to food insecurity. There were no statistically significant differences between moderate (median: 7 days; Q1-Q3: 5-12) and severe (median: 8 days; Q1-Q3: 5-16) acute malnutrition when compared by days of hospitalization. CONCLUSIONS: The main etiologic factors of malnutrition in our study population were related to problems in the amount of food provided and transition in consistency of complementary feeding.

Breakout Session and Report Back: Collaboration of Rheumatologists and Dermatologists for the Care of Patients With Psoriatic Disease.

Multidisciplinary care is essential for the management of patients with psoriatic disease (PsD), considering the great range of cutaneous and musculoskeletal symptoms and the potential for associated comorbidities and extraarticular manifestations. Consequently, combined rheumatology/dermatology clinics represent a gold standard model of care for patients with PsD. Many challenges are associated with the establishment of these clinics in routine clinical practice. In this report, we describe the thoughts and debates within a collaborative care breakout session during the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2023 annual meeting. The breakout discussion focused around 3 main topics: (1) challenges of dermatologist-rheumatologist collaboration; (2) innovative approaches to encourage collaboration; and (3) how to identify patients with psoriasis at high risk of developing PsA.

Humanização na perspectiva dos profissionais da saúde atuantes em unidades de terapia intensiva: revisão integrativa / Humanization from the perspective of health professionals workingin Intensive Care Units: integrative review / La humanización desde la perspectiva de los profesionales de la salud que trabajan en Unidades de Cuidados Intensivos: revisión integrativa

Introdução:Esteartigo apresenta uma revisão integrativa da literatura em relação à compreensãodos profissionais sobre humanização na Unidade de Terapia Intensiva. Objetivo: Analisar os estudos científicos que abordem a percepção sobre humanização entre profissionais da saúde atuantes em Unidades de Terapia Intensiva.Metodologia:Revisão integrativa da literatura. Nas bases de dados e biblioteca virtual selecionadas, utilizou-se os descritores em ciências da saúde: percepção, humanização da assistência e unidades de terapia intensiva, combinados com o operador booleano "AND".As etapas de seleção dos artigos,compreenderam: identificação do tema e seleção da pergunta norteadora; estabelecimento dos critérios de inclusão e exclusão; identificação dos estudos selecionados e pré-selecionados; categorização dos estudos selecionados; análise e interpretação dos resultados; apresentação dos achados da revisão com a síntese do conhecimento.Os critérios de inclusão abrangeram:publicações dos últimos 10 anos (2013-2023), que atendessem ao objetivo do estudo, artigos disponíveis na íntegra nas bases de dados selecionadas, nos idiomas inglês, português e espanhol. Foram excluídos estudos duplicados, trabalhos de conclusão de curso, teses, dissertações, editoriais, cartas, resumos de anais, livros, estudo de caso e relatos de experiência. Resultados:Foram incluídos 16 artigos, revelandotrês categorias temáticas: compreensão dos profissionais sobre a humanização, fatores facilitadores e dificultadores para consolidar a humanização e os benefícios da prática humanizada.Considerações finais:Verificou-se a dificuldade em definir um conceito de humanização pelos profissionais da saúde. Foram destacados os elementos facilitadores da prática humanizada, incluindo empatia, respeito, acolhimento e comunicação adequada. Além disso, foi possível observar os obstáculos, como a falta de materiais, dimensionamento inadequado, ambiente inadequado, sobrecarga de trabalho, rotatividade da equipe e estresse. Adicionalmente, foi possível observar a percepção dos profissionais quanto aos benefícios da prática humanizada na Unidade de Terapia Intensiva (AU).

Introduction:This article presents an integrative literature revision of the understanding ofprofessionals about humanization in the Intensive Care Unit. Objective:Analyze scientific studies that address the perception of humanization among health professionals working in Intensive Care Units. Methodology:Literature integrative revision. In thedatabases and virtual library selected, we used the descriptors in health sciences: perception, humanization of assistance and intensive care units, combined with the Boolean operator "AND". The article selection steps included: identification of the topic and selection of the guiding question; establishment of inclusion and exclusion criteria; identification of the selected and pre-selected studies; categorization of the selected studies; analysis and interpretation of the results; presentation of the results of the revision and the synthesis of knowledge. The inclusion criteria were: publications from the last 10 years (2013-2023), which met the study's objective, articles available in full in the selected databases, in English, Portuguese and Spanish. Duplicate studies, term papers, theses, dissertations, editorials, letters, abstracts from proceedings, books, case studies and experience reports were excluded. Results:Sixteen articles were included, disclosing three thematic categories: professionals' understanding of humanization, factors that facilitate and hinder the consolidation of humanization, and the benefits of humanized practice. Final considerations:Health professionals had difficulty defining a concept of humanization. The elements that facilitate humanized practice were highlighted, including empathy, respect, hospitality and proper communication. In addition, there were obstacles including a shortage of materials, inadequate dimensioning, an unsuitable environment, work overload, staff turnover and stress. In addition, it was possible to observe the professionals' perception of the benefits of humanized practice in the Intensive Care Unit (AU).

