Orientações de alta: cartões padronizados ajudam na compreensão dos pacientes do pronto socorro?

OBJECTIVE: To determine whether the addition of discharge standard illustrated cards improves understanding of patients in the emergency room. METHODS: We conducted a prospective, randomized, interventional study with 228 patients discharged from the emergency department. All patients were interviewed and tested for the level of understanding of discharge instructions. Some of them received the intervention, with the standard cards, and another did not, constituting the control group. RESULTS: The average of followed discharge guidelines of the group that received the cards was higher than the control group, with statistical significance (p=0.009). When segregated by age, the group between 16 and 35 years of both sexes had the best average of followed guidelines, statistically, than the average of the control group (p=0.01). The difference between the mean orientations between the control group and the card for patients undergoing procedures was statistically significant (p=0.02); as for the stratification according to the number of procedures, the significance increases when that is equal to 1 (p=0.001) and decreased the more procedures were carried out. CONCLUSION: The introduction of discharge standard orientation cards was associated with improvement in the understanding of patients. Without replacing the verbal directions, which establishes dialogue and doctor-patient bonding, cards appear as auxiliary elements, facilitating understanding and care guidelines.

Práticas educativas de mães de bebês: efeitos de um programa de intervenção

This research aims to describe the effects of an intervention program focusing on parenting practices of mothers of babies by comparing pre- and post -test (intragroup comparison) performed with groups of adolescent mothers and adult mothers (intergroup comparison). Participants were 40 mothers, 20 adolescents and 20 adults. To collect data we used the Parenting Styles Inventory for Mothers of Babies (IEPMB), applied before and after the intervention, which is characterized for ten weekly meetings on topics related to the cycle of human development and parenting practices. The results showed significantly better educational practices for adolescent mothers compared to adult mothers especially in the first evaluation conducted. The intervention group was effective for most participants, adults and adolescents, who improved their parenting practices or remained appropriate. It discusses the importance of interventional groups to improve parenting practices of mothers of babies.

Simulation-based ultrasound-guided central venous cannulation training program

PURPOSE: To propose a simulation-based ultrasound-guided central venous cannulation skills' training program, during residency.METHODS: This study describes the strategies for learning the ultrasound-guided central venous cannulation on low-fidelity bench models. The preparation of bench models, educational goals, processes of skill acquisition, feedback and evaluation methods were also outlined. The training program was based on key references to the subject.RESULTS: It was formulated a simulation-based ultrasound-guided central venous cannulation teaching program on low-fidelity bench models.CONCLUSION: A simulation-based inexpensive, low-stress, no-risk learning program on low-fidelity bench models was proposed to facilitate acquisition of ultrasound-guided central venous cannulation skills by residents-in-training before exposure to the living patient.

Laparoscopic Heller Myotomy and Fundoplication in Patients with Chagas' Disease Achalasia and Massively Dilated Esophagus

Laparoscopic Heller myotomy and fundoplication is considered today the treatment of choice for achalasia. The optimal treatment for end-stage achalasia with esophageal dilation is still controversial. This multicenter and retrospective study aims to evaluate the outcome of laparoscopic Heller myotomy in patients with a massively dilated esophagus. Eleven patients (mean age, 56 years; 6 men) with massively dilated esophagus (esophageal diameter greater than 10 cm) underwent a laparoscopic Heller myotomy and anterior fundoplication between 2000 and 2009 at three different institutions. Preoperative workup included upper endoscopy, esophagram, and esophageal manometry in all patients. Average follow-up was 31.5 months (range, 3 to 60 months). Two patients (18%) had severe dysphagia, four patients (36%) had mild and occasional dysphagia to solid food, and five patients (45%) were asymptomatic. All patients gained or kept body weight, except for the two patients with severe dysphagia. Of the two patients with severe dysphagia, one underwent esophageal dilatation and the other a laparoscopic esophagectomy. They are both doing well. Heller myotomy relieves dysphagia in the majority of patients even when the esophagus is massively dilated.

