Satisfação do paciente com a fisioterapia :tradução, adequação cultura e validação de um instrumento de medida

The measurement of patient satisfaction can provide information about the success of the care provider in reaching the values and meeting the expectations of the patient. The purpose of this study was to translate into the Portuguese language and to culturally customize to the Brazilian population the instrument to measure patient satisfaction with physical therapy elaborated by Goldstein et al. The study sample was made up of 279 patients who were undergoing physical therapy treatment at 39 different private clinics in a middle-sized town in northeastern Brazil. For the translation of the survey instrument, the back-translation technique was employed, in association with the bilingual method. The reliability and validity of the Brazilian version of the instrument were both assessed. Reliability analysis, carried out with the computation of Cronbach alpha coefficients, showed that the measures obtained with the instrument have a high degree of internal consistency. The aspects dealing with the patient therapist relationship are the most important predictors of satisfaction, followed by those dealing with courtesy, privacy, and practical aspects such as efficiency of the facility in the patient admissions process, setting up of appointments, and waiting time in waiting room. Items dealing with aspects such as location of the facility and availability of parking facilities may underestimate the reliability of the instrument. This study translated, culturally customized, and validated an instrument to measure patient satisfaction with physical therapy originally developed in English. By so doing, this study has made this instrument available to the Brazilian society, and it has rendered it a useful parameter that can be utilized in our country in the field of physical therapy

Avaliação macroscópica, microscópica e histomorfométrica do tecido cicatricial pós-cirúrgico de eqüinos submetidos a duas técnicas de neurectomia digital

Avaliou-se macro e microscopicamente o tecido cicatricial pós-operatório de eqüinos submetidos a duas técnicas de neurectomia digital: guilhotina (TG) e stripping (TS). Decorridos 14 meses das cirurgias, foram colhidas 32 amostras de tecido cicatricial em quatro éguas, que tiveram os membros submetidos a ambas as técnicas. À macroscopia, verificaram-se as dimensões da cicatriz do coto proximal e a distância entre os cotos proximal e distal. À microscopia, foi quantificada a proporção de tecido nervoso regenerado por meio de histomorfometria. Não houve diferença nas dimensões do tecido cicatricial, contudo a distância entre cotos foi 5,6 vezes maior na TS (P<0,001). Histologicamente, observou-se a presença de tecido conjuntivo frouxo e denso, macrófagos e fibras nervosas delgadas em ambas as técnicas cirúrgicas. Estruturas nodulares, compostas por fascículos nervosos, foram visualizadas em 56,2% (9/16) das amostras colhidas em nervos submetidos à TS. As porcentagens médias de tecido nervoso no tecido cicatricial foram de 0,31% na TG e 2,6% na TS (P<0,001). Concluiu-se que o retorno à sensibilidade nervosa deve demorar mais a ocorrer após a TS, devido à maior distância entre cotos. A maior proporção de tecido nervoso sugere que essa técnica favorece a regeneração nervosa.

Estudo clínico, cirúrgico e anatomopatológico de intussuscepção em quatro bovinos

Descrevem-se os achados clínico, cirúrgico e anatomopatológico de intussuscepção em quatro bovinos fêmeas. Observaram-se intussuscepção do jejuno, com obstrução total, em três animais, e intussuscepção do cólon, com obstrução parcial, em um animal. A presença de parasitismo intenso por Oesophagostomum sp. em dois animais sugere a participação desse parasita na gênese da intussuscepção.

