Desafios e mudanças no processo de trabalho das equipes de saúde da família no cenário pandêmico: relato de experiência / Challenges and changes in the work process of family health teams in the pandemic scenario: experience report

O presente estudo tem por objetivo realizar um relato de experiência demonstrando a percepção de discentes do curso de odontologia na sua participação na prática da atenção primária à saúde (APS), vivenciadas em um cenário pandêmico e com base no combate a enfrentamentos e desafios impostos no processo de trabalho das equipes de saúde da família. Este estudo trata - se de relato de experiência, de caráter descritivo e retrospectivo, associado à uma pesquisa bibliográfica para que trousse o embasamento teórico necessário para a descrição do relato de experiência vivenciado. No decorrer da pandemia, a Equipe de saúde da família exerceu importante papel e atuou na linha de prevenção e controle desta, sendo uma das maiores ferramentas de apoio. Na odontologia, a atuação da equipe de saúde bucal devido a fatores de risco inerentes à esta modalidade de ocupação, ficou limitada em seu exercício. O conhecimento de muitos dos profissionais da rede pública foi colocado em questão, assim como sua vivência, limitações e o medo de contrair a doença. Os profissionais da equipe de saúde, mostraram que o trabalho interprofissional e um bom relacionamento aumentou o incentivo e a responsabilidade de equipe.

This study aims to carry out an experience report demonstrating the perception of students of the dentistry course in their participation in the practice of primary health care (PHC), experienced in a pandemic scenario and based on the fight against confrontations and challenges imposed on the work process of family health teams. This study is an experience report, descriptive and retrospective, associated with bibliographical research to bring the necessary theoretical basis for the description of the lived experience report. During the pandemic, the Family Health Team played an important role and acted in the line of prevention and control of this, being one of the greatest support tools. In dentistry, the performance of the oral health team, due to risk factors inherent to this type of occupation, was limited in its exercise. The knowledge of many public health professionals was questioned, as well as their experience, limitations and fear of contracting the disease. Health team professionals showed that interprofessional work and a good relationship increased team incentive and responsibility.

SEOM-GG clinical guidelines for the management of germ-cell testicular cancer (2023).

Testicular germ cell tumors are the most common tumors in adolescent and young men. They are curable malignancies that should be treated with curative intent, minimizing acute and long-term side effects. Inguinal orchiectomy is the main diagnostic procedure, and is also curative for most localized tumors, while patients with unfavorable risk factors for recurrence, or those who are unable or unwilling to undergo close follow-up, may require adjuvant treatment. Patients with persistent markers after orchiectomy or advanced disease at diagnosis should be staged and classified according to the IGCCCG prognostic classification. BEP is the most recommended chemotherapy, but other schedules such as EP or VIP may be used to avoid bleomycin in some patients. Efforts should be made to avoid unnecessary delays and dose reductions wherever possible. Insufficient marker decline after each cycle is associated with poor prognosis. Management of residual masses after chemotherapy differs between patients with seminoma and non-seminoma tumors. Patients at high risk of relapse, those with refractory tumors, or those who relapse after chemotherapy should be managed by multidisciplinary teams in experienced centers. Salvage treatment for these patients includes conventional-dose chemotherapy (TIP) and/or high-dose chemotherapy, although the best regimen and strategy for each subgroup of patients is not yet well established. In late recurrences, early complete surgical resection should be performed when feasible. Given the high cure rate of TGCT, oncologists should work with patients to prevent and identify potential long-term side effects of the treatment. The above recommendations also apply to extragonadal retroperitoneal and mediastinal tumors.

The Effects of Mobile Primary Health Teams: Evidence from the Médico del Barrio Strategy in Ecuador.

Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N=55,666), 2012-13 (N=92,500) and 2018-19 (N=168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program's implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have had mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.

Cognitive versatility and adaptation to fluid participation in hospital emergency department teams.

Role-based frameworks have long been the cornerstone of organizational coordination, providing clarity in role expectations among team members. However, the rise of "fluid participation"-a constant shift in team composition and skill sets-poses new challenges to traditional coordination mechanisms. In particular, with fluid participation, a team's roles can oscillate between disconnected and intersecting, or between lacking and having overlap in the capabilities and expectations of different roles. This study investigates the possibility that a disconnected set of roles creates a structural constraint on the flexible coordination needed to perform in volatile contexts, as well as the mitigating role of cognitive versatility in a team's strategically-central member. Utilizing a sample of 342 teams from a hospital Emergency Department, we find that teams with a disconnected role set are less effective than teams with an intersecting role set as demonstrated by longer patient stays and increased handoffs during shift changes. Importantly, the presence of a cognitively versatile attending physician mitigates these negative outcomes, enhancing overall team effectiveness. Our findings remain robust even after accounting for other variables like team expertise and familiarity. This research extends the Carnegie School's seminal work on fluid participation by integrating insights from psychology and organizational behavior, thereby identifying key individual attributes that can bolster team coordination in dynamic settings.

