Spiritual support for people living with HIV/AIDS: A Brazilian explorative, descriptive study

y In this exploratory and descriptive research, we identified the meaning of religion and spirituality in the experience of patients at a public health service for treatment of HIV/AIDS in a Brazilian upcountry town. Eight participants were selected through theoretical sampling. Data were collected through semistructured interviews, and analyzed by means of qualitative content analysis. The emerging themes were religion: a path to support, and God is everything. Religion, as a path that leads patients to different sources of support, included exploration of different churches, acknowledgment of guilt, and finding strength to cope with the disease, rationalization of the disease process, meeting other churchgoers, and finding God and faith. God, an important source of support, was present in prayers, in the belief in healing through faith, and in the feeling of comfort and relief. Because spirituality and religion were seen as important sources of support, in this study we that health professionals include these aspects in care planning.

Food restrictions of patients who are undergoing treatment for oral and oropharyngeal cancer

Purpose: Oral squamous cell carcinoma and its treatment are associated with facial disfigurement and functional inabilities that may lead to malnutrition or under nourishment. This study assessed the incidence of food restrictions in patients undergoing treatment for oral and oropharyngeal cancer. Method: We interviewed 120 patients in two hospitals in Sao Paulo, Brazil, using a structured food frequency questionnaire comprising the most commonly consumed foods in Brazil. This questionnaire was applied twice; the first time to inform dietary patterns prior to the diagnosis of cancer and the second time to assess recent modifications of diet that were associated with the disease and its treatment. Hospital files provided information on clinical status. Multivariate Poisson regression models assessed covariates with prognostic value. Results: One third of patients suffered major food restrictions (i.e., they reduced substantially the intake of more than 50% of the most commonly consumed food items before the diagnosis); 39% suffered a less severe condition (they could not eat less than 50% of the most commonly consumed food items before the diagnosis, and they needed changes in food preparation). Larger tumour size (adjusted incidence ratio IR = 1.45), posterior location (IR = 1.33), radiotherapy (IR = 1.84), loss of tongue mobility (IR = 1.36) and loss of teeth (IR = 1.25) in the surgery were associated significantly with the study outcome. Conclusion: This study identified clinical predictors of food restrictions in patients undergoing treatment for oral and oropharyngeal cancer. This knowledge may contribute to improve patient care and management, and to develop interventions aimed at preventing nutritional depletion of these patients. (C) 2011 Elsevier Ltd. All rights reserved.

A integralidade da assist��ncia �� crian��a na percep����o do aluno de gradua����o em enfermagem

Estudo de abordagem qualitativa que objetivou identificar como alunos de gradua����o percebem a integralidade do cuidado da crian��a no seu processo de aprendizagem, em um Curso de Bacharelado em Enfermagem do interior paulista. Entrevistou-se 89 alunos em junho e dezembro de 2009. Os dados coletados foram analisados mediante an��lise de conte��do, sendo identificadas quatro tem��ticas. A integralidade �� vista como cuidado inteiro, envolvendo crian��a, fam��lia, condi����es de vida, meio ambiente. A institui����o de ensino prop��e inser����o precoce do aluno na realidade; este desmistifica o ideal de cuidado, deparando-se com o real. O professor instiga o aluno a refletir sobre sua pr��tica, para que esta fa��a sentido e tamb��m sejam apreendidos o saber e o fazer relacionado �� integralidade do cuidado �� crian��a.

A humaniza����o do cuidado na forma����o dos profissionais de sa��de nos cursos de gradua����o

A proposta desta pesquisa bibliogr��fica �� conhecer e analisar a produ����o cient��fica do campo da sa��de, em peri��dicos nacionais, sobre o ensino da humaniza����o do cuidado nos cursos de gradua����o. Realizou-se um levantamento bibliogr��fico na base de dados LILACS, utilizando o termo humaniza����o, com textos publicados a partir do ano de 2000 at�� 2010, sendo analisados 42 artigos. Da an��lise dos artigos emergiram tem��ticas centrais: Humaniza����o: algumas considera����es sobre seus conceitos; Universidade e as Diretrizes Curriculares Nacionais para os Cursos de Gradua����o na ��rea da Sa��de: rela����es com o ensino da humaniza����o; Mudan��as curriculares, conte��dos e estrat��gias de ensino-aprendizagem no cuidado humanizado e Sujeitos do processo ensino-aprendizagem: alunos e professores na aprendizagem da humaniza����o do cuidado. Alguns elementos te��rico-pr��ticos v��m sendo constru��dos sobre o ensino da humaniza����o no contexto de sa��de, sendo imprescind��vel, todavia, maiores investimentos na constru����o efetiva de novos modos de cuidar.

