The patient journey of fibromyalgia in Latin America.

OBJECTIVES: To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. METHODS: Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. RESULTS: Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. CONCLUSION: The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self- management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.

[Translated article] Insertion of S1 iliosacral screws in the computed tomography room: An alternative to improve safety in the percutaneous management of posterior pelvic ring injuries.

INTRODUCTION: The main complication of percutaneous iliosacral screw fixation is implant malposition, which can lead to vascular and nerve damage. The anatomical variability of the sacrum can make screw insertion difficult under fluoroscopic guidance. Among the methods described to improve the accuracy of this technique, stands out the use of computed tomography (CT). The aim of this study is to compare the results of iliosacral screw insertion with fluoroscopy or CT navigation. METHODOLOGY: Retrospective cohort study of 66 iliosacral screws in 56 patients during 11 years. The screws were inserted with fluoroscopy in the operating room or with CT in the radiodiagnosis area. We collected data on patient characteristics, lesions, treatment, and clinical and radiological results. RESULTS: Forty-seven screws were inserted with fluoroscopy and 19 with CT. A percentage of 18.2 of screws perforated the S1 osseous corridor. All of them were inserted with fluoroscopy guidance (0 vs. 34%; p<0.01). Those operated with CT accumulated more sacral dysmorphism criteria than those operated with fluoroscopy (2.2 vs. 1.6; p=0.02). The S1 corridor on the axial CT view was narrower in those in whom perforation had occurred (18.8 vs. 21.0mm; p=0.02). Two cases with perforation developed S1 radiculalgia. Two endopelvic screws had to be removed. CONCLUSION: We advise the use of CT guidance for iliosacral screw insertion in patients with sacral dysmorphism or narrow S1 corridors in facilities where other navigation methods are not available.

El viaje del paciente con fibromialgia en Latinoamérica / The patient journey of fibromyalgia in Latin America

Objetivos: Explorar la experiencia de las personas con fibromialgia (FM) en países latinoamericanos con objeto de identificar problemas en la atención sanitaria y otros ámbitos potencialmente solucionables. Métodos: Estudio cualitativo con enfoque fenomenológico y de análisis de contenido a través de grupos focales y metodología de viaje del paciente (Ux del inglés User Experience). Se llevaron a cabo 9 grupos focales virtuales con pacientes con FM y profesionales sanitarios en Argentina, México y Colombia reclutados a partir de informantes clave y redes sociales. Resultados: Participaron 43 personas (33 clínicos y 10 pacientes). Los agentes que interaccionan con el paciente en la enfermedad se encuentran en 3 esferas: la de la atención sanitaria, la del apoyo y vida laboral y la del contexto socioeconómico. La línea del viaje presenta 2 grandes tramos, 2 bucles y una línea discontinua delgada. Los 2 grandes tramos representan los tiempos que van desde los primeros síntomas hasta la visita médica y desde el diagnóstico hasta el seguimiento. Los bucles incluyen: 1.°) sucesión de diagnósticos, tratamientos erróneos y derivaciones a especialistas y 2.°) nuevos síntomas cada cierto tiempo, visitas a especialistas y dudas diagnósticas. Pocos pacientes logran la fase final de autonomía. Conclusión: El viaje de una persona con FM en Latinoamérica está lleno de obstáculos. La meta deseada es que todos los agentes entiendan que el automanejo por parte del paciente con FM es una parte indispensable del éxito, y solo se puede lograr accediendo a recursos de forma precoz y guiado por profesionales.(AU)

Objectives: To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. Methods: Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. Results: Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. Conclusion: The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self-management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.(AU)

Insertion of S1 iliosacral screws in the computed tomography room: An alternative to improve safety in the percutaneous management of posterior pelvic ring injuries. / Inserción de tornillos iliosacros S1 en la sala de tomografía computarizada. Una alternativa para mejorar la seguridad en el tratamiento percutáneo de las lesiones posteriores del anillo pélvico.

INTRODUCTION: The main complication of percutaneous iliosacral screw fixation is implant malposition, which can lead to vascular and nerve damage. The anatomical variability of the sacrum can make screw insertion difficult under fluoroscopic guidance. Among the methods described to improve the accuracy of this technique, stands out the use of computed tomography (CT). The aim of this study is to compare the results of iliosacral screw insertion with fluoroscopy or CT navigation. METHODOLOGY: Retrospective cohort study of 66 iliosacral screws in 56 patients during 11 years. The screws were inserted with fluoroscopy in the operating room or with CT in the radiodiagnosis area. We collected data on patient characteristics, lesions, treatment, and clinical and radiological results. RESULTS: Forty-seven screws were inserted with fluoroscopy and 19 with CT. A percentage of 18.2 of screws perforated the S1 osseous corridor. All of them were inserted with fluoroscopy guidance (0 vs. 34%; p<0.01). Those operated with CT accumulated more sacral dysmorphism criteria than those operated with fluoroscopy (2.2 vs. 1.6; p=0.02). The S1 corridor on the axial CT view was narrower in those in whom perforation had occurred (18.8 vs. 21.0mm; p=0.02). Two cases with perforation developed S1 radiculalgia. Two endopelvic screws had to be removed. CONCLUSION: We advise the use of CT guidance for iliosacral screw insertion in patients with sacral dysmorphism or narrow S1 corridors in facilities where other navigation methods are not available.