Introducción:Este artículo presenta una revisión integradora de la literatura en relación a la comprensión de los profesionales sobre humanización en la Unidad de Cuidados Intensivos. Objetivo:Analizar los estúdios científicos que aborden la percepciónsobre humanización entre profesionales de la salud actuantes en Unidades de Cuidados Intensivos. Metodología:Revisión integrativa de la literatura. En las bases de datos y biblioteca virtual seleccionadas, se utilizó los descriptores en ciencias de la salud: percepción, humanizaciónde la asistencia y unidades de cuidados intensivos.Las etapasde selección de los artículos fueron las siguientes: identificación del tema y selección de la pregunta orientadora; establecimiento de los criterios de inclusión y exclusión;identificación de los estúdios seleccionados y preseleccionados; categorización de los estudios seleccionados; análisis e interpretación de los resultados; presentación de los hallazgos de la revisióncon la síntesis delconocimiento. Los criterios de inclusión abarcaron: publicaciones de los últimos diez años (2013-2023),que atendieran al objetivo del estudio, artículos disponibles íntegramente en las bases de datos seleccionadas, en los idiomas inglés, portugués y español. Se excluyeron estudios duplicados, trabajos de fin de grado, tesis, disertaciones, editoriales, cartas, resúmenes de anales, libros, estudio de caso y relatos de experiencia. Resultados:Fueron incluidos 16 artículos, revelando tres categorías temáticas: comprensión de los profesionales sobre la humanización, factores facilitadores y dificultadores para consolidar la humanización y los beneficios de la práctica humanizada. Consideraciones finales:Se verificó la dificultad para definir un concepto de humanización por los profesionales de la salud. Se destacaron los elementos facilitadores de la práctica humanizada, incluyendo empatía, respeto, acogimiento y comunicación adecuada. Además de eso, fue posible observar los obstáculos, como la falta de materiales, dimensionamiento inadecuado, ambiente inadecuado, sobrecarga de trabajo, rotación del equipo y estrés. Adicionalmente, fue posible observar la percepción de los profesionales en cuanto a los beneficios de la práctica humanizada en la Unidad de Cuidados Intensivos (AU).

O caráter interprofissional da Atenção Primária à Saúde no Brasil / Interprofessional field of Primary Health Care in Brazil

Nesta Tribuna, os autores discutem as transformações da sociedade e seu impacto na construção dos sistemas de saúde e a comprovada importância da Atenção Primária à Saúde, com a abordagem do processo de saúde-doença de modo singular e articulado ao contexto social por meio do trabalho em equipe interprofissional. A criação dos Núcleos de Apoio à Saúde da Família, recentemente rebatizados como Núcleos Ampliados de Saúde da Família e Atenção Básica, é um bom exemplo da imperiosa importância dessa abordagem interprofissional no âmbito da atenção primária. Contudo, nessa interlocução, também emergem desafios e fragilidades. Esses aspectos são suscitados na reflexão proposta.

In this forum, the authors discuss the transformations in society and their impact on the construction of health systems and the proven importance of Primary Health Care, with a unique approach to the health-disease process that is articulated with the social context through interprofessional teamwork. The creation of Family Health Support Centers, recently renamed Expanded Family Health and Primary Care Centers, is a good example of the imperative importance of this interprofessional approach in the context of primary care. However, in this dialogue, challenges and weaknesses also emerge. These aspects are raised in the proposed reflection.

Cultura de segurança em unidades de terapia intensiva na perspectiva da equipe multiprofissional: Estudo multicêntrico / Cultura de seguridad en unidades de terapia intensiva en la perspectiva del equipo multiprofesional: Estudio multicéntrico / Safety Culture in intensive care units from multiprofessional team perspective: A multicenter study

Resumo Introdução: A Cultura de Segurança do Paciente é considerada um importante componente estrutural dos serviços, que favorece a implantação de práticas seguras e a diminuição da ocorrência de eventos adversos. Objetivo: Identificar os fatores associados à cultura de segurança do paciente nas unidades de terapia intensiva adulto em hospitais de grande porte da região Sudeste do Brasil. Método: Estudo transversal do tipo survey e multicêntrico. Participaram 168 profissionais de saúde de quatro unidades (A, B, C e D) de terapia intensiva adulto. Foi utilizado o questionário "Hospital Survey on Patient Safety Culture". Considerou-se como variável dependente o nível de cultura de segurança do paciente e variáveis independentes aspectos sociodemográficos e laborais. Foram usadas estatísticas descritivas e para a análise dos fatores associados foi elaborado um modelo de regressão logística múltipla. Resultados: Identificou-se associação entre tipo de hospital com onze dimensões da cultura de segurança, quanto à função a categoria profissional médico, técnico de enfermagem e enfermeiro foram relacionadas com três dimensões; o gênero com duas dimensões e tempo de atuação no setor com uma dimensão. Conclusão: Evidenciou-se que o tipo de hospital, categoria profissional, tempo de atuação no setor e gênero foram associados às dimensões de cultura de segurança do paciente.

