Appropriateness and imaging outcomes of ultrasound, CT, and MR in the emergency department: a retrospective analysis from an urban academic center.

PURPOSE: To evaluate the appropriateness and outcomes of ultrasound (US), computed tomography (CT), and magnetic resonance (MR) orders in the ED. METHODS: We retrospectively reviewed consecutive US, CT, and MR orders for adult ED patients at a tertiary care urban academic center from January to March 2019. The American College of Radiology Appropriateness Criteria (ACRAC) guidelines were primarily used to classify imaging orders as "appropriate" or "inappropriate". Two radiologists in consensus judged specific clinical scenarios that were unavailable in the ACRAC. Final imaging reports were compared with the initial clinical suspicion for imaging and categorized into "normal", "compatible with initial diagnosis", "alternative diagnosis", or "inconclusive". The sample was powered to show a prevalence of inappropriate orders of 30% with a margin of error of 5%. RESULTS: The rate of inappropriate orders was 59.4% for US, 29.1% for CT, and 33.3% for MR. The most commonly imaged systems for each modality were neuro (130/330) and gastrointestinal (95/330) for CT, genitourinary (132/330) and gastrointestinal (121/330) for US, neuro (273/330) and gastrointestinal (37/330) for MR. Compared to inappropriately ordered tests, the final reports of appropriate orders were nearly three times more likely to demonstrate findings compatible with the initial diagnosis for all modalities: US (45.5 vs. 14.3%, p < 0.001), CT (46.6 vs. 14.6%, p < 0.001), and MR (56.3 vs. 21.8%, p < 0.001). Inappropriate orders were more likely to show no abnormalities compared to appropriate orders: US (65.8 vs. 38.8%, p < 0.001), CT (62.5 vs. 34.2%, p < 0.001), and MR (61.8 vs. 38.7%, p < 0.001). CONCLUSION: The prevalence of inappropriate imaging orders in the ED was 59.4% for US, 29.1% for CT, and 33.3% for MR. Appropriately ordered imaging was three times more likely to yield findings compatible with the initial diagnosis across all modalities.

Experiences of high-risk parturient women with the use of non-invasive care technologies / Experiencias de parturitas de alto riesgo con el uso de tecnologías de atención no invasivas / Experiências das parturientes de alto risco com o uso das tecnologias não invasivas de cuidado

ABSTRACT Objective: to analyze high-risk parturient women's experiences with the use of non-invasive nursing care technologies during labor. Method: this is qualitative and descriptive research, with twenty high-risk postpartum women admitted to a tertiary maternity hospital in the state of Rio de Janeiro, Brazil. Data were collected from April to July 2019 through semi-structured interviews, subjected to thematic content analysis and analyzed in light of Kristen Swanson's Theory of Caring. Results: the experiments revealed that theory processes were associated with the use of non-invasive care technologies by nurses. "Maintaining belief", "knowing" and "being with" were made up of the following technologies: encouraging self-confidence; understanding the lived experience; bond formation; and creating a supportive and helpful relationship with parturient women. The "doing for" and "enabling" processes included other technologies that promoted comfort and facilitated the experience such as: encouraging active participation and conscious breathing; stimulation of vertical positions and pelvic movements; companion involvement in care; using resources, such as warm water, Swiss balls and essential oils; and applying massages. Conclusion: parturient women realize that the use of non-invasive care technologies by nurses shapes experiences of well-being during labor, expressed in feelings of safety, acceptance, respect, appreciation, support and comfort. The importance of investing in nurses' work in assisting high-risk pregnancies is highlighted, as these technologies provide respectful care and women's satisfaction with childbirth.

RESUMEN Objetivo: analizar las experiencias de parturientas de alto riesgo con el uso de tecnologías de atención de enfermería no invasivas durante el parto. Método: investigación cualitativa y descriptiva, con veinte puérperas de alto riesgo ingresadas en una maternidad de tercer nivel del estado de Río de Janeiro, Brasil. Los datos fueron recolectados de abril a julio de 2019 a través de entrevistas semiestructuradas, sometidos a análisis de contenido temático y analizados a la luz de la Teoría del Cuidado de Kristen Swanson. Resultados: los experimentos revelaron que los procesos teóricos estaban asociados con el uso de tecnologías de atención no invasivas por parte de las enfermeras. "Mantener la creencia", "saber" y "estar con" se componían de las siguientes tecnologías: fomentar la confianza en uno mismo; comprender la experiencia vivida; formación de enlaces; y construir una relación de apoyo y ayuda con la parturienta. Los procesos de "hacer por" y "habilitar" incluyeron otras tecnologías que promovieron la comodidad y facilitaron la experiencia, tales como: fomentar la participación activa y la respiración consciente; estimulación de posiciones verticales y movimientos pélvicos; participación del acompañante en el cuidado; aprovechamiento de recursos, como agua tibia, pelotas suizas y aceites esenciales; y aplicando masajes. Conclusión: las parturientas se dan cuenta de que el uso de tecnologías de atención no invasivas por parte de las enfermeras da forma a experiencias de bienestar durante el parto, expresadas en sentimientos de seguridad, aceptación, respeto, aprecio, apoyo y comodidad. Se destaca la importancia de invertir en la labor de enfermería en la asistencia a embarazos de alto riesgo, ya que estas tecnologías brindan un cuidado respetuoso y la satisfacción de las mujeres con el parto.

