Implementation of a Real-Time Documentation Assistance Tool: Automated Diagnosis (AutoDx).

BACKGROUND: Clinical documentation improvement programs are utilized by most health care systems to enhance provider documentation. Suggestions are sent to providers in a variety of ways, and are commonly referred to as coding queries. Responding to these coding queries can require significant provider time and do not often align with workflows. To enhance provider documentation in a more consistent manner without creating undue burden, alternative strategies are required. OBJECTIVES: The aim of this study is to evaluate the impact of a real-time documentation assistance tool, named AutoDx, on the volume of coding queries and encounter-level outcome metrics, including case-mix index (CMI). METHODS: The AutoDx tool was developed utilizing tools existing within the electronic health record, and is based on the generation of messages when clinical conditions are met. These messages appear within provider notes and required little to no interaction. Initial diagnoses included in the tool were electrolyte deficiencies, obesity, and malnutrition. The tool was piloted in a cohort of Hospital Medicine providers, then expanded to the Neuro Intensive Care Unit (NICU), with addition diagnoses being added. RESULTS: The initial Hospital Medicine implementation evaluation included 590 encounters pre- and 531 post-implementation. The volume of coding queries decreased 57% (p < 0.0001) for the targeted diagnoses compared with 6% (p = 0.77) in other high-volume diagnoses. In the NICU cohort, 829 encounters pre-implementation were compared with 680 post. The proportion of AutoDx coding queries compared with all other coding queries decreased from 54.9 to 37.1% (p < 0.0001). During the same period, CMI demonstrated a significant increase post-implementation (4.00 vs. 4.55, p = 0.02). CONCLUSION: The real-time documentation assistance tool led to a significant decrease in coding queries for targeted diagnoses in two unique provider cohorts. This improvement was also associated with a significant increase in CMI during the implementation time period.

Explanatory argumentation in natural language for correct and incorrect medical diagnoses.

BACKGROUND: A huge amount of research is carried out nowadays in Artificial Intelligence to propose automated ways to analyse medical data with the aim to support doctors in delivering medical diagnoses. However, a main issue of these approaches is the lack of transparency and interpretability of the achieved results, making it hard to employ such methods for educational purposes. It is therefore necessary to develop new frameworks to enhance explainability in these solutions. RESULTS: In this paper, we present a novel full pipeline to generate automatically natural language explanations for medical diagnoses. The proposed solution starts from a clinical case description associated with a list of correct and incorrect diagnoses and, through the extraction of the relevant symptoms and findings, enriches the information contained in the description with verified medical knowledge from an ontology. Finally, the system returns a pattern-based explanation in natural language which elucidates why the correct (incorrect) diagnosis is the correct (incorrect) one. The main contribution of the paper is twofold: first, we propose two novel linguistic resources for the medical domain (i.e, a dataset of 314 clinical cases annotated with the medical entities from UMLS, and a database of biological boundaries for common findings), and second, a full Information Extraction pipeline to extract symptoms and findings from the clinical cases and match them with the terms in a medical ontology and to the biological boundaries. An extensive evaluation of the proposed approach shows the our method outperforms comparable approaches. CONCLUSIONS: Our goal is to offer AI-assisted educational support framework to form clinical residents to formulate sound and exhaustive explanations for their diagnoses to patients.

Psicanálise profana: diagnóstico e experiência trans / Psychanalyse profane: diagnostic et expérience trans / Profane psychoanalysis: diagnosis and trans experience

Este artigo parte do exame da relação entre o poder de normalização, o dispositivo diagnóstico e a patologização da transexualidade para expor a função da norma em diferentes prismas na discussão sobre o normal e o patológico no contexto da experiência trans. São pautadas as dificuldades decorrentes dos pressupostos normativos que servem como diretrizes para políticas públicas e privadas de acesso ao processo transexualizador. Mediante uma discussão epistêmica, a experiência trans e sua patologização são analisadas em relação à função diagnóstica na psiquiatria e na psicanálise, observando o rigor de suas especificidades. Por fim, a orientação lacaniana é apresentada como alternativa à psiquiatrização e patologização da experiência trans, tendo em vista o seu distinto uso diagnóstico, o privilégio da singularidade em sua prática e o caráter subversivo de sua epistemologia.