Resumen Introducción: La cultura de seguridad del paciente se considera un componente estructural importante de los servicios, que favorece la aplicación de prácticas seguras y la reducción de la aparición de acontecimientos adversos. Objetivo: Identificar los factores asociados a la cultura de seguridad del paciente en unidades de terapia intensiva adulto en hospitales de la región Sudeste del Brasil. Metodología: Estudio transversal de tipo encuesta y multicéntrico. Participaron 168 profesionales de salud de cuatro unidades (A, B, C y D) de terapia intensiva adulto. Se utilizó el cuestionario "Hospital Survey on Patient Safety Culture". Se consideró como variable dependiente el nivel de cultura de seguridad del paciente y variables independientes los aspectos sociodemográficos y laborales. Fueron usadas estadísticas descriptivas y, para analizar los factores asociados, fue elaborado un modelo de regresión logística múltiple. Resultados: Se identificó asociación entre tipo de hospital con once dimensiones de cultura de seguridad del paciente. En relación a la función, personal médico, técnicos de enfermería y personal de enfermería fueron asociados con tres dimensiones, el género con dos dimensiones y tiempo de actuación con una dimensión en el modelo de regresión. Conclusión: Se evidenció que el tipo de hospital, función, tiempo de actuación en el sector y género fueron asociados a las dimensiones de la cultura de seguridad del paciente.

Abstract Introduction: Patient safety culture is considered an important structural component of the services, which promotes the implementation of safe practices and the reduction of adverse events. Objective: To identify the factors associated with patient safety culture in adult intensive care units in large hospitals in Belo Horizonte. Method: Cross-sectional survey and multicenter study. A total of 168 health professionals from four units (A, B, C and D) of adult intensive care participated. The questionnaire "Hospital Survey on Patient Safety Culture" was used. The patient's level of safety culture was considered as a dependent variable, and sociodemographic and labor aspects were the independent variables. Descriptive statistics were used and a multiple logistic regression model was developed to analyze the associated factors. Results: An association was identified between the type of hospital and eleven dimensions of the safety culture. In terms of function, the doctors, nursing technicians, and nurse were related to three dimensions; gender with two dimensions, and time working in the sector with one dimension. Conclusion: It was evidenced that the type of hospital, function, time working in the sector, and gender were associated with the dimensions of patient safety culture.

Percepción de competencia bioética y deliberación ético-clínica conjunta medicina-enfermería en hospitalización pediátrica básica

Introducción: las competencias bioéticas permiten abordar colectiva y críticamente, aspectos éticos involucrados en la práctica clínica. Pero, la deliberación ética simultánea de médico/as con enfermero/as, en pacientes no críticos, es inhabitual. Objetivo: constatar la percepción de médico/as y enfermero/as de un hospital de alta complejidad, sobre sus competencias bioéticas y deliberación sincrónica, en hospitalizados pediátricos sin riesgo vital. Métodos: se realizó un estudio descriptivo y transversal mediante encuesta, a médico/as y enfermero/as del servicio médico-quirúrgico infantil, sobre presencia, modalidad de enseñanza de bioética en pregrado, percepción de tener conocimiento bioético suficiente para aplicarlo clínicamente y si hubo análisis ético-clínico conjunto, en pacientes hospitalizados. Resultados: la mayoría de los encuestados 47/54 (87%) recibió formación teórica obligatoria en bioética durante el pregrado. De ellos, 19/29 (65,5%) médico/as y 11/18 (61,1%) enfermero/as reconocieron que esta formación fue insuficiente para aplicarla en el trabajo. 25/35 (71,4%) médicos, afirmó participar en deliberación ética antes de enviar un caso al comité de ética asistencial, pero esta deliberación ocasionalmente incluyó a enfermero/as ya que, sólo 2/19 (10,5%) de los enfermero/as señalaron intervenir en este tipo de deliberación. Conclusiones: médico/as y enfermero/as que trabajan en pediatría y cirugía infantil, perciben insuficiencias de formación en pregrado en bioética e impericia para aplicar contenidos a la práctica cotidiana. La deliberación ética sobre casos clínicos pediátricos de enfermero/as es esporádica respecto de médico/as en hospitalización médico-quirúrgica básica.