RESUMO Objetivo: analisar as experiências das parturientes de alto risco com o uso das tecnologias não invasivas de cuidado de enfermagem durante o trabalho de parto. Método: pesquisa qualitativa e descritiva, com vinte puérperas de alto risco internadas em uma maternidade terciária do estado do Rio de Janeiro, Brasil. Os dados foram coletados de abril a julho de 2019, através de entrevistas semiestruturadas, submetidos à análise de conteúdo temática e analisados à luz da Teoria dos Cuidados de Kristen Swanson. Resultados: as experiências revelaram que os processos da teoria se associaram ao uso das tecnologias não invasivas de cuidado pelas enfermeiras. "Manter a crença", "conhecer" e "estar com" se conformaram com as seguintes tecnologias: incentivo à autoconfiança; compreensão da experiência vivida; formação de vínculo; e construção da relação de apoio e ajuda com a parturiente. Os processos "fazer por" e "possibilitar" contemplaram outras tecnologias que promoveram conforto e facilitaram a experiência como: incentivo à participação ativa e respiração consciente; estímulo aos posicionamentos verticalizados e movimentos pélvicos; envolvimento do acompanhante nos cuidados; uso de recursos, como água morna, bola suíça e óleos essenciais; e aplicação de massagens. Conclusão: as parturientes percebem que o uso das tecnologias não invasivas de cuidado pelas enfermeiras conforma experiências de bem-estar no trabalho de parto, expressas em sentimentos de segurança, acolhimento, respeito, valorização, apoio e conforto. Ressalta-se a importância de investimentos na atuação das enfermeiras na assistência às gestações de alto risco, pois essas tecnologias proporcionam cuidados respeitosos e satisfação das mulheres com o parto.

Material didáctico para el desarrollo de la competencia comunicativa audio-oral en la educación médica de posgrado

Fundamento: El conocimiento del inglés como el idioma empleado globalmente en diversos sectores, se ha convertido, junto a las tecnologías de la información y las comunicaciones, es una herramienta de formación, trabajo y entretenimiento indispensable; el dominio de este posibilita las relaciones de cooperación e intercambio de profesionales del sector de la salud en varios países. Objetivo: Diseñar un material didáctico para el desarrollo de la competencia comunicativa audio-oral en inglés en estudiantes de posgrado de la carrera de Medicina, mediante el empleo de tecnologías de la información y la comunicación. Metodología: Se realizó una investigación de desarrollo con enfoque mixto en la Universidad de Ciencias Médicas de Holguín durante el período marzo-julio de 2022. Se asumió el método dialéctico materialista como concepción general de la investigación y se emplearon otros del nivel teórico: histórico-lógico, análisis y síntesis e inducción deducción, sistémico-estructural-funcional y revisión documental; empíricos: encuesta, entrevista y observación participativa. Resultados: Las principales dificultades estuvieron relacionadas con el insuficiente tratamiento de la competencia comunicativa audio-oral en inglés, se constató la importancia de la misma dentro del proceso de enseñanza-aprendizaje del inglés, pues establece las pautas generales que se deben seguir para una comunicación efectiva y se instituye desde una mirada holística del acto comunicativo del profesional. Conclusiones: Los especialistas valoraron el material como adecuado por su estructura y factibilidad para su implementación. Después de su aplicación se evidenció su efectividad en la consolidación del aprendizaje en este nivel educacional a través de la preparación idiomática.

Background: Knowledge of English as the language used globally in various sectors, has increasingly become, together with information and communications technologies, an indispensable training, work and entertainment tool in the current era. Its domain enables cooperation relations and exchange of professionals in the health sector in various countries. Objective: To design a didactic material for the development of audio-oral communicative competence in English in postgraduate medical students, through the use of Information and Communication Technologies (ICT). Methods: A development research with a mixed approach was carried out at the Holguín University of Medical Sciences during the period March-July 2022. It was assumed the dialectical materialist method as the general conception of the research and others of the theoretical level: historical- logical, analysis and synthesis and induction deduction, systemic-structural-functional and documentary review; empirical: survey, interview and participatory observation. Results: The main difficulties were related to an insufficient treatment of audio-oral communicative competence in English, it was confirmed its importance within the teaching-learning process of English, since it establishes the general guidelines that must be followed for an effective communication. Moreover, it is instituted from a holistic view of the professional communicative act. Conclusions: The specialists assessed the material as adequate due to its structure and feasibility for its implementation. After its application, it was evidenced its effectiveness in consolidating learning in this educational level through language training.

Parto culturalmente adecuado desde la perspectiva de enfermería, visión contemporánea y particularidades en pacientes reumáticas

La maternidad es un proceso complejo que se encuentra determinado por factores objetivos y subjetivos. A pesar de ser inherente a todos los seres humanos se ve influenciado por elementos culturales que determinan, en buena medida la conducta de la población para con la maternidad. El objetivo de la presente investigación fue exponer los elementos relacionados con la denominación del parto culturalmente adecuado desde la perspectiva de enfermería basado en un enfoque contemporáneo de la maternidad, atendiendo a las particularidades de la paciente reumática. Se realizó un análisis global de las características básicas y distintivas de la maternidad en distintos continentes, basado en la perspectiva de la atención de enfermería, para ser comparado con el proceso que se desarrolla actualmente en el Ecuador; adicionalmente se prestó atención a los elementos distintivos de la atención en pacientes reumáticas. Los resultados muestran las diferencias existentes en un mismo proceso y evidencian como los elementos culturales son capaces de influenciar el desarrollo y la atención de la maternidad en Ecuador. Se concluye que existen particularidades en Ecuador que son distintivas en la atención de enfermería durante la maternidad; estas se ven influenciadas por las costumbres regionales, pero conservan su identidad evidenciando el papel que juega la interculturalidad en cada uno de los momentos trascendentales de los seres humanos.

Maternity is a complex process that is determined by objective and subjective factors. Despite being inherent to all human beings, it is influenced by cultural elements that largely determine the behavior of the population towards motherhood. The objective of this research was to expose the elements related to the culturally appropriate name of childbirth from the nursing perspective based on a contemporary approach to motherhood, taking into account the particularities of the rheumatic patient. A global analysis of the basic and distinctive characteristics of maternity in different continents was carried out, based on the perspective of nursing care, to be compared with the process currently taking place in Ecuador; Additionally, attention was paid to the distinctive elements of care in rheumatic patients. The results show the differences that exist in the same process and show how cultural elements are capable of influencing the development and care of maternity in Ecuador. It is concluded that there are particularities in Ecuador that are distinctive in nursing care during maternity; These are influenced by regional customs, but retain their identity, evidencing the role that interculturality plays in each of the transcendental moments of human beings.

