Clinical, epidemiological, and care profile of hospitalized patients with retinoblastoma in Brazil

ABSTRACT Purpose: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil. Methods: Using data from the Hospital Cancer Registry of the Instituto Nacional de Câncer, patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0-19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20-75, >75 cases). Results: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1-14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals. Conclusions: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services.

Perception and satisfaction of blind individuals regarding an electronic cane prototype with a wearable haptic device

ABSTRACT Purpose: This study aimed to evaluate the perception and degree of satisfaction of blind individuals regarding an electronic cane prototype with a wearable haptic interface. Methods: Two scenarios with different obstacles were created to conduct tests with the canes (the user's cane and the prototype one). The perception and satisfaction of participants regarding the electronic cane were assessed using a questionnaire, the number of collisions during the tests, and the time each individual took to complete the course in each scenario. Results: Ten blind individuals who used the white cane participated in this study. Eight were males, and two were females. Their age ranged from 23 to 43 (average 32.3 ± 7.13 years and median 32 years). There was a tendency for fewer collisions with ground obstacles when the electronic cane was used than when the white cane was used. However, there was no statistically significant difference between the number of collisions and the course completion time in each scenario with either canes tested. Conclusion: Overall, the perception and satisfaction of individuals regarding the prototype used were positive.

Nivel de cumplimiento de metas internacionales de seguridad en un Sanatorio privado 2023 / Level of compliance with international safety goals in a private Sanatorium 2023

La presente investigación pretende evaluar el nivel de cumplimiento de las metas internacionales, que representan el foco principal para la mejora de calidad y seguridad de atención de los pacientes. La seguridad del paciente involucra a todos los estudios, prácticas y acciones promovidas por las instituciones sanitarias para disminuir y eliminar los riesgos de daños innecesarios relacionados con el cuidado de la salud. Metodología: Estudio descriptivo, observacional y transversal. De fuentes primaria y secundaria, Resultados: se abordaron las metas N° 1 la cual consiste en Identificar a los pacientes correctamente y la meta N° 6 la cual se refiere a Reducir el riesgo de lesiones en pacientes como resultado de caídas. En primer lugar, se destaca el cumplimiento en la identificación correcta del paciente y en segunda instancia la mejora del cumplimiento de medidas de prevención de caídas. Conclusión: Esta proximidad de los valores obtenidos genera un aspecto positivo para mejorar la seguridad de los pacientes y que, si bien el cumplimiento de las metas no es el deseado, es cercano al porcentaje planteado. Lo que en definitiva hace a este estudio un antecedente importante en la mejora continua con vista al futuro cercano[AU]

This research aims to evaluate the level of compliance with international goals, which represent the main focus for improving the quality and safety of patient care. Patient safety involves all studies, practices and actions promoted by health institutions to reduce and eliminate the risks of unnecessary harm related to health care. Methodology: Descriptive, observational and transversal study. From primary and secondary sources, Results: goals No. 1 were addressed, which consists of Identifying patients correctly and goal No. 6, which refers to Reducing the risk of injuries in patients as a result of falls. Firstly, compliance with correct patient identification stands out and secondly, improvement in compliance with fall prevention measures. Conclusion: This proximity of the values obtained generates a positive aspect to improve patient safety and that, although the fulfillment of the goals is not as desired, it is close to the proposed percentage. Which ultimately makes this study an important precedent in continuous improvement for the near future[AU]

Esta pesquisa tem como objetivo avaliar o nível de cumprimento das metas internacionais, que representam o foco principal para a melhoria da qualidade e segurança do atendimento ao paciente. A segurança do paciente envolve todos os estudos, e ações promovidas pelas instituições de saúde para reduzir e eliminar os riscos de danos desnecessários relacionados à assistência à saúde. Metodologia: Estudo descritivo, observacional e transversal. De fontes primárias e secundárias, dependendo do indicador e do objetivo para o qual a medição está sendo realizada. Resultados: Nesta pesquisa serão abordadas as metas nº1, que consiste em Identificar corretamente os pacientes e a meta nº 6, que es Reduzir o risco de lesões nos pacientes em decorrência de quedas. Foi realizado nos dois locais. Em primeiro lugar, destaca-se o cumprimento da correta identificação do paciente e, em segundo lugar, a melhoria no cumprimento das medidas de prevenção de quedas. Conclusão: Essa proximidade dos valores obtidos gera um aspecto positivo para melhorar a segurança do paciente e que, embora o cumprimento das metas não seja o desejado, está próximo do percentual proposto. O que acaba por tornar este estudo um precedente importante na melhoria contínua com vista ao futuro próximo.

