Evaluación de la implementación de la iniciativa HEARTS en una comunidad rural de Venezuela, 2023 / Evaluation of Implementation of the HEARTS Initiative in a Rural Community in Venezuela, 2023 / Avaliação da implementação da iniciativa HEARTS em uma comunidade rural da Venezuela, 2023

[RESUMEN]. Objetivo. Evaluar la implementación de estrategias de la iniciativa HEARTS en una comunidad de la República Bolivariana de Venezuela. Métodos. Estudio cuasiexperimental, con la evaluación de la cascada de cuidado, factores impulsores e índices de madurez y desempeño cuatro meses después de la implementación de la iniciativa HEARTS en la comunidad La Marroquina en 52 pacientes con hipertensión (HTA). Los datos se procesaron en el programa SPSS® versión 25.0. Se aplicaron las pruebas t-Student y de ji cuadrado para determinar la significancia estadística. Resultados. Completaron los cuatro meses de seguimiento 50 pacientes, 63,5% con baja escolaridad y estrato socioeconómico bajo o muy bajo. Al inicio, 11,5% estaba controlado, y 40,4% inició con monoterapia. Al cuarto mes, 100% de las personas hipertensas recibieron el diagnóstico, 92% recibió tratamiento y 52% alcanzó la meta de control de HTA. El 72% recibía terapia combinada. De las personas hipertensas, 70% mantenía cifras de presión arterial <140/90 mmHg. El índice de madurez alcanzó nivel 4 de 5, y el índice de desempeño se clasificó en incipiente. Conclusión. Este trabajo muestra, en un corto tiempo, un buen índice de madurez en la implementación de un protocolo estandarizado de diagnóstico, tratamiento y seguimiento de la HTA en una población rural, por parte de personal médico y no médico supervisado, que mejora las tasas de diagnóstico, tratamiento y control en los hipertensos, y empieza a mostrar su desempeño. El mantenimiento de esta iniciativa tendrá un gran impacto en la salud de esta población. Se recomienda su implementación como política de salud pública nacional.

[ABSTRACT]. Objective. To evaluate the implementation of HEARTS strategies in a community in the Bolivarian Republic of Venezuela. Methods. Quasi-experimental study evaluating the cascade of care, driving factors, and maturity and performance indicators four months after implementation of the HEARTS initiative in 52 patients with high blood pressure (BP) in the community of La Marroquina. The data were processed using SPSS® Statistics, version 25.0. Student's t-distribution and chi-square tests were applied to determine statistical significance. Results. Fifty patients, 63.5% of them with a low educational level and low or very low socioeconomic status, completed the four-month monitoring period. At baseline, 11.5% had controlled BP and 40.4% initiated monotherapy. By the fourth month, 100% of patients with high BP had been diagnosed, 92% had received treatment, and 52% had achieved control of their BP. Seventy-two percent were receiving combined therapy. Seventy percent of the hypertensive individuals maintained blood pressure levels <140/90 mmHg. The maturity index score was 4 of 5, and the performance index was classified as incipient. Conclusion. This work shows that, in a short time, a good maturity index was achieved through the implementation, by medical and supervised non-medical personnel, of a standardized protocol for diagnosis, treatment, and monitoring of high blood pressure in a rural population. Rates of diagnosis, treatment, and BP control improved, with incipient performance results. Sustaining this initiative will have a major impact on the health of this population. Its implementation as a national public health policy is recommended.

[RESUMO]. Objetivo. Avaliar a implementação das estratégias da iniciativa HEARTS em uma comunidade da República Bolivariana da Venezuela. Métodos. Estudo quase-experimental que avaliou a cascata de cuidados, fatores determinantes e índices de maturidade e desempenho quatro meses após a implementação da iniciativa HEARTS na comunidade de La Marroquina, Venezuela. Foram avaliados 52 pacientes com hipertensão arterial. A análise estatística foi realizada no software SPSS®, versão 25.0. O teste t de Student e o teste qui-quadrado foram usados para determinar a significância estatística. Resultados. Cinquenta pacientes completaram o acompanhamento de quatro meses. Desses, 63,5% tinham baixa escolaridade e nível socioeconômico baixo ou muito baixo. No início do estudo, 11,5% apresentavam doença controlada e 40,4% estavam em monoterapia. No quarto mês, 100% dos pacientes com hipertensão arterial haviam sido diagnosticados, 92% haviam recebido tratamento, 52% haviam atingido a meta de controle da hipertensão e 72% estavam recebendo terapia combinada. Dos pacientes com hipertensão, 70% mantinham níveis pressóricos <140 × 90 mmHg. O índice de maturidade foi avaliado como nível 4 (de 5), e o desempenho foi classificado como incipiente. Conclusão. Este estudo demonstra, após pouco tempo, um bom índice de maturidade na implementação de um protocolo padronizado de diagnóstico, tratamento e acompanhamento da hipertensão arterial em uma população rural atendida por pessoal médico e não médico supervisionado. Observa-se melhoria das taxas de diagnóstico, tratamento e controle dos pacientes com hipertensão, demonstrando de forma incipiente seu desempenho. Dar continuidade a essa iniciativa terá uma repercussão importante na saúde dessa população. Recomendando-se que a iniciativa seja implementada como política nacional de saúde pública.