Notas cartogr��ficas do trabalho na Estrat��gia Sa��de da Fam��lia: rela����es entre trabalhadores e popula����o

Essa pesquisa-interven����o teve como objetivo cartografar os movimentos institu��dos e instituintes presentes no trabalho da Estrat��gia Sa��de da Fam��lia, no que tange a composi����o de suas pr��ticas cuidativas. O referencial te��rico metodol��gico fundamentou-se na an��lise institucional, linha esquizoanal��tica. Foram realizados encontros grupais com uma equipe para discutir o modo como realizavam os cuidados coletivos em a����o de educa����o permanente em sa��de. Os sujeitos da pesquisa foram trabalhadores da equipe e estudantes em atividade acad��mica no servi��o. A m��dia de participa����o foi de doze pessoas por encontro, sendo que se desenvolveram oito encontros no per��odo de mar��o a julho de 2010. Os dados foram agrupados em dois estratos imanentes: as rela����es da equipe e a rela����o com os usu��rios. Os estratos apontaram para o atravessamento das institui����es de educa����o, justi��a e da divis��o t��cnica e social do trabalho. A reflex��o coletiva em grupo mostrou-se potente, para desnaturalizar processos institu��dos e interrogar lugares, saberes e pr��ticas.

Articula����o das a����es e intera����o dos Agentes Comunit��rios de Sa��de na equipe de Sa��de da Fam��lia

O estudo de abordagem qualitativa teve como objetivo compreender as rela����es sociais entre o Agente Comunit��rio de Sa��de (ACS) e a equipe de Sa��de da Fam��lia (SF), nesse sentido, destaca-se a articula����o das a����es e a intera����o entre trabalhadores. Foram realizadas 23 observa����es participantes e 11 entrevistas semiestruturadas com uma equipe de SF em um munic��pio do interior de S��o Paulo, Brasil. Identificou-se que o ACS, como elo, desenvolve a����es operacionais para agilizar o trabalho da equipe. Como la��os de liga����o, desempenham a����es articuladas ao trabalho da equipe, interagindo com os trabalhadores, construindo planos assistenciais em comum, aproximando equipe e comunidade, adequando a����es de cuidado ��s necessidades das pessoas. Na pr��tica comunicativa, ao falarem de si, falam da pr��pria comunidade, pois �� seu representante e porta-voz na equipe. Concluiu-se que o Agente Comunit��rio de Sa��de pode ser um trabalhador estrat��gico se suas a����es compreenderem uma dimens��o mais pol��tica e social do trabalho em sa��de.

A educa����o em sa��de no cuidado de usu��rios do Programa Automonitoramento Glic��mico

O trabalho relata, de maneira sistematizada e cr��tica, a experi��ncia de um Projeto de Extens��o no per��odo de 2010 a 2011. Teve como foco a����es de educa����o em sa��de como estrat��gia para melhorar a ades��o das pessoas com diabetes mellitus e insulinodependentes, de uma Unidade B��sica de Sa��de do munic��pio de S��o Paulo, ao Programa Automonitoramento Glic��mico. Al��m disso, pretendeu-se contribuir na reorganiza����o do processo de trabalho em rela����o ao Programa na unidade. Foram utilizadas estrat��gias de educa����o em sa��de em grupos educativos e visitas domiciliares, assim, possibilitando cuidados mais singulares. Dados dos usu��rios foram organizados em planilha e em pastas para as equipes de Sa��de da Fam��lia, facilitando na identifica����o dos usu��rios, inclusive os faltosos, e auxiliando na descentraliza����o do cuidado. Com as a����es de educa����o em sa��de, pretendeu-se contribuir para um cuidado mais integral e emancipat��rio aos usu��rios, para um cont��nuo refletir dos trabalhadores quanto a suas pr��ticas.