Interpretación de la praxis cultural de la maternidad desde la enfermería antropológica

La interculturalidad, con base en las costumbres y creencias arraigadas, determina en buena medida el accionar d ellos seres humanos. Desde el punto de vista salubrista el accionar de enfermería responde al aporte de cuidados básicos y avanzados orientados al restablecimiento o mantenimiento del adecuado estado de salud de las personas. Durante el periodo de maternidad y el trabajo de parto los profesionales de enfermería juegan un papel fundamental no solo con la gestante, sino con el recién nacido, la familia y el contexto social que los rodea. El objetivo de la presente investigación fue interpretar la praxis cultural de la maternidad desde el punto de vista de la enfermería antropológica, basado en la opinión de personas en base a categorías previamente definidas y clasificadas como de mayor, mediana y poca frecuencia. Las categorías definidas como de mayor frecuencia fueron las creencias y costumbres, la familia, el trabajo de parto y los sistemas de salud. Como categorías de mediana frecuencia se definieron el calvario y dolor, las emociones y sentimiento y las prácticas pos parto. Por último, fueron definidas el embarazo y la religión como categorías de poca frecuencia. Se hace una interpretación de como las costumbres se incorporan dentro de la praxis cotidiana, estableciéndose como una conducta arraigada; por lo que las teorías dejan de ser únicamente teorías para convertirse en una experiencia vivida, siendo este el principal resultado del estudio y posible punto de parida a otras investigaciones sobre el tema.

Interculturality, based on deeply rooted customs and beliefs, largely determines the actions of human beings. From the health point of view, nursing actions respond to the contribution of basic and advanced care aimed at restoring or maintaining the adequate state of health of people. During the maternity period and labor, nursing professionals play a fundamental role not only with the pregnant woman, but also with the newborn, the family, and the social context that surrounds them. The objective of this research was to interpret the cultural praxis of maternity from the point of view of anthropological nursing, based on the opinion of people based on previously defined categories and classified as higher, medium, and infrequent. The categories defined as the most frequent were beliefs and customs, family, labor and health systems. Ordeal and pain, emotions and feelings, and postpartum practices were defined as medium frequency categories. Lastly, pregnancy and religion were defined as infrequent categories. An interpretation of how customs are incorporated into daily praxis is made, establishing itself as a rooted behavior; Therefore, the theories are no longer just theories to become a lived experience, this being the main result of the study and a possible starting point for another research on the subject.

Programa de salud y enfoque sociocultural en comunidades rurales de Ancash, Perú / Health Program and Sociocultural Approach in Rural Communities of Ancash, Peru

Introducción: En intervenciones con tecnologías apropiadas, orientadas a mejorar la salud respiratoria, predomina el precepto de que en comunidades rurales, su sola aplicación resuelve los problemas de salud. Aun cuando la educación socio-cultural ha adquirido una alta prioridad, sigue ocupando una importancia menor. Objetivo: Comprender cómo las particularidades y las semejanzas de los programas de salud con tecnología apropiada, de ayer y de hoy, impactan en la calidad de vida de las mujeres rurales. Métodos: Se realizó un estudio con diseño cualitativo. En un primer momento, en tres grupos de La Esperanza, se evaluaron tres propuestas: Grupo 1 (Cocina Mejorada-Programa Educativo), Grupo 2 (Cocina Mejorada) y Grupo 3 (Programa Educativo). Cada grupo estuvo conformado por 15 mujeres. La información se obtuvo a partir de los cambios observados y las notas de campo. En un segundo momento, se analizaron las percepciones sobre cocinas mejoradas recientemente implementadas, a través de la realización de entrevistas a tres mujeres residentes en Chamana. Resultados: En La Esperanza, el grupo 1 alcanzó cambios ostensibles en todas las variables. El grupo 2 mantuvo prácticas inadecuadas. El grupo 3 logró cambios en las variables no vinculadas con la tecnología apropiada. En Chamana, debido a una capacitación insuficiente, las mujeres no reconocen las buenas prácticas para el uso de las cocinas mejoradas ni su impacto en la salud. Conclusiones: Una implementación con cocina mejorada acompañada con un pertinente programa educativo resulta cualitativamente superior. La presunción de que las tecnologías apropiadas por sí solas, podrían generar los cambios deseados, es cuestionable a todas luces(AU)

Introduction: In interventions with appropriate technologies, aimed at improving respiratory health, the precept that in rural communities their application alone solves health problems predominates. Although socio-cultural education has acquired a high priority, it is still of lesser importance. Objective: To understand how the particularities and similarities of health programs with past and present appropriate technology impact the quality of life of rural women. Methods: A qualitative study was conducted. Initially, three proposals were evaluated in three groups of La Esperanza: Group 1 (Improved Cooking-Educational Program), Group 2 (Improved Cooking) and Group 3 (Educational Program). Each group consisted of 15 women. Information was obtained from observed changes and field notes. In a second moment, perceptions about recently implemented improved cookstoves were analyzed, through interviews with three women living in Chamana. Results: In La Esperanza, group 1 achieved significant changes in all variables. Group 2 maintained inadequate practices. Group 3 achieved changes in variables not linked to appropriate technology. In Chamana, due to insufficient training, women do not recognize good practices for the use of improved cookstoves and their impact on health. Conclusions: An implementation with improved cooking accompanied by a relevant educational program is qualitatively superior. The presumption that appropriate technologies alone could bring about the desired changes is clearly questionable(AU)

Desarrollo del inglés oral a través del aprendizaje a distancia y las nuevas tecnologías / Developing oral English through distance learning and new technologies

Fundamento: La enseñanza del idioma inglés constituye una prioridad en la preparación integral de los profesionales de la salud. En las circunstancias actuales la modalidad de educación a distancia es una vía para garantizar la continuidad del proceso docente-educativo en la educación médica superior. Objetivo: Diseñar para su implementación un sistema de tareas docentes que contribuya a desarrollar la habilidad de expresión oral en inglés a través de la educación a distancia en los estudiantes de 2.do año de Medicina. Metodología: Se realizó un estudio experimental en la Universidad de Ciencias Médicas de Holguín durante el período de marzo hasta septiembre de 2021. Se utilizó el método dialéctico materialista como concepción metodológica general de la investigación y se emplearon otros del nivel teórico: análisis y síntesis, inducción-deducción, sistémico-estructural-funcional, histórico-lógico y modelación; empíricos: análisis documental, encuesta, observación de clases, y estadísticos. Resultados: Las principales dificultades estuvieron relacionadas con limitaciones en el tratamiento de la expresión oral en inglés, la insuficiente preparación de los estudiantes en torno a la temática abordada y sus limitaciones en la habilidad de expresión oral en este idioma, por lo que se elaboró un sistema de tareas docentes para solucionar estos aspectos. Conclusiones: Los especialistas valoraron el sistema como adecuado por su estructura y factibilidad de implementación, contribuyó de forma efectiva en la consolidación de la formación cultural y en el plano motivacional.