Você está pensando, refletindo, analisando o que você vê e o que você faz o tempo todo: percepção de residentes de Medicina de Família e Comunidade sobre vídeo feedback / You are thinking, reflecting, analysing what you see and what you do all the time: perception of General Practice trainees about video feedback / Estás pensando, reflexionando, analizando lo que ves y lo que haces todo el tiempo: percepción de los residentes de Medicina Familiar y Comunitaria sobre vídeo feedback

Introdução: A comunicação é reconhecida como uma habilidade central por vários órgãos reguladores internacionais da educação médica. O ensino específico de habilidades de comunicação é fundamental para melhorar a comunicação dos médicos. As técnicas experienciais mostraram superioridade em comparação com os modelos tradicionais. A utilização de consultas reais ajuda os estudantes a visualizar melhor as suas competências de entrevista e a refletir sobre elas. Com os avanços da tecnologia, o uso de consultas médicas gravadas em vídeo tornou-se a abordagem padrão para o ensino da comunicação. No entanto, a eficácia dessa técnica depende do envolvimento ativo dos estudantes. As suas contribuições e comentários dos pares sobre a consulta gravada são essenciais para a aprendizagem. Contudo, a perspectiva do estudante sobre a utilidade dessa abordagem educativa recebeu pouca atenção. Objetivos: Compreender a percepção da aprendizagem dos residentes de medicina de família e comunidade resultante da atividade de vídeo feedback na sua formação profissional. Métodos: Estudo exploratório, qualitativo, realizado com residentes do primeiro ano de medicina de família e comunidade de um programa de residência estabelecido em São Paulo, Brasil. Os participantes foram entrevistados após as sessões educativas, que foram analisadas por meio de análise temática reflexiva. Resultados: A autopercepção de sua prática, o aprendizado de habilidades de comunicação e os ganhos afetivos foram identificados pelos participantes como pontos de aprendizado derivados da atividade de vídeo feedback. Além disso, sobre o aprendizado de habilidades específicas de comunicação, eles mencionaram comunicação não-verbal e verbal, conexões entre teoria e prática, estrutura de consulta e oportunidades para cristalizar conhecimentos. Os ganhos afetivos incluíram sentir-se parte de um grupo, melhora da autoestima, superação de inseguranças, percepção de consultas mais efetivas, reforço do gosto pelo trabalho e reconhecer a necessidade de mais aprendizado. Conclusões: Os ganhos de aprendizagem identificados em nosso estudo levaram a uma experiência de humanidade compartilhada, que permite aos participantes serem mais efetivos técnica e afetivamente com seus pacientes. Além disso, identificamos que a atividade educativa de vídeo feedback pode ser utilizada para outros possíveis fins educacionais além do ensino da comunicação.

Introduction: Communication is recognized as a central skill by various international medical education regulatory bodies. Specific teaching on communication skills is important to enhance doctors' communication. Experiential techniques appear to be superior compared to traditional models. Real-life consultation helps trainees visualize their interview skills and reflect on them. Upgraded by technology, the use of video-recorded medical visits became the standard approach for communication teaching. However, the effectiveness pf this technique relies on trainees' active involvement. Their inputs and peer feedback on the recorded consultation are essential to learning. Despite its importance, their perspective on the usefulness of video feedback in medical education has received limited attention. Objective: To understand the perception of learning among general practice trainees as a result of the video feedback activity in their vocational training. Methods: An exploratory, qualitative study, conducted with first-year general practice trainees from an established training program in São Paulo, Brazil. Participants were interviewed after educational session, which were analyzed using reflexive thematic analysis. Results: Self-perception of their practice, communication skills learning, and affective gains were identified by participants as learning points derived from the video feedback activity. Furthermore, for specific communication skills learning, they mentioned nonverbal and verbal communication, theory and practice connections, consultation structure and opportunities for crystallizing knowledge. Affective gains included feeling part of a group, improving self-esteem, overcoming insecurities, perception of more effective consultations, reinforcing fondness for their work, and need for more learning. Conclusions: The learning gains identified in our study led to an experience of common humanity, which allowed participants to be more technically and affectively effective with their patients. Also, we identified that the video feedback educational activity can be used for other possible educational purposes, beyond the teaching of communication.

Introducción: La comunicación es reconocida como una habilidad fundamental por varios organismos reguladores internacionales de educación médica. La enseñanza específica de habilidades de comunicación es importante para mejorar la comunicación de los médicos. Las técnicas experienciales parecen ser superiores a los modelos tradicionales. El uso de consultas reales ayuda a los estudiantes a visualizar y reflexionar mejor sobre sus habilidades de entrevista. Actualizado por la tecnología, el uso de consultas médicas grabadas en video se ha convertido en el enfoque estándar para la enseñanza de la comunicación. Sin embargo, para que la técnica funcione, la participación de los estudiantes es crucial. Sus contribuciones y comentarios de los compañeros sobre la consulta grabada son esenciales para el aprendizaje. Sin embargo, la perspectiva de los estudiantes sobre la utilidad de este enfoque educativo ha recibido poca atención. Objetivos: Comprender la percepción del aprendizaje por parte de los residentes de medicina de familia y comunitaria como resultado de la actividad de vídeo feedback en su formación profesional. Métodos: Estudio cualitativo exploratorio realizado con residentes de primer año de medicina familiar y comunitaria de un programa de residencia establecido en São Paulo, Brasil. Los participantes fueron entrevistados después de una sesión educativa, que fueron analizados mediante análisis temático reflexivo. Resultados: La autopercepción de su práctica, el aprendizaje de habilidades comunicativas y las ganancias afectivas fueron identificadas por los participantes como puntos de aprendizaje derivados de la actividad de vídeo feedback. Además, sobre el aprendizaje de habilidades comunicativas específicas, mencionaron la comunicación verbal y no verbal, las conexiones entre la teoría y la práctica, la estructura de consulta y las oportunidades para cristalizar conocimientos. En cuanto a las ganancias afectivas, relataron sentirse parte de un grupo, mejora de la autoestima, superación de las inseguridades, percepción de consultas más efectivas, refuerzo del gusto por el trabajo y necesidad de más aprendizaje. Conclusión: Los logros de aprendizaje identificados en nuestro estudio llevaron a una experiencia de humanidad compartida, que permite a los participantes ser técnica y afectivamente más efectivos con sus pacientes. Además, identificamos que la actividad educativa de vídeo feedback puede ser utilizada para otros posibles fines educativos, además de la enseñanza de la comunicación.