Vivências de familiares do paciente internado em unidade de terapia intensiva: estudo fenomenológico

This study originated from my concerns as critical care nurse, regarding the lived experience of the family member of the patient that is hospitalized in the intensive care unit - ICU. The purpose of the study was to comprehend the experience of the family members while having a loved one interned in an ICU, and to identify the common elements of the phenomenon, based on the descriptions of their experiences. Considering that the object of study involves subjective and social questions, the study was conducted using some fundamental ideas of descriptive phenomenology as a referential and the situated phenomenon as suggested by Martins and Bicudo (1989). Ten (10) family members of patients that were interned in the ICU of private hospital in Natal, RN were interviewed using the following leading question: What is it like to have a member of your family interned in the ICU? Five thematic structural categories emerged from the comprehensive analysis of the interviews: Fear of the family member s death; Lack of humanization; Social isolation; Confidence in the ICU; and Overload to the personal life. The description of the phenomenon enabled a new look at how the care team relates to the family members of the patients interned in the ICU, providing some guidance on how to construct a humanized care that involves the family and that is based on affective human relations. This involves a rethinking of the care provided by team to the family and stimulates the reformulation of personal and social attitudes, and of hospital organizational norms

O sofrimento do paciente na UTI : escutando a sua experiência

In tertiary care, the Intensive Care Unit (ICU) is nowadays one of the most complex settings in providing care to critically ill patients and could make the difference in favor of life. Nevertheless, the stigma of death which pervades the imagination when the ICU is mentioned and the excessive importance placed on machines rather than on the human being end up by causing distress to some extent. As the purpose of this investigation is to understand the distress caused to a patient in an ICU, it has been grounded on the following question: What kind of distress does a patient go through during his/her experience in an ICU? This study has, therefore, an analytical and reflexive character embedded in a qualitative dimension of a phenomenological approach based on narratives. To this purpose, five patients were interviewed from November to December 2008. Out of the empirical material gathered from these narratives we were able to identify several factors that cause distress to ICU patients. Among them were: the certainty that they are critically ill and fear death, a closed room, too much lighting, a typical loneliness arising from being isolated from family members and dear ones, lack of communication with the professional staff, and noise; besides having to undergo therapeutic procedures. In summary, although the ICU is seen as a place of distress, in many aspects and in accord with this research, such distress can and should be relieved. On the other hand, being near to death leads them to a redefinition of life, said the patients.

Conhecimento do enfermeiro sobre o processo de cuidar do paciente com traumatismo cranioencefálico

Estudo de caráter exploratório e descritivo, de abordagem quantitativa, realizado num hospital de urgência hospitalar referência em traumatologia, em Natal/RN, com o objetivo de identificar o conhecimento do enfermeiro a respeito da ECGl para avaliação do nível de consciência e do processo de cuidar na fase pré-hospitalar e hospitalar às vítimas de TCE. A população constou de 44 enfermeiros e os dados foram coletados entre abril e maio de 2010. Os resultados mostram que, 35 (79,5%) dos enfermeiros eram do sexo feminino; 17 (38,64%) estavam na faixa etária entre 24 a 30 anos e 12 (27,27%) entre 51 a 60 anos; 25(56,82%) solteiros, 30 (68,18%) católicos e 25 (56,82%) sem filhos; 40 (90,90%) eram formados por instituições públicas, 18 (40,92%) tinham tempo de serviço na enfermagem acima de 21 anos e 14 (31,82%) até quatro anos; 18 (40,91%) estavam alocados nas UTIs e 13 (29,55%) atuavam em mais de um setor e 20 (65,90%) possuíam especialização. Dos que estavam mais especializados, 18 (40,92%) tinham tempo de serviço até quatro anos e 08 (34,48%) acima de 21 anos. Todos relataram ter prestado assistência às vítimas de TCE e 36 (81,82%) sentiam-se preparados; 35 (46,67%) adquiriram essas informações na prática e apenas 8 (10,67%) na graduação. Em relação a opinião dos pesquisados sobre os empecilhos que dificultam esta assistência, 23 (23,01%) relataram déficit de recursos humanos e 19 (20,65%) despreparo da equipe de enfermagem, estrutura física inadequada e recursos materiais precários. Como propostas de solução para os problemas, 26 (47,27%) sugeriram reforma na gestão e 13 (23,63%) referiram educação continuada. Em relação a ECGl, 40 (90,1%) afirmaram conhecê-la, 33 (82,50%) a utilizavam, 32 (80%) conheciam sua finalidade, 25 (62,5%) acertaram os indicadores fisiológicos e 36 (90%) classificaram corretamente a gravidade do TCE. Dos enfermeiros que utilizam a ECGl, 23 (92%) conheciam seus indicadores e classificação e 20 (60,61%) utilizavam uma vez por plantão. Em relação às dificuldades no manejo da ECGl, 11 (21,58%) não tinham nenhum problema; 10 (19,60%) citaram a falta de tempo e com o mesmo percentual responderam interpretação da resposta verbal nos pacientes intubados. Quanto ao conhecimento dos enfermeiros na descrição do processo de cuidar, 31 (70,45%) das respostas da fase pré e 35 (79,55%) da hospitalar não possuíam etapas importantes, sendo consideradas como incorretas. Quanto à afirmativa dos enfermeiros em estar, e realmente estar preparados para esta assistência, detectamos que daqueles que disseram estar preparados, apenas 12 (33,33%) acertaram todos os passos do atendimento pré hospitalar e 6 (16,67%) no atendimento hospitalar. Concluímos que diante dos resultados obtidos, os enfermeiros conhecem a ECGl, no entanto, necessitam de capacitação para sua melhor compreensão e utilização. Quanto ao conhecimento do processo de cuidar aos pacientes com TCE, é necessário modificar urgente esta realidade, especialmente na atenção às ações desenvolvidas pelo enfermeiro no âmbito hospitalar, onde as consequências das lesões secundárias, muitas delas evitadas com diagnóstico precoce e intervenções imediatas, podem acarretar incapacidades permanentes e prejudicar a qualidade de vida desses indivíduos