The predictive model of hydrobiological diversity in the Asana-Tumilaca basin, Peru based on water physicochemical parameters and sediment metal content.

The hydrobiological diversity in the basin depends on biotic and abiotic factors. A predictive model of hydrobiological diversity for periphyton and macrobenthos was developed through multiple linear regression analysis (MLRA) based on the physicochemical parameters of water (PPW) and metal content in sediments (MCS) from eight monitoring stations in the Asana-Tumilaca Basin during the dry and wet seasons. The electrical conductivity presented values between 47.9 and 3617 µS/cm, showing the highest value in the Capillune River due to the influence of geothermal waters. According to Piper's diagram, the water in the basin had a composition of calcium sulfate and calcium bicarbonate-sulfate. According to the Wilcox diagram, the water was found to be between good and very good quality, except for in the Capillune River. The Shannon-Wiener diversity indices (H') were 2.62 and 2.88 for periphyton, and 2.10 and 2.44 for macrobenthos, indicating moderate diversity; for the Pielou's evenness index (J'), they were 0.68 and 0.70 for periphyton, and 0.68 and 0.59 for macrobenthos, indicating similar equity, in the dry and wet seasons, respectively, for both indices. In the model there were three cases, where the first two cases only worked with PPW or MCS, and case 3 worked with PPW and MCS. For case 3, the predicted values for H' and J' of periphyton and macrobenthos concerning those observed presented correlation coefficients of 0.7437 and 0.6523 for periphyton and 0.9321 and 0.8570 for macrobenthos, respectively, which were better than those of cases 1 and 2. In addition, principal component analysis revealed that the As, Pb, and Zn contents in the sediments negatively influenced the diversity, uniformity, and richness of the macrobenthos. In contrast, Cu and Cr had positive impacts because of the adaptation processes.

Application of the galactomannan gel from Cassia grandis seeds for biomedical purposes: Study of the incorporation of collagenases and their release profile.

The galactomannan-based gel from Cassia grandis seeds was used to incorporate Penicillium sp. UCP 1286 and commercial collagenases. Experiments were carried out according to a 23-full factorial design to identify the most significant parameters for the incorporation process. The pH of the incorporation solution (pHi), stirring time (t), and initial protein concentration in the crude extract (PCi) were selected as the three independent variables, and the efficiency of collagenase incorporation (E) and collagenolytic activity (CA) after 360 min as the responses. pHi and PCi showed positive statistically significant effects on E, while CA was positively influenced by pHi and t, but negatively by PCi. The fungi collagenase was released from the gel following a pseudo-Fickian behavior. Additionally, no <76 % of collagenase was efficiently incorporated into the gel retaining a high CA (32.5-69.8 U/mL). The obtained results for the commercial collagenase (E = 93.88 %, CA = 65.8 U/mL, and n = 0.10) demonstrated a pseudo-Fickian behavior similar to the fungi-collagenase. The results confirm the biotechnological potential of the gel as an efficient matrix for the incorporation of catalytic compounds; additionally, the incorporation of collagenases was achieved by retaining the proteases CA and releasing them in a controlled manner.

Prescrição farmacêutica em farmácias comunitárias públicas e privadas de Vitória-ES: barreiras e facilitadores para a implementação da atividade / Pharmacist prescribing in public and private community drugstores in Vitória, Espírito Santo State: barriers and facilitators for the implementation of the activity

Resumo A prescrição farmacêutica avança no mundo, com diferentes países regulando a prática. No Brasil, essa regulação ocorreu em 2013, porém são escassas as informações sobre sua inserção no cotidiano do exercício farmacêutico. Este estudo objetivou analisar a prescrição farmacêutica no município de Vitória-ES, Brasil, e os fatores que influenciam na adesão da prática. Trata-se de um estudo qualitativo com 20 farmacêuticos e 10 gestores de farmácias comunitárias públicas e privadas, realizado a partir de entrevistas, com posterior análise de conteúdo temática para apreender percepções e opiniões. Os farmacêuticos desta pesquisa não prescreviam. Farmacêuticos e gestores identificaram facilitadores para a implementação da atividade, com destaque para os fatores: infraestrutura; fácil acesso ao farmacêutico; e boa receptividade à prescrição. Como barreiras, os fatores foram: número insuficiente de recursos humanos; falta de estímulo institucional à prescrição; e fatores individuais. Além da observação da não execução da prescrição farmacêutica, este estudo trouxe uma oportunidade para identificar elementos que podem estar contribuindo para que o exercício dessa atividade não seja realizado nas farmácias comunitárias. Adaptar rotinas ou contratar pessoal se mostraram as principais modificações necessárias. Paralelamente, ações destinadas a qualificar a formação por meio da educação permanente também se apresentam como necessárias.