Five Percent 5-Fluorouracil in a Cream or for Superficial Peels in the Treatment of Advanced Photoaging of the Forearms: A Randomized Comparative Study

BACKGROUND The antimetabolite 5-fluorouracil (5-FU) is used for topical treatment of actinic keratosis. Overall improvement in the skin is also observed. Additionally, 5-FU was reported to be used for superficial peels.OBJECTIVES To evaluate the efficacy and safety of 5% 5-FU cream compared with peels for photodamaged forearms.METHODS This interventional, randomized, comparative, evaluator-blind study included 32 patients with severe photoaging of forearms. The regimens comprised either application of 5% 5-FU cream everyday for 4 weeks on 1 forearm and 4 weekly peels on the other. Efficacy assessment included: clinical photodamage scores, opinion of patients and investigators, and blind photographic evaluation by independent observers. Skin biopsies were performed for histologic and immunohistochemical analysis. Safety evaluation comprised observation of adverse events.RESULTS Clinical and histologic findings confirmed the benefits of topical 5% 5-FU, in cream or peels, which improved skin appearance and decreased the dermal elastotic material. Immunohistochemistry showed reduced levels of epidermal p53 and increase in the level of procollagen I. Results were maintained after 6 months. Predictable adverse events occurred, with no differences between treatments. Patients reported better tolerability to peels.CONCLUSION Five percent 5-FU cream or peels was safe and effective for the treatment of photodamaged forearms. Decreased epidermal p53 levels and new dermal collagen were confirmed.

Endoscopic approach for a laryngeal neoplasm in a dog

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

Efeito da aldosterona e da espironolactona na hipertrofia ventricular esquerda em pacientes com doença renal crônica em hemodiálise

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

Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.

Valor de corte para teste respiratório com isótopos estáveis (Carbono 13) no diagnóstico do Helicobacter pylori utilizando IRMS para análise do sopro

After the isolation of Helicobacter pylori from an injury at the stomach mucosa by Marshall and Wareen, work that was recognized with the Nobel Prize of Medicine or Physiology in 2005, many other works showed the relationship between the presence of H. pylori and diseases at the digestive system, such as gastritis, gastric, duodenal and peptic ulcer, and stomach cancer. The 13C-Urea Breath Test - 13C-UBT is a non-invasive diagnostic method that utilizes the breath of a patient to determine the presence of H. pylori through stable isotopes. This work aimed to find an ideal 13C-UBT Isotopic Ratio Mass Spectroscopy cut-off value (a threshold between positive and negative) to diagnose H. pylori infection at Brazilian population. Patients were selected at the UNESP-Botucatu Clinical Hospital Endoscopy Section. With these results it was possible to indicate that the best cut-off value is between 2.5 to 6 ‰ of Delta Over Baseline (DOB)

Endoscopia do trato gastrointestinal de cães e gatos

Endoscopy of the gastrointestinal tract is a specialized minimally invasive diagnostic method and with both diagnostic and therapeutic possibilities. It is divided into two major groups, the rigid and flexible endoscopy. The first most widely used for visualization of body cavities that do not have a light, like the chest, for example, and the second for those with light as the gastrointestinal tract. In Brazil there are few professionals, veterinary hospitals or clinics that offer this type of service. Thus, endoscopy is an area of expertise of the veterinarian who is in huge expansion and has shown great applicability with excellent results in both clinical medicine and surgical small animals

Principais aspectos cirúrgicos da urolitíase em cães

Urolithiasis occurs with relatively frequency among the diseases that affect the urinary tract of dogs. It`s fundamental that samples of the uroliths are sent for analysis, because, in agreement with the mineral composition of the urolith and also its location, the choice is made between the surgical treatment or the clinical dissolution. Cystotomy is the surgical technique more accomplished in the bladder of small animals, due to its simplicity, when in comparison with other procedures for removal of calculi. With the aid of lithotripsy and endoscopy, the surgical interventions in the urinary treatment tend to be less and less invasive, minimizing the risks of subsequent complications. Chances of recurrence of the urolithiasis are usually larger in patients submitted to the surgical intervention. Besides, the time elapsed among regressive episodes is larger after the clinical dissolution