Assistência aos portadores de úlceras venosas: proposta de protocolo

Venous ulcers (VU), recurrent chronic wounds resulting from Chronic Venous Insufficiency (CVI), affect different age groups and would severely affect ambulation of patients. The lesions require treatment lasting and complex and are responsible for significant morbidity and mortality. Thus, this study aims to identify the important aspects covered in the scientific literature protocol for assisting patients with venous ulcers, identifying the issues to be proposed by the judges of the study (nurses, doctors and physiotherapists) to the protocol of care provided to patients venous ulcers and present the structure of protocol proposed by the judges of the study to assist patients with venous ulcers treated at a referral hospital of Rio Grande do Norte. This is a descriptive study using a quantitative approach, carried out at the dressings, located in the outpatient surgical clinic of the Hospital University Onofre Lopes (HUOL), located in East Sanitary District, Natal-RN. The sample consisted of 39 professionals, 30 nurses, seven doctors and two physical therapists, team members HUOL surgical clinic and other public and private institutions of Rio Grande do Norte and Jequié/Bahia. These professionals were the judges responsible for selecting the guidelines already proposed in the literature on VU protocols. Approved by the Ethics in Research HUOL (Report n.o 081/07), began the first stage of the study which consisted of reviewing the scientific literature about the relevant aspects to be included in a protocol for assisting patients with VU. These aspects were organized into a proposed questionnaire to the judges of the study. Following examination, held on the content validation with application of the Kappa (K), accepting a score higher than 0.80 and the Likert Scale, whereas rates from 4.0 to 5.0. The data collected were organized in Microsoft Excel and exported into Statistical Package for Social Sciences (SPSS) 15.0. The literature review included national and international scientific articles, thesis, dissertation and institutional protocols. Regarding the characterization of professional nurses predominated (76.1%), between 34 and 45 years (41.0%), female (79.5%), married/consensual union (46.2%), with specialization in VU care (61.5%), working in the hospital network (46.1%), with up to 5 years experience in VU (69.2%) and claiming to feel prepared to care for these injuries (92.3 %). With regard to aspects that had very good agreement (K ≥ 0.81), remained the items found in the literature with some modifications. In the analysis of the proposed evaluation items had very important, ranging from 4.1 (drug treatment) to 4.9 (patient assessment and care of the injury and the injured and perilesional skin). The proposition of the protocol is arranged in eleven items: A) Evaluation of patient and lesion, B) Registration and documentation, C) the wound and perilesional skin, D) an indication of coverage, E) Use of antibiotic and pain treatment, F) Surgical treatment of CVI, G) Drug treatment, H) Improving venous return and prevetion of recurrence, I) Referral of patients, J) Training and K) Reference and counter reference