Patient navigation models for mental health of parents expecting or caring for an infant or young child: A systematic review.

Patient navigation (PN) aims to improve timely access to healthcare by helping patients to "navigate" complex service provision landscapes. PN models have been applied in diverse healthcare settings including perinatal mental health (PMH). However, the practice models and implementation of PN programs vary widely, and their impact on engagement with PMH services has not been systematically investigated. This systematic narrative review study aimed to (1) identify and describe existing PMH PN models, (2) understand their effectiveness in improving service engagement and clinical outcomes, (3) review patient and provider perceptions, and (4) explore facilitators and barriers to program success. A systematic search of published articles/reports describing PMH PN programs/service delivery models targeting parents in the period from conception to 5 years postpartum was conducted. In total, 19 articles describing 13 programs were identified. The analysis yielded a number of commonalities and differences across program settings, target populations, and the scope of the navigator role. While there was promising evidence to support the clinical efficacy and impact on service utilization of PN programs for PMH, the current evidence base is sparse. Further research evaluating the efficacy of such services, and facilitators and barriers to their success, is warranted.

La meta de Navegación del Paciente (PN) es mejorar el acceso a tiempo a servicios de cuidado de salud por medio de ayudar a los pacientes a "navegar" los complejos esquemas de provisión de servicios. Los modelos PN han sido aplicados en diversos escenarios de cuidados de salud incluyendo la salud mental perinatal (PMH). Sin embargo, los modelos de la práctica e implementación de programas PN varían ampliamente, y su impacto en la participación de los servicios PMH no ha sido sistemáticamente investigada. Este estudio de revisión narrativa sistemática se propuso 1) identificar y describir modelos PMH PN existentes, 2) comprender su eficacia para mejorar la participación en el servicio y resultados clínicos, 3) examinar las percepciones de pacientes y proveedores, y 4) explorar factores facilitadores y barreras al éxito del programa. Se llevó a cabo una sistemática investigación de artículos/reportes publicados que describen modelos que proveen programas/servicios de PMH PN con enfoque en los padres en el período desde la concepción hasta los 5 años posteriores al parto. En total, se identificaron 19 artículos que describían 13 programas. Los análisis dieron como resultado un número de puntos comunes y diferencias a través de la composición de los programas, la población a la cual se dirigían, y el ámbito del papel del navegador. A pesar de que se observó una evidencia prometedora para apoyar la efectividad clínica y el impacto sobre la utilización del servicio de programas PN para PMH, la base actual de la evidencia es escasa. Es necesaria una posterior investigación para evaluar la efectividad de tales servicios, y puntos que los faciliten o barreras al éxito de éstos.

La Navigation du Patient (abrégé ici NP en français) a pour but d'améliorer l'accès rapide aux soins de santé en aidant les patients à « naviguer ¼ un paysage complexe d'offre de services. Les modèles NP ont été appliqués dans divers contextes de soins de santé y compris la santé mentale périnatale (SMP en français ici). Cependant les modèles de pratique et de mises en place de programmes NP varient grandement, et leur impact sur l'engagement avec des services SMP n'a pas encore été examiné systématiquement. Cette étude narrative systématique s'est donnée pour but de 1) identifier et décrire les modèles NP existants, 2) comprendre leur efficacité à améliorer d'engagement du service et ses résultats cliniques, 3) passer en revue les perceptions du patient et du prestataire, et 4) explorer ce qui facilite et fait obstacle au succès du programme. Une recherche systématique d'articles/rapports publiés décrivant des modèles de prestation de NP SMP visant des parents dans la période de la conception à 5 ans postpartum a été faite. En tout 19 articles décrivant 13 programmes ont été identifiés. L'analyse a produit un nombre de points communs et de différences au travers des contextes des programmes, des populations ciblées et de la portée du rôle de navigateur. Bien qu'il y ait des preuves promettantes soutenant l'efficacité clinique et l'impact de l'utilisation de services des programmes NP pour la SMP la base de preuves actuelle est éparse. Des recherches supplémentaires évaluant l'efficacité de tels services ainsi que les facteurs de facilitation et les barrières au succès sont nécessaires.

Pachyoliva columellaris G.B. Sowerby I, 1825 (Olividae, Caenogastropoda) in Peru: tidal migrations and population density

The gastropod Pachyoliva columellaris (formerly Olivella columellaris) is particularly common on many sandy beaches in North Peru. In the studied region north of Paita, Piura province, the species reaches densities of over 80,000 individuals per beach meter. The snails perform tidal migrations throughout the lunar cycle although tidal amplitudes differ four-fold between neap and spring tide. Not all animals complete their tidal migrations, and significant numbers remain above the water line at low tide. Throughout the tidal cycle, the proportion of small individuals is increased near the water line whereas large animals dominate in lower beach zones. I conclude that the sandy beaches north of Paita are well-suited for further studies of P. columellaris and the mechanisms underlying tidal migrations in invertebrates.