��lcera venosa e terapia compressiva para enfermeiros: desenvolvimento de curso online

OBJETIVO: Descrever a elabora����o de um curso on-line sobre ��lcera venosa, com enfoque em terapia compressiva, para capacita����o de enfermeiros. M��TODOS: O desenvolvimento do curso on-line seguiu as fases de an��lise, design, desenvolvimento, implementa����o e avalia����o, baseadas no design instrucional contextualizado. RESULTADOS: O curso dividiu-se em dez m��dulos estruturados no ambiente virtual de aprendizagem Moodle. Caracterizou-se por uma proposta construtivista, visando ampliar a participa����o do aluno, disponibilizar as principais refer��ncias, revis��es e consensos, bem como utilizar objetos multim��dia e recursos did��ticos interativos. CONCLUS��O: O curso possibilita a capacita����o profissional do enfermeiro em terapia compressiva de maneira inovadora, flex��vel, interativa em diversos ambientes de cuidado.

O conhecimento de estrat��gias de comunica����o no atendimento �� dimens��o emocional em cuidados paliativos

O estudo objetivou investigar o conhecimento e a utiliza����o de estrat��gias de comunica����o no cuidado da dimens��o emocional do paciente sob cuidados paliativos. Com abordagem quantitativa, foi realizado entre agosto/2008 e julho/2009, junto a 303 profissionais de sa��de que trabalhavam ou tinham contato frequente com estes pacientes, por meio da aplica����o de question��rio. Os dados sofreram tratamento estat��stico descritivo e anal��tico. Os profissionais denotaram desconhecimento de estrat��gias de comunica����o, evidenciando-se diferen��a significativa (p-valor 0,0011) na compara����o entre sujeitos com e sem forma����o pr��via em cuidados paliativos, denotando que quem possui capacita����o paliativista conhece/utiliza mais estrat��gias comunicacionais na aten����o �� dimens��o emocional de seus pacientes. As estrat��gias mais citadas pelos sujeitos foram: escuta ativa, reafirma����es verbais de solicitude, uso de perguntas abertas e toque afetivo. Conclui-se que h�� pouco conhecimento e utiliza����o insatisfat��ria de estrat��gias de comunica����o, pelos profissionais de sa��de no cuidado �� dimens��o emocional de pacientes sob cuidados paliativos.

Health care use of long-term survivors of childhood cancer: the British Childhood Cancer Survivor Study

Purpose Survivors of childhood cancer are at high risk of chronic conditions, but few studies investigated whether this translates into increased health care utilization. We compared health care service utilization between childhood cancer survivors and the general British population and investigated potential risk factors. Methods We used data from the British Childhood Cancer Survivor Study, a population-based cohort of 17,981 individuals diagnosed with childhood cancer (1940-1991) and surviving ��� 5 years. Frequency of talks to a doctor, hospital outpatient visits, and day-patient and inpatient hospitalizations were ascertained by questionnaire in 10,483 survivors and were compared with the General Household Survey 2002 data by using logistic regression. Results Among survivors, 16.5% had talked to a doctor in the last 2 weeks, 25.5% had attended the outpatient department of a hospital in the last 3 months, 11.9% had been hospitalized as a day patient in the last 12 months, and 9.8% had been hospitalized as an inpatient in the last 12 months. Survivors had talked slightly more often to a doctor than the general population (odds ratio [OR], 1.2; 95% CI, 1.1 to 1.3) and experienced increased hospital outpatient visits (OR, 2.5; 95% CI, 2.3 to 2.8), day-patient hospitalizations (OR, 1.4; 95% CI, 1.3 to 1.6) and inpatient hospitalizations (OR, 1.9; 95% CI, 1.7 to 2.2). Survivors of Hodgkin's lymphoma, neuroblastoma, and Wilms tumor had the highest ORs for day-patient care, whereas survivors of CNS tumors and bone sarcomas had the highest OR for outpatient and inpatient care. The OR of health care use did not vary significantly with age of survivor. Conclusion We have quantified how excess morbidity experienced by survivors of childhood cancer translates into increased use of health care facilities.

Substance use disorder treatment programs in Switzerland and the USA: Program characteristics and 1-year outcomes