A roda da vida: revelações de uma paciente em hemodiálise.

Reconstruct, from listening, the life histories of a chronic renal patient, submitted to hemodialysis, is the objective of this investigation. How methodological procedure,we worked with oral history of life, ,according Meihy, within a qualitative approach. For this, we had the approval of the Ethics Committee in Research of Hospital Universitário Onofre Lopes (HUOL), under protocol no 591/2011. As instrument to approach the patient, we did interviews with open questions, conducted in the patient's house. There were five meetings, in which we hear his story, experiences and ways of coping during their course of illness and treatment. The analysis was based on the collaborator's narratives, anchored in studies dealing with oral history, of human subjectivity, highlighting the resilience, as indicated Cyrulnik. Her story leads us to conclude that despite the adversities of life and suffering, there is in humans, the strength to navigate the streams and be happy. This is the lesson that leaves us the collaborator this study.

Segurança do paciente no sistema de medicação: análise de enfermeiros de um hospital de ensino

This study aimed to identify and describe the factors related to Patient Safety in a medication system according to the nurses analysis in a teaching hospital from the photographic analysis method. This was a cross-sectional, descriptive study with mixed approach in a teaching hospital in Rio Grande do Norte. The population consisted of 42 nurses from inpatient units, of which 34 composed the study sample. As eligibility criteria, we defined nurses from public service and nurses who agreed to participate. Ethical determinations were observed, the study was submitted to the Ethics and Research of the University Hospital Onofre Lopes, obtaining the assent with ethical assessment certificate (CAAE 0098.0.051.294-11). For data collection, we used the photographic method (Photographic Analysis Technique) by Patricia Marck (Canada). It was developed in two phases: at first, we randomly captured photos from the medication system, resulting in 282 images; then we selected/processed the photographs, which were reduced to 10 images in Microsoft Excel 2010; in the second phase, the nurses answered the questionnaire divided into socio-professional profile and Digital Photography Scoring Tool (questions a and b ). For analysis of the question a , we used the content analysis technique, and for b , we used the Statistical Package for the Social Sciences 20.0 (temporary license). The socio-professional profile revealed the predominance of females; age group 34-43 years; professionals with specialization; 10-18 years of length of service; and nurses working exclusively in the hospital and who know the Patient Safety. The photographic analysis in relation to Patient Safety resulted in specific categories for each stage of the medication system. Regarding disposal, we identified Proper verification ; Improper verification ; Correct identification ; Disposal in single doses ; and Improper Environment , with predominance of that last category. As for storage: Proper storage ; Improper storage ; Risk of exchange/disappearance ; and Poor hygiene , with special reference to improper storage. In preparation: Risk of exchanging medication/patient ; Inappropriate physical space ; and Inadequate 9 preparation of controlled drugs , highlighting the first category. In drug administration: Lack of Personal Protective Equipment ; Use of Personal Protective Equipment ; Improper administration technique ; Proper administration technique ; Correct drug identification ; Incorrect drug identification ; and Peripheral venous access without identification . From the safety assessment of 10 photographs, by adapting the scores (1-10) to the Likert Scale, we identified three Totally Unsafe (Level 1), three Unsafe (Level 2), three Partially Safe (Level 3), one Safe (Level 4), and no photograph considered Totally Safe. This study identified the prevalence of unsafety in the medication system in the nurses opinion. We were also able to understand that, although nurses identify safety aspects, the most prevalent categories characterize an unsafe assessment. Nursing needs to reflect on its practice, identifying gaps in the medication system in order to achieve a proper and safe care