Introduction: Bioethical skills are essential for addressing, both collectively and critically, ethical issues that arise in clinical practice. However, joint ethical deliberation between physicians and nurses with non-critical patients is uncommon Objective: To study the perception of physicians and nurses regarding their bioethical skills in a high-complexity hospital and whether they engage in collective deliberation in units of pediatric inpatients not at vital risk. Methods: A descriptive, cross-sectional study was conducted via a survey targeting physicians and nurses in the pediatric medical-surgical service. The survey inquired about the presence and modality of bioethics teaching during undergraduate education, the perception of having sufficient bioethical knowledge for clinical application, and whether joint ethical-clinical analysis was performed regarding hospitalized patients. Results: Most respondents, 47/54 (87%), had received mandatory theoretical training in bioethics during their undergraduate education. 19/29 (65.5%) physicians and 11/18 (61.1%) nurses acknowledged that this training was insufficient for application in their work. A high percentage of physicians, 19/29 (65.5%), claimed to carry out ethical analysis of cases before referring them to the healthcare ethics committee, occasionally including nurses since only 2/18 (11.1%) of the nurses indicated participation in such analysis. Conclusions: Medical and nursing professionals who work in pediatrics and children's surgery perceive insufficiencies in undergraduate training in bioethics issues and an inability to apply content to daily practice. Ethical deliberation on pediatric clinical cases by nurses is sporadic compared to doctors in basic medical-surgical hospitalization.

Giving a voice to families of people with intestinal stoma: reflections on training, care and management / Dando voz a las familias de personas con estomía intestinal: reflexiones sobre formación, asistencia y gestión / Dando voz às famílias de pessoas com estomia intestinal: reflexões sobre formação, assistência e gestão

Objective: To reflect on aspects of training, care and management that contribute to supporting families of people with intestinal stomas. Method: A theoretical reflection study based on a substantive theory developed with 12 families of people with ostomies due to intestinal cancer. Results: With the development of the substantive theory, it was possible to give a voice to families of people with ostomies due to intestinal cancer based on what they identify as the need for multidisciplinary and interdisciplinary care capable of completing the procedural phases experienced throughout the investigated trajectory. For these care changes to be effective, healthcare professional training must include intestinal ostomy care in their curricula. Also, changes in intersectoral management are updating the Management of Users with Disabilities, investing in infrastructure, mainly in adequate public restrooms. Conclusion: This reflection demonstrates the importance of implementing these changes in training, care and management, which help in planning family-centered care, considering that the family provides home care based on interactions, and helps and empowers their family member to implement self-care for ostomy. (AU)

Objetivo: Reflexionar sobre aspectos de la formación, la asistencia y la gestión que contribuyan al cuidado de las familias de personas con estomía intestinal. Método: Estudio de reflexión teórica basado en una teoría sustantiva desarrollada con 12 familias de personas con estomías por cáncer intestinal. Resultados: Con el desarrollo de la teoría sustantiva se logró dar voz a las familias de personas estomáticas por cáncer intestinal a partir de lo que identifican como la necesidad de una asistencia multidisciplinaria e interdisciplinaria capaz de completar las fases procesuales vividas a lo largo de la trayectoria investigada. Para que estos cambios de atención sean efectivos, la formación de los profesionales de la salud debe incluir el cuidado de las ostomías intestinales en sus planes de estudio. También son necesarios cambios en la gestión intersectorial, como la actualización de la Gestión de Usuarios con Discapacidad e inversiones en infraestructura, principalmente en baños públicos adecuados. Conclusión: Esta reflexión demuestra la importancia de implementar estos cambios en la capacitación, la asistencia y la gestión, que ayuden en la planificación del cuidado centrado en la familia, considerando que la familia brinda cuidados en el hogar a partir de interacciones y ayuda y empodera a su familiar para llevar a cabo el autocuidado de la estomía. (AU)

Objetivo: Refletir sobre aspectos da formação, da assistência e da gestão que contribuam para o cuidado com as famílias de pessoas com estomia intestinal. Método: Estudo de reflexão teórica partindo de uma teoria substantiva desenvolvida com 12 famílias de pessoas com estomia por câncer intestinal. Resultados: Com o desenvolvimento da teoria substantiva, foi possível dar voz às famílias de pessoas com estomia por câncer intestinal com base no que elas identificaram como necessidade de assistência multiprofissional e interdisciplinar capaz de perfazer as fases processuais experienciadas ao longo da trajetória investigada. Para que essas mudanças assistenciais sejam efetivadas, a formação de profissionais da saúde deve instituir nos currículos os cuidados com estomias intestinais, também são necessárias alterações na gestão intersetorial visando atualizar o Gerenciamento dos Usuários com Deficiências e investir em infraestrutura, principalmente banheiros públicos adequados. Conclusão: Esta reflexão demonstra a importância de efetivar essas modificações na formação, na assistência e na gestão, a fim de auxiliar no planejamento de um cuidado centrado na família, tendo em vista que ela presta os cuidados no domicílio, partindo das interações e auxiliando e potencializando seu familiar para efetivar o autocuidado com a estomia. (AU)

Team climate and patients' perception of primary healthcare attributes in Brazil: a cross-sectional study.