Abstract Pharmacist prescribing advances in the world with different countries regulating this activity. In Brazil, this regulation took place in 2013, but there is little information about its insertion in the routine of pharmacist practice. This study aimed to analyze the pharmacist prescribing in the city of Vitória, Espírito Santo state, Brazil, and the factors that influence adherence to the practice. This is a qualitative study based on interviews with 20 pharmacists and 10 managers of public and private community drugstores with subsequent content analysis to apprehend perceptions and opinions. The pharmacists in this research did not prescribe. Pharmacists and managers identified facilitators for the implementation of the activity, highlighting the following factors: infrastructure; easy access to the pharmacist; and good receptivity to the prescription. As barriers, the factors were insufficient number of human resources; lack of institutional stimulus to prescribing; and individual factors. In addition to the observation of non-execution of pharmacist prescribing, this study provided an opportunity to identify elements that may contribute to the non-existence of this activity in community drugstores. Adapting routines or hiring staff were the main necessary changes. At the same time, actions aimed at qualifying training through permanent education are also necessary.

AC-PLT: An algorithm for computer-assisted coding of semantic property listing data.

In this paper, we present a novel algorithm that uses machine learning and natural language processing techniques to facilitate the coding of feature listing data. Feature listing is a method in which participants are asked to provide a list of features that are typically true of a given concept or word. This method is commonly used in research studies to gain insights into people's understanding of various concepts. The standard procedure for extracting meaning from feature listings is to manually code the data, which can be time-consuming and prone to errors, leading to reliability concerns. Our algorithm aims at addressing these challenges by automatically assigning human-created codes to feature listing data that achieve a quantitatively good agreement with human coders. Our preliminary results suggest that our algorithm has the potential to improve the efficiency and accuracy of content analysis of feature listing data. Additionally, this tool is an important step toward developing a fully automated coding algorithm, which we are currently preliminarily devising.

Parthenolide inhibits proliferation and invasion, promotes apoptosis, and reverts the cell-cell adhesion loss through downregulation of NF-κB pathway TNF-α-activated in colorectal cancer cells.

The activation of the nuclear factor-κB (NF-κB) pathway has been associated with the development and progression of colorectal cancer (CRC). Parthenolide (PTL), a well-known inhibitor of the NF-κB pathway, has emerged as an alternative treatment. However, whether PTL activity is tumor cell-specific and dependent on the mutational background has not been defined. This study investigated the antitumor role of PTL after tumor necrosis factor-α (TNF-α) stimulation in various CRC cell lines with different mutational statuses of TP53. We observed that CRC cells displayed different patterns of basal p-IκBα levels; PTL reduced cell viability according to p-IκBα levels and p-IκBα levels varied among the cell lines according to the time of TNF-α stimulation. High concentrations of PTL reduced more effectively p-IκBα levels than low doses of PTL. However, PTL increased total IκBα levels in Caco-2 and HT-29 cells. In addition, PTL treatment downregulated p-p65 levels in HT-29 and HCT-116 cells stimulated by TNF-α in a dose-dependent manner. Moreover, PTL induced cell death via apoptosis and reduced the proliferation rate of TNF-α-treated HT-29 cells. Finally, PTL downregulated the messenger RNA levels of interleukin-1ß, a downstream cytokine of NF-κB, reverted the E-cadherin-mediated disorganization of cell-cell contacts, and decreased the invasion of HT-29 cells. Together, these results suggest a differential antitumoral activity of PTL on CRC cells with different mutational statuses of TP53, modulating cell death, survival, and proliferation underlying the NF-κB pathway TNF-α-induced. Therefore, PTL has emerged as a potential treatment for CRC in an inflammatory NF-κB-dependent manner.

Approaching Self-Bonded Medium Density Fiberboards Made by Mixing Steam Exploded Arundo donax L. and Wood Fibers: A Comparison with pMDI-Bonded Fiberboards on the Primary Properties of the Boards.

This study presents an unexplored method to produce formaldehyde-free MDF. Steam exploded Arundo donax L. (STEX-AD) and untreated wood fibers (WF) were mixed at different mixing rates (0/100, 50/50, and 100/0, respectively) and two series of boards were manufactured, with 4 wt% of pMDI, based on dry fibers, and self-bonded. The mechanical and physical performance of the boards was analyzed as a function of the adhesive content and the density. The mechanical performance and dimensional stability were determined by following European standards. The material formulation and the density of the boards had a significant effect on both mechanical and physical properties. The boards made solely of STEX-AD were comparable to those made with pMDI, while the panels made of WF without adhesive were those that performed the worst. The STEX-AD showed the ability to reduce the TS for both pMDI-bonded and self-bonded boards, although leading to a high WA and a higher short-term absorption for the latter. The results presented show the feasibility of using STEX-AD in the manufacturing of self-bonded MDF and the improvement of dimensional stability. Nonetheless, further studies are needed especially to address the enhancement of the internal bond (IB).