Protocolo de avaliação do cuidado de enfermagem e da segurança do paciente em unidades de terapia intensiva

The reports of adverse events date from 1990 up to the present day. Conceptually, these adverse events are unintentional injuries unrelated to the underlying disease, causing measurable lesions in patients, extending the period of hospitalization, or leading to death. These issues require discussions with regard to patient safety, improved quality of service, and preventing medical errors. In the Intensive Care Units, this concern is greater because these are sectors of intensive care to individuals with hemodynamic changes and imminent risk of death. Therefore, it is essential to conduct evaluation processes to investigate aspects of quality of nursing care and patient safety in these spaces. For that reason, we aimed to propose the Evaluation protocol of nursing care and patient safety in Intensive Care Units. For its achievement, we needed to: 1) analyze the evolution of the patient safety concept used in scientific productions, under Rodgers evolutionary concept; 2) identify the necessary items to build the evaluation protocol of nursing care and patient safety in the Intensive Care Unit, from the available evidence in literature; 3) construct an instrument for content validation of the evaluation protocol of nursing care and patient safety in the Intensive Care Unit; and 4) describe and evaluate the appropriateness of the content for an evaluation protocol of nursing care and patient safety in the Intensive Care Unit. This is a methodological study for the content validation of the abovementioned protocol. To meet the first three specific objectives, we used the integrative literature review in Theses Database of the Coordination for the Improvement of Higher Education Personnel and the portal of the Collaborating Centre for Quality of Care and Patient Safety. The fourth specific objective happened through the participation of judges, located from the Lattes curricula, in the content validation process developed in two stages: Delphi 1 and Delphi 2. As instrument, we used the electronic form of Google docs. We present in tables the answers from the evaluation instruments by Delphi consensus and Content Validity Index (CVI) of the entire protocol. We summarized the results in articles entitled Analysis of the patient safety concept: Rodgers evolutionary concept ; Scientific evidence regarding patient safety in the Intensive Care Unit ; Technological device for the content validation process: experience report ; and Evaluation protocol of nursing care and patient safety in Intensive Care Units. The Embodied Opinion of the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte, No. 461,246, under CAAE 19586813.2.0000.5537, approved the study. Thus, we conclude the protocol valid in its content, constituting an important tool for evaluating the quality of nursing care and patient safety in Intensive Care Units

Clima e cultura de segurança do paciente em uma maternidade escola: percepção dos profissionais de enfermagem em terapia intensiva

Since the publication of the report "To Err is Human" by the Institute of Medicine (IOM) , which estimated that between 44.000 to 98.000 Americans die annually as a result of errors in health care, patient safety spent gaining prominence, emerging studies assess the safety culture by measuring the safety climate. In this context, the aim of this study was to identify safety culture perceived by nursing professionals working in the intensive care unit of a maternity school in Natal/RN through the Security Attitudes Questionnaire (SAQ). This was a descriptive study, cross-sectional and quantitative approach undertaken in the Intensive Care Unit Maternal and Neonatal a maternity school in Natal/RN. The project was submitted to and approved by Brazil Platform Zip/UFRN under number 309 540 and CAAE 16489713.7.0000.5537. It was used to collect data two instruments: a questionnaire in order to collect socio-demographic data of the subjects and the Questionário Atitudes de Segurança , a cultural adaptation to Portuguese of the instrument of the World Health Organization titled Safety Attitudes Questionnaire - (SAQ ) Short Form 2006. The collected data were analyzed quantitatively by the organization in electronic databases in Microsoft Excel 2010 spreadsheet and exported to statistical software for free access to be coded, tabulated and analyzed using descriptive statistics. The study included a total of 50 nurses, 31 and 19 of the NICU Maternal ICU, predominantly female, mean age 35 years, median time of 10 years training and working in maternity, mostly, less than 05 anos. As a result, two articles were produced. The first refers to the first two domains of the instrument entitled "climate of teamwork" and "climate security" . The scores of the two areas were slightly higher in Maternal ICU compared to the NICU, but no sector has reached the ideal minimum score of 75: in the first domain Maternal ICU had an average of 74.77, with medians of 75 and 100, while Neonatal ICU reached an average of 69.61 with median also 75 and 100, while the second field means were 69.35 and 66.01 for Maternal and Neonatal ICUs respectively, with a median of 100 in the two sectors. The second article relates to the field "Perception Management Unit and Hospital", which 9 assessed the perception of management units and motherhood by professionals. In general, the items of the domain in question also obtained scores below the ideal minimum: 63.68 to 51.02 and maternal ICU for neonatal, featuring a clear separation between the management and the professionals who work in direct care. These findings indicate a warning sign for the institution and point to the need to implement actions aimed at patient safety