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

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

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

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

Empatia (parte I): contribuições para a abordagem centrada na pessoa / Empathy (part I): contributions to a person-centered approach / Empatía (parte I): contribuciones a un enfoque centrado en la persona

Introdução: Este artigo explora o tema da empatia na relação médico-paciente. Objetivo: Contribuir para o aperfeiçoamento das habilidades de comunicação clínica ao revisar o entendimento e a aplicação da empatia na prática clínica. Métodos: Trata-se de uma revisão não sistemática dos principais livros utilizados na comunicação clínica sobre o tema da empatia. O recorte metodológico compreendeu as seguintes etapas: (1) amostra intencional da literatura; (2) coleta e leitura de dados ­ i.e., extração de fragmentos dos textos; (3) análise do conteúdo, com o foco na definição, importância e instrumentalização para a aplicação prática; (4) seleção e síntese, para facilitar a compreensão e a contextualização sobre o tema; e (5) comparação e ponderação do conteúdo selecionado. Resultados: A abrangência com que a empatia foi trabalhada na literatura selecionada resultou em três níveis de densidade empática: baixa, moderada e alta. Assim, a baixa densidade empática limitou-se mais à definição e importância do tema; a densidade moderada incorporou algum exemplo de como aplicar a empatia, porém de forma fragmentada; e a alta densidade empática abordou o tema de modo mais completo, facilitando a instrumentalização na prática clínica. Há concordância na literatura analisada de que a prática da empatia reflete-se na melhoria do cuidado médico, entretanto seu exercício permanece no campo racional. Ao exemplificar a aplicação prática da empatia, os autores sugerem que o médico adote uma postura isenta de julgamentos, ao mesmo tempo que propõem um exercício imaginativo, de adivinhação dos sentimentos/emoções do paciente. Apesar de os autores de alta densidade empática compreenderem a importância das emoções e nomeá-las no processo, percebe-se a necessidade de um desdobramento e aprofundamento a partir desse ponto. Conclusões: Por se tratar de um assunto complexo, com vários matizes, a empatia é abordada de diferentes formas na literatura selecionada. Isso evidencia sua riqueza e originalidade, ao mesmo tempo que apresenta lacunas para sua aplicação na prática clínica.

Introduction: This article explores the theme of empathy in the doctor-patient relationship. Objective: To contribute to the improvement of clinical communication skills by reviewing the understanding and application of empathy in clinical practice. Methods: A non-systematic review of the main books used in clinical communication on the topic of empathy. The methodological approach consisted in the following steps: (1) An intentional sample of the literature; (2) Data collection and reading, i.e., extracting fragments from texts; (3) Content analysis, focusing on definition, importance and instrumentalization for practical application; (4) Selection and synthesis to facilitate understanding and contextualization on the topic; and (5) Comparison and ponderance of the selected content. Results: The scope within which empathy was worked on in the selected literature resulted in three levels of empathic density: low, moderate, and high. Thus, low empathic density was limited to definition and importance; moderate density incorporated some examples of how to apply empathy in a fragmented way; high empathic density addressed the topic more fully, facilitating instrumentation in clinical practice. There is agreement in the literature analyzed that the practice of empathy reflects on the improvement of medical care. However, its exercise remains in the rational field. By exemplifying the practical application of empathy, the authors suggest that the physician adopt a non-judgmental posture, while proposing an imaginative exercise of guessing the patient's feelings/emotions. Although high-density empathy authors understand the importance of emotions and name them in the process, there is a need for an unfolding and deepening from this point on. Conclusions: Empathy is a complex subject with several nuances and is approached in different ways in the selected literature. This evidences its richness and originality, at the same time that it presents gaps for the application of empathy in clinical practice.

Introducción: Este artículo explora el tema de la empatía en la relación médico-paciente. Objetivo: contribuir a la mejora de las habilidades de comunicación clínica mediante la revisión de la comprensión y aplicación de la empatía en la práctica clínica. Método: se trata de una revisión no sistemática de los principales libros utilizados en comunicación clínica sobre el tema de la empatía. El enfoque metodológico comprendió los siguientes pasos: (1) Una muestra intencional de la literatura; (2) Recopilación y lectura de datos, es decir, extracción de fragmentos de textos; (3) Análisis de contenido, centrándose en definición, importancia e instrumentalización para la aplicación práctica; (4) Selección y síntesis para facilitar la comprensión y contextualización sobre el tema; y (5) Comparación y ponderación del contenido seleccionado. Resultados: el alcance con el que se trabajó la empatía en la literatura seleccionada tuvo como resultado tres niveles de densidad empática: baja, moderada y alta. Así, la baja densidad empática se limitaba más a la definición y la importancia; densidad moderada, incorporó algún ejemplo de cómo aplicar la empatía, pero de manera fragmentada; alta densidad empática se acercó del tema de manera más completa, facilitando la instrumentación en la práctica clínica. Existe acuerdo en la literatura analizada en que la práctica de la empatía se refleja en la mejora de la atención médica. Sin embargo, su ejercicio queda en el campo racional. Al ejemplificar la aplicación práctica de la empatía, los autores sugieren que el médico adopte una postura no crítica, al tiempo que propone un ejercicio imaginativo de adivinar los sentimientos/emociones del paciente. Si bien los autores de alta densidad empática entienden la importancia de las emociones y las nombran en el proceso, existe la necesidad de un desdoblamiento y profundización a partir de este punto. Conclusiones: Por tratarse de un tema complejo y con varios matices, la empatía es abordada de diferentes maneras en la literatura seleccionada. Esto evidencia su riqueza y originalidad, al mismo tiempo que presenta vacíos para la aplicación de la empatía en la práctica clínica.