Yeast-amoeba interaction influences murine cryptococcosis.

The virulence of Cryptococcus spp. is modulated in the natural environment through interaction with abiotic and biotic factors, and this can occasionally have implications for the progression of cryptococcosis in mammals. Hence, we evaluated whether the prior interaction of highly virulent Cryptococcus gattii strain R265 with Acanthamoeba castellanii influenced the progression of cryptococcosis. The influence of the capsule on endocytosis was evaluated using amoeba and yeast morphometrics. Mice were intratracheally infected with yeast re-isolated from the amoeba (Interaction), yeast without prior contact with the amoeba (Non-Interaction), or sterile phosphate-buffered saline (SHAM). Morbidity signs and symptoms were monitored during the survival curve, while cytokine and fungal burden measurements and histopathological analysis were performed on the 10th day post infection. Morbidity and mortality parameters in experimental cryptococcosis were influenced by the prior interaction of yeast with amoeba, which led to phenotypic changes in the cryptococcal cells, polysaccharide secretion, and their tolerance to oxidative stress. Our results suggest that a prior yeast-amoeba interaction modulates yeast virulence, which is associated with a greater tolerance to oxidative stress related to the exo-polysaccharide content and influences the progression of cryptococcal infection.

Particles' Organization in Direct Oil-in-Water and Reverse Water-in-Oil Pickering Emulsions.

This paper addresses the impact of the particle initial wetting and the viscosity of the oil phase on the structure and rheological properties of direct (Oil/Water) and reverse (Water/Oil) Pickering emulsions. The emulsion structure was investigated via confocal microscopy and static light scattering. The flow and viscoelastic properties were probed by a stress-controlled rheometer. Partially hydrophobic silica particles have been employed at 1 and 4 wt.% to stabilize dodecane or paraffin-based emulsions at 20 vol.% of the dispersed phase. W/O emulsions were obtained when the particles were dispersed in the oily phase while O/W emulsions were prepared when the silica was introduced in the aqueous phase. We demonstrated that, although the particles adsorbed at the droplets interfaces for all the emulsions, their organization, the emulsion structure and their rheological properties depend in which phase they were previously dispersed in. We discuss these features as a function of the particle concentration and the oil viscosity.

Assessing the burden of family caregivers of cancer patients: a cross-sectional study / Avaliação da sobrecarga de familiares cuidadores de pacientes com câncer: estudo transversal / Evaluación de la carga de los cuidadores familiares de pacientes con câncer

Objective: Evaluate the burden of family caregivers of cancer patients in a Brazilian oncology hospital. Method: Quantitative, descriptive, and cross-sectional research conducted in a Brazilian oncology hospital, located in Minas Gerais. Data collection occurred through the application of a questionnaire containing sociodemographic questions, and the Zarit scale, which assesses the degree of burden of caregivers, was used. Inclusion criteria were family car-egivers over 18, whose family member had a diagnosis of cancer, and who was involved in caregiving. The association between burden and the explanatory variables was performed from the multiple linear regression model. The program SPSS version 20 was used to perform the analyses. Results: Among the 125 individuals interviewed, the majority were under 38 years old, 66.4% were female, 45.6% were children, and 22.4% were spouses. The time of care varied from six months (39.2%) to two years (21.6%), and 80% of the interviewed individuals acted directly in the care of the ill person; 97.6% did not present overload. Conclusions: The caregivers, in general, did not present overload; however, it was verified reduction in the quality of life of these caregivers when the questions of the Zarit scale referring to the psychological and social relations domains, separately, were analyzed. (AU)

Objetivo: Avaliar a sobrecarga dos familiares cuidadores de pacientes com câncer num hospital oncológico brasileiro. Método: Pesquisa quantitativa, descritiva e transversal, realizada em um hospital oncológico brasileiro, localizado em Minas Gerais. A coleta de dados ocorreu por meio da aplicação de um questionário contendo perguntas socio-demográficas e foi utilizada a escala de Zarit, que avalia o grau de sobrecarga dos cuidadores. Os critérios de inclusão foram familiares cuidadores acima de 18 anos, cujo membro da família tivesse o diagnóstico de câncer 2https://www.revistas.usp.br/rmrpAssessment of the burden of family caregiverse que estivesse envolvido no cuidado. A associação entre sobrecarga e as variáveis explicativas foi realizada a par-tir do modelo de regressão linear múltipla. O programa SPSS versão 20 foi utilizado para a realização das análises. Resultados: Dentre os 125 indivíduos entrevistados, a maioria possuía menos de 38 anos, 66,4% eram do sexo feminino, 45,6% eram filhos e 22,4% cônjuges. O tempo de prestação de cuidados variou de seis meses (39,2%) a dois anos (21,6%) e 80% dos entrevistados atuavam diretamente nos cuidados, 80% atuavam diretamente nos cuidados do ente adoecido, 97,6% não apresentaram sobrecarga. Conclusões: Os cuidadores, de uma forma geral, não apresentaram sobrecarga, porém, constatou-se uma redução na qualidade de vida destes cuidadores, quando analisadas as questões da escala Zarit referentes aos domínios psicológico e de relações sociais, isoladamente. (AU)