Revisitando o eletrocorticograma intra-operatório na epilepsia mesial do lobo temporal: relevância das oscilações de alta frequência

Epilepsies are neurological disorders characterized by recurrent and spontaneous seizures due to an abnormal electric activity in a brain network. The mesial temporal lobe epilepsy (MTLE) is the most prevalent type of epilepsy in adulthood, and it occurs frequently in association with hippocampal sclerosis. Unfortunately, not all patients benefit from pharmacological treatment (drug-resistant patients), and therefore become candidates for surgery, a procedure of high complexity and cost. Nowadays, the most common surgery is the anterior temporal lobectomy with selective amygdalohippocampectomy, a procedure standardized by anatomical markers. However, part of patients still present seizure after the procedure. Then, to increase the efficiency of this kind of procedure, it is fundamental to know the epileptic human brain in order to create new tools for auxiliary an individualized surgery procedure. The aim of this work was to identify and quantify the occurrence of epilepticform activity -such as interictal spikes (IS) and high frequency oscillations (HFO) - in electrocorticographic (ECoG) signals acutely recorded during the surgery procedure in drug-resistant patients with MTLE. The ECoG recording (32 channels at sample rate of 1 kHz) was performed in the surface of temporal lobe in three moments: without any cortical resection, after anterior temporal lobectomy and after amygdalohippocampectomy (mean duration of each record: 10 min; N = 17 patients; ethic approval #1038/03 in Research Ethic Committee of Federal University of São Paulo). The occurrence of IS and HFO was quantified automatically by MATLAB routines and validated manually. The events rate (number of events/channels) in each recording time was correlated with seizure control outcome. In 8 hours and 40 minutes of record, we identified 36,858 IS and 1.756 HFO. We observed that seizure-free outcome patients had more HFO rate before the resection than non-seizure free, however do not differentiate in relation of frequency, morphology and distribution of IS. The HFO rate in the first record was better than IS rate on prediction of seizure-free patients (IS: AUC = 57%, Sens = 70%, Spec = 71% vs HFO: AUC = 77%, Sens = 100%, Spec = 70%). We observed the same for the difference of the rate of pre and post-resection (IS: AUC = 54%, Sens = 60%, Spec = 71%; vs HFO: AUC = 84%, Sens = 100%, Spec = 80%). In this case, the algorithm identifies all seizure-free patients (N = 7) with two false positives. To conclude, we observed that the IS and HFO can be found in intra-operative ECoG record, despite the anesthesia and the short time of record. The possibility to classify the patients before any cortical resection suggest that ECoG can be important to decide the use of adjuvant pharmacological treatment or to change for tailored resection procedure. The mechanism responsible for this effect is still unknown, thus more studies are necessary to clarify the processes related to it