Vivencias del profesional de enfermería en el cuidado humanizado a personas con diversidad de género

Introducción: La atención en salud de los profesionales de enfermería a personas con diversidad de género puede verse afectada negativamente por la heteronormatividad que ha regido históricamente la sociedad. Actualmente es un desafío resguardar y buscar acciones para entregar un cuidado humanizado inclusivo. Objetivo: Comprender las vivencias del profesional de enfermería al brindar el cuidado humanizado a personas con diversidad de género. Método: Investigación cualitativa, con un enfoque fenomenológico. Se entrevistó a cuatro profesionales de enfermería. La información se recopiló a través de entrevistas individuales y grupales semiestructuradas; los discursos fueron analizados y se realizó una triangulación de los conceptos principales. Resultados: El cuidado humanizado se manifiesta a través de tres dimensiones: vivencias al brindar cuidados humanizados, factores que facilitan la entrega del cuidado humanizado y factores que lo dificultan. Las categorías incluidas en la primera dimensión son igualdad, empatía, respeto y aprendizaje. Los factores que facilitan los cuidados humanizados tienen como categorías la acogida y la formación continua, y los factores que lo dificultan tienen las categorías de nombre social y recelo. Conclusión: El cuidado humanizado a personas con diversidad de género requiere valores de igualdad y empatía, junto con una formación inclusiva desde pregrado. La deficiencia en el desarrollo de habilidades blandas dificulta la relación enfermero-paciente, mientras que el recelo de la persona con diversidad de género obstaculiza las primeras consultas. La integración del nombre social y la formación continua son esenciales para promover un ambiente de confianza y reducir la sensación de vulnerabilidad y discriminación.

Introdução: O atendimento em saúde prestado pelos profissionais de enfermagem às pessoas com diversidade de gênero pode ser afetado negativamente pela heteronormatividade que historicamente rege a sociedade. Atualmente, é um desafio resguardar e buscar ações para proporcionar um cuidado humanizado e inclusivo. Objetivo: Compreender as vivências do profissional de enfermagem ao prestar o cuidado humanizado a pessoas com diversidade de gênero. Método: Pesquisa qualitativa, com abordagem fenomenológica. Foram entrevistados quatro profissionais de enfermagem. As informações foram coletadas por meio de entrevistas semiestruturadas individuais e em grupo; os discursos foram analisados e foi realizada uma triangulação dos principais conceitos. Resultados: O cuidado humanizado se manifesta por meio de três dimensões: vivências ao fornecer cuidados humanizados, fatores que facilitam a prestação de cuidado humanizado e fatores que a dificultam. As categorias incluídas na primeira dimensão são igualdade, empatia, respeito e aprendizado. Os fatores que facilitam os cuidados humanizados incluem acolhimento e formação contínua, enquanto os fatores que os dificultam incluem o uso do nome social e o receio. Conclusão: O cuidado humanizado a pessoas com diversidade de gênero requer valores de igualdade e empatia, juntamente com formação inclusiva desde o nível de graduação. A deficiência no desenvolvimento de habilidades interpessoais dificulta o relacionamento enfermeiro-paciente, enquanto o receio da pessoa com diversidade de gênero dificulta as primeiras consultas. A integração do nome social e a formação continuada são essenciais para promover um ambiente de confiança e reduzir a sensação de vulnerabilidade e discriminação.

Introduction: Health care by nursing professionals to people with gender diversity can be negatively affected by the heteronormativity that has historically governed society. It is challenging to safeguard and seek actions to provide inclusive humanized care Objective: To understand the nursing professional's experiences when providing humanized care to people with gender diversity. Method: Qualitative research with a phenomenological approach. Four nursing professionals were interviewed. The information was collected through semi-structured individual and group interviews; the discourses were analyzed, and central concepts were triangulated.Results: Humanized care is manifested through three dimensions: experiences in providing humanized care, factors that facilitate the delivery of humanized care and factors that hinder it. The categories included in the first dimension are equality, empathy, respect and learning. Factors that facilitate humanized care have the categories of welcoming and continuing education, and factors that hinder it have the categories of social name and suspicion. Conclusion: Humanized care for people with gender diversity requires values of equality and empathy, together with inclusive training from undergraduate level. Deficiency in the development of soft skills hinders the nurse-patient relationship, while suspicion of the gender-diverse person hinders first consultations. The integration of the social name and continuous training are essential to promote an environment of trust and reduce the feeling of vulnerability and discrimination.