Objetivo: Evaluar la carga de los cuidadores familiares de pacientes con cáncer en un hospital oncológico brasileño. Método: Investigación cuantitativa, descriptiva y transversal, realizada en un hospital oncológico brasileño, ubicado en Minas Gerais. La recogida de datos se realizó mediante la aplicación de un cuestionario con preguntas sociodemográficas y se utilizó la escala de Zarit, que evalúa el grado de carga de los cuidadores. Los criterios de inclusión fueron los cuidadores familiares mayores de 18 años, cuyo miembro de la familia había sido diagnosticado de cáncer y estaba involucrado en el cuidado. La asociación entre la carga y las variables explicativas se realizó a partir del modelo de regresión lineal múltiple. Se utilizó el programa SPSS versión 20 para realizar los análisis. Resultados: Entre las 125 personas entrevistadas, la mayoría tenía menos de 38 años, el 66,4% eran mujeres, el 45,6% eran hijos y el 22,4% cónyuges. El tiempo de atención varió de seis meses (39,2%) a dos años (21,6%) y el 80% de los entrevistados actuó directamente en el cuidado del enfermo, el 97,6% no presentó sobrecarga. Conclusiones: Los cuidadores, en general, no presentaron sobrecarga, sin embargo, se verificó una reducción en la calidad de vida de estos cuidadores cuando se analizaron las preguntas de la escala de Zarit referidas a los dominios psicológico y de relaciones sociales, por separado. (AU)

Long-term resistance to 5-fluorouracil promotes epithelial-mesenchymal transition, apoptosis evasion, autophagy, and reduced proliferation rate in colon cancer cells.

The drug, 5-fluorouracil (5FU) is a standard first-line treatment for colorectal cancer (CRC) patients. However, drug resistance acquisition remains an important challenge for effective clinical outcomes. Here, we established a long-term drug-resistant CRC model and explored the cellular events underlying 5FU resistance. We showed that 5FU-treated cells (HCT-116 5FUR) using a prolonged treatment protocol were significantly more resistant than parental cells. Likewise, cell viability and IC50 values were also observed to increase in HCT-116 5FUR cells when treated with increasing doses of oxaliplatin, indicating a cross-resistance mechanism to other cytotoxic agents. Moreover, HCT-116 5FUR cells exhibited metabolic and molecular changes, as evidenced by increased thymidylate synthase levels and upregulated mRNA levels of ABCB1. HCT-116 5FUR cells were able to overcome S phase arrest and evade apoptosis, as well as activate autophagy, as indicated by increased LC3B levels. Cells treated with low and high doses displayed epithelial-mesenchymal transition (EMT) features, as observed by decreased E-cadherin and claudin-3 levels, increased vimentin protein levels, and increased SLUG, ZEB2 and TWIST1 mRNA levels. Furthermore, HCT-116 5FUR cells displayed enhanced migration and invasion capabilities. Interestingly, we found that the 5FU drug-resistance gene signature is positively associated with the mesenchymal signature in CRC samples, and that ABCB1 and ZEB2 co-expressed at high levels could predict poor outcomes in CRC patients. Overall, the 5FU long-term drug-resistance model established here induced various cellular events, and highlighted the importance of further efforts to identify promising targets involved in more than one cellular event to successfully overcome drug-resistance.

Prescrição farmacêutica: uma revisão sobre percepções e atitudes de pacientes, farmacêuticos e outros interessados / Pharmacist prescribing: a review of perceptions and attitudes of patients, pharmacists and other interested professionals

Resumo A prescrição farmacêutica é uma experiência em expansão em alguns países desenvolvidos, com diferentes sistemas de saúde. Conhecer a contribuição que essa atividade pode desempenhar no processo de assistência à saúde e investigar sua aceitação é de fundamental interesse para os países que a regularam. Este estudo de revisão de literatura, portanto, objetivou desenhar o estado da arte da investigação acadêmica sobre percepção, opiniões e atitudes no contexto da prática da prescrição farmacêutica em países que a adotaram. Para isso, realizou-se investigação nas bases de dados MEDLINE, Scopus, Embase, SciELO e LILACS, resultando na seleção de 17 estudos. Da análise dos artigos, emergiram três categorias de discussão: "compreensão da prática e benefícios percebidos"; "aceitação e adesão à prática"; "barreiras à prática". Os resultados mostraram aceitação e percepções variáveis nos diferentes públicos, dependendo, entre outras questões, do nível de conhecimento e experiência dos pacientes e dos profissionais de saúde, do perfil do farmacêutico ou da modalidade de prescrição. Este estudo aponta alguns desafios envolvidos na prática da prescrição farmacêutica e seus achados podem ser úteis para sugerir caminhos para o fortalecimento da prática.

