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RESUMO Introdução: A garantia na oferta de cuidados paliativos (CP) a pacientes e seus familiares que enfrentam doenças graves e ameaçadoras da vida é uma responsabilidade ética dos sistemas de saúde, bem como dos profissionais. Diversas ações contribuem para a garantia na prestação desse tipo de cuidado, podendo-se destacar o ensino em CP para os profissionais de saúde. No Brasil, a inclusão do ensino de CP na graduação é exceção, tanto para o curso de Medicina como de Enfermagem. Objetivo: Este estudo teve como objetivos identificar quais são as competências paliativistas recomendadas para o ensino de CP nas graduações em Medicina e Enfermagem, e caracterizar as evidências das melhores práticas para o ensino de CP para graduandos desses cursos. Método: Trata-se de uma revisão integrativa de literatura, em que foram utilizarados os seguintes descritores: Medical student, Nursing student, education, learning, teaching e palliative care. A busca ocorreu, com o emprego do recurso booleano OR e AND, nas bases de dados eletrônicas Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PubMed, Scopus e Web of Science. Resultado: A estratégia de busca gerou 182 artigos potenciais para inclusão nesta revisão. Destes, 85 foram excluídos por não estarem dentro dos critérios de inclusão, e 13, por não estarem disponíveis para acesso na plataforma digital. Os artigos incluídos trouxeram aspectos das competências a serem desenvolvidas para prática de CP, estratégias de ensino e estrutura curricular. A maior parte dos estudos incluídos teve como enfoque as estratégias de ensino, com destaque para as metodologias ativas que têm por objetivo não apenas a transferência de conhecimento, mas também o desenvolvimento de habilidades e atitudes para oferta de um cuidado que visa ao alívio do sofrimento. Conclusão: A revisão integrativa de literatura desenvolvida permitiu identificar as competências a serem adquiridas ainda nas graduações em Medicina e Enfermagem para que os futuros profissionais possam ofertar CP primários, bem como as melhores estratégias de ensino utilizadas.
ABSTRACT Introduction: Ensuring the provision of Palliative Care (PC) to patients and their families who face serious and life-threatening diseases is an ethical responsibility of health systems and professionals. Several actions are listed to guarantee the provision of this type of care, with emphasis on the teaching of PC for health professionals. In Brazil, the inclusion of PC training in undergraduate courses is an exception, both for medicine and nursing courses. This study aims to identify which palliative competencies are recommended for the teaching of palliative care in undergraduate medicine and nursing, and characterize the best practices for the teaching of PC for undergraduates of these courses. Method: This is an integrative literature review, with the chosen descriptors being Medical Students, Nursing Students, Education, Learning, Teaching and Palliative Care. The search was performed using the Boolean resource OR and AND, in the electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and Caribbean Literature in Health Sciences (LILACS), PubMed, Scopus and Web of Science. Results: The search strategy generated 182 potential articles for inclusion in the review. Of these, 85 were excluded due to failing to meet the inclusion criteria and 13 were excluded because they were not available for access on the digital platform. The articles included brought aspects of the competencies to be developed for the practice of PC, teaching strategies and curricular structure. Discussion: Most of the included studies focused on teaching strategies, especially active methodologies that aimed at not only knowledge transfer, but also the development of skills and attitudes to offer care that aims to alleviate suffering. Final Considerations: An integrative literature review allowed us to identify the competencies to be acquired during the medicine and nursing undergraduate courses so that future professionals can offer primary PC, as well as the best teaching strategies used.
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Systemic lupus erythematosus (SLE) is a complex systemic autoimmune disease with various clinical and serological manifestations. Previous studies have shown the association of SLE and anti-Ro antibody with a series of clinical manifestations. We investigated this association in Brazilian patients with SLE. Five hundred and nine consecutive patients who fulfilled the revised American College of Rheumatology criteria for the SLE were enrolled in the study from June to December 2007. All patients were from our Service of Rheumatology, School of Medicine, University of São Paulo, Brazil. Frequencies of a series of laboratorial and clinical manifestations were calculated. Anti-Ro antibody was associated to anti-La antibody, female, and cutaneous vasculitis. In multivariate analysis, patients with anti-Ro antibody has 1.63 (95% CI 1.07-2.50) more risk to develop cutaneous vasculitis than patients without this antibody. Our data have demonstrated that anti-Ro antibody is an independent useful serologic marker for cutaneous vasculitis.