Exploring critical factors in pediatric palliative care in Latin America: A scoping review.

This scoping review aimed to provide an overview of the current landscape of pediatric palliative care in Latin America, including policies, regulations, available resources, challenges, barriers, and evidence-based recommendations. We conducted a comprehensive search for peer-reviewed articles related to pediatric palliative care in Latin America, considering both review and empirical articles published in English, Portuguese, or Spanish within the last decade. Our review initially identified 30 publications, which were subjected to a full-text assessment. The majority of these articles originated from Brazil, Mexico, and Chile, highlighting a regional concentration of research efforts. Notably, we observed a scarcity of comprehensive research and specific studies on pediatric palliative care in Latin America. Our findings revealed significant challenges, including resource limitations, the absence of dedicated policies, and the critical need for interdisciplinary teams to address the multifaceted aspects of pediatric palliative care. In light of our review, we emphasise the necessity for more extensive and representative research efforts, as well as the continuous updating of scientific evidence in the field of pediatric palliative care within the Latin American context. The recommendations derived from this review aim to contribute to the enhancement of pediatric palliative care services and accessibility throughout Latin America.

Lived experiences of caregivers upon receiving occupational therapy through telehealth amidst the pandemic / Experiências vividas por cuidadores em terapia ocupacional por meio de telessaúde no meio de uma pandemia

Abstract Within the context of the COVID-19 pandemic, telehealth was seen to be a viable and alternative solution to provide occupational therapy services in the Philippines. This phenomenological study aimed to describe the lived experiences of Filipino parents and carers in receiving occupational therapy through telehealth for their children with disabilities. We interviewed 10 participants who were considered primary carers of a Filipino child with disabilities undergoing telehealth during the COVID-19 pandemic situation. An interpretative phenomenological analysis involving double hermeneutics was employed to analyze the interviews that yielded four themes: "dimensions of telehealth in occupational therapy", "reinforcing family-centered occupational therapy", "emphasizing an occupational therapist's advocacy role", and "telehealth in occupational therapy-today and tomorrow". Our findings suggest that in order for telehealth to be a sustainable service, it should be seen not merely as an alternative in the occupational therapy service delivery process. Although telehealth remains to be an evolving concept and practice within health services, telehealth must be practiced within the principles of family-centered care approaches, interprofessional collaboration, and health accessibility and equitability. This study hopes to facilitate intersections between service providers and service users to cultivate a shared goal of bringing together experiences that will inform a more contextualized occupational therapy and telehealth practice at the tail-end of the pandemic. In conclusion, telehealth in occupational therapy shall not be an alternative, but an integrative tool that occupational therapists can maximize to transform occupational therapy access and equity.

Resumo No contexto da pandemia da COVID-19, a telessaúde foi considerada uma solução viável e alternativa para a prestação de serviços de terapia ocupacional nas Filipinas. Este estudo fenomenológico teve como objetivo descrever as experiências vividas por pais e cuidadores filipinos ao receberem terapia ocupacional por meio da telessaúde para seus filhos com deficiência. Entrevistamos 10 participantes que eram considerados cuidadores primários de uma criança filipina com deficiência submetida à telessaúde durante a situação de pandemia da COVID-19. Uma análise fenomenológica interpretativa envolvendo dupla hermenêutica foi empregada para analisar as entrevistas, resultando em quatro temas: "dimensões da telessaúde na terapia ocupacional", "reforçando a terapia ocupacional centrada na família", "enfatizando o papel de militância do terapeuta ocupacional" e "telessaúde na terapia ocupacional - hoje e amanhã". As nossas descobertas sugerem que, para que a telessaúde seja um serviço sustentável, deve ser vista não apenas como uma alternativa no processo de prestação de serviços de terapia ocupacional. Embora a telessaúde continue a ser um conceito e uma prática em evolução nos serviços de saúde, deve ser praticada dentro dos princípios de abordagens de cuidados centrados na família, colaboração interprofissional e acessibilidade e equidade em saúde. Este estudo espera facilitar interseções entre prestadores e usuários de serviços para cultivar um objetivo comum de reunir experiências que informarão uma terapia ocupacional e uma prática de telessaúde mais contextualizadas no final da pandemia. Concluindo, a telessaúde na terapia ocupacional não deve ser uma alternativa, mas sim uma ferramenta integrativa que os terapeutas ocupacionais podem maximizar para transformar o acesso e a equidade à terapia ocupacional.