Abstract Pharmacist prescribing is a growing reality in some developed counties, with varied health systems. Understanding the contribution that this activity can offer in the healthcare process, and investigating its acceptance is of utmost importance for the countries that implement and regulate this type of system. This literature review aimed to design a state-of-the-art academic investigation on the perception, opinions, and attitudes in the context of pharmacist prescribing practices in countries that have adopted this system. To achieve this, the present study conducted an investigation of the Medline, Scopus, Embase, SciELO, and Lilacs databases, resulting in the selection of 17 studies. From the analysis of the articles, three categories of discussion arose: "understanding of the practice and perceived benefits", "acceptance and adherence to the practice, and "hindrances to the practice". The results showed varied acceptance and perceptions among the different publics, depending, among other questions, on the level of knowledge and experience of the patients and health professionals, on the profile of the pharmacists, or on the prescribing modality. This study highlights some challenges involved in the practice of pharmacist prescribing, and its findings can be useful in suggesting a means through which to strengthen the practice.

Pharmacist prescribing: a review of perceptions and attitudes of patients, pharmacists and other interested professionals. / Prescrição farmacêutica: uma revisão sobre percepções e atitudes de pacientes, farmacêuticos e outros interessados.

Pharmacist prescribing is a growing reality in some developed counties, with varied health systems. Understanding the contribution that this activity can offer in the healthcare process, and investigating its acceptance is of utmost importance for the countries that implement and regulate this type of system. This literature review aimed to design a state-of-the-art academic investigation on the perception, opinions, and attitudes in the context of pharmacist prescribing practices in countries that have adopted this system. To achieve this, the present study conducted an investigation of the Medline, Scopus, Embase, SciELO, and Lilacs databases, resulting in the selection of 17 studies. From the analysis of the articles, three categories of discussion arose: "understanding of the practice and perceived benefits", "acceptance and adherence to the practice, and "hindrances to the practice". The results showed varied acceptance and perceptions among the different publics, depending, among other questions, on the level of knowledge and experience of the patients and health professionals, on the profile of the pharmacists, or on the prescribing modality. This study highlights some challenges involved in the practice of pharmacist prescribing, and its findings can be useful in suggesting a means through which to strengthen the practice.

A prescrição farmacêutica é uma experiência em expansão em alguns países desenvolvidos, com diferentes sistemas de saúde. Conhecer a contribuição que essa atividade pode desempenhar no processo de assistência à saúde e investigar sua aceitação é de fundamental interesse para os países que a regularam. Este estudo de revisão de literatura, portanto, objetivou desenhar o estado da arte da investigação acadêmica sobre percepção, opiniões e atitudes no contexto da prática da prescrição farmacêutica em países que a adotaram. Para isso, realizou-se investigação nas bases de dados MEDLINE, Scopus, Embase, SciELO e LILACS, resultando na seleção de 17 estudos. Da análise dos artigos, emergiram três categorias de discussão: "compreensão da prática e benefícios percebidos"; "aceitação e adesão à prática"; "barreiras à prática". Os resultados mostraram aceitação e percepções variáveis nos diferentes públicos, dependendo, entre outras questões, do nível de conhecimento e experiência dos pacientes e dos profissionais de saúde, do perfil do farmacêutico ou da modalidade de prescrição. Este estudo aponta alguns desafios envolvidos na prática da prescrição farmacêutica e seus achados podem ser úteis para sugerir caminhos para o fortalecimento da prática.

Autocuidado espiritual da equipe de enfermagem de um hospital oncológico / Spiritual self-care of the nursing staff of an oncology hospital / Autocuidado espiritual del personal de enfermería de un hospital de oncología