El gasterópodo Pachyoliva columellaris (antes Olivella columellaris) es particularmente común en las playas arenosas del norte de Perú. En la región estudiada al norte de Paita, provincia de Piura, la especie alcanza densidades de más de 80.000 individuos por metro de playa. Los caracoles realizan migraciones mareales durante todo el ciclo lunar, aunque las amplitudes de marea difieren cuatro veces entre la marea muerta y la marea viva. No todos los animales completan sus migraciones mareales y un número significativo permanece por encima del nivel del agua en marea baja. Durante todo el ciclo de marea, la proporción de individuos pequeños aumenta cerca del nivel del agua, mientras que los animales grandes dominan en las zonas bajas de la playa. Concluyo que las playas arenosas al norte de Paita son apropiadas para estudios adicionales de P. columellaris y los mecanismos de las migraciones de marea en invertebrados.

Revisando Conceptos de Acceso, Trayectorias, Participación y Conocimiento Tácito en Investigaciones Sobre Pacientes y Cobertura en Salud.

OBJECTIVES: This study aimed to characterize 5 approaches that have been developed in research on patients and health coverage, which reveal information from the perspective of patients: (1) access to healthcare, (2) therapeutic trajectories, (3) social participation in decision making on health coverage, (4) tacit knowledge, and (5) communities of practice. METHODS: This is a narrative literature review, based on searches performed in PubMed/MEDLINE and Web of Science, between August and December 2021. A total of 45 scientific articles were selected for analysis, which were complemented by a gray literature search that provided 6 additional manuscripts. RESULTS: Improving access to health services requires an understanding of the meaning of the concept of access from the users themselves. The patient trajectory approach contributes by emphasizing that the focus of analysis must adopt the patient's perspective, given that it provides valuable information for the decision making on health coverage. In addition, the role that social participation has in the process to grant trust and legitimacy is described. Tacit knowledge makes explicit the importance of revealing it as a source of information that adds value to the decision-making process. Finally, communities of practice are described as spaces where new ways of experiencing the disease originate, as well as ways of relating to the health system and its actors. CONCLUSIONS: The article raises the relevance that various social actors know these approaches, as well as strategies to integrate them into the assessment processes in terms of health coverage.

Private health plan operator: breast care navigation program and care line / Operadora de planes de salud privados: programa de navegación y línea de asistencia para el cuidado de las mamas / Operadora de plano de saúde privado: programa de navegação e linha de cuidado de atenção à mama

ABSTRACT Objective: to develop a navigation program for patients in the breast care line, beneficiaries of a private health plan operator. Method: a convergent care research study, related to the stages of the Guide for the Development and Implementation of Patient Navigation Programs, consisting of the phases: diagnosis; planning; implementation; and evaluation, using instruments specifically designed for each phase. It was conducted from January to September 2022 in Porto Alegre, Brazil. Results: during the diagnosis, the patients' demographic profile was identified and the flow they followed through the health services was analyzed. Interviews were carried out with the professionals involved in patient care, and the main barriers that might be faced by patients were surveyed. In planning, the program structure was considered. During implementation, a navigation pilot was carried out with two nurses from different areas; and the nurse navigators' performance profile and a proposal of topics for team training were constructed. An evaluation was carried out using the Plan, Do, Study and Act tool at the end of each stage. A breast care line and navigation program were created for the patients. Conclusion: two products were developed: Planned Care Line, with important prevention actions favoring screening and early diagnosis of the disease; and the Navigation Program for line assistance, in which attention is centered on the patients, with an evaluation of their needs, elimination of barriers that make it difficult for them to navigate the health system and guidance in each stage of the path.

RESUMEN Objetivo: desarrollar un programa de navegación para pacientes de la línea de asistencia para el cuidado de las mamas, en mujeres afiliadas a una operadora de planes de salud privados. Método: investigación convergente y asistencial, relacionada a las etapas propuestas en la Guía para el Desarrollo e Implementación de Programas de Navegación de Pacientes, compuesto por las siguientes fases: diagnóstico, planificación, implementación y evaluación, utilizando instrumentos elaborados específicamente para cada fase. El estudio se realizó entre enero y septiembre de 2022 en Porto Alegre, Brasil. Resultados: en el diagnóstico se identificó el perfil demográfico de las pacientes, al igual que se analizó el camino que recorrieron en los servicios de salud. Se realizaron entrevistas con los profesionales involucrados en atender a las pacientes, y se sondearon los principales obstáculos que podrían enfrentar las mujeres. En la planificación se contempló la estructura del programa. En la implementación se llevó a cabo una prueba piloto de navegación con dos enfermeras de distintas áreas, además de elaborarse el perfil de actuación de los enfermeros navegadores y una propuesta de temas para capacitar al equipo. Se realizó una evaluación con la herramienta Plan, Do, Study and Act al término de cada etapa. Se creó una línea de asistencia para el cuidado de las mamas y un programa de navegación para las pacientes. Conclusión: se desarrollaron dos productos: Línea de Asistencia Planificada, con importantes acciones de prevención que favorecen el screening y diagnóstico temprano de la enfermedad; y el Programa de Navegación para cumplir con la línea de asistencia, en el que la atención se centra en la paciente, evaluando sus necesidades, eliminando obstáculos que le dificultan transitar por el sistema de salud y orientándola en cada etapa del trayecto.