Background: English language teaching is a priority in the comprehensive preparation of medical professionals. In the current circumstances, distance education is a way to continue the teaching-learning process in higher medical education. Objective: To design for its implementation a system of learning tasks aimed at developing oral expression skills in English through distance education in 2.nd year medical students. Methodology: It was adopted the materialist dialectical method as the general methodological conception of the research, and other methods, from the theoretical level: analysis and synthesis, induction-deduction, systemic-structural-functional, historical-logical and modeling; empirical: documentary analysis, survey, class observation and statistical procedures. Result: The main difficulties were related to the limitations in the treatment of the oral expression in the English language, insufficient preparation of the students on the analyzed topic and their limited ability to develop oral expression in this language, so a system of learning tasks was developed to solve these aspects. Conclusions: The experts considered the system adequate in terms of its structure and feasibility of implementation, contributing effectively to the consolidation of cultural training and at the motivational level.

Maternal Blood Fatty Acid Levels in Fetal Growth Restriction / Níveis sanguíneos maternos de ácidos graxos na restrição do crescimento fetal

Abstract Objective: To assess the maternal blood levels of fatty acids (FAs) in pregnancies with fetal growth restriction (FGR). Methods: This prospective cross-sectional study included pregnant women with gestational age between 26 and 37 + 6 weeks with FGR and appropriate for gestational age (AGA) fetuses. The levels of saturated, trans, monounsaturated, and polyunsaturated FAs were measured using centrifugation and liquid chromatography. The Student's t-test, Mann-Whitney test, and general linear model, with gestational age and maternal weight as covariants, were used to compare FA levels and the FGR and AGA groups. The Chi-square was used to evaluate the association between groups and studied variables. Results: Maternal blood sample was collected from 64 pregnant women, being 24 FGR and 40 AGA. A weak positive correlation was found between the palmitoleic acid level and maternal weight (r = 0.285, p = 0.036). A weak negative correlation was found between the gamma-linoleic acid level and gestational age (r = −0.277, p = 0.026). The median of the elaidic acid level (2.3 vs. 4.7ng/ml, p = 0.045) and gamma-linoleic acid (6.3 vs. 6.6ng/ml, p = 0.024) was significantly lower in the FGR than the AGA group. The palmitoleic acid level was significantly higher in the FGR than AGA group (50.5 vs. 47.6ng/ml, p = 0.033). Conclusion: Pregnant women with FGR had lower elaidic acid and gamma-linoleic acid levels and higher palmitoleic acid levels than AGA fetuses.

Resumo Objetivo: Avaliar os níveis sanguíneos maternos de ácidos graxos (AGs) em gestações com restrição de crescimento fetal (RCF). Métodos: Este estudo prospectivo transversal incluiu gestantes com idade gestacional entre 26 e 37 semanas e 6 dias com RCF e fetos adequados para a idade gestacional (AIG). Os níveis de ácidos graxos saturados, trans, monoinsaturados e poliinsaturados foram medidos usando centrifugação e cromatografia líquida. O teste t-Student, o teste de Mann-Whitney e o modelo linear geral, com idade gestacional e peso materno como covariantes, foram utilizados para comparar os níveis de AGs e os grupos RCF e AIG. O teste Qui-quadrado foi utilizado para avaliar a associação entre os grupos e as variáveis estudadas. Resultados: Amostra de sangue materno foi coletada de 64 gestantes, sendo 24 RCF e 40 AIG. Uma correlação positiva fraca foi encontrada entre o nível de ácido palmitoleico e o peso materno (r = 0,285, p = 0,036). Uma correlação negativa fraca foi encontrada entre o nível de ácido gama-linoleico ea idade gestacional (r = −0,277, p = 0,026). A mediana do nível de ácido elaídico (2,3 vs. 4,7 ng/ml, p = 0,045) e ácido gama-linoleico (6,3 vs. 6,6 ng/ml, p = 0,024) foram significativamente menores no grupo RCF do que no grupo AIG. O nível de ácido palmitoleico foi significativamente maior no grupo RCF do que no grupo AIG (50,5 vs. 47,6 ng/ml, p = 0,033). Conclusão: Gestantes com RCF apresentaram níveis mais baixos de ácido elaídico e ácido gama-linoleico e níveis mais elevados de ácido palmitoleico do que os fetos AIG.

Global Breast Cancer Initiative: A platform to address the psycho-oncology of cancer in low- and middle-income countries for improving global breast cancer outcomes.

BACKGROUND: Psycho-oncology is a clinical specialty in which the humanistic aspects of cancer diagnoses and treatment are addressed to reduce the psychological burden for patients and their caregivers to optimize patient participation, cancer outcomes and quality-of-life, which is especially critical in cultures where cancer is perceived as invariably fatal. Psycho-oncology programs face multiple barriers in low- and middle-income countries, including limited resource allocation and lack of training, both of which have been impediments to psycho-oncology programs becoming recognized as core competencies in cancer management and part of a standard medical curriculum. PURPOSE: This paper discusses the role of the Global Breast Cancer Initiative (GBCI) in helping to overcome inequities in breast cancer care and improve clinical outcomes from a psycho-oncology perspective as a model for improved cancer care in limited resource settings. FINDINGS: GBCI applies a comprehensive framework encompassing all phases of cancer care (defined through three pillars spanning the continuum of cancer management) and includes addressing the physical, psychological, and social needs of women throughout the life-course. Efforts to promote policies that increase access to early detection and treatment programs and improve health literacy among the public are important strategies to mitigate the most common emotional and physical challenges reported by people with cancer accessing care. CONCLUSIONS: Future efforts will focus on the integration of culturally appropriate guidance to promote early cancer detection and treatment completion through training programs for clinicians to establish core competencies in psycho-oncology. Emerging advocacy efforts in the oncology arena may help guide the integration of psycho-oncology services into routine care in countries where these services are not already integrated into the standard curriculum.

