Interdisciplinary approach to the management of Ewing sarcoma: A case report

Ewing sarcoma is a common primary bone malignancy occurring in childhood and adolescence. This case report describes a 4-year-old female patient who had Ewing sarcoma in the left clavicular region. The patient underwent total excision of the left clavicle and subsequently developed periodontitis and multiple carious lesions after chemotherapy. Caries risk and salivary flow rate tests were performed, followed by periodontal treatment, topical fluoride application, restoration of caries, and oral hygiene instruction. The care of this patient demonstrates that an interdisciplinary approach is essential to eliminate all foci of infection, minimize morbidity, and improve the patient's general health before, during, and after oncological treatment. © 2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

Atención farmacéutica como proceso pedagógico: Relato de un caso

The autonomy pedagogy allows the integration among theory, practice and reflection in the learning process. Applied to pharmaceutical care, the patient-centered process to achieve desired goals of therapy enables to build, rebuild and share knowledge and experiences with patients, in a critic and progressive way, inquiring and investigating. Therefore, it is possible to design a care plan according to patient experience, working together with the pharmaceutical care practitioner, to solve drugtherapy problems detected, with the patient as the center of the health care system. © 2012 Ediciones Mayo, S.A. Todos los derechos reservados.

Grupo interdisciplinar: Construção de unidade educacional sistematizada em aprendizagem baseada em problemas

In 2003 the construction team of the 1st grade of the medical and nursing courses from a medical school began a work aiming at curriculum reconstruction, and restructured cognitive contents and the integration of basic and clinical aspects, in order to adapt to the incentive program for Curriculum Changes (PROMED) which allows for the continuity of curricular innovations. This team worked considering the group dynamics, a method already used in tutorial sessions which teachers have some familiarity with. For a good group performance the team participants were divided into two subgroups: one for constructing educational problems and the other for doing cognitive assessment exercises. The team and the subgroups met weekly, and every 15 days the group met for socialization of information, identifying the strengths and weaknesses of the process and/or products. A good adhesion, an active involvement of participants and satisfaction expressed by each participant with their inclusion in the group were reflected in the final product and contributed to the subjects' commitment to the proposal. This way, in the process the individual transformations and relations in a situation requiring the collaboration of professionals were essential in the process of permanent curricular reconstruction.

Spirituality: Do teachers and students hold the same opinion?

Background:  Few studies have investigated potential differences between the opinions of educators and undergraduates regarding spirituality in patient care. Understanding these differences, could lead to better strategies for educational proposes. Purpose:  To compare the opinions of medical teachers (MTs) and medical students (MSs) regarding spirituality training in a Brazilian medical school. Methods:  A cross-sectional study was conducted. MTs and MSs filled out a questionnaire containing the Duke Religion Index, and questions regarding spirituality in clinical practice and at medical school. A comparison between early-curriculum MSs, late curriculum MSs and MTs was carried out. Chi-square (categorical) and Mann-Whitney (continuous/ordinal) tests were used. Results:  A total of 475 MSs and 44 MTs were evaluated. Results showed that MSs did not address spirituality as frequently as MTs (p<0.001), and that most participants did not feel prepared to address this issue, and believe that Brazilian medical schools are not giving all the required information in this field. Nevertheless, they believe MSs should be prepared to discuss these issues. Late-curriculum MSs believed that spirituality plays a more positive role in patient health (p=0.027), and were more prone to address this issue than early-curriculum MSs (p=0.023). Conclusion:  These findings revealed some of the challenges faced by spirituality medical training in Brazil, and differences between MTs and MSs regarding this issue. Further studies are needed to replicate these findings in other countries. © Blackwell Publishing Ltd 2013.

Caring for heart transplant recipients: The lived experience of primary caregivers

Objective: To understand the experience of primary caregivers of heart transplant recipients. Methods: A phenomenological approach was used to understand the caregivers' experience of caring for a heart transplant patient. In-depth interviews were conducted with 11 caregivers, in a Brazilian hospital, from December 2008 to March 2009. Results: Following the transplant, caregivers' lives change drastically; their priority becomes providing care for their relative. Despite successful transplant results, the uncertainty about future remains, generating permanent distress. Anxiety is exacerbated by familial or economic problems and, consequently, many participants turn to their local communities for support. Some caregivers learn from the experience and plan return to regular activities. Others feel helpless, unable to overcome personal losses and difficulties. Conclusions: Nurses are ideally placed to lead the way by providing family-centered support and education for caregivers of heart recipients. Listening to the concerns of family caregivers seems to be an essential aspect of effective interventions. © 2013 Elsevier Inc.