Fatores clínicos do bem-estar de mulheres em parturição: perspectivas deontológicas e da bioética principialista / Clinical factors of women in labor well-being: deontological and bioethical principlism perspectives / Factores clínicos del bienestar de la mujer en trabajo de parto: perspectivas deontológicas y de la bioética principialista

Objetivo: avaliar os fatores clínicos associados ao bem-estar das mulheres durante o trabalho de parto e parto à luz da bioética principialista e da deontologia. Método: estudo transversal com abordagem quantitativa. Participaram 396 puérperas internadas em um hospital municipal do sudoeste da Bahia, e os dados foram coletados no período de janeiro a maio de 2023, após aprovação do comitê de ética em pesquisa. Os dados foram organizados no software Excel e analisados via SPSS v.25. a partir da regressão logística multinomial. Resultados: a maior parte da amostra apresentou bem-estar com assistência em saúde, mulheres que tiveram parto realizado por profissionais não médicos apresentaram mais chances de níveis de bem-estar "adequado". E mulheres que não tiveram a via de parto cesárea apresentaram aumento de chances de bem-estar. Conclusão: é necessário que os profissionais reflitam sobre suas ações, condicionando-as à humanização no parto, em observância aos princípios bioéticos.

Objective: to evaluate the clinical factors associated with women's well-being during labor and delivery in the light of bioethics principlism and deontology. Method: a cross-sectional study with a quantitative approach was conducted. It involved 396 postpartum women admitted to a municipal hospital in the southwest of Bahia. Data were collected from January to May 2023, after approval from the research ethics committee. The data were tabulated using Excel software and analyzed using SPSS v.25 through Multinomial Logistic Regression. Results: majority of the sample exhibited well-being with health care assistance. Women who underwent delivery performed by non-medical professionals showed higher chances of "adequate" levels of well-being. Additionally, women who did not undergo cesarean delivery showed increased chances of well-being. Conclusion: It is necessary for professionals to reflect on their actions, conditioning them to the humanization of childbirth, according to bioethical principles.

Objetivo: evaluar los factores clínicos asociados al bienestar de la mujer durante el trabajo de parto y parto a la luz de la bioética y la deontología principialista. Método: estudio transversal con enfoque cuantitativo. Incluyó 396 puérperas ingresadas en un hospital municipal del suroeste de Bahía. Recolección de datos de enero a mayo de 2023, con aprobación del comité de ética en investigación. Los datos se tabularon en el software Excel y se analizaron mediante SPSS v.25. utilizando regresión logística multinomial. Resultados: la mayoría de las participantes de la muestra presentó bienestar con la atención para la salud; las que tuvieron partos realizados por profesionales no médicos tenían más probabilidades de tener niveles "adecuados" de bienestar; las que no tuvieron parto por cesárea tenían mayores probabilidades de tener bienestar. Conclusión: es necesario que los profesionales reflexionen sobre sus acciones y las adecuen para humanizar el parto, respetando los principios bioéticos.

Fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática / Intervening factors in the management of nursing care for children hospitalized with rheumatic heart disease / Factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática

Objetivo: analisar os fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo descritivo-exploratório com abordagem qualitativa, que utilizou a Teoria Fundamentada em Dados e o Interacionismo Simbólico, respectivamente, como referencial metodológico e teórico. A coleta de dados foi realizada em uma instituição especializada em atendimento cardiológico, no munícipio do Rio de Janeiro. Foram entrevistados 19 profissionais de enfermagem através de um roteiro semiestruturado. Resultado: emergiram os seguintes fatores intervenientes na prática da gerência do cuidado: condição socioeconômica da família, comportamento da criança, condições de trabalho, comunicação ineficaz, educação permanente, trabalho em equipe e experiência profissional. Conclusão: os resultados apontam para a necessidade de proposição de estratégias de ação e interação que facilitem a prática gerencial de cuidado à criança com cardiopatia reumática e sua família face aos fatores intervenientes identificados.

Objective: to analyze the factors involved in the management of nursing care for children hospitalized with rheumatic heart disease. Method: this is a descriptive-exploratory study with a qualitative approach, which used Data-Based Theory and Symbolic Interactionism, respectively, as methodological, and theoretical references. Data was collected in an institution specializing in cardiac care in the city of Rio de Janeiro. Nineteen nursing professionals were interviewed using a semi-structured script. Result: the following intervening factors in the practice of care management emerged: the family's socioeconomic status, the child's behavior, working conditions, ineffective communication, continuing education, teamwork, and professional experience. Conclusion: the results point to the need to propose strategies for action and interaction that facilitate management practice in caring for children with rheumatic heart disease and their families, given the intervening factors identified.

Objetivo: analizar los factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio descriptivo-exploratorio con enfoque cualitativo, cuyos marcos metodológico y teórico fueron la Teoría Fundamentada y el Interaccionismo Simbólico, respectivamente. La recolección de datos se realizó en una institución especializada en atención cardiológica, en la ciudad de Río de Janeiro. Fueron entrevistados 19 profesionales de enfermería mediante un cuestionario semiestructurado. Resultado: surgieron los siguientes factores intervinientes en la práctica de la gestión del cuidado: condición socioeconómica de la familia, comportamiento del niño, condiciones de trabajo, comunicación ineficaz, educación continua, trabajo en equipo y experiencia profesional. Conclusión: los resultados indican que es necesario proponer estrategias de acción e interacción que faciliten la práctica de la gestión del cuidado al niño con cardiopatía reumática y a sus familiares, con respecto a los factores intervinientes identificados.