Objetivo: compreender as ações realizadas pela equipe de Enfermagem de um hospital oncológico para o desenvolvimento do autocuidado espiritual. Métodos: estudo descritivo-exploratório de abordagem qualitativa, realizado num hospital oncológico brasileiro. Foram entrevistados 12 profissionais de Enfermagem do hospital em janeiro de 2018. Os dados foram analisados através da Análise de Conteúdo. O estudo respeitou os aspectos éticos, parecer 2.415.223. Resultados: as cinco categorias desvelaram que o desenvolvimento da espiritualidade ocorre por meio do auxílio ao próximo e ato de cuidar; da interação social e do diálogo; do exercício de práticas religiosas; pela composição de canções; e ainda uma que revelou a negação de práticas relacionadas ao desenvolvimento espiritual. Conclusão: cuidado ao próximo, interação social, práticas religiosas e lúdicas foram apontadas como promotoras do autocuidado espiritual. Sugere-se a potencialização destas atividades, visto a importância da espiritualidade para pacientes e familiares, reverberando positivamente no cuidado prestado pela equipe de Enfermagem

Objective: to understand the actions performed by the nursing team of an oncology hospital for the development of spiritual self-care. Methods: descriptive-exploratory study with a qualitative approach, carried out in a Brazilian oncologic hospital. Twenty-two nursing professionals from the hospital were interviewed in January 2018. The data were analyzed through Content Analysis. The study respected ethical aspects, legal opinion 2.415.223. Results: the five categories showed that the development of spirituality occurs through the help of others and the act of caring; social interaction and dialogue; the exercise of religious practices; by the composition of songs; and one that revealed the denial of practices related to spiritual development. Conclusion: care for others, social interaction, religious and playful practices were identified as promoters of spiritual self-care. The enhancement of these activities is suggested, given the importance of spirituality for patients and families, positively reverberating in the care provided by the Nursing team

Objetivo: comprender las acciones realizadas por el equipo de enfermería de un hospital oncológico para el desarrollo del autocuidado espiritual. Métodos: estudio descriptivo-exploratorio con abordaje cualitativo, realizado en un hospital oncológico brasileño. Veintidós profesionales de enfermería del hospital fueron entrevistados en enero de 2018. Los datos fueron analizados a través del Análisis de Contenido. El estudio respetó aspectos éticos, opinión 2.415.223. Resultados: las cinco categorías mostraron que el desarrollo de la espiritualidad se produce a través de la ayuda de otros y el acto de cuidar; interacción social y diálogo; el ejercicio de prácticas religiosas; por la composición de canciones; y uno que reveló la negación de prácticas relacionadas con el desarrollo espiritual. Conclusión: el cuidado de los demás, la interacción social, las prácticas religiosas y lúdicas se identificaron como promotores del autocuidado espiritual. Se sugiere la potenciación de estas actividades, dada la importancia de la espiritualidad para los pacientes y sus familias, repercutiendo positivamente en los cuidados brindados por el equipo de Enfermería

Baja incidencia y alta mortalidad por COVID-19 en Cirugía General durante la primera ola de la pandemia / Low incidence and high COVID-19 mortality in a General Surgery during the first wave of the pandemia

Resumen Introducción y objetivo: La infección por coronavirus (COVID-19) en pacientes intervenidos es causa de importante mortalidad posoperatoria, aunque su incidencia es variable. El objetivo primario fue evaluar la incidencia de COVID-19 en los pacientes intervenidos en nuestro Servicio de Cirugía General y Digestiva, durante el máximo impacto de la pandemia en España. El objetivo secundario fue evaluar la mortalidad perioperatoria y determinar los factores de riesgo para la infección por COVID-19. Materiales y Método: Estudio observacional retrospectivo de pacientes consecutivos sometidos a Cirugía General y Digestiva con ingreso superior a 24 h, del 1 de febrero de 2020 al 30 de abril de 2020 en un hospital terciario de Madrid, España. Resultados: Se analizaron 441 pacientes: 423 sin COVID-19 y 18 con COVID-19. Las características preoperatorias y operatorias fueron similares para ambos grupos, salvo por el grado ASA (American Society of Anesthesiologists). La incidencia de COVID-19 en los pacientes intervenidos fue del 4,1%. La mortalidad posoperatoria fue elevada, del 22,2% en pacientes con COVID-19, frente a un 2,8% en pacientes no COVID-19 (p: 0,003). Los factores de riesgo para la infección por COVID-19 en los pacientes intervenidos fueron una estancia hospitalaria prolongada (OR: 1,035 [95% CI: 1,007-1,065]) y la reintervención quirúrgica (OR: 5,025 [95% CI: 1,650-15,311]). Conclusión: Las intervenciones durante la pandemia de COVID-19 causaron una baja tasa de infección con elevada mortalidad posoperatoria. La intervención quirúrgica debe valorarse frente al riesgo adicional para el paciente en contextos de alta transmisión.