RESUMO Objetivo: Desenvolver um programa de navegação para pacientes da linha de cuidado de atenção à mama, beneficiárias de uma operadora de plano de saúde privado. Método: Pesquisa convergente assistencial, relacionada às etapas do Guia de Desenvolvimento e Implantação de Programas de Navegação de Pacientes, composto pelas fases: diagnóstico, planejamento, implantação e avaliação, utilizando instrumentos elaborados para cada fase. Foi realizada em Porto Alegre, Brasil, de janeiro a setembro de 2022. Resultados: No diagnóstico, identificou-se o perfil demográfico dos pacientes, análise do fluxo percorrido por eles nos serviços de saúde. Realizaram-se entrevistas com os profissionais envolvidos no atendimento ao paciente, e fez-se levantamento das principais barreiras que poderiam ser enfrentadas por ele. No planejamento, contemplou-se a estrutura do programa. Na implantação, realizou-se piloto de navegação com duas enfermeiras de áreas distintas; e construíram-se o perfil de atuação do enfermeiro navegador e uma proposta de temas para capacitação da equipe. Realizou-se avaliação com a ferramenta Plan, Do, Study and Act ao término de cada etapa. Construíram-se às pacientes, linha de cuidado de atenção à mama e o programa de navegação. Conclusão: Desenvolveram-se dois produtos: Linha de Cuidado Planejada, com ações importantes de prevenção favorecendo o rastreamento e diagnóstico precoce da doença; e o Programa de Navegação para atendimento à linha, em que a atenção é centrada no paciente, com avaliação de suas necessidades, eliminação de barreiras que lhe dificultam trafegar no sistema de saúde e seu direcionamento em cada etapa da jornada.

Experience of care nurses: approaches to the principles of navigation of cancer patients / Experiencia de enfermeros de cuidado: aproximaciones a los principios de navegación de pacientes con cáncer / Experiência de enfermeiras assistenciais: aproximações aos princípios da navegação de pacientes oncológicos

ABSTRACT Objective: To understand the experiences of nurses assisting cancer patients, according to Harold Freeman´s principles of navigation. Method: A qualitative study conducted in a large public hospital in the State of São Paulo in December 2021. Six nurses were interviewed using a semi-structured script with questions about the care of cancer patients and their families. The data were submitted to content analysis with theoretical framework of Harold Freeman. Results: Five categories emerged from the statements: fluidity in care; integration between teams; bond with patients and families; competencies of care nurses in the navigation of cancer patients; valorization and facilities in team training. Conclusion: According to the categories observed, we can consider that the experiences of care nurses working in an oncology unit revealed the strengthening of navigation principles contributing to the care and minimization of barriers, which can facilitate and/or soften the therapeutic path of the cancer patient.

RESUMEN Objetivo: Comprender las experiencias de enfermeros que asisten a pacientes con cáncer, según los principios de navegación de Harold Freeman. Método: Estudio cualitativo realizado en un gran hospital público del Estado de São Paulo en diciembre de 2021. Seis enfermeros fueron entrevistados utilizando un guión semiestructurado con preguntas sobre el cuidado de pacientes con cáncer y sus familias. Los datos fueron sometidos al análisis de contenido con el referencial teórico de Harold Freeman. Resultados: De los enunciados surgieron cinco categorías: fluidez en el cuidado; integración entre equipos; vínculo con pacientes y familias; competencias de los enfermeros asistenciales en la navegación de pacientes oncológicos; valoración y facilidades en la formación de equipos. Conclusión: De acuerdo con las categorías observadas, podemos considerar que las experiencias de los enfermeros asistenciales que actúan en una unidad de oncología revelaron el fortalecimiento de los principios de navegación contribuyendo al cuidado y minimización de barreras, lo que puede facilitar y/o suavizar el camino terapéutico del cáncer paciente.

RESUMO Objetivo: Compreender as experiências de enfermeiras assistenciais aos pacientes oncológicos, segundo os princípios da navegação de Harold Freeman. Método: Estudo de abordagem qualitativa, realizado em hospital público de grande porte no interior do Estado de São Paulo no mês de dezembro de 2021. Foram entrevistadas seis enfermeiras por meio de roteiro semiestruturado com questões acerca do atendimento ao paciente oncológico e familiares. Os dados foram submetidos à análise de análise de conteúdo com referencial teórico de Harold Freeman. Resultados: Cinco categorias emergiram dos depoimentos: fluidez na assistência; integração entre as equipes; vínculo com pacientes e familiares; competências das enfermeiras assistenciais na navegação de pacientes oncológicos; valorização e facilidades no treinamento das equipes. Conclusão: De acordo com as categorias observadas, podemos considerar que as experiências de enfermeiras assistenciais que atuam em unidade oncológica revelaram o fortalecimento dos princípios de navegação contribuindo para o atendimento e minimização de barreiras, o que pode facilitar e/ou suavizar o trajeto terapêutico do paciente oncológico.