Cet article commence par examiner la relation entre le pouvoir de normalisation, le dispositif de diagnostic et la pathologisation de la transsexualité pour exposer la fonction de la norme sous différents angles dans la discussion sur le normal et le pathologique dans le contexte de l'expérience trans. Les difficultés découlant des hypothèses normatives qui servent de lignes directrices aux politiques publiques et privées sur l'accès au processus de transsexualisation sont mises en question. À travers une discussion épistémique, l'expérience trans et sa pathologisation sont analysées en relation avec la fonction diagnostique en psychiatrie et en psychanalyse, en observant la rigueur de leurs spécificités. Enfin, l'orientation lacanienne est présentée comme une alternative à la psychiatrisation et à la pathologisation de l'expérience trans, compte tenu de son usage diagnostique distinct, du privilège de la singularité dans sa pratique et du caractère subversif de son épistémologie

This article begins by examining the relationship between the power of normalization, the diagnostic device and the pathologization of transsexuality to expose the function of the norm from different perspectives in the discussion about the normal and the pathological in the context of the trans experience. Difficulties arising from normative assumptions that serve as guidelines for public and private policies on access to the transsexualization process are examined. Through an epistemic discussion, the trans experience and its pathologization are analyzed in relation to the diagnostic function in psychiatry and psychoanalysis, observing the rigor of their specificities. Finally, the Lacanian orientation is presented as an alternative to the psychiatrization and pathologization of the trans experience, given its distinct diagnostic use, the privilege of singularity in its practice and the subversive character of its epistemology

Diagnosis: What Is the Structure of Its Reasoning?

How does the diagnosis process work? This essay traces the philosophical underpinnings of diagnosis from Hume through Kant, Peirce, and Popper, analyzing how pathologists amalgamate sensibility, intuition, and imagination to form new hypotheses that can be tested by evidence and experience.

Detección de las necesidades de capacitación de los asistentes de farmacia / Detection of training needs in pharmacy assistants

Introducción: La capacitación es, sin duda, uno de los temas actuales más importantes cuando se habla de competitividad, innovación y mejora continua de una empresa. Este proceso implica: detección de necesidades, planeación, implementación, evaluación, retroalimentación y seguimiento de resultados. El eje fundamental de este proceso es el Diagnóstico de Necesidades de Capacitación, pues señala de manera precisa los aspectos sobre los cuales ha de trabajar el capacitador. Objetivo: Realizar un diagnóstico de las necesidades de capacitación de los asistentes de farmacia del Municipio Santa Clara. Métodos: Para elaborar el Diagnóstico de Necesidades de Capacitación se utilizó el método comparativo. Este método se basa en la identificación de las discrepancias entre lo que es y lo debe ser, lo que posibilita constatar los requisitos que son necesarios cubrir. Se utilizaron como técnicas la entrevista y la encuesta. Resultados: Finalmente, después del análisis de todos los datos obtenidos de las matrices y preguntas abiertas, se elaboró el Diagnóstico de Necesidades de Capacitación final que se entregó a la Empresa Farmacias y Ópticas. Conclusiones: Estos resultados mostraron que esta empresa necesita de manera inmediata implementar actividades de capacitación a sus asistentes de farmacia en lo referente a conocimientos.