Nurses' perception of the nursing process and its relationship with leadership / Percepción de los enfermeros sobre el proceso de enfermería y su relación con el liderazgo / Percepção dos enfermeiros sobre o processo de enfermagem e sua relação com a liderança

ABSTRACT Objectives: to describe Nurses' perception of the Nursing Process and its relationship with leadership. Methods: action research conducted between September/2021 and April/2022 with nurses from a medium-sized hospital in southern Brazil. The data investigated, one of the stages of the method, was collected using the Focus Group technique and submitted to Strategic Focus Analysis. Results: three categories emerged from the organized and analyzed data, namely: Nursing Process: a tool that qualifies nursing care; Conditions that weaken the Nursing Process; and Strategies that enhance the Systematization of Nursing Care. Final Considerations: the perception of the Nursing Process and its relationship with leadership are not always understood as complementary themes. Although they recognize that the Nursing Process is sometimes imposed as normative, nurses do not perceive the importance of the role of the leader, who is considered a key player in conducting and boosting the Systematization of Nursing Care.

RESUMEN Objetivos: describir la percepción de los Enfermeros sobre el Proceso de Enfermería y su relación con el liderazgo. Métodos: se trata de una investigación-acción realizada entre septiembre de 2021 y abril de 2022 entre enfermeros de un hospital de medio porte del sur de Brasil. Los datos investigados, una de las etapas del método, fueron recolectados mediante la técnica de Grupo Focal y sometidos al Análisis Focal Estratégico. Resultados: los datos organizados y analizados resultaron en tres categorías, a saber: Proceso de Enfermería como herramienta que cualifica los cuidados de enfermería; Condiciones que debilitan el Proceso de Enfermería; y Estrategias que potencian la Sistematización de los Cuidados de Enfermería. Consideraciones Finales: la percepción del Proceso de Enfermería y su relación con el liderazgo no siempre se toma en cuenta como tema complementario. Aunque los Enfermeros reconocen que el Proceso de Enfermería se impone a veces como normativo, no perciben la importancia del papel del líder, considerado como un actor clave para conducir y dinamizar la Sistematización de los Cuidados de Enfermería.

RESUMO Objetivos: descrever a percepção dos Enfermeiros sobre o Processo de Enfermagem e a sua relação com a liderança. Métodos: pesquisa-ação conduzida entre setembro/2021 e abril/2022 com enfermeiros de um hospital de médio porte do sul do Brasil. Os dados investigados, uma das etapas do método, foram coletados por meio da técnica de Grupo Focal e submetidos à Análise Focal Estratégica. Resultados: dos dados organizados e analisados resultaram três categorias, quais sejam: Processo de Enfermagem: ferramenta qualificadora da assistência de enfermagem; Condições que fragilizam o Processo de Enfermagem; e Estratégias que potencializam a Sistematização da Assistência de Enfermagem. Considerações Finais: a percepção de Processo de Enfermagem e a sua relação com a liderança nem sempre são apreendidos como temas complementares. Embora reconheçam que o Processo de Enfermagem é, por vezes, imposto como normativo, os Enfermeiros não percebem a relevância da função do líder, considerado ator-chave na condução e dinamização da Sistematização da Assistência de Enfermagem.

Looking for related posts on GitHub discussions.

Software teams increasingly adopt different tools and communication channels to aid the software collaborative development model and coordinate tasks. Among such resources, software development forums have become widely used by developers. Such environments enable developers to get and share technical information quickly. In line with this trend, GitHub announced GitHub Discussions-a native forum to facilitate collaborative discussions between users and members of communities hosted on the platform. Since GitHub Discussions is a software development forum, it faces challenges similar to those faced by systems used for asynchronous communication, including the problems caused by related posts (duplicated and near-duplicated posts). These related posts can add noise to the platform and compromise project knowledge sharing. Hence, this article addresses the problem of detecting related posts on GitHub Discussions. To achieve this, we propose an approach based on a Sentence-BERT pre-trained general-purpose model: the RD-Detector. We evaluated RD-Detector using data from three communities hosted in GitHub. Our dataset comprises 16,048 discussion posts. Three maintainers and three Software Engineering (SE) researchers manually evaluated the RD-Detector results, achieving 77-100% of precision and 66% of recall. In addition, maintainers pointed out practical applications of the approach, such as providing knowledge to support merging the discussion posts and converting the posts to comments on other related posts. Maintainers can benefit from RD-Detector to address the labor-intensive task of manually detecting related posts.

Incidencia de la cultura organizacional, en el rendimiento deportivo de los equipos de eSport