Navegación e historia de la ciencia: Fray Andrés de Urdaneta y el Tornaviaje / Navigation and history of science: Fray Andrés de Urdaneta and the “Tornaviaje”

Fray Andrés de Urdaneta recibe la orden, en 1558, de preparar el Tornaviaje, es decir, hallar una ruta de retorno que permita conectar por mar el virreinato de Nueva España y las islas del Sudeste Asiático de forma estable, un paso imprescindible para el establecimiento de bases permanentes y de comercio en Asia. Lo primero que hace es sugerir al rey Felipe II una excusa para ir allí por “razonas humanitarias”, pues sabe de la dudosa legalidad del viaje de acuerdo a los términos del Tratado de Tordesillas. A continuación, aborda los problemas de logística. Como conocía bien la costa de Jalisco, propone el puerto de Acapulco como terminal americana. Continuaría redactando un informe para Luis de Velasco, pero cuyo destinatario final era Felipe II, en el que explica las razones por las que el viaje debe hacerse desde México, y no directamente desde la península, dada la dificultad que suponía tener que atravesar el estrecho de Magallanes y las grandes distancias.(AU)

Fray Andrés de Urdaneta receives the order, in 1558, to prepare the “Tornaviaje”, that is to say, to find a return route that allows to connect by sea the viceroyalty of New Spain and the islands of Southeast Asia in a stable way, an essential step for the establishment of permanent bases and commerce in Asia. The first thing he does is to suggest to King Philip II an excuse to go there for "humanitarian reasons", since he knows of the dubious legality of the trip according to the terms of the Treaty of Tordesillas. He then addresses the logistical problems. As he knew the coast of Jalisco well, he proposes the port of Acapulco as the American terminal. He would go on to write a report for Luis de Velasco, but whose final addressee was Philip II, in which he explains the reasons why the voyage should be made from Mexico, and not directly from the peninsula, given the difficulty of having to cross the Strait of Magellan and the great distances involved.(AU)

Atuação de enfermeiras navegadoras oncológicas na pandemia covid-19: desafios e inovações / Oncology nurse navigator performance in the covid-19 pandemic: challenges and innovations / Desempeño de enfermeras navegadoras de oncología en la pandemia de covid-19: desafíos y innovaciones

Objetivo: Relatar a experiência de enfermeiras oncológicas navegadoras na implementação de ações organizacionais para a manutenção da assistência a pacientes durante a pandemia da COVID-19. Métodos: Relato de experiência, desenvolvido entre março a julho de 2020, utilizando o Planejamento Estratégico Situacional. Resultados: Notou-se no primeiro momento a diminuição dos pacientes nos serviços para diagnósticos, alteração na rotina dos pacientes em tratamento oncológico e aumento da exposição ao vírus. No segundo momento, foram traçados os objetivos para manutenção do serviço, minimização das dúvidas sobre a pandemia e estabelecimento de medidas de segurança. No terceiro momento, foram planejadas as seguintes ações: manutenção do diagnóstico precoce e das rotinas terapêuticas; identificação de sinais e sintomas relacionados à COVID-19 e ações de segurança voltadas à redução da exposição ao vírus. No quarto momento, as ações foram executadas e constatamos como desafios a serem superados: a dificuldade de telemonitoramento e de acesso aos exames pelas plataformas digitais e, como inovação, a organização do serviço de "drive-thru" para administração de medicamentos. Conclusão: Atuar na navegação oncológica em tempos de pandemia requer conhecimento científico, habilidade técnica e criatividade para desenvolver ações que possam garantir a efetividade e a qualidade dos cuidados de enfermagem. (AU)

Objective: To report the experience of oncology navigating nurses in implementing organizational actions to maintain care during the COVID-19 pandemic. Methods: Experience report, developed between March and July 2020, using Situational Strategic Planning. Results: At first, there was a decrease in the number of patients in the diagnostic services, changes in the routine of patients undergoing cancer treatment and an increased exposure to the virus. In the second step, the objectives for maintaining the service, minimizing doubts about the pandemic and establishing of security measures. In the third moment, the following actions were planned: maintenance of early diagnosis and therapeutic routines; identification of signs and symptoms related to COVID-19 and safety actions turned to reduction of virus exposure. In the fourth moment, the actions were carried out and we found as challenges to be overcome, the difficulty of telemonitoring and access to exams through digital platforms and; as an innovation, the organization of the drive-thru service for the application of medicines. Conclusion: Acting in oncological navigation in times of pandemic requires scientific knowledge, technical skill and creativity to develop actions that can guarantee the effectiveness and the quality of nursing care. (AU)

Objetivo: Reportar la experiencia de enfermeras navegantes oncológicas en la implementación de acciones organizacionales para el matenimiento de la asistencia durante la pandemia de COVID-19. Métodos: Informe de experiencia, desarrollado entre marzo y julio de 2020, utilizando la Planificación Estratégica Situacional. Resultados: En el primer momento, hubo una disminución en el número de pacientes en los servicios de diagnóstico, cambios en la rutina de los pacientes en tratamiento oncológico y un aumento en la exposición del virus a los servicios de salud. En el segundo momento, se fijaran las metas para el mantenimiento del servicio, minimización de las dudas sobre la pandemia y establecer medidas de seguridad. En el tercer momento se planificaron las siguientes acciones: mantenimiento de los diagnósticos tempranos y las rutinas terapéuticas; identificación de las señales y síntomas relacionados con COVID-19 y acciones de seguridad dirigidas a reducir la exposición al virus. En el cuarto momento, se llevaron a cabo las acciones y encontramos como desafíos a superar: la dificultad de la telemonitorización y el acceso a los exámenes a través de plataformas digitales y, como innovación, la organización del servicio drive-thru para la aplicación de medicamentos. Conclusión: Actuar en la navegación oncológica en tiempos de pandemia requiere conocimiento científico, habilidad técnica y creatividad para crear acciones que puedan asegurar la efectividad y calidad de la atención de enfermería. (AU)