Introduction: training is, undoubtedly one of the most important current issues when talking about competitiveness, innovation and continuous improvement of a company. This process involves: detection of needs, planning, implementation, evaluation, feedback and monitoring of results. The fundamental axis of this process is the Diagnosis of Training Needs, since it indicates precisely the aspects on which the trainer must work. Objective: to carry out a diagnosis of the training needs in pharmacy assistants from Santa Clara municipality. Methods: the comparative method was use to prepare the Training Needs Diagnosis. This method is based on the identification of discrepancies between what is and what should be; it made possible to verify the necessary requirements to be met. Interviews and surveys were used as techniques. Results: Finally, after analyzing all the data obtained from the matrices and the open questions, a final Diagnosis of Training Needs was prepared and delivered to the Pharmacy and Optics Company. Conclusions: these results showed that this company needs to immediately implement training activities for their pharmacy assistants in terms of knowledge.

Encefalitis de Hashimoto. Presentación de un caso / Hashimoto Encephalitis. Case Report

INTRODUCCIÓN La Encefalitis de Hashimoto (EH) es una encefalopatía de naturaleza autoinmune, con buena respuesta al tratamiento con corticoides, títulos séricos elevados de anticuerpos antitiroideos y de curso subagudo con recaídas-remisiones. Es una enfermedad poco frecuente, con una presentación clínica variable y fisiopatología aún desconocida. PRESENTACIÓN DEL CASO: Paciente femenina de 76 años con antecedentes de hipotiroidismo primario. Ingresó con un síndrome confusional agudo. Al examen físico vigil, Glasgow 13/15, subfebril (37.8°C) desorientada temporoespacialmente, ecolalia, pupilas isocóricas y reactivas, sin focalidad neurológica. Signos meníngeos negativos. Laboratorio: Hipocalcemia leve (7.8mg/dl), hipopotasemia (K 3,2 mmol/l), PCR 221.9 mg/L. Test rápido para VIH negativo. TC de encéfalo sin alteraciones. Punción lumbar líquido cristal de roca, proteínas 1 g/l, glucosa 0.67 g/l, láctico 1.3, leucocitos 77 células/microL (100% mononucleares). Se interpretó inicialmente como Encefalitis de etiología viral y se le indicó aciclovir. Presentó sensorio alternante, excitación psicomotriz y convulsión tónica clónica generalizada. Debido a deterioro súbito del sensorio, se realizó intubación orotraqueal y se trasladó a Unidad de Terapia Intensiva (UTI). Permaneció bajo asistencia mecánica ventilatoria y con vasopresores. Laboratorio: VDRL, p24 y anticuerpos HIV negativos, TSH 27,82, T4 0,41. PCR de LCR: Virus herpes simple 1 y 2, citomegalovirus y JC negativos. Hemocultivos negativos. Ante sospecha clínica de Encefalitis de Hashimoto, se solicitaron anticuerpos antitiroideo peroxidasa (aTPO), antitiroglobulina (aTG) y Anticuerpos Anti-Receptor de TSH (TRABS), que resultaron positivos. Recibió tratamiento con levotiroxina endovenosa e hidrocortisona. Normaliza valores. Por fallo en el weaning, se realizó traqueostomía. Luego de 21 días de internación en Terapia Intensiva pasó a clínica con posterior alta hospitalaria. Discusión: La EH se puede considerar como diagnóstico, solo después de descartar otras causas. En el caso expuesto se llegó al diagnóstico luego de descartar otras causas posibles, con anticuerpos antitiroideos positivos en altas concentraciones y respuesta al tratamiento con corticoides. Conclusión: Se destaca la necesidad de ampliar el conocimiento de esta patología con el fin de disminuir el subdiagnóstico y promover un inicio precoz del tratamiento, mejorando así su progresión y calidad de vida de los pacientes.