Los eSports o deportes electrónicos han ganado relevancia mundial, pero en Latinoamérica hay una brecha de desarrollo respecto a otras regiones. El objetivo de esta investigación consistió en analizar la influencia de la cultura organizacional, en el rendimiento de los equipos de eSports de Valorant que participaron en el torneo denominado 88 CUP. El torneo se desarrolló del 19 de febrero al 30 de abril de 2023, con la participación de 35 equipos pertenecientes a Ecuador, Colombia, México, Guatemala, Venezuela, Costa Rica, Cuba, El Salvador, Honduras, Panamá, Perú y República Dominicana. Se empleó el instrumento de Cameron y Quinn, adaptado por Ibarra (2019) para evaluar la cultura organizacional, y para el rendimiento deportivo se recopilaron datos de la puntuación media de combate en el torneo 88 CUP; través de esta puntuación, se calculó el índice de rendimiento deportivo en una escala de 0 a 100. El estudio de datos se realizó con el análisis de componentes principales no lineales y ecuaciones estructurales. Los resultados mostraron un promedio de rendimiento deportivo de 25 sobre 100 puntos y apenas el 10 % de los equipos alcanzaron un rendimiento superior a 70. Además, la cultura adhocrática y clan prevalecen en los equipos estudiados. Se estableció un modelo de relación causal de la cultura organizacional en el rendimiento deportivo, donde las dimensiones adhocráticas, jerárquica y de mercado tuvieron un impacto significativo y positivo; en tanto, la dimensión clan tuvo una influencia significativa y negativa en el rendimiento deportivo.

Os eSports ou esportes eletrônicos ganharam relevância global, mas na América Latina existe uma lacuna de desenvolvimento em comparação com outras regiões. O objetivo desta pesquisa foi analisar a influência da cultura organizacional no desempenho das equipes de Valorant eSports que participaram do torneio denominado 88 CUP. O torneio aconteceu de 19 de fevereiro a 30 de abril de 2023, com a participação de 35 seleções do Equador, Colômbia, México, Guatemala, Venezuela, Costa Rica, Cuba, El Salvador, Honduras, Panamá, Peru e República Dominicana. Para avaliar a cultura organizacional foi utilizado o instrumento Cameron e Quinn, adaptado por Ibarra (2019), e para o desempenho esportivo foram coletados dados sobre a pontuação média de combate no torneio 88 CUP; por meio dessa pontuação, foi calculado o índice de desempenho esportivo em uma escala de 0 a 100. O estudo dos dados foi realizado com análise de componentes principais não lineares e equações estruturais. Os resultados mostraram um desempenho esportivo médio de 25 em 100 pontos e apenas 10% das equipes obtiveram desempenho superior a 70. Além disso, a cultura adocrática e de clã prevalece nas equipes estudadas. Foi estabelecido um modelo de relação causal da cultura organizacional sobre o desempenho desportivo, onde as dimensões adocrática, hierárquica e mercadológica tiveram um impacto significativo e positivo; entretanto, a dimensão do clã teve uma influência significativa e negativa no desempenho desportivo.

eSports or electronic sports have gained global relevance, but in Latin America there is a development gap compared to other regions. The objective of this research was to analyze the influence of organizational culture on the performance of Valorant eSports teams that participated in the tournament called 88 CUP. The tournament took place from February 19 to April 30, 2023, with the participation of 35 teams from Ecuador, Colombia, Mexico, Guatemala, Venezuela, Costa Rica, Cuba, El Salvador, Honduras, Panama, Peru and the Dominican Republic. The Cameron and Quinn instrument, adapted by Ibarra (2019), was used to evaluate organizational culture, and for sports performance, data was collected on the average combat score in the 88 CUP tournament; through this score, the sports performance index was calculated on a scale from 0 to 100. The data study was carried out with the analysis of non-linear principal components and structural equations. The results showed an average sports performance of 25 out of 100 points and only 10% of the teams achieved a performance greater than 70. In addition, the adhocratic and clan culture prevail in the teams studied. A causal relationship model of organizational culture on sports performance was established, where the adhocratic, hierarchical and market dimensions had a significant and positive impact; meanwhile, the clan dimension had a significant and negative influence on sports performance.

Análisis dinámico de un equipo interprofesional que implementa un programa de atención psicosocial a víctimas de la guerra / Dynamic analysis of an interprofessional team implementing a psychosocial intervention program for war victims

Resumen Este estudio analiza los cambios estructurales experimentados por un equipo interprofesional que implementa un programa de intervención psicosocial dirigido a víctimas de la guerra en Colombia. Los equipos están compuestos por psicólogos, trabajadores sociales y facilitadores comunitarios que proporcionan atención a nivel individual, familiar y comunitario. Se aplicaron métodos de evaluación estructural para identificar cambios en la cohesión de las redes de reconocimiento entre profesionales, así como la preferencia para colaborar y el intercambio de información enviada y recibida. La recogida de información se produjo en dos series temporales -tiempo 1 (T1) y tiempo 2 (T2)- con un intervalo de tres meses. Se utilizó una estadística aplicada al análisis de datos relacionales para determinar los cambios en las redes en T1 y T2. En el período de referencia se incrementó la densidad en las redes de reconocimiento [. = 1.7105, (IC 95 %: -.0123 - .185), . < .0444] y de preferencia para trabajar [. = 2.0942, (IC 95 %: .005 - .1521), . < .0218]. Las redes de intercambio de información no experimentaron cambios significativos. Las regresiones múltiples a nivel diádico indican que la preferencia para trabajar e intercambiar información en T1, predicen el intercambio de información relativo tanto a peticiones de información recibidas como enviadas en T2. Se discuten los resultados para optimizar la implementación de programas de intervención psicosocial desarrolladas por equipos interprofesionales.