Validación de los modelos de impresión 3D paciente-específicos para cirugía ortopédica oncológica pélvica / Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery

Introducción: Los tumores del anillo pélvico suponen un reto por la dificultad de obtener márgenes quirúrgicos adecuados. Herramientas como la navegación quirúrgica o la impresión 3D para la fabricación de plantillas de posicionamiento quirúrgico paciente-específicas ayudan en la planificación preoperatoria y la ejecución intraoperatoria. Su correcta colocación es fundamental en localizaciones complejas como la pelvis, por lo que es necesario identificar los errores de posicionamiento. El objetivo de este estudio es demostrar la fiabilidad en la colocación de plantillas 3D para la realización de osteotomías en el anillo pélvico. Material y métodos: Estudio experimental en cadáver con 10 hemipelvis. Se realiza TC para la obtención del modelo tridimensional, planificación de osteotomías, diseño de plantillas de posicionamiento en rama isquiopubiana (I), iliopubiana (P), supracetabular (S) y cresta iliaca (C); y un marcador de posicionamiento (rigid-body) sobre las plantillas C y S para la navegación. Las plantillas y el rigid-body son impresos en 3D y se colocan según planificación previa. La navegación permite comprobar la posición final de las plantillas y de las osteotomías. Resultados: El posicionamiento de las plantillas respecto a la planificación preoperatoria varió dependiendo de la localización, siendo mayor el error en las de cresta iliaca. Utilizando la navegación, la media de error de distancia al plano de corte está en 3,5mm, excepto en pubis (5-8mm), estando condicionado por la posición del rigid body. Conclusión: El uso de plantillas paciente-específicas impresas en 3D es una herramienta fiable para la realización de osteotomías en cirugía oncológica pélvica.(AU)

Introduction: Pelvic ring tumors pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies. Material and methods: Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked. Results: The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis 5-8mm), being conditioned by the position of the rigid body. Conclusion: The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.(AU)

[Translated article] Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery / Validación de los modelos de impresión 3D paciente-específicos para cirugía ortopédica oncológica pélvica

Introducción: Los tumores del anillo pélvico suponen un reto por la dificultad de obtener márgenes quirúrgicos adecuados. Herramientas como la navegación quirúrgica o la impresión 3D para la fabricación de plantillas de posicionamiento quirúrgico paciente-específicas ayudan en la planificación preoperatoria y la ejecución intraoperatoria. Su correcta colocación es fundamental en localizaciones complejas como la pelvis, por lo que es necesario identificar los errores de posicionamiento. El objetivo de este estudio es demostrar la fiabilidad en la colocación de plantillas 3D para la realización de osteotomías en el anillo pélvico. Material y métodos: Estudio experimental en cadáver con 10 hemipelvis. Se realiza TC para la obtención del modelo tridimensional, planificación de osteotomías, diseño de plantillas de posicionamiento en rama isquiopubiana (I), iliopubiana (P), supracetabular (S) y cresta iliaca (C); y un marcador de posicionamiento (rigid-body) sobre las plantillas C y S para la navegación. Las plantillas y el rigid-body son impresos en 3D y se colocan según planificación previa. La navegación permite comprobar la posición final de las plantillas y de las osteotomías. Resultados: El posicionamiento de las plantillas respecto a la planificación preoperatoria varió dependiendo de la localización, siendo mayor el error en las de cresta iliaca. Utilizando la navegación, la media de error de distancia al plano de corte está en 3,5mm, excepto en pubis (5-8mm), estando condicionado por la posición del rigid body. Conclusión: El uso de plantillas paciente-específicas impresas en 3D es una herramienta fiable para la realización de osteotomías en cirugía oncológica pélvica.(AU)

Introduction: Pelvic ring tumors pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies. Material and methods: Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked. Results: The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis 5-8mm), being conditioned by the position of the rigid body. Conclusion: The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.(AU)

[Translated article] Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery.

INTRODUCTION: Pelvic ring tumours pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies. MATERIAL AND METHODS: Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked. RESULTS: The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis (5-8mm), being conditioned by the position of the rigid body. CONCLUSION: The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.

Broncoscopia guiada por navegación electromagnética / Electromagnetic navigation bronchoscopy

La broncoscopia guiada por navegación electromagnética es una técnica que posibilita el diagnóstico de lesiones pulmonares periféricas de pequeño tamaño con una gran precisión y seguridad, permitiendo en muchos casos la detección precoz de cáncer de pulmón. Facilita la realización tanto de biopsias transbronquiales como de punciones y cepillados. Este procedimiento ofrece la posibilidad de evitar métodos diagnósticos invasivos como la cirugía, con el consiguiente ahorro económico, de tiempo y de complicaciones. Asimismo, es útil para la colocación de marcadores fiduciales para la radioterapia estereotáxica en pacientes con cáncer de pulmón que no son candidatos a la resección pulmonar.(AU)