Team climate and attributes of primary healthcare (PHC) are key elements for collaborative practice. Few researchers have explored the relationship between team climate and patients' perceptions of PHC. This study aimed to assess the association between team climate and patients' perceptions of primary healthcare attributes. A quantitative approach was adopted. In Stage 1, Team climate was assessed using Team Climate Inventory in 118 Family Health Strategy (FHS) teams at a PHC setting. In Stage 2, Patients' perceptions of PHC attributes were assessed using the Primary Care Assessment Tool (PCATool) in a sample of 844 patients enrolled in teams studied in Stage 1. Cluster analysis was used to identify team climate groups. The analysis used multilevel linear regression models. Patients assigned to teams with the highest team climate scores had the highest PHC attributes scores. Patients who reported affiliation at the team level had the highest PCATool scores overall. They also scored higher on the attributes of comprehensiveness and coordinated care compared to patients with affiliation to the health unit. In conclusion, patients under the care of FHS teams exhibiting a more favorable team climate had more positive patient perceptions of PHC attributes.

Rehabilitación neurológica en la variante faringo-cérvico-braquial del síndrome de Guillain-Barré: reporte de un caso pediátrico / Neurological rehabilitation in the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome: a pediatric case report

RESUMEN Introducción: El síndrome de Guillain-Barré (SGB) es la principal causa de parálisis en niños, y la variante faringo-cérvico-braquial (FCB) es poco común. Esta variante atípica se asocia con secuelas y requiere rehabilitación prolongada. Dado el enfoque predominante durante el tratamiento agudo, este estudio describe la evolución motora, respiratoria y funcional de un niño con SGB, variante FCB, en un centro de neurorrehabilitación durante el período subagudo. Presentación del caso: Un niño de 11 años ingresó con cuadriparesia fláccida y un mayor compromiso en los miembros superiores (MMSS), traqueotomizado y dependiente para las actividades de la vida diaria. Recibió un programa de evaluación y abordaje interdisciplinario intensivo. Logró la decanulación, la marcha y la independencia funcional con adaptaciones, y fue dado de alta luego de 16 semanas. Conclusión: La evolución del caso concuerda con lo reportado en la literatura sobre la presencia de secuelas y los tiempos prolongados de recuperación de la variante FCB. El niño recibió rehabilitación interdisciplinaria intensiva durante 16 semanas y, aún luego de un año, continuaba presentando debilidad a nivel distal de los MMSS y fatiga. Estos hallazgos resaltan la importancia de una intervención temprana y una rehabilitación integral en pacientes pediátricos con esta variante particular del SGB.

ABSTRACT Introduction: The Guillain-Barré syndrome (GBS) is the primary cause of paralysis in children, with the pharyngeal-cervical-brachial (PCB) variant being rare. This atypical form is associated with sequelae and requires prolonged rehabilitation. Given the predominant focus during acute treatment, this study describes the motor, respiratory, and functional clinical course of a child with GBS, PCB variant, in a neurorehabilitation center during the subacute period. Case presentation: An 11-year-old boy was admitted with flaccid quadriparesis and greater involvement of the upper limb (UL), tracheotomized, and dependent for activities of daily living. He underwent an intensive interdisciplinary evaluation and treatment program. The patient achieved decannulation, gait, and functional independence with adaptations, and was discharged after 16 weeks. Conclusion: The clinical course of the case aligns with the literature regarding the presence of sequelae and prolonged recovery times of the PCB variant. The child underwent intensive interdisciplinary rehabilitation for 16 weeks and, even after one year, continued to experience weakness in the distal UL and fatigue. These findings highlight the importance of early intervention and comprehensive rehabilitation in pediatric patients with this particular variant of GBS.

Opportunities and challenges of lupus care in Latin America, the Middle East, and Asia-Pacific: A call to action.

Lupus remains a disease with a low prioritisation in the national agendas of many countries in Latin America, the Middle East, and Asia-Pacific, where there is a dearth of rheumatologists and limited access to new or even standard lupus treatments. There is thus an important need for education, advocacy, and outreach to prioritise lupus in these regions to ensure that patients receive the care they need. This article reviews some of the specific challenges facing the care and management of people with lupus in these regions and suggests strategies for improving patient outcomes. Specifically, we review and discuss (with a focus on the aforementioned regions) the epidemiology of lupus; economic costs, disease burden, and effects on quality of life; barriers to care related to disease assessment; barriers to effective treatment, including limitations of standard treatments, high glucocorticoid use, inadequate access to new treatments, and low adherence to medications; and strategies to improve lupus management and patient outcomes. We hope that this represents a call to action to come together and act now for the lupus community, policymakers, health authorities, and healthcare professionals to improve lupus management and patient outcomes in Latin America, the Middle East, and Asia-Pacific.