Abstract The study analyzes the structural changes experienced by an interprofessional team implementing a psychosocial intervention program for victims of war in Colombia. The program is called "PAPSIVI" (Programa de Atención Psicosocial y Salud Integral a Víctimas), which has been operating in Colombia since 2013, thanks to Law 1448 of 2011 to improve the quality of life and repair the damage of the victims of the armed conflict in Colombia. It only served people registered in the Single Registry of Victims (RUV), which had 9'165,126 records throughout the country until September 2021. This program follows a comprehensive and restorative approach that defines victims as protagonists of their own process of empowerment and positive change (Laplante and Holguin, 2006; Thompson, 1996). For this purpose, a multilevel intervention is carried out at the individual, family and community levels. The program is implemented by teams of professionals (psychologists, social workers and community facilitators) of varying sizes depending on the number of victims served in the municipalities. Psychologists provide individual psychological care and, to a lesser extent, family therapy is also offered to try to repair psychosocial damage from exposure to situations of violence (Oficina de Promoción Social, 2017). Social workers carry out community interventions to promote the associative fabric and social capital. Community promoters are facilitators and connect professionals with the potential beneficiaries of the intervention. The latter are very important, having themselves the status of victims, which increases the ecological validity of the intervention. Due to the characteristics of the implementation of this initiative, which takes into account the difficulties of the context (with situations of deprivation and vulnerability), as well as the particularities of the participants, it is valid to ask in this research what are the structural changes experienced by the teams of professionals who implement PAPSIVI. For this, structural evaluation methods were applied to identify changes in the cohesion of recognition networks among professionals, the preference to collaborate and the exchange of information sent and received. Data collection took place in two time series (T1 before - T2 after) with an interval of three months. Statistics applied to relational data analysis were used to determine changes in the networks at time T2. In the results it was found that in the baseline period the density in the recognition [t = 1.7105, (95 % CI: -.0123 - .185), p < .0444] and work preference [t = 2.0942, (95 % CI: .005 - .1521), p < .0218] networks increased. Information exchange networks did not experience significant changes. Multiple regressions at the dyadic level indicate that the preference for working and exchanging information at T1 predicts information exchange relative to both information requests received and sent at T2. It is concluded that the results shed light for: (a) optimize the design of psychosocial intervention teams; (b) improve their functioning by introducing horizontal organizational communication tools (among the members of each team), transversal (among the members of the teams implementing the program in different municipalities), and vertical (by promoting communication between professionals and program managers/responsible persons), and (c) achieve that changes in the structure of the teams serve as a diagnostic tool for functional problems of the team associated with the exchange of professional information and the referral of users. Ultimately, better integration of the teams leads to better psychosocial profiles of the users of programs such as PAPSIVI and allows them to better adapt their activities to the needs of the users, which improves the effectiveness of the intervention (Virto, 2021).

Production and reception of human resource management practices for health promotion.

Organizations thrive when there is a healthy relationship between people, i.e., where there is high social capital. Human resource management practices (HRMP) contribute to promoting social capital and mental health in organizations. However, there remains a gap in the literature on practices to promote mental health, as well as on the difference in perception of the function of the practices between those who promote them and those who receive them. Thus, this study aimed to identify what HRMP oriented toward mental health promotions are, how they are perceived, and whether there is variation among these perceptions. Twenty managers and 11 subordinates were interviewed. To achieve the first two objectives, a content analysis was performed, and for the last, a lexical analysis. In the content analysis, the following categories emerged for both groups: work organization and idiosyncratic deals and affective social support. Only in the managers did the categories of informational support, communication, and maintaining good interpersonal relationships emerge. The lexical analysis suggested that managers perceive task-related practices as promoting mental health, while teams attribute importance to affective social support practices. HRMP psychological principles were described. Social support practices should be adopted as human resource protective strategies for mental health.

The Importance of Crowd Support and Team Quality to Home Advantage in Brazilian Soccer League First Division.

Our aims in the present study were to analyze home advantage (HA) and number of goals scored in consideration of the presence or absence of crowd support and the influence of team quality during the last 11 seasons of the Brazilian Soccer League first division. We analyzed data from 4162 matches played in the Brazilian Soccer League in seasons 2012-2022 (3563 matches with an audience and 599 matches without an audience). We calculated HA by comparing the number of points won at home as a percentage of the total number of points gained, and we also recorded the number of goals scored by home and away teams. For analyses, we divided the teams based on home and away matches, with and without crowds, and we classified teams into three ability groups, based on the points scoring percentage of the team at the end of the season. There was a HA in all seasons analyzed (i.e., home teams won more than 50% of the total points won at home); but in matches in empty stadiums, the HA was reduced significantly, compared to matches with crowd support (66.6% with crowd vs. 57.2% without crowd, p < 0.05). The number of goals in all seasons was higher for home teams than for away teams; however, away teams scored more goals in empty stadiums than in stadiums with crowd support (p < 0.05). The HA was greater in matches with crowd support than in matches without crowd support (p < 0.01), independent of the team's ability level; but, top teams scored more goals than weaker teams (p < 0.01). In conclusion, in the Brazilian Soccer League, the HA and number of goals scored were affected by the presence or absent of an audience in the stadiums. While top teams scored more goals than weaker teams, the HA was lower without than with crowds, independent of team quality.