Incidência de obstrução em cateteres periféricos intravenosos em adultos e fatores relacionados / Incidence of obstruction in peripheral intravenous catheters in adults and related factors / Incidencia de obstrucción en catéteres intravenosos periféricos en adultos y factores relacionados

Objetivo: analisar a incidência e os fatores relacionados à obstrução de cateter intravenoso periférico em adultos hospitalizados. Método: uma coorte prospectiva, realizada a partir da observação de 203 cateteres, entre fevereiro de 2019 e maio de 2020, em hospital público e de ensino brasileiro. Foram consideradas variáveis clínicas e do cateter. Os dados foram analisados descritivamente e por estatística inferencial. Resultados: o tempo de permanência variou entre um a 15 dias e a obstrução ocorreu em 7,5% das observações. Houve aumento do risco de obstrução em relação ao sexo (RR=0,49 / p=0,186), à idade (RR=1,20/ p=0,732), aos cateteres de maior calibre (RR=0,53/ p=0,250), à inserção no dorso da mão até antebraço (RR=2,33/ p=0,114) e ao tempo do cateter in situ (RR=033/ p=0,433). Conclusão: O cuidado diário e observação do cateter intravenoso periférico são importantes para minimizar o surgimento de complicações locais e sistêmicas e manter a patência do dispositivo.

Objective: to analyze the incidence and factors related to peripheral intravenous catheter obstruction in hospitalized adults. Method: a prospective cohort, based on the observation of 203 catheters, between February 2019 and May 2020, in a Brazilian public teaching hospital. Clinical and catheter variables were taken into account. The data was analyzed descriptively and using inferential statistics. Results: the length of stay ranged from one to 15 days and obstruction occurred in 7.5% of the observations. There was an increased obstruction risk in relation to gender (RR=0.49 / p=0.186), age (RR=1.20/ p=0.732), larger catheters (RR=0.53/ p=0.250), insertion in the back of the hand up to the forearm (RR=2.33/ p=0.114) and the time length the catheter was in situ (RR=033/ p=0.433). Conclusion: Daily care and observation of the peripheral intravenous catheter is important to minimize the appearance of local and systemic complications and maintain the patency of the device.

Objetivo: analizar la incidencia y los factores relacionados con la obstrucción del catéter intravenoso periférico en adultos hospitalizados. Método: cohorte prospectiva, realizada mediante la observación de 203 catéteres, entre febrero de 2019 y mayo de 2020, en un hospital escuela público brasileño. Se consideraron variables clínicas y del catéter. Los datos se analizaron de forma descriptiva y mediante estadística inferencial. Resultados: el tiempo de permanencia varió entre uno y 15 días y la obstrucción ocurrió en el 7,5% de las observaciones. Hubo mayor riesgo de obstrucción en relación con el sexo (RR=0,49 / p=0,186), la edad (RR=1,20 / p=0,732), los catéteres de mayor calibre (RR=0,53 / p= 0,250), la inserción en el dorso de la mano hasta el antebrazo (RR=2,33/ p=0,114) y el tiempo del catéter in situ (RR=033/ p=0,433). Conclusión: el cuidado diario y la observación del catéter intravenoso periférico son importantes para minimizar la aparición de complicaciones locales y sistémicas y mantener la permeabilidad del dispositivo.

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

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

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

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

Cross-cultural adaptation and validation of the Hospital Survey on Patient Safety questionnaire for a Chilean hospital.

BACKGROUND: Hospital Survey on Patient Safety version 2.0 (HSOSPS 2.0) from the Agency for Healthcare Research and Quality enables hospitals to gather the information needed to evaluate the patient safety culture within their institution. However, version 2.0 has not been widely implemented in Chile. This study aims to customize and validate the original HSOSPS 2.0 for a Chilean hospital. METHODS: Translation and cross-cultural adaptation, content validity through a group of experts, and a pilot test with cognitive pretest were applied to 259 participants from the nursing team in 11 hospital services to study construct validity and reliability. RESULTS: In the current study, a version of the questionnaire adapted to the Chilean cultural context showed excellent content validity with an index of 0.982 (S-CVI). After conducting exploratory factor analysis, a new model with 7 dimensions and 23 questions was proposed, down from the original 10 dimensions and 32 questions. This new model explains 71% of the variability. The model's goodness of fit indicators were CFI=0.995, TLI=0.994, and RMSEA=0.048. The results of McDonald's Omega showed high overall reliability with 0.9325. CONCLUSIONS: This study provides a validated measurement instrument that contributes to improving patient safety conditions at the level of the hospital nursing team in highly complex establishments in Chile. However, the dimensions, such as the number of items, were reduced This questionnaire can be used in future nursing research by expanding the sample among health professionals in Chile. RELEVANCE TO CLINICAL PRACTICE: Applying this version of the questionnaire will be highly beneficial for clinical administrators and nursing staff. It will improve their care practices and promote patient safety in public hospitals in Chile, as well as assist in enhancing nursing policies.