Multiprofessional perceptions and barriers to early mobilization in intensive care: a study at a university hospital / Percepções multiprofissionais e barreiras à mobilização precoce na terapia intensiva: um estudo em um hospital universitário

INTRODUCTION: Hospitalization often causes mobility difficulties and hinders daily activities. Progressive mobilization of patients in intensive care units (ICUs) is safe and linked to better clinical and functional outcomes. OBJECTIVE: To assess the perception of a multidisciplinary team in the ICUs of a university hospital regarding early mobilization (EM). METHODS: A prospective observational study was conducted using data collected from professionals and students in the ICU of Clementino Fraga Filho University Hospital at the Federal University of Rio de Janeiro between June and December 2019. Data on EM perception were collected using a questionnaire. Descriptive statistics and Fisher's exact tests were used to analyze the differences between the professional categories. RESULTS: In comparison to physiotherapists (88%), a smaller percentage of physicians (37.5%) and nurses (50%) reported that patients on mechanical ventilation (MV) are mobilized within 48 hours (P80%), with the main perceived barriers being the availability of professionals (58%), the clinical condition of patients (55%), and patients undergoing procedures (45%). CONCLUSION: In a university hospital without an established EM protocol, the multidisciplinary team showed satisfactory knowledge and perceptions of EM. However, creating institutional protocols and guidelines is essential to engage multidisciplinary teams in implementing EM and overcoming barriers.

INTRODUÇÃO: A hospitalização frequentemente causa dificuldades de mobilidade e compromete as atividades da vida diária. A mobilização progressiva de pacientes em unidades de terapia intensiva (UTI) é segura e está associada a melhores resultados clínicos e funcionais. OBJETIVO: Avaliar a percepção da equipe multiprofissional das UTIs de um hospital universitário quanto à mobilização precoce (MP). MÉTODOS: Foi realizado um estudo prospectivo e observacional com dados coletados de profissionais e estudantes da UTI do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro entre junho e dezembro de 2019. Os dados sobre a percepção da MP foram coletados por meio de questionário. A estatística descritiva e o teste exato de Fisher foram utilizados para analisar as diferenças entre categorias profissionais. RESULTADOS: Em comparação aos fisioterapeutas (88%), um percentual menor de médicos (37,5%) e enfermeiros (50%) relataram que os pacientes em ventilação mecânica (VM) são mobilizados em 48 horas (P80%), sendo as principais barreiras percebidas a indisponibilidade de profissionais (58%), a condição clínica (55%) e pacientes submetidos a procedimentos (45%). CONCLUSÃO: Em um hospital universitário sem protocolo de MP estabelecido, a equipe multidisciplinar apresenta percepção satisfatória sobre a MP. Contudo, a criação de protocolos e diretrizes institucionais é essencial para engajar a equipe na implementação da MP e na superação de barreiras.

Effects of interprofessional practice on nursing workload in hospitals: A systematic review.

OBJECTIVE: To synthesise scientific evidence on interprofessional practice in hospital care and the effects on nursing workload. METHODS: Systematic mixed method review, registered in PROSPERO (CRD42021225627) and conducted in the following databases: CINAHL, Medline, Web of Science and Scopus, with no restrictions on the publication period of the studies. Primary studies were recruited on nurses' interprofessional practice (actions and interactions with other professional categories) in hospitals and the effects on one or more dimensions of nursing workload (quantitative, qualitative, physical, cognitive, emotional, time and variation). Scientific articles available in open access, in English, Spanish or Portuguese, were included. The searches were carried out in January 2021. The studies were evaluated by pairs of independent researchers to verify methodological quality, through the Mixed Method Appraisal Tool, and data extraction. To summarise the studies, thematic analysis was adopted. RESULTS: A total of 1774 publications were assessed for eligibility and 17 studies were included. Of these, two were mixed methods, four were qualitative, and 11 were quantitative, published between 2011 and 2020. The main scenarios investigated were Intensive Care Units and/or Inpatient Units. During data analysis, three thematic categories emerged: Interprofessional practice in coping with emotional overload; Time dedicated by nurses to professional communication; and Working conditions and patient care. The third category consisted of three subthemes: Conflict and flexibility in the context of practice; Working conditions and interprofessional practice; and Effects on patient care. CONCLUSIONS: The evidence points to the emotional overload of nurses in the face of uncooperative practices. Interprofessional actions, especially communicative ones, demand nurses' time and impact the care provided. The results contribute to political decisions and health work management.

Multidisciplinary team for patients with neurocutaneous syndromes: The little discussed importance of dentistry.

Neurocutaneous syndromes comprise a heterogeneous group of congenital or hereditary conditions that are known to be associated with the risk of different disorders and complications. Two of the most common neurocutaneous syndromes are Neurofibromatosis type 1 (NF1) and Tuberous Sclerosis Complex (TSC). Although there appears to be a general consensus on the importance of a multidisciplinary approach in managing these cases, there is still very little emphasis in discussions addressed in the literature on the role of dentistry in accordance with the perspective of comprehensive care. Evidence-based propositions, together with a broad discussion of new insights in this regard, should have the ability to strongly impact related future perspectives, aiming for greater advances and better outcomes for these patients. In this review article, the authors discuss updated general aspects of NF1 and TSC, and the potential additional roles of dentistry, in addition to addressing suggestions for actions in dentistry at related levels of care, as well as priorities for future research.