Electromagnetic navigation-guided bronchoscopy is a technique that enables the diagnosis of small peripheral lung lesions with great precision and safety, allowing early detection of lung cancer. It facilitates the performance of both transbronchial biopsies, punctures and brushings. This procedure offers the possibility of avoiding invasive diagnostic methods such as surgery, with the consequent economic, time and complication savings. It is also useful for placement of fiducial markers for stereotactic radiation therapy in lung cancer patients who are not candidates for lung resection.(AU)

Benefícios do programa de navegação de pacientes e assistência de enfermagem em oncologia: revisão integrativa / Beneficios del programa de atención de enfermería de navegación y oncología del paciente: revisión integrativa / Benefits of the patient navigation and oncology nursing care program: integrative review

Objetivo: analisar pesquisas que adotaram como objeto os benefícios do programa navegação de pacientes e a assistência de enfermagem. Método: Trata-se de uma revisão integrativa utilizando a estratégia PICO (Paciente, Intervenção, Comparação e Desfecho). Bases de dados selecionadas: LILACS, Medline, IBECS, BDENF e SCIELO, entre 2015 e 2020. Descritores de busca: Enfermagem; Navegação de pacientes; Oncologia; Assistência. Resultados: Foram analisados 11 artigos, nos quais pode-se verificar que os benefícios relativos à inserção do programa de navegação de pacientes e da enfermagem dentro dos serviços de oncologia foram: reestruturação de ambos buscando a padronização e diretrizes; agilidade no tratamento; além do empoderamento da família/cliente no seguimento dos processos/tratamentos. Conclusões: No Brasil, há poucos estudos relacionados a implementação do programa de navegação a da assistência em enfermagem na oncologia. Porém, a literatura existente trouxe como promissores os benefícios ao cliente/família e à instituição, além da agilidade nos processos inerentes ao tratamento(AU)

Objective: to analyze research that adopted the benefits of the patient navigation program and nursing care as their object. Method: This is an integrative review using the PICO strategy (Patient, Intervention, Comparison and Outcome). Selected databases: LILACS, Medline, IBECS, BDENF and SCIELO, between 2015 and 2020. Search descriptors: Nursing; Patient navigation; Oncology; Assistance. Results: 11 articles were analyzed, in which it can be verified that the benefits related to the insertion of the navigation program for patients and nursing within the oncology services were: restructuring of both seeking standardization and guidelines; agility in treatment; in addition to the empowerment of the family/client in following the processes/treatments. Conclusions: In Brazil, there are few studies related to the implementation of the navigation program and nursing care in oncology. However, the existing literature brought as promising benefits to the client/family and the institution, in addition to the agility in the processes inherent to the treatment(AU)

Objetivo: analizar las investigaciones que adoptaron como objeto los beneficios del programa de navegación del paciente y los cuidados de enfermería. Método: Se trata de una revisión integradora que utiliza la estrategia PICO (Paciente, Intervención, Comparación y Resultado). Bases de datos seleccionadas: LILACS, Medline, IBECS, BDENF y SCIELO, entre 2015 y 2020. Descriptores de búsqueda: Enfermería; Navegación del paciente; Oncología; Asistencia. Resultados: Se analizaron 11 artículos, en los cuales se puede constatar que los beneficios relacionados con la inserción del programa de navegación para pacientes y enfermería dentro de los servicios de oncología fueron: reestructuración de ambos buscando estandarización y lineamientos; agilidad en el tratamiento; además del empoderamiento de la familia / cliente en el seguimiento de los procesos / tratamientos. Conclusiones: En Brasil, existen pocos estudios relacionados con la implementación del programa de navegación y cuidados de enfermería en oncología. Sin embargo, la literatura existente trajo como beneficios prometedores para el cliente / familia y la institución, además de la agilidad en los procesos inherentes al tratamiento.(AU)

Resultados de la ablación con catéter con mínimo o nulo empleo de fluoroscopia en pacientes pediátricos con taquiarritmias supraventriculares / Results of catheter ablation with zero or near zero fluoroscopy in pediatric patients with supraventricular tachyarrhythmias

Introducción y objetivos: La exposición a radiación ionizante en los procedimientos de ablación conlleva riesgos para la salud, sobre todo en pacientes pediátricos. Nuestro objetivo es comparar la seguridad y la eficacia de la ablación guiada por un sistema de navegación intracardiaca no fluoroscópica (SNINF) con las de la ablación guiada exclusivamente por fluoroscopia en pacientes pediátricos. Métodos: Se analizaron los resultados de la ablación con catéter en pacientes pediátricos con vías accesorias de riesgo o taquicardias supraventriculares remitidos a nuestro centro en un periodo de 6 años. Se compararon los procedimientos guiados solo por fluoroscopia (grupo A) y los guiados por SNINF (grupo B). Resultados: Se analizaron 120 procedimientos de ablación en 110 pacientes (edad, 11±3,2 años; el 70% varones), 62 procedimientos en el grupo A y 58 en el grupo B. No se encontraron diferencias significativas entre ambos grupos en éxito del procedimiento (el 95% del grupo A y el 93,5% del grupo B; p=0,53), complicaciones (el 1,7 frente al 1,6%; p=0,23) y recurrencia (el 7,3 frente al 6,9%; p=0,61). Sin embargo, el tiempo de fluoroscopia (mediana, 1,1 frente a 12 min; p<0,0005) y el tiempo de ablación (mediana, 96,5 frente a 133,5 s; p=0,03) fueron menores en el grupo B. La presencia de cardiopatía se comportó como un predictor independiente de recurrencia (p=0,03). Conclusiones: El SNINF para guiar los procedimientos de ablación en pacientes pediátricos reduce el tiempo de exposición a la radiación ionizante. Su empleo generalizado en las ablaciones pediátricas podría reducir el riesgo atribuido a la radiación (AU)