Tempo Ideal para a coleta do sopro no teste respiratório com isótopos estáveis (13C) para o diagnóstico do Helicobacter pylori

A study was conducted to determine the optimal time for collecting the breath examination urea breath marked with the stable isotope 13C. We selected patients before undergoing the examination of endoscopy at the Endoscopy Section of the University Hospital of Botucatu - SP. A screening was performed to determine which patients wanted and could participate. Before performing endoscopy basal sample was collected from the patient and then the labeled urea ingested. The blows were collected in double every 2.5 minutes until an interval of 30.0 minutes after were collected every 5.0 minutes until the time of 45.0 minutes . The samples were analyzed in a mass spectrometer for isotope ratio, located in the center of Stable Isotopes, Institute of Biosciences, UNESP - Botucatu campus. The data were studied and arranged in the form of graphics to better interpretation of results. Based on the obtained results it was determined that a standby time of 15.0 minutes to collect the wind is sufficient for accurate diagnosis and effective

Curso de formação inicial em sexualidade: relato de uma proposta interventiva

The present study aimed to identify the conceptions of students of a Pedagogy course about infantile sexuality and gender relations, checking the needs that they appointed concerning studies about sexuality and sex education in their graduation. Using this information, the authors implemented an interventional course. The instruments used for data collection were two questionnaires. 342 students participated in the first phase of the study, corresponding to the completion of the questionnaire. 38 people participated on the second step – applying the course. The issues they indicated as necessary in their course were: sexuality, sex education, child sexuality, sexual abuse, adolescence and sexuality and disability. Finally, the results of the course were very satisfactory, however, reveals how much we still need to do for training professionals to implement the work of sex education in the school context.

Longitudinal results of a 10-year clinical trial of repair of amalgam restorations

The aim of this prospective, blind, and randomized clinical trial was to assess the effectiveness of repair of localized clinical defects in amalgam restorations that were initially scheduled for replacement. A cohort of 20 patients with 40 (Class I and Class II) amalgam restorations that presented one or more clinical features that deviated from the ideal (Bravo or Charlie) according to US Public Health Service criteria, were randomly assigned to either the repair or the replacement group—A: repair, n = 19; and B: replacement, n = 21. Two examiners who had calibration expertise evaluated the restorations at baseline and 10 years after according to seven parameters: marginal occlusal adaptation, anatomic form, surface roughness, marginal staining, contact, secondary caries, and luster. After 10 years, 30 restorations (75%) were evaluated (Group A: n = 17; Group B: n = 13). Repaired and replaced amalgam restorations showed similar survival outcomes regarding marginal defects and secondary caries in patients with low and medium caries risk, and most of the restorations were considered clinically acceptable after 10 years. Repair treatment increased the potential for tooth longevity, using a minimally interventional procedure. All restorations trend to downgrade over time.

Triagem interventiva: a caracterização de uma demanda

This paper analyzes the process of sorting through the intervening demand survey that reaches the Center for Research and Applied Psychology (CPPA) “Dr. Betti Katzenstein” UNESP Assis. The objective was to better understand the reality of conflicts that people face and, therefore, to characterize the patients who seek help in CPPA. With greater understanding of demand, it is possible to trace more consistent referrals and tailor the service to the school clinic profile of clients that demand. Recalling that the actual attendance of screening is already a form of interventional care, because it provides patient care from first contact. This was a documentary research, which had collected their data sheets of the CPPA trials conducted in 2011. 394 screenings were performed. We present the distribution of the demand for sex, age and complaint that motivated the search for care. It can be concluded that the characterization allows a customer routing more efficient services offered at the institution, as it contributes to a better understanding delineated in each case and a reduced number of dropouts in the screening process.