Execução do ultrassom à beira leito no paciente crítico: protocolo de revisão de escopo / Bedside ultra sound execution for critical patient: scope review protocol

OBJETIVO: Descrever as evidências científicas acerca do ultrassom à beira do leito, executado pelos profissionais de saúde em ambiente crítico. MÉTODO: Revisão de escopo pautado nas normas e termos metodológicos do Joanna Briggs Institute (JBI), norteada pela pergunta "Como está descrito na literatura o uso do Point-of-Care Ultrasound - POCUS / ultrassom à beira do leito pelos profissionais de saúde na assistência direta ao paciente crítico?". A busca envolve nove bases de dados e na literatura cinzenta. A seleção de evidências se apresenta em três etapas, e para o gerenciamento das referências dos estudos se utiliza o software Mendeley. A avaliação dos estudos está sustentada nos critérios preestabelecidos de inclusão, e foi realizada por três revisores, sendo dois de modo independente e um terceiro para a preciação das divergências. Os dados extraídos têm apresentação descritiva e sintética dos resultados.

OBJECTIVE: To describe the scientific evidence about bedside ultrasound health professionals performing in a critical environment. METHOD: Scope review based on Joanna Briggs Institute methodological terms and standards, guided by the question "How is the use of Point-of-Care Ultrasound - POCUS / ultrasound at the bedside described in the literature by health professionals in direct care to critical patients?". The search involves nine data bases and in the gray literature. The selection of evidence is in three stages, and the Mendeley software is used to manage study references. The study evaluation is based on the pre-established inclusion criteria and was carried out by three reviewers, two independently and a third, to assess differences. The extracted data has a descriptive and synthetic presentation of the results.

Guia cuidativo-educacional manejo do óbito neonatal: produção a partir do itinerário de pesquisa freiriano* / Care-educational guide to neonatal death management: production based on Freire's research itinerary / Guía educativa y de cuidados para el manejo de la muerte neonatal: producción a partir del Itinerario de investigación de Freire

Objetivo: produzir um guia cuidativo-educacional para e com os profissionais de saúde de uma Unidade de Terapia Intensiva, a partir da compreensão de suas práticas vivenciadas no manejo do óbito neonatal. Método: estudo metodológico, qualitativo, guiado pelo Itinerário de Pesquisa de Paulo Freire, constituído por três etapas: Investigação temática, Codificação e Descodificação e Desvelamento crítico. Realizado em uma maternidade pública em Manaus, Amazonas, Brasil, com a participação de 24 profissionais. Resultados: o guia foi organizado em três capítulos sobre os cuidados e preparo do bebê; orientações para a equipe de saúde do que fazer diante da perda neonatal; apoio a equipe e direitos maternos diante da perda. Conclusão: a tecnologia foi produzida com uma estratégia metodológica que contribuiu para a compreensão das práticas de cuidado no manejo do óbito neonatal, marcadas por sentimentos traumáticos, que de forma coletiva, os participantes se sentirem estimulados a buscar intervenções sistematizadas, acolhedoras e humanizadas.

Objective: to produce a care-educational guide for and with health professionals in an Intensive Care Unit, based on an understanding of their practices in neonatal death management. Method: a qualitative and methodological study guided by Paulo Freire's Research Itinerary, consisting of three stages: Thematic investigation; Coding and Decoding; and Critical Unveiling. It was carried out at a public maternity hospital in Manaus, Amazonas, Brazil, with the participation of 24 professionals. Results: the guide was organized into three chapters on care and preparation of the neonate; guidelines for the health team on what to do in the face of neonatal loss; support for the team; and maternal rights facing the loss. Conclusion: the technology was produced with a methodological strategy that contributed to understanding care practices in neonatal death management, marked by traumatic feelings, which collectively encouraged the participants to seek systematized, welcoming and humanized interventions.

Objetivo: crear una guía educativa y de cuidados para y con los profesionales de la salud de una Unidad de Cuidado Intensivo, a partir d comprender las prácticas que experimentan en el manejo de la muerte neonatal. Método: estudio metodológico y cualitativo, guiado por el Itinerario de Investigación de Paulo Freire, constituido por tres etapas: Investigación temática, Codificación y Descodificación, y Desvelamiento crítico. El estudio se realizó en una maternidad pública de Manaus, Amazonas, Brasil, con participación de 24 profesionales. Resultados: la guía se organizó en tres capítulos sobre los cuidados y la preparación del neonato; pautas para el equipo de salud sobre qué hacer frente a una muerte neonatal; apoyo para el equipo; y derechos maternos frente a la pérdida. Conclusión: la tecnología se produjo con una estrategia metodológica que ayudó a comprender las prácticas de cuidado en el manejo de la muerte neonatal, marcadas por sentimientos traumáticos y que, en forma colectiva, los participantes se sintieran estimulados a buscar intervenciones sistematizadas, acogedoras y humanizadas.