Introduction and objectives: Ionizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients. Methods: We analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B). Results: We analyzed 120 catheter ablation procedures in 110 pediatric patients (11±3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P=.53), complications (1.7% vs 1.6%; P=.23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1minutes vs 12minutes; P <.0005) and ablation time (median 96.5seconds vs 133.5seconds; P=.03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P=.03). Conclusions: The use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation (AU)

Results of catheter ablation with zero or near zero fluoroscopy in pediatric patients with supraventricular tachyarrhythmias.

INTRODUCTION AND OBJECTIVES: Ionizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients. METHODS: We analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B). RESULTS: We analyzed 120 catheter ablation procedures in 110 pediatric patients (11±3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P=.53), complications (1.7% vs 1.6%; P=.23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1minutes vs 12minutes; P <.0005) and ablation time (median 96.5seconds vs 133.5seconds; P=.03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P=.03). CONCLUSIONS: The use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation.

Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery. / Validación de los modelos de impresión 3D paciente-específicos para cirugía ortopédica oncológica pélvica.

INTRODUCTION: Pelvic ring tumors pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies. MATERIAL AND METHODS: Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked. RESULTS: The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis (5-8mm), being conditioned by the position of the rigid body. CONCLUSION: The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.

Osteosintesis asistida con navegación 2D con tornillos iliacosacros percutáneos en lesiones del anillo pélvico posterior / Assisted osteosynthesis with 2D navigation with percutaneous iliacosacral screws in posterior pelvic ring injuries

Introducción: La osteosíntesis percutánea sacroiliaca guiada por radioscopia en lesiones del anillo pélvico posterior sigue siendo la técnica de referencia. Sin embargo, el desarrollo de técnicas como la cirugía asistida por navegación 2D/3D o por tomografía han mejorado la facilidad y seguridad en la colocación de los tornillos. Objetivo: Presentar la técnica de fijación asistida por navegación en 2D y los resultados clínicos y radiológicos obtenidos. Materiales y métodos: Se revisaron 23 pacientes con disrupción del anillo pélvico posterior (luxación y/o fractura sacroiliaca) intervenidos mediante fijación percutánea asistida por navegación 2D (Sistema Synergy de Medtronic®) en el hospital desde 2017 hasta la actualidad. Se recogieron variables demográficas, de clasificación, terapéuticas y las complicaciones derivadas. Se utilizó la escala modificada de valoración POS (Multicenter Study Group Pelvis Outcome Scale) para evaluar el resultado clínico, radiológico y social. Resultados: Ocho pacientes presentaban luxación sacro-iliaca y 15 tenían fractura a través del sacro. Se implantaron 40 tornillos iliacosacros. El tiempo quirúrgico medio fue de 20 minutos para cada tornillo. Fueron necesarios ocho pulsos de radioscopia de media por intervención. Hubo tres tornillos (7.5%) mal posicionados. 15 pacientes obtuvieron un resultado bueno o excelente en el formulario POS. Conclusiones: La técnica asistida por navegación es una alternativa con buenos resultados. Facilita al cirujano la colocación correcta de los tornillos en el corredor óseo sacro, acortando el tiempo quirúrgico y con una menor exposición a radiaciones ionizantes. Es útil para todo tipo de lesiones del anillo y cuando son necesarias maniobras de reducción.

Introduction: Radioscopy-guided percutaneous sacroiliac osteosynthesis in posterior pelvic ring lesions continues to be the reference technique. However, the development of techniques such as surgery assisted by 2D/3D navigation or tomography have improved the ease and safety in screw placement. Objective: To present the 2D navigation-assisted fixation technique and the clinical and radiological results obtained. Materials and methods: 23 patients with disruption of the posterior pelvic ring (dislocation and/or sacroiliac fracture) who underwent percutaneous fixation assisted by 2D navigation (Medtronic® Synergy System) at the hospital from 2017 to the present were reviewed. Demographic, classification, therapeutic variables and resulting complications were collected. The modified POS (Multicenter Study Group Pelvis Outcome Scale) assessment scale was used to evaluate the clinical, radiological and social outcome. Results: Eight patients had sacro-iliac dislocation and 15 had a fracture through the sacrum. 40 iliacosacral screws were implanted. The average surgical time was 20 minutes for each screw. An average of eight fluoroscopy pulses were necessary per intervention. There were three screws (7.5%) incorrectly positioned. 15 patients had a good or excellent result on the POS form. Conclusions: The navigation-assisted technique is an alternative with good results. It makes it easier for the surgeon to correctly place the screws in the sacral bone corridor, shortening surgical time and with less exposure to ionizing radiation. It is useful for all types of ring injuries and when reduction maneuvers are necessary.