Cacto development: care program for mothers of children with congenital zika syndrome / Desarrollo de cacto: programa de atención a madres de niños con síndrome de zika congénito / Desenvolvimento do cacto: programa de cuidado às mães de crianças com síndrome congênita do zika

ABSTRACT Objective: to develop a unitary caring program for mothers of children with Congenital Zika Syndrome. Method: this is a methodological study, based on Unitary Caring Science, developed in two phases: creation, consisting of six moments, and content validity, through the participation of 36 experts on the subject, professional caregivers and mothers. The Content Validity Index and the Content Validity Ratio were used for data analysis. Results: the program was named CACTO, composed of seven care modalities: Taking care of my mind; Upright and correct position; Taking care of my sleep; Family that is together; Mirror mirror on the wall; Mother who takes care of mother; Facing prejudices. CACTO was validated with a Content Validity Index ≥0.88 and critical Content Validity Ratio values greater than or equal to the cutoff point defined for each group of experts. Conclusion: the translation of Unitary Caring Science into a care program encourages professionals to promote innovative care, valuing acceptance, autonomy, citizenship and critical awareness, advocating in favor of emancipatory interactional care. CACTO is a technological innovation that can transform professional care, promote the resolution of mothers' health needs and enhance the quality of life of children with Congenital Zika Syndrome, family and caregivers themselves.

RESUMEN Objetivo: desarrollar un programa de atención unitaria para madres de niños con síndrome congénito causado por el virus Zika. Método: estudio metodológico, basado en la Ciencia del Cuidado Unitario, desarrollado en dos fases: creación, compuesta por seis momentos, y validación de contenido a través de la participación de 36 expertos en el tema, cuidadores profesionales y madres. Para el análisis de los datos se utilizaron el Índice de Validez de Contenido y la Razón de Validez de Contenido. Resultados: el programa se denominó CACTO, compuesto por siete modalidades de atención: Cuidando mi mente; Posición erguida y correcta; Cuidando mi sueño; Familia que llega junta; Espejo, espejo mío; Madre que cuida a la madre; Enfrentando los prejuicios. CACTO fue validado con un Índice de Validez de Contenido ≥0.88 y valores críticos de Relación de Validez de Contenido mayores o iguales al punto de corte definido para cada grupo de expertos. Conclusión: la traducción de la Ciencia del Cuidado Unitario en un programa de cuidado alienta a los profesionales a promover un cuidado innovador, valorando la aceptación, la autonomía, la ciudadanía y la conciencia crítica, abogando por el cuidado interaccional emancipador. El CACTO es una innovación tecnológica que puede transformar la atención profesional, promover la resolución de las necesidades de salud de las madres y mejorar la calidad de vida de los niños con síndrome congénito causado por el virus Zika, la familia y los propios cuidadores.

RESUMO Objetivo: desenvolver um programa de cuidado unitário às mães de crianças com Síndrome Congênita do vírus Zika. Método: estudo metodológico, fundamentado na Ciência do Cuidado Unitário, desenvolvido em duas fases: criação, constituída por seis momentos, e validação de conteúdo mediante participação de 36 experts na temática, cuidadoras profissionais e mães. O Índice de Validação de Conteúdo e o Content Validity Ratio foram utilizados para análise dos dados. Resultados: o programa foi nomeado de CACTO, composto por sete modalidades de cuidado: Cuidando da minha mente; Posição ereta e correta; Cuidando do meu sono; Família que chega junto; Espelho espelho meu; Mãe que cuida de mãe; Enfrentando preconceitos. O CACTO foi validado com Índice de Validação de Conteúdo ≥0,88 e valores do Content Validity Ratio crítico maior ou igual ao ponto de corte definido para cada grupo de experts. Conclusão: a translação da Ciência do Cuidado Unitário em programa de cuidado estimula as profissionais a promoverem cuidados inovadores, valorizando o acolhimento, autonomia, cidadania e consciência crítica, advogando em favor do cuidado interacional emancipatório. O CACTO é uma inovação tecnológica que pode transformar os cuidados profissionais, promover resolutividade das necessidades de saúde das mães e potencializar qualidade de vida da criança com Síndrome Congênita do vírus Zika, família e das próprias cuidadoras.

Ações e atitudes das enfermeiras na abordagem das parturientes sobre tecnologias não invasivas de cuidado / Nurse's actions and attitudes in approaching parturient women on non-invasive care technologies / Acciones y actitudes de las enfermeras en el enfoque de las parturientas sobre tecnologías de cuidado no invasivas

Objetivos: conhecer as ações das enfermeiras obstétricas para mobilizar as parturientes quanto ao uso das tecnologias não invasivas de cuidado; e discutir as atitudes destas profissionais diante da não adesão das parturientes a estas tecnologias. Método: estudo qualitativo e exploratório, com 17 enfermeiras obstétricas. Os dados foram coletados de novembro de 2019 a janeiro de 2020, através de entrevistas, submetidos à análise temática e discutidos à luz do conceitos da Teoria de Madeleine Leininger. Resultados: as mulheres são mobilizadas com as seguintes ações: construção de vínculo; compartilhamento de saberes; colaboração de outras enfermeiras; e incentivo à participação do acompanhante. Diante da não adesão, as atitudes das enfermeiras perpassam pela negociação ou imposição cultural. Conclusão: Incorporar os valores da parturiente no processo de cuidar é fundamental para evitar o choque cultural, seja por meio da negociação do cuidado desmedicalizado ou da preservação do padrão medicalizado.