AIM: This study compared matched samples of substance use disorder (SUD) patients in Swiss and United States (US) residential treatment programs and examined the relationship of program characteristics to patients' substance use and psychosocial functioning at a 1-year follow-up. DESIGN AND SETTING: The study used a prospective, naturalistic design and a sample of 10 public programs in the German-speaking part of Switzerland and 15 US public treatment programs. PARTICIPANTS: A total of 358 male patients in Swiss programs were matched on age, marital status and education with 358 male patients in US programs. A total of 160 Swiss and 329 US patient care staff members also participated. MEASUREMENT: Patients completed comparable inventories at admission, discharge and 1-year follow-up to assess their substance use and psychological functioning and receipt of continuing care. Staff members reported on program characteristics and their beliefs about substance use. FINDINGS: Compared to Swiss patients, US patients had more severe substance use and psychological problems at intake and although they did not differ on abstinence and remission at follow-up, had somewhat poorer outcomes in other areas of functioning. Swiss programs were longer and included more individual treatment sessions; US programs included more group sessions and were more oriented toward a disease model of treatment. Overall, length of program, treatment intensity and 12-step orientation were associated with better 1-year outcomes for patients in both Swiss and US programs. CONCLUSIONS: The sample of Swiss and US programs studied here differed in patient and treatment characteristics; however, in general, there were comparable associations between program characteristics and patients' 1-year outcomes. These findings suggest that associations between treatment processes and patients' outcomes may generalize from one cultural context to another.

Can outcome prediction data change patient outcomes and organizational outcomes?

PURPOSE OF REVIEW: Intensive care medicine consumes a high share of healthcare costs, and there is growing pressure to use the scarce resources efficiently. Accordingly, organizational issues and quality management have become an important focus of interest in recent years. Here, we will review current concepts of how outcome data can be used to identify areas requiring action. RECENT FINDINGS: Using recently established models of outcome assessment, wide variability between individual ICUs is found, both with respect to outcome and resource use. Such variability implies that there are large differences in patient care processes not only within the ICU but also in pre-ICU and post-ICU care. Indeed, measures to improve the patient process in the ICU (including care of the critically ill, patient safety, and management of the ICU) have been presented in a number of recently published papers. SUMMARY: Outcome assessment models provide an important framework for benchmarking. They may help the individual ICU to spot appropriate fields of action, plan and initiate quality improvement projects, and monitor the consequences of such activity.

Can RapidTEG accelerate the search for coagulopathies in the patient with multiple injuries?

Hypothesis: Early recognition of coagulopathy may improve the care of patients with multiple injuries. Rapid thrombelastography (RapidTEG) is a new variant of thrombelastography (TEG), in which coagulation is initiated by the addition of protein tissue factor. The kinetics of coagulation and the times of measurement were compared for two variants of TEG--RapidTEG and conventional TEG, in which coagulation was initiated with kaolin. The measurements were performed on blood samples from 20 patients with multiple injuries. The RapidTEG results were also compared with conventional measurements of blood coagulation. The mean time for the RapidTEG test was 19.2 +/- 3.1 minutes (mean +/- SD), in comparison with 29.9 +/- 4.3 minutes for kaolin TEG and 34.1 +/- 14.5 minutes for conventional coagulation tests. The mean time for the RapidTEG test was 30.8 +/- 5.72 minutes, in comparison with 41.5 +/- 5.66 minutes for kaolin TEG and 64.9 +/- 18.8 for conventional coagulation tests---measured from admission of the patients to the resuscitation bay until the results were available. There were significant correlations between the RapidTEG results and those from kaolin TEG and conventional coagulation tests. RapidTEG is the most rapid available test for providing reliable information on coagulopathy in patients with multiple injuries. This has implications for improving patient care.