INTRODUCTION: Hashimoto's Encephalitis (HE) is an autoimmune encephalopathy, with a good response to treatment with corticosteroids, high serum titers of antithyroid antibodies and a subacute course with relapses-remissions. It is a rare disease, with a variable clinical presentation and still unknown pathophysiology. CASE REPORT: A 76-year-old female patient with a history of primary hypothyroidism. She was admitted with acute confusional syndrome. On physical examination, she was awake, she was Glasgow 13/15, she was subfebrile (37.8°C), disoriented temporally, echolalia, isochoric and reactive pupils, without neurological focality. Negative meningeal signs. Laboratory: Mild hypocalcemia (7.8 mg/dl), hypokalemia (K 3.2 mmol/l), CRP 221.9 mg/L. Rapid test for HIV negative. Brain CT without alterations. Lumbar puncture rock crystal liquid, proteins 1 g/l, glucose 0.67 g/l, lactic acid 1.3, leukocytes 77 cells/microL (100% mononuclear). It was initially interpreted as Encephalitis of viral etiology and acyclovir was prescribed. He presented alternating sensory, psychomotor excitement, and generalized tonic-clonic seizure. Due to sudden deterioration of the sensorium, orotracheal intubation was performed and he was transferred to the Intensive Care Unit. He remained under mechanical ventilatory assistance and with vasopressors. Laboratory: VDRL, p24 and HIV antibodies negative, TSH 27.82, T4 0.41. CSF PCR: Herpes simplex virus 1 and 2, cytomegalovirus and JC negative. Negative blood cultures. Due to clinical suspicion of Hashimoto's Encephalitis, anti-thyroid peroxidase (aTPO), anti-thyroglobulin (aTG) antibodies and Anti-TSH Receptor Antibodies (TRABS) were requested, which were positive. She was treated with intravenous levothyroxine and hydrocortisone. Normalized values. Due to weaning failure, a tracheostomy was performed. After 21 days of hospitalization in the Intensive Care Unit, she was admitted to the clinic and subsequently discharged from the hospital. Discussion: HD can be considered as a diagnosis, only after ruling out other causes. In the case presented, the diagnosis was made after ruling out other possible causes, with positive antithyroid antibodies in high concentrations and response to treatment with corticosteroids. Conclusion: The need to expand knowledge of this pathology is highlighted in order to reduce underdiagnosis and promote early initiation of treatment, thus improving its progression and quality of life of patients.

[The multi-professional alliance in the diagnostic process]. / L'alliance pluriprofessionnelle dans la démarche diagnostique.

Professional support for elderly people suffering from cognitive impairment needs to be comprehensive, and requires the active involvement of a wide range of professionals. Two clinical cases show how the combined support of a therapeutic day-care center and medical specialists can improve the quality of life of patients and their families, by helping to refine diagnoses or adjust treatment.

Kairos in diagnostics.

Kairos has been a key concept in medicine for millennia and is frequently understood as "the right time" in relation to treatment. In this study we scrutinize kairos in the context of diagnostics. This has become highly topical as technological developments have caused diagnostics to be performed ever earlier in the disease development. Detecting risk factors, precursors, and predictors of disease (in biomarkers, pre-disease, and pre-pre-disease) has resulted in too early diagnoses, i.e., overdiagnoses. Nonetheless, despite vast advances in science and technology, diagnoses also come too late. Accordingly, timing diagnostics right is crucial. In this article we start with giving a brief overview of the etymology and general use of the concepts of kairos and diagnosis. Then we delimit kairos in diagnostics by analysing "too early" and "too late" diagnosis and by scrutinizing various phases of diagnostics. This leads us to define kairos of diagnostics as the time when there is potential for sufficient information for making a diagnosis that is most helpful for the person. It allows us to conclude that kairos is as important in diagnostics as in therapeutics.

Manejo y resultados de pacientes con diverticulitis aguda: experiencia de cinco años en el Hospital San Vicente Fundación / Management and results of patients with acute diverticulitis. Five year-experience at the San Vicente Fundación Hospital