Objective: to learn what action is taken by obstetric nurses to mobilize parturient women towards the use non-invasive care technologies; and to discuss nurses' attitudes to parturients' non-adherence to these technologies. Method: in this exploratory, qualitative study, with 17 obstetric nurses, data were collected through interviews, from November 2019 to January 2020, subjected to thematic analysis and discussed in light of the concepts of Madeleine Leininger's Theory. Results: women were mobilized by the following actions: bonding; knowledge sharing; collaboration from other nurses; and encouragement for companion participation. Faced with non-adherence to technologies, nurses' actions hinge on negotiation or cultural imposition. Conclusion: incorporating the mother's values into the care process, either by negotiating de-medicalized care or maintaining standard medicalized care, is essential in order to avoid culture shock.

Objetivo: conocer las acciones de las enfermeras obstétricas para movilizar a las parturientas sobre el uso de tecnologías de atención no invasivas; y discutir las actitudes de estos profesionales frente a la no adherencia de las parturientas a estas tecnologías. Método: estudio cualitativo y exploratorio, junto a 17 enfermeras obstétricas. Los datos fueron recolectados de noviembre de 2019 a enero de 2020, a través de entrevistas, sometidos a análisis temático y discutidos a la luz de los conceptos de la Teoría de Madeleine Leininger. Resultados: las mujeres se movilizan con las siguientes acciones: construcción de vínculos; intercambio de conocimientos; colaboración de otras enfermeras; y fomento a la participación del acompañante. Frente a la no adherencia, las actitudes de los enfermeros pasan por la negociación o imposición cultural. Conclusión: Incorporar los valores de la madre en el proceso de cuidado es fundamental para evitar el choque cultural, ya sea a través de la negociación de la atención desmedicalizada o la preservación del estándar medicalizado.

Stem cells as an option for the treatment of COVID-19.

The application of stem cells is among the many strategies currently available for the treatment of multiple diseases. Stem cells are characterized as undifferentiated cells that have the ability to differentiate towards multiple lineages and self-renewal, among other attributes. Since the first umbilical cord stem cell transplant for the treatment of Fanconi anemia, the use of stem cells for the treatment of multiple diseases, including coronavirus disease 2019, has increased, showing promising results that require evaluation through research studies that include a longer follow-up time. Therefore, the main objective of this Letter is to provide an update on the use of stem cells in the treatment of severe acute respiratory syndrome coronavirus 2, as well as identify the main challenges and limitations presented by this type of therapy.

Mamografia de rastreamento, atenção primária e decisão compartilhada: a voz das mulheres / Screening mammography, primary care, and shared decision-making: the voice of women

Em relação à última diretriz brasileira do Instituto Nacional do Câncer/Ministério da Saúde sobre a detecção precoce do câncer de mama, destacamos as incertezas sobre a tomada de decisão compartilhada relativas a benefícios e riscos do rastreamento mamográfico. Este artigo expressa as percepções de usuárias de serviços de Atenção Primária à Saúde sobre a decisão compartilhada nesse cenário, sendo resultado de uma pesquisa qualitativa que utilizou grupos focais, como instrumentos de produção de dados, e análise de conteúdo temática, para a sistematização de resultados. As participantes revelaram não participarem dedecisão compartilhada no rastreamento mamográfico, o que nos leva a ressaltar a importância de nortear os cuidados em saúde com base em tecnologias leves, ou seja, tecnologias relacionais, e a valorizar, também, a necessidade de implementação de certos aspectos conceituais e de princípios fundamentais, que precisam ser discutidos e realçados para que a decisão compartilhada seja implementada.

According to the latest Brazilian guidelines from the National Cancer Institute/Ministry of Health on early detection of breast cancer, we highlight the uncertainties about shared decision-making concerning the benefits and risks of mammographic screening. This article expresses the perceptions of users of Primary Health Care services concerning shared decision-making in this scenario. As a result of qualitative research, it used focus groups as an instrument for data production and thematic content analysis to systematize the results. The participants revealed that there is no shared decision-making concerning mammographic screening, which leads us to emphasize that health care guidelines should be based on light technologies,that is, relational technologies. They should also discuss and highlight related conceptual aspects and fundamental principles so that shared decision-making can be implemented.

Aceitabilidade social de tecnologias da atenção primária à saúde: uma revisão de escopo / Social acceptance of primary health care technologies: a scoping review

Alma-Ata definiu a Atenção Primária à Saúde (APS) como "cuidados essenciais de saúde baseados em métodos e tecnologias práticas, cientificamente bem fundamentadas e socialmente aceitáveis"1, mas parece faltar "aceitabilidade social" paradiversas tecnologias usadas na APS, além de pouca investigação de tal conceito. Esta pesquisa buscou compreendera aceitabilidade social das tecnologias praticadas na APS,no Brasil e no mundo, por meio de uma revisão de escopo, visando mapear conceitos-chave, tipos de evidências e lacunas no campo através de sistemática busca, seleção e síntese do conhecimento existente. Buscaram-se artigos de 1978 a 2019 no Medline -PubMed, BVS/Lilacs, Academic Search Premier, Web of Science, Science Direct, SciELO e CINAHL complete. Pesquisou-se, também, nas referências desses artigos e por meio de busca complementar efetuada no Google e no Google Scholar. Identificados13.874 artigos, foram selecionados 201 para tabulação e análise. Encontrou-se grande variedade de tecnologias usadas na APS em 41 países, que foram organizadas em forma temática. Identificaram-se sete acepções para"aceitabilidade social": percepções sobre uma tecnologia, intenções de aceitar uma tecnologia, aceitar uma tecnologia ou não, confiança, participação, acesso e qualidade do cuidado.

Alma-Ata defined Primary Health Care (PHC) as "essential health care based on practical, scientifically and socially acceptable methods and technology," 1 but it seems that several technologies used in PHC lack social acceptability ­a concept seldom investigated. This research was pursued to acknowledge the social acceptability of PHC technologies, in Brazil and in the world, through a Scoping Review, in order to map concepts, evidence, and gaps in the research field through a systematic search, selection, and synthesis of existing knowledge. The articles, published between the years of 1978 and 2019, were searched in the following databases: Medline-PubMed, BVS/Lilacs, Academic Search Premier, Web of Science, Science Direct, SciELO, and CINAHL Complete. Further references cited in these articles were explored along with complementary searches on Google and Google Scholar. Out of 13,874 articles identified, 201 wereselected for data extraction and analysis. As a result, thematic maps of the large scope of technologies used in PHC were created. Seven different groups were created to assess "social acceptability": perceptions about a specific technology; the intentionto accept it; simply accepting it; trust; participation; access; and quality of care.