Patientensicherheit in der Hausarztpraxis

Einleitung Aus der Schweizer Grundversorgung lagen bisher noch keine systematischen Daten zu kritischen Ereignissen und zum Sicherheitsklima vor. Aus diesem Grund wurde eine Befragung von ��rzten und Medizinischen Praxisassistentinnen (MPA) in Deutschschweizer Hausarztpraxen sowie ein Folgeprojekt spezifisch zur Telefon-Triage durchgef��hrt. Methoden Mit Hilfe eines standardisierten Fragebogens wurden Fachpersonen in Hausarztpraxen zu Sicherheitsrisiken und zum Sicherheitsklima in ihren Praxen befragt. Der Fragebogen enthielt neben Fragen zum Sicherheitsklima Beschreibungen von 23 kritischen Ereignissen in Hausarztpraxen, die bez��glich H��ufigkeit des Auftretens in der Praxis in den vergangenen zw��lf Monaten sowie der Schadensfolge beurteilt wurden, als das Ereignis zum letzten Mal in der Praxis aufgetreten ist. Zudem beantworteten ��rzte und MPA eine offene Frage, nach den f��r sie besonders relevanten Risiken f��r die Patientensicherheit in ihren Praxen. Im Folgeprojekt wurden Interviews und Gruppendiskussionen mit MPA und ��rzten gef��hrt, um eine Prozessanalyse der Telefon-Triage durchzuf��hren und ein Hilfsmittel f��r Hausarztpraxen zur St��rkung einer sicheren Telefon-Triage zu entwickeln. Ergebnisse 630 ��rzte und MPA (50,2% ��rzte, 49,8% MPA) haben an der Studie teilgenommen. 30% der ��rzte und 17% der MPA gaben an, mindestens einen der untersuchten Ereignisse t��glich oder w��chentlich in ihrer Praxis zu beobachten. Fehler bei der Dokumentation wurden am h��ufigsten beobachtet. Ereignisse, die sich aufgrund der Schadensfolge als besonders relevant erwiesen, waren Fehleinsch��tzungen bei Kontaktaufnahmen der Patienten mit der Praxis, Diagnosefehler, mangelnde ��berwachung von Patienten nach therapeutischen Massnahmen und Fehler in Zusammenhang mit der Medikation. Die Medikation (28% der Nennungen), medizinische Verrichtungen in der Praxis (11%) und die Telefon-Triage (7%) wurden am h��ufigsten als die Risiken genannt, die die Studienteilnehmer in ihren Praxen gerne eliminieren w��rden. In Bezug auf das Sicherheitsklima erwiesen sich insbesondere Teamsitzungen und regelm��ssige Qualit��tszirkel-Teilnahme als relevante Pr��diktoren f��r die Dimension ���Teambasierte Aktivit��ten und Strategien zur Fehlerpr��vention���. Berufsgruppenunterschiede zwischen ��rzten und MPA konnten sowohl hinsichtlich der berichteten Sicherheitsrisiken, als auch beim Sicherheitsklima beobachtet werden. Fazit Die Ergebnisse der Studie legen die Telefon-Triage als bislang wenig beachteten jedoch sehr relevanten Sicherheitsbereich in der Grundversorgung dar. Um die Sicherheit der Telefon-Triage zu st��rken, wurde ein Anschlussprojekt durchgef��hrt, aus dem heraus ein Leitfaden f��r Hausarztpraxen entwickelt wurde. Dieser Leitfaden soll ��rzte und MPA in einer gemeinsamen und kritischen Auseinandersetzung von Strukturen und Prozessen rund um die Telefon-Triage sowie der Entwicklung von Verbesserungsschritten unterst��tzen. Die systematisch beobachteten Berufsgruppenunterschiede sind ein wichtiger Hinweis daf��r, dass das gesamte Praxisteam in die Analyse von Sicherheitsrisiken und die Entwicklung von Massnahmen einbezogen werden sollte. Nur so k��nnen Risiken umfassend erfasst und f��r alle Fachpersonen relevante und getragene Verbesserungen initiiert werden. Dieser Ansatz der Team-Involvierung bildet die Basis f��r den Praxisleitfaden zur Telefon-Triage.

Sexual Health Education from the Perspective of School Staff: Implications for Adoption and Implementation of Effective Programs in Middle School

Introduction: US teens are having sex early; however, the vast majority of schools do not implement evidence-based sexual health education (SHE) programs that could delay sexual behavior and/or reduce risky behavior. This study examines middle school staff���s knowledge, attitudes, barriers, self-efficacy, and perceived support (psychosocial factors known to influence SHE program adoption and implementation). Methods: Professional school staff from 33 southeast Texas middle schools completed an internet or paper-based survey. Prevalence estimates for psychosocial variables were computed for the total sample. Chi-square and t-test analyses examined variation by demographic factors. Results: Almost 70% of participants were female, 37% white, 42% black, 16% Hispanic; 20% administrators, 15% nurses/counselors, 31% non-physical education/non-health teachers, 28% physical education/health teachers; mean age = 42.78 years (SD = 10.9). Over 90% favored middle school SHE, and over 75% reported awareness of available SHE curricula or policies. More than 60% expressed confidence for discussing SHE. Staff perceived varying levels of administrator (28%-56%) support for SHE and varying levels of support for comprehensive sex education from outside stakeholders (e.g., parents, community leaders) (42%-85%). Overall, results were more favorable for physical education/health teachers, nurses/counselors, and administrators (when compared to non-physical education/non-health teachers) and individuals with experience teaching SHE. Few significant differences were observed by other demographic factors. Conclusions: Overall, study results were extremely positive, which may reflect a high level of readiness among school staff for adopting and implementing effective middle school SHE programs. Study results highlight the importance of several key action items for schools.