O Impacto da Liderança nos Comportamentos de Aprendizagem das Equipes de Trabalho / The Impact of Leadership on Work Teams Learning Behaviors

Resumo As equipes têm se consolidado como unidades estratégicas nas organizações, assim como seus comportamentos de aprendizagem consolidam-se como um dos processos grupais mais efetivos para atingimento de resultados, com o líder exercendo papel fundamental. O objetivo deste estudo foi mensurar o papel preditivo dos estilos de liderança transacional e transformacional sobre os comportamentos de aprendizagem da equipe. A testagem foi realizada com 79 equipes, média de 10 pessoas por equipe, integrantes de seis empresas, que responderam instrumentos sobre estilo de liderança e comportamentos de aprendizagem, presencialmente. Os resultados, nível meso, revelaram que a liderança explica 18,4% dos comportamentos de aprendizagem. Depreende-se, então, a importância do líder para criação de ambiente propícios ao compartilhamento e aprendizagem de equipes.

Abstract Teams have been consolidated as strategic units in organizations, as well as their learning behaviors as one of the most effective group processes for results achievement; and the leader has exercised a fundamental role. The aim of this study was to analyze the predictive role of transactional and transformational leadership styles on the team learning behaviors. The testing was conducted with 79 teams, mean of 10 people per team, members of six companies, which responded to instruments about leadership styles and learning behaviors in a face-to-face collection. The results, meso level, revealed that leadership explains 18,4% of learning behaviors. It is understandable, then, the importance of the leader for creating adequate environment for sharing and learning of the teams.

The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer.

Lung cancer is a major cause of cancer deaths worldwide. Non-small-cell lung cancer (NSCLC) represents most lung cancer cases, and approximately one-third of patients present with stage III disease at diagnosis. As multiple treatment plans can be adopted for these patients depending on tumor size and nodal staging, stage III NSCLC management is challenging. Over the past decades, multidisciplinary teams (MDTs) have been implemented in healthcare services to coordinate actions among the different health care professionals involved in cancer care. The aim of this review was to discuss real-world evidence of the impact of MDTs on stage III NSCLC management, survival, and quality of life. Here, we performed a literature review to investigate the role of nutrition and navigational nursing in NSCLC care and the influence of MDTs in the choice of treatment plans, including immunotherapy consolidation, and in the management of chemotherapy and radiotherapy-related adverse events. We also performed a mapping review to identify gaps in the implementation of cancer care MDTs in healthcare services around the world.

Guidelines adopted by agile teams in privacy requirements elicitation after the Brazilian general data protection law (LGPD) implementation.

The Brazilian General Data Protection Law (LGPD) implementation has impacted activities carried out by the software development teams. Due to it, developers had to become aware of the existing techniques and tools to carry out privacy requirements elicitation. Extending our previous work, we have investigated the actions taken by organizations regarding the LGPD, specifically in software development, considering the perception of agile development teams after two years of the LGPD implementation. In addition, we also investigated the perception of an agile team regarding the practices, techniques, and tools previously cited by practitioners as potential solutions for use in this context, along with techniques already in use in the current context. We have conducted a systematic literature review (SLR) and selected 36 primary studies. Furthermore, we have conducted a survey with 53 IT practitioners and semi-structured interviews with ten practitioners. The LGPD principles are known by most agile teams and are being implemented by the organizations, although the existing tools to support privacy requirements elicitation are still underused by agile teams. Moreover, agile teams consider that software requirements and software construction are the most impacted areas of knowledge by the LGPD, and most of them use user stories in privacy requirements elicitation. Our findings reveal that agile teams and Brazilian organizations are more concerned with user data privacy issues after the LGPD became effective. However, agile teams still face challenges in privacy requirements elicitation.

Association of Time to Rapid Response Team Activation With Patient Outcomes Using a Range of Physiologic Deterioration Thresholds.