The impact of coronavirus disease (COVID-19) in intervened patients seems to cause large postoperative mortality, although its incidence varies among centres. Primary aim was to evaluate the incidence of COVID-19 on the patients intervened in our General and Digestive Surgery Department, during the maximum impact of the pandemia in Spain. Secondary outcomes were evaluating perioperative mortality, and determining the risk factors for COVID-19 infection. Materials and Method: Retrospective single centre study of consecutive patients undergoing general and gastrointestinal surgical procedures with more than 24 hours of inhospital stay, from February 1, 2020 to April 30, 2020 in a tertiary referral centre in Madrid, Spain. Results: A total of 441 patients were analysed: 423 were non-COVID-19 patients while 18 of them had COVID-19. Preoperative and operative characteristics were similar for both groups, unless for the American Society of Anesthesiologists grade. The incidence of COVID-19 in our intervened patients was 4.1%. Postoperative mortality was high among surgical patients with COVID-19, with a mortality rate of 22.2% compared to a 2.8% in non COVID-19 patients. The risk factors for COVID-19 infection were a prolonged postoperative stay (OR: 1.035 [95% CI: 1.007-1.065]) and the need of a reintervention (OR: 5.025 [95% CI: 1.650-15.311]). Conclusion: Surgical interventions during the COVID-19 pandemia resulted in a low infection rate but a high postoperative COVID-19 mortality. The decision to intervene must be carefully balanced against the additional risk for patients in a high transmission setting.

Prophylactic Use of Negative Pressure Wound Therapy Reduces Surgical Site Infections in Elective Colorectal Surgery: A Prospective Cohort Study.

Background: The main purpose was to assess the efficacy of negative pressure wound therapy (NPWT) for surgical site infection (SSI) in elective open and laparoscopic open-assisted colorectal surgery. The primary end point was to establish SSI within 30 days post-operatively. The secondary aim was hospital stay and to assess SSI predictors in a multivariable analysis. Patients and Methods: A prospective cohort study was undertaken between January 2017 and December 2018 in patients undergoing elective colorectal surgery, both through open and minimally invasive approaches, to whom NPWT or fully occlusive dressing were applied. Baseline data were compared between the two groups and multivariable analysis was performed to identify SSI risk factors. Results: Two hundred patients were included: 100 NPWT patients and 100 closed dressing patients. No differences between the two groups were found. The incidence of SSI in the control dressing group was 19% versus 9% in the NPWT group, which was substantially different (odds ratio [OR] 0.30; 95% confidence interval [CI] 0.11-0.83; p = 0.02). No differences were found in hospital length of stay (12.33 d in NPWT group vs. 12.39 d in the control group; p = 0.82). A body mass index (BMI) of 30-35 (p = 0.04), BMI >35 (p = 0.03), and midline wound (p = 2.68) were found to be predictors of SSI in multivariable analysis. Conclusion: The prophylactic use of NPWT in laparotomy incisions for patients undergoing elective colorectal surgery (both through open and laparoscopic approach) is associated with a reduction in SSI rates.

Assessing Smoothness of Arm Movements With Jerk: A Comparison of Laterality, Contraction Mode and Plane of Elevation. A Pilot Study.

Measuring the quality of movement is a need and a challenge for clinicians. Jerk, defined as the quantity of acceleration variation, is a kinematic parameter used to assess the smoothness of movement. We aimed to assess and compare jerk metrics in asymptomatic participants for 3 important movement characteristics that are considered by clinicians during shoulder examination: dominant and non-dominant side, concentric and eccentric contraction mode, and arm elevation plane. In this pilot study, we measured jerk metrics by using Xsens® inertial measurement units strapped to the wrists for 11 different active arm movements (ascending and lowering phases): 3 bilateral maximal arm elevations in sagittal, scapular and frontal plane; 2 unilateral functional movements (hair combing and low back washing); and 2 unilateral maximal arm elevations in sagittal and scapular plane, performed with both arms alternately, right arm first. Each arm movement was repeated 3 times successively and the whole procedure was performed 3 times on different days. The recorded time series was segmented with semi-supervised algorithms. Comparisons involved the Wilcoxon signed rank test (p < 0.05) with Bonferroni correction. We included 30 right-handed asymptomatic individuals [17 men, mean (SD) age 31.9 (11.4) years]. Right jerk was significantly less than left jerk for bilateral arm elevations in all planes (all p < 0.05) and for functional movement (p < 0.05). Jerk was significantly reduced during the concentric (ascending) phase than eccentric (lowering) phase for bilateral and unilateral right and left arm elevations in all planes (all p < 0.05). Jerk during bilateral arm elevation was significantly reduced in the sagittal and scapular planes versus the frontal plane (both p < 0.01) and in the sagittal versus scapular plane (p < 0.05). Jerk during unilateral left arm elevation was significantly reduced in the sagittal versus scapular plane (p < 0.05). Jerk metrics did not differ between sagittal and scapular unilateral right arm elevation. Using inertial measurement units, jerk metrics can well describe differences between the dominant and non-dominant arm, concentric and eccentric modes and planes in arm elevation. Jerk metrics were reduced during arm movements performed with the dominant right arm during the concentric phase and in the sagittal plane. Using IMUs, jerk metrics are a promising method to assess the quality of basic shoulder movement.