Introducción. Los datos epidemiológicos de la diverticulitis en Colombia son limitados. El objetivo de este artículo fue caracterizar una población que ingresó con diverticulitis aguda al Hospital Universitario San Vicente Fundación, un centro de referencia de la ciudad de Medellín, Colombia, para analizar la presentación y comportamiento de la enfermedad en la población local, con estadísticas propias y desenlaces de la enfermedad en los últimos años. Métodos. Estudio observacional retrospectivo, descriptivo, entre enero de 2015 y diciembre de 2019. Se hizo un estudio exploratorio uni-, bi- y multivariado de factores de riesgo para fallo en el tratamiento y la mortalidad. Resultados. Se incluyeron 103 pacientes. Se presentó principalmente en mujeres y la edad promedio fue de 65 años. La diverticulitis Hinchey Ia fue la más frecuente (41,7 %) y el manejo médico fue exitoso en todos los casos, mientras que en las tipo III y IV, todos se manejaron de forma quirúrgica, con tasas de éxito entre el 50 y el 64 %. La presencia de signos de irritación peritoneal al examen físico, el recuento de leucocitos y la PCR, el ingreso a la Unidad de Cuidados Intensivos y la mortalidad aumentaron de forma directamente proporcional con el estadio de Hinchey. Conclusiones. Existe una relación directamente proporcional entre la clasificación de Hinchey y los signos de respuesta inflamatoria clínicos y paraclínicos, la necesidad de manejo quirúrgico, la estancia en la Unidad de Cuidados Intensivos y la mortalidad.

Introduction. Epidemiological data on diverticulitis in Colombia are limited. The objective of this article was to characterize a population that was admitted with acute diverticulitis to the San Vicente Fundación University Hospital, a reference center in the city of Medellín, Colombia, to analyze the presentation and behavior of the disease in the local population, with its own statistics, and outcomes of the disease in recent years. Methods. Retrospective descriptive observational study between January 2015 and December 2019. An exploratory uni-, bi- and multivariate study of risk factors for treatment failure and mortality was performed. Results. A total of 103 patients were included. The most frequent Hinchey classification was Ia (41.7%). It occurs mainly in women, mean age 65 years. Hinchey Ia diverticulitis is the most frequent and medical management is successful in 100% of cases; while in III and IV, 100% were managed surgically with success rates between 50 and 64%. The presence of peritoneal signs on physical examination, leukocyte count and CRP, ICU admission and mortality increased directly proportional with Hinchey stage. Conclusions. There is a directly proportional relationship between Hinchey staging with clinical and paraclinical signs of inflammatory response, need for surgical management, ICU stay and mortality.

Plan de acción adulto del Plan nacional de cáncer 2022-2027 / Adult Action Plan of the National Cancer Plan 2022-2027

El Plan de Acción del Plan Nacional de Cáncer para Adultos 2022-2027 se propone el desafío de disminuir la mortalidad prematura por cáncer, aumentar la sobrevida, reducir el incremento observado en las tasas de incidencia, y medir el impacto del cáncer en la calidad de vida de las personas con diagnóstico oncológico y sus familias. Integra tres áreas prioritarias: promoción y protección de la salud; tamizajes; diagnóstico, tratamiento y seguimiento. A estas se suma un área transversal que considera el desarrollo de la red oncológica, la investigación científica, los registros oncológicos y la participación ciudadana.

Câncer materno: a compreensão da criança e suas representações / Maternal cancer: the child's understanding and its representations / Cáncer materno: comprensión del niño y sus representaciones

O câncer é uma doença crônico-degenerativa, que tem como uma de suas principais características a capacidade de invadir tecidos e órgãos do corpo, favorecendo o crescimento desordenado de células. É uma doença que impacta fortemente a pessoa enferma e todos à sua volta, incluindo sua família e seus amigos. A partir desse cenário, este trabalho visou compreender a visão da criança e o impacto emocional sofrido diante do diagnóstico de câncer da mãe. Buscou-se avaliar, a partir de ferramentas lúdicas e do desenho-estória, o entendimento da criança em relação ao processo de adoecimento materno, tomando como base o referencial psicanalítico para reconhecer como ela lidou com a situação. Participaram desta pesquisa uma mulher de 39 anos com diagnóstico de câncer em remissão e seu filho de 9 anos. Os resultados demonstraram que o adoecimento materno causou impactos emocionais significativos e assustadores para o infante, gerando fantasias irreais relacionadas ao câncer e a si próprio. Dessa forma, considera-se de fundamental importância o cuidado estendido aos familiares do indivíduo doente, a fim de que se tenha um olhar a todos que sofrem diante desse contexto.(AU)