Clinical deterioration of hospitalized patients is common and can lead to critical illness and death. Rapid response teams (RRTs) assess and treat high-risk patients with signs of clinical deterioration to prevent further worsening and subsequent adverse outcomes. Whether activation of the RRT early in the course of clinical deterioration impacts outcomes, however, remains unclear. We sought to characterize the relationship between increasing time to RRT activation after physiologic deterioration and short-term patient outcomes. DESIGN: Retrospective multicenter cohort study. SETTING: Three academic hospitals in Pennsylvania. PATIENTS: We included the RRT activation of a hospitalization for non-ICU inpatients greater than or equal to 18 years old. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary exposure was time to RRT activation after physiologic deterioration. We selected four Cardiac Arrest Risk Triage (CART) score thresholds a priori from which to measure time to RRT activation (CART score ≥ 12, ≥ 16, ≥ 20, and ≥ 24). The primary outcome was 7-day mortality-death or discharge to hospice care within 7 days of RRT activation. For each CART threshold, we modeled the association of time to RRT activation duration with 7-day mortality using multivariable fractional polynomial regression. Increased time from clinical decompensation to RRT activation was associated with higher risk of 7-day mortality. This relationship was nonlinear, with odds of mortality increasing rapidly as time to RRT activation increased from 0 to 4 hours and then plateauing. This pattern was observed across several thresholds of physiologic derangement. CONCLUSIONS: Increasing time to RRT activation was associated in a nonlinear fashion with increased 7-day mortality. This relationship appeared most marked when using a CART score greater than 20 threshold from which to measure time to RRT activation. We suggest that these empirical findings could be used to inform RRT delay definitions in further studies to determine the clinical impact of interventions focused on timely RRT activation.

Avances en tumores del estroma gastrointestinal: ¿hacia dónde vamos?

Gastrointestinal Stromal Sarcomas (GIST) are mesenchymal neoplasms whose incidence accounts for 1-2% of digestive tumors, being located in the stomach (55-60%) and small intestine (30%). The advances in its knowledge and management succeeded in the last years have being spectacular. This review aims to summarize the most important of them for surgeons. We identified four areas of interest: molecular oncology, laparoscopic approach, management of GIST located at unusual locations, and management of advanced GIST. Advances in the field of molecular oncology lead to the discovery of new oncogenic mutations making the term Wil Type GIST obsolete. Moreover, these advances allow for the development of 2 new drugs: Avapritinib and Ripretinib, that added to the previous 3 commercially available drugs (imatinib, sunitinib and regorafenib) make possible the management of GIST with resistant mutations. The principles of the surgical management of primary GIST are well stablished which laparoscopic approach must accomplish. This approach is limited by 2 main factors: location and size. The diagnosis of GIST in unusual locations as esophagus, duodenum, rectum of out of the gastrointestinal tract (EGIST), implies an extraordinary therapeutic challenge, being imperative to manage them by surgeons and oncologist among others in the setting of a multidisciplinary team. The management of advanced/metastatic GIST has changed in a revolutionary fashion because surgery is now part of its treatment as adjuvant to tyrosine kinase inhibitors.

Los tumores del estroma gastrointestinal (GIST) suponen el 1-2% de los tumores digestivos, siendo su localización más frecuente el estómago (55-60%) y el intestino delgado (30%). Los avances más importantes sucedidos en los últimos años se centran en cuatro áreas: biología molecular, abordaje quirúrgico laparoscópico, manejo técnico del GIST en localizaciones inusuales y tratamiento e integración de la cirugía en el manejo del GIST avanzado. Los avances en el conocimiento de la biología molecular del GIST han dado lugar a la progresiva identificación de nueva mutaciones oncogénicas que hacen del concepto wild type obsoleto. Estos avances han permitido el desarrollo de dos nuevos fármacos, avapritinib y ripretinib, lo que permite el tratamiento de pacientes con mutaciones resistentes a las tres líneas terapéuticas clásicas. El tratamiento quirúrgico del GIST se rige por unos principios técnicos bien establecidos que el abordaje laparoscópico debe cumplir, abordaje que queda limitado por dos factores clave: localización y tamaño. El GIST de localización infrecuente (esófago, duodeno o recto, o extradigestivo) supone un reto terapéutico. Estos pacientes deben ser manejados en un contexto multidisciplinario. La cirugía queda integrada en el manejo del GIST avanzado, considerándose como adyuvante a los inhibidores de la tirosina cinasa.

Lessons Learned from a Medical Response Team 45 Days Post-Hurricane Maria in Puerto Rico.

INTRODUCTION: Describe the lived experience of a grassroots, nongovernmental disaster medical team (DMT) through a research lens and share practical lessons learned based on the DMT's experience to support and inform future response teams. METHOD: Forty-five days after Hurricane Maria, a nongovernmental DMT provided primary medical care by means of community-based pop-up clinics and home visitations in 5 different areas of Puerto Rico. Observational data, photo images, and debriefing notes were collected and documented in the response team's daily activity log. Field notes were coded using a descriptive coding method and then categorized into 2 domains specific to public health and medical diagnosis. RESULTS: Medical aid was provided to nearly 300 (N = 296) residents. Field note observations identified exhaustion related to living conditions and the exacerbation of underlying conditions, such as reactive airway diseases, diabetes, hypertension, and depression due to the compounding effects of multiple post-disaster triggers. During home visitations, feelings of sadness and helplessness were identified secondary to natural disaster trauma and current living conditions. CONCLUSION: Our nongovernmental DMT displayed similar characteristics demonstrated by federal DMTs post-natural disaster. Several strategic lessons learned emerged from the public health intervention important to future nongovernmental DMTs.