Analysis of inteins in the Candida parapsilosis complex for simple and accurate species identification

Inteins are coding sequences that are transcribed and translated with flanking sequences and then are excised by an autocatalytic process. There are two types of inteins in fungi, mini-inteins and full-length inteins, both of which present a splicing domain containing well-conserved amino acid sequences. Full-length inteins also present a homing endonuclease domain that makes the intein a mobile genetic element. These parasitic genetic elements are located in highly conserved genes and may allow for the differentiation of closely related species of the Candida parapsilosis (psilosis) complex. The correct identification of the three psilosis complex species C. parapsilosis, Candida metapsilosis, and Candida orthopsilosis is very important in the clinical setting for improving antifungal therapy and patient care. In this work, we analyzed inteins that are present in the vacuolar ATPase gene VMA and in the threonyl-tRNA synthetase gene ThrRS in 85 strains of the Candida psilosis complex (46 C. parapsilosis, 17 C. metapsilosis, and 22 C. orthopsilosis). Here, we describe an accessible and accurate technique based on a single PCR that is able to differentiate the psilosis complex based on the VMA intein. Although the ThrRS intein does not distinguish the three species of the psilosis complex by PCR product size, it can differentiate them by sequencing and phylogenetic analysis. Furthermore, this intein is unusually present as both mini- and full-length forms in C. orthopsilosis. Additional population studies should be performed to address whether this represents a common intraspecific variability or the presence of subspecies within C. orthopsilosis. Copyright © 2013, American Society for Microbiology. All Rights Reserved.

Entre o êxito e a frustação com a operacionalização da SAE: recursos humanos como componente determinante para a visibilidade do enfermeiro no processo de trabalho

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Planos de tratamento das fraturas coronárias e corono-radiculares propostos por especialistas em dentística titulados pela Unesp - Araçatuba

Pós-graduação em Odontologia - FOA

Eventos adversos: análise de um instrumento de notificação utilizado no gerenciamento de enfermagem

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Adesão dos profissionais de saúde às precauções de contato em unidade de terapia intensiva

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Desafios do Programa HIPERDIA e implicações para a enfermagem

INTRODUÇÃO: O Programa HIPERDIA foi implantado em 2001 na atenção básica devido à gravidade epidemiológica da Hipertensão Arterial Sistêmica (HAS) e o Diabetes Mellitus (DM), afecções que podem acarretar sérias complicações incutindo limitações e sofrimento na vida de seus portadores e suas famílias. Nesse contexto, ressalte-se a importância da prevenção primária dessas afecções e de suas complicações. Passado mais de uma década de sua implementação, cabe refletir acerca do impacto nas condições de saúde que o Programa tem gerado entre seus usuários. OBJETIVOS: Elucidar os princípios, a filosofia e a política norteadora do Programa HIPERDIA do Ministério da Saúde (MS); descrever como funciona o atendimento do usuário pela equipe de saúde de um Programa HIPERDIA; explorar os comportamentos de vida e saúde demonstrados pelos usuários do HIPERDIA após sua inserção no Programa. DESCRIÇÃO METODOLÓGICA: Trata-se de um Estudo de Caso segundo Yin (2010) cujo objeto de estudo foi um Programa HIPERDIA executado numa Unidade Básica de Saúde da periferia de Belém-PA. Os dados foram obtidos por meio de entrevista com usuários, equipe e gestores do Programa, além da observação direta do campo, consulta de prontuários e da documentação oficial do MS. A análise dos dados obtidos foi feita por meio da estratégia analítica “Contando com Proposições Teóricas” e da técnica analítica “Combinação de Padrão”. RESULTADOS: A precarização da gestão do Programa HIPERDIA ilustrada por deficiências na infraestrutura, insumos, medicamentos e fragilidades na rede de referência e contrarreferência, a demanda espontânea excessiva que sobrecarrega a equipe de saúde alocada em número insuficiente e o contexto de pobreza e violência urbana em que os usuários vivem contribuem para a baixa adesão ao regime terapêutico e limitam a equipe em sua atuação interdisciplinar e integral. Ademais, o modelo de atenção vigente é pautado no tradicional, baseado em consultas e prescrições e que não tem se demonstrado suficiente para atender integralmente às necessidades de atenção ao portador de condição crônica, que requer cuidados prolongados com adoção de estilos de vida mais condizentes e saudáveis. CONSIDERAÇÕES FINAIS: Grandes desafios se desenham diante dos dados emergidos deste estudo e envolvem ações macrogovernamentais e intersetoriais que promovam melhorias nas condições de vida da população o que requer vontade política para investimento dos recursos necessários. Não obstante a isso, a enfermagem pode dar sua contribuição promovendo cuidado cultural e ações de autocuidado, personalizando o plano de ação e trazendo a corresponsabilidade do usuário e sua família na melhoria de sua condição de saúde.

Recuperação acelerada após reparo cirúrgico aberto eletivo do aneurisma da aorta abdominal: revisão sistemática da literatura

Pós-graduação em Anestesiologia - FMB

Vivências de pacientes com câncer em cuidados paliativos e o significado da espiritualidade

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Characterization of the intrahospital transport of critically ill patients

Objective: Characterizing the transport of critically ill patients in an adult intensive care unit.Methods: Cross-sectional study in which 459 intra -hospital transports of critically ill patients were included. Data were collected from clinical records of patients and from a form with the description of the materials and equipment necessary for the procedure, description of adverse events and of the transport team.Results: A total of 459 transports of 262 critically ill patients were carried out, with an average of 51 transports per month. Patients were on ventilatory support (41.3 %) and 34.5 % in use of vasoactive drugs. Adverse events occurred in 9.4% of transports and 77.3 % of the teams were composed of physicians, nurses and nurse technicians.Conclusion: The transport of critically ill patients occurred in the morning period for performing computerized tomographies (CT scans) with patients dependent on mechanical ventilation and vasoactive drugs. During the transports the equipment was functioning, and the adverse events were attributed to clinical changes of patients.

Streptococcal acute pharyngitis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)