Cancer is a chronic-degenerative disease that has as one of its main characteristics the ability to invade tissues and organs of the body, favoring the disordered cell growth. It is a disease that strongly impacts the sick person and everyone around them, including their family and friends. Based on this scenario, this work aimed to understand the child's view and the emotional impact suffered in the face of the mother's cancer diagnosis. It sought to evaluate, with ludic tools and drawing history, the child's understanding about the mother's illness process, based on the psychoanalytic framework to recognize how they deal with the situation. A 39-year-old woman diagnosed with cancer, in remission, and her 9-year-old son participated in this research. The results showed that the maternal illness caused significant and frightening emotional impacts for the infant, creating unrealistic fantasies related to cancer and to himself. Thus, the care extended to the sick individual's family and to the relatives is considered of fundamental importance, to give a complete care for all those who suffer in this context.(AU)

El cáncer es una enfermedad crónico-degenerativa, que tiene como una de sus principales características la capacidad de invadir tejidos y órganos, favoreciendo un crecimiento desordenado de las células. Enfermedades como esta impactan fuertemente a la persona que está enferma y a todos los que la rodean, incluidos familiares y amigos. Considerando esta situación, este estudio tuvo como objetivo comprender la percepción de un niño y el impacto emocional que sufrió ante el diagnóstico del cáncer vivido por su madre. Se pretendió evaluar, utilizando herramientas lúdicas y de dibujo-cuento, la comprensión del niño al proceso de enfermedad materna, buscando reconocer cómo el niño manejó este proceso a partir del referencial teórico psicoanalítico. En esta investigación participaron una mujer de 39 años diagnosticada de cáncer en remisión y su hijo de 9 años. Los resultados mostraron que los impactos emocionales de la enfermedad materna fueron significativos y aterradores para el infante, generando fantasías irreales relacionadas con el cáncer y él mismo. De esta forma, el cuidado extendido a la familia del individuo que está enfrentando esta enfermedad es importante para promover una atención integral a quienes la padecen en este contexto.(AU)

Representações sociais sobre maternidade na reprodução humana assistida: discursos de mulheres inférteis / Social representations of motherhood in assisted human reproduction: discourses of infertile women / Representaciones sociales de la maternidad en la reproducción humana asistida: relatos de mujeres infértiles

Este trabalho tem o objetivo de analisar as concepções de maternidade para mulheres inférteis de diferentes níveis socioeconômicos que estão em tratamento de reprodução assistida. Trata-se de um estudo qualitativo, descritivo, que utilizou como instrumento uma entrevista semiestruturada e contemplou temas como o significado de família, desejo/expectativas sobre filho e gestação e expectativas sobre a maternidade. Participaram da pesquisa 48 mulheres inférteis acima de 35 anos que usam tecnologias de reprodução assistida de alta complexidade em instituições privada e pública. Os dados foram tratados pela análise de conteúdo em que emergiram os temas: representações sociais da família; representações sociais da maternidade; expectativas com a gestação e os modelos maternos; e o filho imaginado. As participantes representaram a família de forma positiva, como um sistema de suporte, de fundação e origem de amor, configurando-a como um laço social. Por outro lado, as concepções de família com base na consanguinidade também estiveram presentes, representando a família pela perpetuação da espécie e pela importância do laço biológico. A maternidade foi marcada por significativa idealização, sendo vista como um papel gratificante e de realização da feminilidade. O peso da cobrança social para procriar também foi sentido como um dever a cumprir e que, na impossibilidade de se realizar, gera sentimentos de inferioridade, menos-valia, impotência e inadequação perante a sociedade, o que reforça o estigma da infertilidade. Tais resultados apontam a importância de reflexões sobre o papel da mulher na nossa cultura, visto que a maternidade é ainda utilizada como medida para o sucesso ou fracasso feminino. Faz-se necessário também refletir sobre a possibilidade da maior inserção do trabalho psicológico na reprodução assistida, visto a carga emocional e social envolvidas nesse processo.(AU)