Dimensión subjetiva de los procesos de trabajo en profesionales de salud en contexto de pandemia: un estudio exploratorio a partir del análisis de dispositivos de Apoyo a los Equipos de Salud en un municipio del Área Metropolitana de Buenos Aires (AMBA)

Resumen: Objetivo: caracterizar la dimensión subjetiva de los procesos de trabajo en el primer nivel de atención en contexto de pandemia, a través de la descripción y análisis de los discursos de los y las trabajadores/as producidos en el marco del dispositivo de Apoyo a los Equipos de Salud implementado en un municipio del área metropolitana de Buenos Aires. Metodología: investigación cualitativa, exploratoria y descriptiva. Estudio de caso único centrado en observación participante en 10 reuniones en centros de salud del Municipio de Tigre, durante los meses de abril y mayo de 2020. La sistematización del material se realizó siguiendo técnicas de análisis de contenido y generación de categorías. Resultados: el análisis permitió identificar cinco categorías emergentes: a) cambios en los escenarios de trabajo, b) emociones y actitudes frente a la tarea, c) vínculos al interior de los equipos, d) vínculos con las autoridades y e) vínculos con la comunidad. Discusión: la dimensión subjetiva contenida en las vivencias relatadas está caracterizada por sensaciones de incertidumbre, miedos, tensiones en la relación entre compañeros/as, con las instancias jerárquicas y con la población asistida, pero también por búsquedas activas de alternativas, apoyo entre compañeros/as, participación, motivación en los sentidos del trabajo, cuidados mutuos y acercamiento a la comunidad. De este modo se hacen visibles aspectos que preexistían a la situación de pandemia y aspectos que el contexto introduce. Finalmente, se arriba a algunas reflexiones sobre las implicancias de la inclusión de este dispositivo en el proceso de trabajo de equipos de salud durante la pandemia.

Abstract: Objective: characterize the subjective dimension of the work processes at the first level of care in the context of a pandemic, through the description and analysis of the speeches of the workers produced within the framework of the Health Team Support device implemented in a municipality in the metropolitan area of Buenos Aires. Methodology: qualitative, exploratory and descriptive research. Single case study focused on participant observation in 10 meetings in health centers of the Municipality of Tigre, during the months of April and May 2020. The systematization of the material was carried out following techniques of content analysis and category generation. Results: the analysis identified five emerging categories: a) changes in work settings, b) emotions and attitudes towards the task, c) ties within teams, d) ties with authorities, and e) ties with the community. Discussion: the subjective dimension contained in the experiences reported are characterized by feelings of uncertainty, fears, tensions in the relationship between colleagues, with hierarchical instances and with the assisted population, but also by active searches for alternatives, support among colleagues, participation, motivation in the sense of work, mutual care and approach to the community. In this way, aspects that pre-existed the pandemic situation and aspects that the context introduce are made visible. Finally, we come up with some reflections on the implications of the inclusion of this device in the work process of health teams during the pandemic.

Resumo: Objetivo: caracterizar a dimensão subjetiva dos processos de trabalho em primeiro nível de atenção em contexto de pandemia, por meio da descrição e análise das falas dos trabalhadores produzidos no âmbito do dispositivo de Apoio à Equipe de Saúde implantado em município da região metropolitana de Buenos Aires. Metodologia: pesquisa qualitativa, exploratória e descritiva. Estudo de caso único com foco na observação participante em 10 encontros em centros de saúde do Município de Tigre, durante os meses de abril e maio de 2020. A sistematização do material foi realizada seguindo técnicas de análise de conteúdo e geração de categorias. Resultados: a análise identificou cinco categorias emergentes: a) mudanças nos ambientes de trabalho, b) emoções e atitudes em relação à tarefa, c) vínculos dentro das equipes, d) vínculos com autoridades e e) vínculos com a comunidade. Discussão: a dimensão subjetiva contida nas vivências relatadas é caracterizada por sentimentos de incerteza, medos, tensões na relação entre colegas, com instâncias hierárquicas e com a população assistida, mas também por buscas ativas de alternativas, apoio entre colegas, participação, motivação no sentido de trabalho, cuidado mútuo e aproximação com a comunidade. Desta forma, tornam-se visíveis os aspectos prévios à situação pandémica e os que o contexto introduz. Por fim, são feitas algumas reflexões sobre as implicações da inclusão desse dispositivo no processo de trabalho das equipes de saúde durante a pandemia.