Outcome of audit and education on blood transfusion practice in obstetrics setting

Abstract Introduction Audit and education are essential pre-requisites in the review and update of blood transfusion practices. Although standard guidelines on appropriate utilization of blood components exists, erroneous use of blood components with no justification still continues. This study evaluates appropriateness of blood transfusion in obstetric settings and identifies key areas requiring educational intervention to improve blood transfusion practice toward the evidence-based at our hospital. Method This was a prospective observational study on the analysis of blood transfusion requisition forms for obstetric patients before and after educational intervention, performed in two Phases from September 2011 to August 2012 and October 2012 to September 2013. The appropriateness of blood utilization was assessed against the Royal College of Obstetricians and Gynecologists Guidelines for blood transfusion and Green-Top Guideline no. 47. Data required for the study were obtained from department records and statistical analysis was performed using the SPSS, version 20 (IBM, USA). Results The total transfusion episodes were 214 in 51 patients and 181 in 43 patients in Phases 1 and 2, respectively. Fresh frozen plasma was the most misused blood component, next to whole blood in Phase 1. However, appropriate utilization of components, including cryoprecipitate (6.6%), reduction in whole blood (34.5-14.4%) and single unit transfusion (23.3-18.2%) were observed in Phase 2. Inappropriate use of blood components, namely, packed red blood cells and fresh frozen plasma dropped significantly (p < 0.05) from 29.7% to 13.1% and 45.1% to 22.5%, respectively, with the exclusion of platelet concentrate (33.3-20.6%, p-value 0.414). Conclusion Audit and targeted education helped in optimizing transfusion practices in the obstetric setting.

BPS and BPF are as Carcinogenic as BPA and are Not Viable Alternatives for its Replacement.

BACKGROUND: Plastic polymers are omnipresent, and life without them is virtually impossible. Despite the advantages provided by the material, conventional plastic also has harmful effects on the environment and human health. Plastics release microplastics and compounds, such as BPA, which is a xenoestrogen and once absorbed by the body, have an affinity for estrogen receptors α and ß, acting as an agonist on human cells, being an endocrine disrupter able to cause various diseases and acting as a potential neoplastic inducer. BPS and BPF are BPA's analogs, a proposed solution to solve its harmful effects. The analogs can be found in daily use products and are used in several industrial applications. OBJECTIVES: In the present work, the researchers aimed to conduct a revisional study on BPA's harmful effects on human health, focusing on its carcinogenic potential, discussing its mechanisms of action, as well as its analogs effects, and identifying if BPS and BPF are viable alternatives to BPA's substitution in plastic polymers' production. METHODS: In this review, articles published in the last 15 years related to the different aspects of conventional plastics and BPA were analyzed and revised with precision. The subjects ranged from conventional plastics and the problems related to their large-scale production, BPA, its negative aspects, and the feasibility of using its analogs (BPS and BPF) to replace the compound. The articles were extensively reviewed and concisely discussed. RESULTS: This study demonstrated that BPA has a high carcinogenic potential, with known mechanisms to trigger breast, ovarian, prostate, cervical, and lung cancers, thus elucidating that its analogs are also xenoestrogens, and they can exert similar effects to BPA and, therefore, cannot be considered viable alternatives for its replacement. CONCLUSION: .This study suggests that new research should be carried out to develop such alternatives, allowing the substitution of plastic materials containing BPA in their composition, such as developing economically viable and sustainable biodegradable bioplastics for socioenvironmental well-being.

Interdisciplinaridade em estágio de vivência acadêmica: reconhecimento da atuação profissional no Sistema de Saúde / Interdisciplinarity in an academic experience internship: recognition of professional performance in the Health System / Interdisciplinaridad en prácticas de experiencia académica: reconocimiento de la actuación profesional en el Sistema de Salud

Objetivo: Descrever a experiência de um estágio acadêmico vivenciado por universitários da área da saúde em um município do Baixo Solimões. Síntese dos dados:Trata-se do relato descritivo de um estágio acadêmico extramuro realizado em Manacapuru, Amazonas, ocorrido no período de outubro de 2019 a fevereiro de 2020. A realização da atividade teve a participação de acadêmicos de Medicina, Enfermagem e Odontologia e contou com a aplicação de práticas em saúde direcionadas à atuação individual e coletiva. Tendo como público-alvo os pacientes atendidos por uma Unidade Básica de Saúde (UBS), os universitários auxiliaram na realização de atendimentos eletivos em suas respectivas áreas de atuação e conduziram atividades de educação em saúde como rodas de conversa, gincanas educativas, palestras interativas e educação continuada à equipe da UBS. Conclusão: As práticas e ações em saúde realizadas no período do estágio extramuro proporcionaram uma integração interdisciplinar satisfatória entre os acadêmicos, possibilitando aos mesmos uma vivência apropriada na atenção básica do Sistema Único de Saúde (SUS).

Objective: To describe the experience of an academic internship completed by university students in the health field in a municipality in Baixo Solimões. Data synthesis: This is a descriptive report of an extramural academic internship carried out in Manacapuru, Amazonas, from October 2019 to February 2020. The activity was carried out with the participation of medical, nursing and dentistry students and included the application of health practices aimed at individual and collective action. Having as a target audience the patients assisted by a Primary Health Care (PHC) center, the university students helped in carrying out elective care in their respective fields and conducted health education activities such as conversation circles, educational scavenger hunts, interactive lectures and continuing education for the PHC center team. Conclusion: The health practices and actions carried out during the extramural internship enabled a satisfactory interdisciplinary integration among the students and allowed them to have an appropriate experience in primary care in the Unified Health System (Sistema Único de Saúde ­ SUS).