This study aimed to analyze the conceptions of motherhood for infertile women from different socioeconomic levels who are undergoing assisted reproduction treatment. This is a qualitative and descriptive study that used a semi-structured interview as an instrument and included topics such as the meaning of family and desires/expectations about the child, pregnancy, and motherhood. A total of 48 infertile women over 35 years of ages using high-complexity assisted reproductive technologies in private and public institutions participated in this research. The data were treated by content analysis in which the following themes emerged: family social representations; social representations of motherhood; expectations with pregnancy and maternal models; and the imagined son. Participants represented the family in a positive way as a support system and the foundation and origin of love, embracing the family as a social bond. On the other hand, the family concepts based on inbreeding were also present, representing the family by perpetuation of the species and the importance of biological bonds. Motherhood was marked by significant idealization, being seen as a gratifying role and the fulfillment of femininity. The weight of the social demand to procreate was also felt as a duty to be fulfilled that, in the impossibility of carrying it out, generates feelings of inferiority, worthlessness, impotence, and inadequacy toward society, which reinforce the stigma of infertility. Results point to the necessary reflections on the role of women and our culture since Motherhood is still used as a measure of female success or failure. They also point to a reflection on the possibility of greater inclusion of psychological work in assisted reproduction given the emotional and social burden involved in this process.(AU)

Este estudio tuvo como objetivo analizar las concepciones de maternidad de mujeres infértiles, de diferentes niveles socioeconómicos, que se encuentran en tratamiento de reproducción asistida. Se trata de un estudio cualitativo, descriptivo, que utilizó como instrumento una entrevista semiestructurada e incluyó temas como el sentido de la familia, deseos/expectativas sobre el hijo y el embarazo y expectativas sobre la maternidad. Participaron en la investigación un total de 48 mujeres infértiles, mayores de 35 años, usuarias de tecnologías de reproducción asistida de alta complejidad en instituciones públicas y privadas. Los datos se sometieron a análisis de contenido del cual surgieron los temas: representaciones sociales familiares; representaciones sociales de la maternidad; expectativas con el embarazo y modelos maternos; hijo imaginado. Las participantes representaron a la familia de manera positiva, como sistema de apoyo, fundamento y origen del amor, configurándola como vínculo social. Por otro lado, también estuvieron presentes las concepciones familiares basadas en la consanguinidad, representando a la familia para la perpetuación de la especie y la importancia del vínculo biológico. La maternidad estuvo marcada por una importante idealización, vista como un rol gratificante y de realización de la feminidad. También se sintió el peso de la demanda social de procrear como un deber que cumplir y que, ante la imposibilidad de realizarlo, genera sentimientos de inferioridad, desvalorización, impotencia e inadecuación en la sociedad, lo que refuerza el estigma de la infertilidad. Por tanto, son necesarias reflexiones sobre el papel de la mujer en nuestra cultura, ya que la maternidad se sigue utilizando como medida del éxito o fracaso femenino. También se reflexiona sobre la posibilidad de una mayor inclusión del trabajo psicológico en la reproducción asistida dada la carga emocional y social que implica este proceso.(AU)

Significados atribuídos por mulheres com câncer de mama ao grupo de apoio / Meanings attributed by women with breast cancer to a support group / Significados atribuidos por las mujeres con cáncer de mama al grupo de apoyo