Risk factors and outcomes of ventilator-associated pneumonia in patients with traumatic brain injury: A systematic review and meta-analysis.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common complication in traumatic brain injury (TBI) patients, which increases morbidity and negatively affects outcomes. Risk factors and outcomes in these patients remain controversial. The aim of the present study is to explore the risk factors and clinical outcomes of patients with VAP and TBI. METHODS: Two researchers conducted independent systematic literature searches of Pubmed, Cochrane Database, Scopus, Medline Ovid, Science Direct databases, published from inception to January 2024. The Newcastle-Ottawa scale was used to assess study quality. A meta-analysis was performed using a random-effects model when heterogeneity I2 > 50 % and a fixed-effects model when I2 < 50 %; in addition, a subgroup analysis was performed to explore VAP risk factors, and publication bias was assessed with the funnel plot and Begg's and Egger's tests. All results were considered statistically significant when p < 0.05. The certainty of the evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. RESULTS: Twelve studies were included in the meta-analysis with a total of 2883 patients. Male gender [OR 1.58 (95 % CI 1.23, 2.02) p < 0.05 I2 0 %] and abbreviated injury scale (head: H-AIS) [≥ 3 OR 2.79 (95 % CI 1.58, 4.93) p < 0.05 I2 0 %] increased the risk of VAP. After subgroup analysis, blood transfusion on admission [OR 1.97 (95 % CI 1.16-3.35) p ≤0.05 I2 5 %] and barbiturate infusion [OR 3.55 (95 % CI 2.01-6.30) p ≤0.05 I2 0 %] became risk factors. Prophylactic antibiotic use [OR 0.67 (95 % CI 0.51-0.88) p ≤0.05 I2 0 %] and younger age MD -3.29 (95 % CI -5.18, -1.40) p ≤0.05 I2 41 %] emerged as significant protective factors. In VAP patients ICU stay [MD 7.02 (95 % CI 6.05-7.99) p ≤0.05 I2 37 %], duration of mechanical ventilation [MD 5.79 (95 % CI 4.40, 7.18) p ≤0.05 I2 79 %] and hospital stay [MD 11.88 (95 % CI 8.71-15.05) p ≤0.05 I2 0 %] were significantly increased. The certainty of the evidence was moderate-high for the outcomes studied. CONCLUSIONS: Male gender, H-AIS ≥ 3, blood transfusion on admission, and barbiturate infusion were risk factors for VAP. In patients with VAP, ICU stay, duration of mechanical ventilation, hospital stay were significantly increased.

Sentiment analysis in medication adherence: using ruled-based and artificial intelligence-driven algorithms to understand patient medication experiences.

BACKGROUND: Studies are exploring ways to improve medication adherence, with sentiment analysis (SA) being an underutilized innovation in pharmacy. This technique uses artificial intelligence (AI) and natural language processing to assess text for underlying feelings and emotions. AIM: This study aimed to evaluate the use of two SA models, Valence Aware Dictionary for Sentiment Reasoning (VADER) and Emotion English DistilRoBERTa-base (DistilRoBERTa), for the identification of patients' sentiments and emotions towards their pharmacotherapy. METHOD: A dataset containing 320,095 anonymized patients' reports of experiences with their medication was used. VADER assessed sentiment polarity on a scale from - 1 (negative) to + 1 (positive). DistilRoBERTa classified emotions into seven categories: anger, disgust, fear, joy, neutral, sadness, and surprise. Performance metrics for the models were obtained using the sklearn.metrics module of scikit-learn in Python. RESULTS: VADER demonstrated an overall accuracy of 0.70. For negative sentiments, it achieved a precision of 0.68, recall of 0.80, and an F1-score of 0.73, while for positive sentiments, it had a precision of 0.73, recall of 0.59, and an F1-score of 0.65. The AUC for the ROC curve was 0.90. DistilRoBERTa analysis showed that higher ratings for medication effectiveness, ease of use, and satisfaction corresponded with more positive emotional responses. These results were consistent with VADER's sentiment analysis, confirming the reliability of both models. CONCLUSION: VADER and DistilRoBERTa effectively analyzed patients' sentiments towards pharmacotherapy, providing valuable information. These findings encourage studies of SA in clinical pharmacy practice, paving the way for more personalized and effective patient care strategies.

Evidence-Based Strategies for Reforming the Medical Curriculum at the National Autonomous University of Honduras: A Systematic Literature Review.

Medical education worldwide has undergone numerous stages of reform. Cultural and financial restraints have decelerated progress in developing countries. Current reforms should focus on creating integrated, competency-based, and student-centered curricula that emphasize patient-centered care. The following review of literature published between 2014 and 2023 on global curricular reforms highlighted key components, challenges, and strategies for implementing or evaluating undergraduate medical programs that prioritize student-centered approaches and competency-based models. This review also compared the current curriculum at the National Autonomous University of Honduras (UNAH) with these international experiences to suggest strategies in order to encourage significant reform. The following review identified 47 articles that provided insights into ideal contexts for curricular reforms, while 15 publications detailed the current state of the UNAH medical curriculum and its potential weaknesses. Additionally, 25 articles discussed specific reforms in other countries, offering valuable results and conclusions for consideration. Drawing from these models and experiences, strategies were proposed for UNAH's curriculum reform, including identifying basic needs, defining project vision, training teaching staff and students, and integrating multidisciplinary teams of experts. Although training all teaching staff abroad may be financially unfeasible, selecting and training key individuals to train others could be a viable alternative. Successful reform requires a comprehensive, periodic, and systematic evaluation. Despite the challenges faced by developing countries, global experiences with alternative reform models offer promising solutions, providing an opportunity for the Faculty of Medical Sciences at UNAH to overcome local limitations and fulfill the primary task of training professionals who are clinically, ethically, and adaptively competent, with a focus on patient-centered and primary care approaches.