Propuesta de Consulta Interdisciplinaria de Medicina del Sueño en Camagüey

Introducción: El sueño garantiza el bienestar físico y mental del individuo mediante retroalimentación directa. Los trastornos del sueño implican alteraciones respecto a calidad y cantidad de horas de sueño y obedecen a una alteración real de su función fisiológica que controla y opera durante el mismo. La Medicina del Sueño es una especialidad nueva, surgida en los últimos 50 años, cuyo campo de acción aborda la prevención, diagnóstico y tratamiento de los trastornos del sueño; los cuales hasta el momento se han identificado alrededor del centenar. Esta enfermedad se ha convertido en problema social crucial y creciente, difícil de abordar en la práctica médica contemporánea; debido a la complejidad en la toma de decisiones respecto a su diagnóstico y tratamiento. Esta temática requiere ser evaluada desde un enfoque interdisciplinario para reducir la morbimortalidad asociada a manifestaciones neurológicas, psicológicas, psiquiátricas, cardiovasculares y endocrinometabólicas. Objetivo: Establecer la propuesta de Consulta Interdisciplinaria de Medicina del Sueño en la provincia Camagüey. Métodos: Se efectuó una investigación cualitativa de tipo descriptivo para la selección de aspectos pertinentes a una consulta especializada proveedora de pacientes pediátricos con trastornos del sueño, en el período comprendido entre julio y diciembre de 2022, en el Centro de Inmunología y Productos Biológicos de la Universidad de Ciencias Médicas de Camagüey. El universo del grupo de trabajo estuvo integrado por ocho profesionales de las Ciencias Médicas. Se utilizaron métodos teóricos como la revisión documental, histórico-lógico, análisis y síntesis, inducción-deducción, métodos matemáticos-estadísticos y métodos computacionales. Resultados: Se conformó un algoritmo de trabajo para la atención médica, que desarrolló el ordenamiento de los elementos sustantivos propios de la analítica polisomnográfica en el contexto cubano. Logró unificar criterios y opiniones generales de manera consensuada por equipos interdisciplinarios. Conclusiones: Resulta definido el documento científico rector de la Consulta Interdisciplinaria de Medicina del Sueño en Camagüey.

Introduction: Sleep guarantees the physical and mental well-being of the individual through direct feedback. Sleep disorders involve alterations in the quality and quantity of hours of sleep and are due to a real alteration in the physiological function that controls and operates during sleep. Sleep Medicine is a new specialty, emerged in the last 50 years, whose field of action addresses the prevention, diagnosis and treatment of sleep disorders; of which around a hundred have been identified so far. This kind of disorders has become a crucial and growing social problem, difficult to address in contemporary medical practice; due to the complexity in decision-making regarding diagnosis and treatment. This topic requires being evaluated from an interdisciplinary approach to reduce morbidity and mortality associated with neurological, psychological, psychiatric, cardiovascular and endocrine-metabolic manifestations. Objective: To establish the proposal of Interdisciplinary Consultation of Sleep Medicine in the province Camagüey. Methods: A qualitative descriptive research was carried out to select aspects relevant to a specialized consultation providing pediatric patients with sleep disorders, in the period between July and December 2022, at the Center for Immunology and Biological Products of the University of Medical Sciences of Camagüey. The universe of the working group was made up of eight professionals from the Medical Sciences. Theoretical methods such as documentary review, historical-logical, analysis and synthesis, induction-deduction, mathematical-statistical methods and computational methods were used. Results: A work algorithm for medical care was formed, which developed the ordering of the substantive elements of polysomnographic analysis in the Cuban context. It manages to unify general criteria and opinions in a consensus by interdisciplinary teams. Conclusions: The governing scientific document of the Interdisciplinary Consultation of Sleep Medicine in Camagüey is defined.

Multidisciplinary team for patients with neurocutaneous syndromes: The little discussed importance of dentistry

Abstract Neurocutaneous syndromes comprise a heterogeneous group of congenital or hereditary conditions that are known to be associated with the risk of different disorders and complications. Two of the most common neurocutaneous syndromes are Neurofibromatosis type 1 (NF1) and Tuberous Sclerosis Complex (TSC). Although there appears to be a general consensus on the importance of a multidisciplinary approach in managing these cases, there is still very little emphasis in discussions addressed in the literature on the role of dentistry in accordance with the perspective of comprehensive care. Evidence-based propositions, together with a broad discussion of new insights in this regard, should have the ability to strongly impact related future perspectives, aiming for greater advances and better outcomes for these patients. In this review article, the authors discuss updated general aspects of NF1 and TSC, and the potential additional roles of dentistry, in addition to addressing suggestions for actions in dentistry at related levels of care, as well as priorities for future research.