A sobrevivência ao câncer de mama é um problema de saúde pública que demanda serviços especializados com foco na reabilitação psicossocial. Entre as necessidades identificadas nesse contexto está o incentivo à adoção de estratégias de promoção de autocuidados pelas mulheres. Uma das estratégias adotadas consiste no grupo de apoio psicológico, que auxilia as pacientes a enfrentar a longa jornada do tratamento. Assim, o objetivo deste estudo é compreender os significados produzidos por mulheres com câncer de mama sobre sua participação em um grupo de apoio. Trata-se de um estudo qualitativo, descritivo e exploratório realizado com dez mulheres com câncer de mama usuárias de um serviço de reabilitação para mastectomizadas. Como referencial metodológico foi utilizada a Teoria Fundamentada nos Dados. A coleta de dados foi realizada por meio de entrevista aberta em profundidade e os conteúdos foram transcritos e codificados. A análise indutiva e o método de comparação constante foram aplicados nos processos de codificação aberta, axial e seletiva, que permitiram identificar três categorias nucleares: percepção das atividades realizadas no grupo, identificação de benefícios e barreiras do convívio no grupo e transformações decorrentes da participação. As participantes significaram sua presença no grupo como fonte de acolhimento, apoio, desenvolvimento de recursos pessoais e amizades, contribuindo para promover sua qualidade de sobrevida. Além dos potenciais benefícios, também foram identificadas barreiras que podem dificultar a adesão e continuidade da participação no grupo, o que sugere a necessidade de incorporar no cuidado um olhar para as dimensões subjetivas da saúde da mulher.(AU)

Surviving breast cancer is a public health problem and depends on services focused on psychosocial rehabilitation. Healthcare providers must encourage women to adopt strategies to promote their self-care. The psychological support group is a resource that helps women to face the long journey of treatment. This study aimed to understand the meanings women with breast cancer produced about their participation in a support group. This exploratory cross-sectional study was carried out with 10 women with breast cancer who use a rehabilitation service for mastectomized patients. Grounded Theory was used as a methodological reference. An open in-depth interview was applied for data collection. The contents were transcribed and coded. Inductive analysis and the constant comparison method were applied in the open, axial, and selective coding processes, which enabled the identification of three core categories: perception of the activities carried out in the group, identification of benefits and barriers of living in the group, and transformations resulting from participation. Participants denote their involvement with the group as a source of shelter, support, development of personal resources and friendships that helps promoting quality of life. Besides these potential benefits, participants also evinced barriers that can hinder adherence and continuity of participation in the group, suggesting the importance of incorporating a look at the subjective dimensions of women's health into care.(AU)

Sobrevivir al cáncer de mama es un problema de salud pública que depende de los servicios centrados en la rehabilitación psicosocial. Entre las necesidades identificadas en esta materia se encuentra el uso de estrategias para promover el autocuidado. Uno de los recursos que ayuda a afrontar el largo camino del tratamiento es el grupo de apoyo psicológico. El objetivo de este estudio es conocer los significados que producen las mujeres con cáncer de mama sobre su participación en un grupo de apoyo. Se trata de un estudio cualitativo, descriptivo y exploratorio, realizado con diez mujeres con cáncer de mama usuarias de un servicio de rehabilitación para mastectomizadas. Como referencia metodológica se utilizó la teoría fundamentada en los datos. Se aplicó una entrevista abierta en profundidad para la recogida de datos, cuyos contenidos fueron transcritos y codificados. El análisis inductivo y el método de comparación constante se aplicaron en los procesos de codificación abierta, axial y selectiva, lo que permitió identificar tres categorías centrales: percepción de las actividades realizadas en el grupo, identificación de los beneficios y las barreras de vivir en el grupo y transformaciones resultantes de la participación. Las mujeres denotan su participación en el grupo como una fuente de acogida, apoyo, desarrollo de recursos personales y amistades, que ayuda a promover la calidad de vida. Además de los beneficios potenciales, también se identificaron barreras que pueden dificultar la adherencia y continuidad de la participación en el grupo, lo que sugiere la necesidad de incorporar en la atención una mirada centrada en las dimensiones subjetivas de la salud de las mujeres.(AU)