Eficácia do tratamento não-cirúrgico em indivíduos com mucosite peri-implantar

It has been shown that the development of peri-implant mucositis is associated with biofilm accumulation. It is believed that the therapeutic approaches used in periodontal disease may have a positive effect in the cases of peri-implant disease. The aim of this study was to evaluate the effectiveness of non-surgical treatment of peri-implant mucositis, with or without the use of chlorhexidine 0,12% in subjects rehabilitated with osseointegrated implants. Thus, patients were randomly divided into test group (chlorhexidine surgical therapy) and control (non-surgical treatment). This therapy consisted of an adaptation of the (Full Mouth scalling and Root Planing) nonoperative protocol FMSRP, but without the use of ultrasound. The visible plaque index (VPI), gingival bleeding index (GBI), probing depth (PD), bleeding on probing (BOP) and keratinized mucosa clinical parameters were evaluated at baseline and at different times after treatment. The data were not normally distributed and the implant was considered the sampling unit. Data were analyzed using Fri edman and Wilcoxon chi-square (=5%), tests using the Statistical Package for Social Sciences 17.0 (SPSS). Thus, 119 implants were evaluated, 61 in the test group and 58 in the control group. The results showed statistically significant differences for the variables: average BTI implants in both groups (p<0,001), mean ISG implants both in the test group (p<0,001), and control (p= 0,006) of implants; PS for the test group (p< 0,001) and control (p = 0,015) and SS (p<0,001) in the two treatment groups. However, there was no statistically significant difference when the groups were compared. The PS and SS variables showed no statistically significant difference in any of independent interest to the study (age, sex, smoking, treatment group, keratinized mucosa at different times, peri-implant biotype, average VPI implants and GBI). Thus, it can be concluded that both the mechanical treatment isolated as its association with chlorhexidine mouthwash 0.12% can be used for the treatment of peri-implant mucositis. Moreover, the condition of oral h ygiene has improved between baseline and six months and the depth and bleeding on probing decreased after three and six months

O cotidiano do(a) Assistente Social frente as demandas apresentadas pela paciente portadora do câncer de mama em tratamento no Hospital Doutor Luiz Antônio em Natal/RN

This work deals with an analysis related to the social worker s practice in the oncology area. It aims to identify demands, work conditions as well as current challenges related to this profession. It considers the specificities of breast cancer and relates it to political decisions in the health sector considering the concept of contemporary capitalism. The study analyzes professional action and the demands presented by breast cancer patients who are currently in treatment in Hospital Dr. Luiz Antônio em Natal-Rio Grande do Norte-Brazil. The methodological procedures considered of documental analysis, semi-structured interviews (with two social workers that work with fifteen breast cancer patients) as well as participant observation; which was done counting with my own professional practice in the oncology area. Thus, the research also discusses the breast cancer issue in the life of the users considering their social-economical, cultural and political determinants. Factors such as age in which the diagnosis was known, the relation user/social workers, number of children, rights of the oncology patient, place where he/she lives, education, civil status, (re)insertion of the professional in the work field, perception of self-esteem and bio-psycho-social representation of breast cancer in the lives of these women, all of which were dealt with in this research

O paciente com infecção de vias aéreas superiores. Quando anestesiar?

JUSTIFICATIVA E OBJETIVOS: Anestesiar, com segurança, a criança com infecção de vias aéreas superiores (IVAS) constitui um dos grandes desafios do anestesiologista. A finalidade deste artigo é discutir a validade de anestesiar e quando anestesiar a criança com IVAS. CONTEÚDO: Estão ressaltados a importância da história clínica na investigação pré-operatória, os fatores que contribuem para o aparecimento de complicações no per e no pós-operatório, assim como o tipo de cirurgia e a técnica anestésica que favorecem estas complicações. CONCLUSÕES: O conhecimento das alterações no trato respiratório que acontecem após IVAS, da importância da avaliação correta da gravidade dos sintomas, dos fatores que podem contribuir para o aparecimento de complicações e da melhor técnica anestésica possibilita a seleção de pacientes com menor risco de desenvolver complicações no período per-operatório.