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

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

Patient positioning in minimally invasive gynecologic surgery: strategies to prevent injuries and improve outcomes.

Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes.

Design and implementation of a stakeholder consultation process for rapid health technology assessments in Argentina.

INTRODUCTION: Health technology assessment (HTA) is a standardized methodology that allows the assessment technologies' value. By incorporating the perspective of stakeholders in a public consultation process, transparency and quality of decisions can be improved. OBJECTIVE: To describe the active stakeholder consultation process for rapid HTAs in an Argentinean, independent, academic, non-profit HTA agency, assessing its initial five years. METHODS: Since 2017, we have been conducting an active public consultation process for rapid HTA documents, inviting producers, healthcare professionals, and patient organizations to provide comments, and their input may lead to changes in the HTA documents. Changes were classified as major (changes to the coverage recommendation), intermediate (changes in efficacy, net benefit, or cost-effectiveness that did not change coverage recommendations), and minor modifications (other changes). RESULTS: From May 2017-August 2022, 308 rapid HTA (rHTA) reports were published, and 3,438 invitations were sent. 140 rHTA (45.5%) received a total of 228 comments. Comments came from producers in 53% (n = 112) and healthcare professional organizations in 31.2% (n = 66). Technologies evaluated were drugs in 37% (n = 114), procedures in 35.5% (n = 109), diagnostic methods in 15.3% (n = 47), and devices in 12.2% (n = 38). Out of 308 rHTA documents, 120 (39%) were modified-mostly minor adjustments (n = 100; 80%), followed by major (n = 12; 10%) and intermediate modifications (n = 8; 6.4%). CONCLUSION: Implementing an active stakeholder involvement process in HTA is feasible in a low- to middle-income country context and strengthens and improves the HTA process.

One-Piece Versus Two-Piece Abutments for Single Crowns in the Esthetic Zone: A Clinical Trial.

OBJECTIVE: To evaluate whether a two-piece abutment is equivalent to a one-piece in peri-implant esthetics, patients' satisfaction, and oral health-related quality of life (OHRQOL) for implant-supported anterior single crown placement. MATERIAL AND METHODS: Thirty implants were allocated sequentially: 15 in the one-piece abutment group (OP) and 15 in the two-piece abutment group (TP). Peri-implant esthetics were evaluated by the pink esthetic score (PES) at temporary crown insertion (T1), after tissue conditioning (T2), and at 30 days after the final crown insertion (T3). OHRQOL was measured using the OHIP-14 and satisfaction was evaluated using the visual analog scale (VAS) at baseline, T1, and T3. Treatment was considered equivalent if the 95% coefficient interval (CI) for mean difference in PES was between -1.5 and +1.5 points. Statistical analysis was performed using Mann-Whitney, SPANOVA, and Student's t-test, with Sidak's posttest, adopting p < 0.05. RESULTS: No differences were found between the groups for any variable and during follow-up. A significant increase in OHRQOL and satisfaction was observed at T3, when compared to baseline (p < 0.05) for both groups. Significant improvements in peri-implant esthetics were also observed throughout the treatment, particularly after tissue conditioning (p < 0.05). Primary and secondary outcomes were evaluated for equivalence, and both abutment types were considered equivalent following the insertion of the temporary crowns. CONCLUSIONS: Two-piece abutment was equivalent to one-piece abutment for peri-implant esthetics, quality of life, or the satisfaction of patients rehabilitated with metal-free single crowns. Tissue conditioning and final crown insertion appear to play a role in improving these outcomes.

Assessment of severity and avoidability of adverse drug reactions in neonates: a reproducibility study of the Hartwig tool and LAAT.

OBJECTIVE: Tools for classifying adverse drug reactions (ADRs) have not yet been validated in the context of the neonatal intensive care unit (NICU). The study aims to investigate the inter-rater reliability of the Hartwig tool and the Liverpool avoidability assessment tool (LAAT) in assessing the severity and avoidability of ADR cases in hospitalized neonates. METHODS: An observational and prospective study was conducted in the NICU of a maternity hospital in Natal, Brazil. The Hartwig tool and LAAT were employed to assess the severity and avoidability of ADRs, respectively. Three experienced clinical pharmacists independently assessed all ADR cases. Inter-rater reliability was measured using Cohen's kappa coefficient (k) with corresponding 95% confidence intervals (CI). RESULTS: Among 79 ADR cases, the mean gestational age was 29.7 ± 4.4 weeks, and the birth weight averaged 1446.0 ± 1179.3 g. The assessment of ADR severity using the Hartwig tool revealed a significant overall correlation (overall k = 0.573; 95% CI 0.395 to 0.753) with exact agreement (EA) and extreme disagreement (ED) rates between evaluators of 86.5% and 2.5%, respectively. However, no statistically significant correlation was observed for determining avoidability using the LAAT (overall k = 0.017; 95% CI - 0.048 to 0.082), with an EA rate of 83.6% and ED rate of 10.1%. CONCLUSION: The Hartwig tool demonstrates good reproducibility among different evaluators in determining the severity of ADRs, unlike the LAAT for assessing avoidability.