Objetivo: Describir la experiencia de una pasantía académica vivida por universitarios del área de la salud en un municipio del Baixo Solimões. Síntesis de los datos: Se refiere al informe descriptivo de una pasantía académica extramuros realizado en Manacapuru, Amazonas, ocurrido entre octubre de 2019 y febrero de 2020. La realización de la actividad tuvo la participación de académicos de medicina, enfermería y odontología y contó con la aplicación de prácticas en salud direccionadas a la actuación individual y colectiva. Teniendo como público meta los pacientes atendidos por una Unidad Básica de Salud (UBS), los universitarios ayudaron en la realización de atendimientos electivos en sus respectivas áreas de actuación y condujeron actividades de educación y en salud como charlas, juegos educativos, conferencias interactivas y educación continuada para el equipo de la UBS. Conclusión: Las prácticas y acciones en salud realizadas en el período de la pasantía extramuros proporcionaron una integración interdisciplinar satisfactoria entre los académicos, posibilitando a los mismos una experiencia apropiada en la atención básica del Sistema Único de Salud (SUS).

Outcome of audit and education on blood transfusion practice in obstetrics setting.

INTRODUCTION: Audit and education are essential pre-requisites in the review and update of blood transfusion practices. Although standard guidelines on appropriate utilization of blood components exists, erroneous use of blood components with no justification still continues. This study evaluates appropriateness of blood transfusion in obstetric settings and identifies key areas requiring educational intervention to improve blood transfusion practice toward the evidence-based at our hospital. METHOD: This was a prospective observational study on the analysis of blood transfusion requisition forms for obstetric patients before and after educational intervention, performed in two Phases from September 2011 to August 2012 and October 2012 to September 2013. The appropriateness of blood utilization was assessed against the Royal College of Obstetricians and Gynecologists Guidelines for blood transfusion and Green-Top Guideline no. 47. Data required for the study were obtained from department records and statistical analysis was performed using the SPSS, version 20 (IBM, USA). RESULTS: The total transfusion episodes were 214 in 51 patients and 181 in 43 patients in Phases 1 and 2, respectively. Fresh frozen plasma was the most misused blood component, next to whole blood in Phase 1. However, appropriate utilization of components, including cryoprecipitate (6.6%), reduction in whole blood (34.5-14.4%) and single unit transfusion (23.3-18.2%) were observed in Phase 2. Inappropriate use of blood components, namely, packed red blood cells and fresh frozen plasma dropped significantly (p<0.05) from 29.7% to 13.1% and 45.1% to 22.5%, respectively, with the exclusion of platelet concentrate (33.3-20.6%, p-value 0.414). CONCLUSION: Audit and targeted education helped in optimizing transfusion practices in the obstetric setting.

Tecnologias sociais para ações de gestão de risco em desastres: uma revisão de escopo / Social technologies for disaster risk management actions: a scoping review

RESUMO Objetivou-se mapear a literatura técnico-científica sobre o desenvolvimento de tecnologias sociais em processos de gestão de risco de desastres em comunidades vulneráveis. Trata-se de uma revisão de escopo, conforme metodologia do Joanna Briggs Institute, cujas buscas foram realizadas de agosto a dezembro de 2021 em 11 bancos de dados e na literatura cinzenta. Revisores independentes participaram da seleção, extração e síntese dos dados. Após a triagem de 1.291 publicações, foram incluídos 6 estudos na revisão. Os critérios de elegibilidade basearam-se na sigla PCC (População, Conceito e Contexto). Evidenciou-se que o conceito de tecnologia social traz em sua essência a transformação social e o empoderamento, elementos estratégicos para o enfrentamento sistematizado dos desastres em populações vulneráveis. Novos estudos mais robustos são importantes para analisar o impacto das tecnologias sociais nos desastres, especialmente levando em consideração o desenvolvimento de políticas públicas e a busca pela resiliência comunitária orientada pelos Objetivos de Desenvolvimento Sustentável e pelo Marco de Sendai para a Redução do Risco de Desastres. O número limitado de estudos identificados aponta para a necessidade de apropriação de tecnologias sociais que possam melhorar efetivamente o padrão de gestão de risco perante tais eventos, tanto de origem natural quanto tecnológica.

ABSTRACT The objective was to map the technical-scientific literature on the development of social technologies in disaster risk management processes with vulnerable communities. This is a scoping review, according to the JBI (Joanna Briggs Institute) methodology, whose searches were carried out from August to December 2021 in eleven databases and gray literature. Independent reviewers participated in the selection, extraction, and synthesis of the data. After screening 1,291 publications, six studies were included in the review. Eligibility criteria were based on the acronym PCC (Population, Concept, and Context). It was evidenced that the concept of social technology brings in its essence social transformation and empowerment, strategic elements for the systematic confrontation of disasters with vulnerable populations. New, more robust studies are important to analyze the impact of social technologies on disasters, especially taking into account the development of public policies and the search for community resilience guided by the Sustainable Development Goals and the Sendai Framework for Disaster Risk Reduction. The limited number of studies identified points to the need for the appropriation of social technologies that can effectively improve the standard of risk management in the face of such events, whether of natural or technological origin.

Tendencias metodológicas para la inclusión social de tecnologías apropiadas en zonas rurales / Methodological Trends for the Social Inclusion of Appropriate Technologies in Rural Areas

Resumen Este artículo tiene por objetivo estudiar las tendencias metodológicas a nivel mundial de tecnologías apropiadas (TA) desarrolladas en zonas rurales con inclusión social. Se realiza una revisión sistemática en bases de datos científicas. Se identifican las principales metodologías (cualitativas, cuantitativas y mixtas), herramientas y enfoques en procesos rurales con TA. Se detectan también los principales factores (social, técnico, económico, ambiental, institucional y cultural) y variables de estudio en procesos de TA rurales. Los continentes con un mayor número de experiencias en TA rurales son África y Asia. El sector de energía asocia el 56,0% de las experiencias detectadas.

Abstract This article aims to study the global methodological trends of appropriate technologies (TAs) developed in rural areas with social inclusion. A systematic review is carried out in scientific databases. The main methodologies (qualitative, quantitative, and mixed), tools and approaches in rural processes with TA are identified. The main factors (social, technical, economic, environmental, institutional, and cultural) and study variables in rural TA processes are also detected. The continents with the highest number of rural TA experiences are Africa and Asia. The energy sector associates 56.0% of the experiences detected.