Percepção profissional sobre tratamento endodôntico em sessão única e múltiplas sessões / Professional perception of single and multi-session endodontic treatment

Na odontologia a decisão do tratamento é exclusiva dos cirurgiões dentistas e suas percepções, incluindo filosofia de tratamento, fazendo com que a prática de novos conceitos, tratamentos ou técnicas dependam não apenas de sua lógica ou eficácia biológica. Sendo assim, este estudo teve como objetivo avaliar os parâmetros envolvidos na tomada de decisão de cirurgiões dentistas clínicos e especialistas para a realização do tratamento endodôntico em sessão única ou múltiplas sessões. Para tanto, este estudo contou com uma coleta de dados através de um questionário online, aplicado cirurgiões dentistas clínicos gerais e especialistas em endodontia. As respostas foram tabuladas e analisadas por meio de estatística descritiva. Os resultados revelaram que a maioria dos endodontistas e dos clínicos gerais prefere realizar tratamento endodôntico em sessão única, devido ao menor desperdício de material, além do melhor domínio da anatomia e tratamento em um único momento. O motivo mais comum para os endodontistas e clínicos gerais escolherem o tratamento com múltiplas visitas é para dentes com prognóstico duvidoso e os casos em que o profissional aguarda a remissão dos sintomas antes da obturação. Em conclusão, a maioria dos endodontistas e dos clínicos gerais preferiu realizar tratamento endodôntico em sessão única.

In dentistry, treatment decisions are made exclusively by dental surgeons and their perceptions, including treatment philosophy, which means that the practice of new concepts, treatments or techniques depends not only on their logic or biological efficacy. Therefore, the aim of this study was to evaluate the parameters involved in clinical and specialist dental surgeons' decision to carry out endodontic treatment in single or multiple sessions. To this end, data was collected using an online questionnaire administered to general dental surgeons and endodontic specialists. The answers were tabulated and analyzed using descriptive statistics. The results revealed that the majority of endodontists and general practitioners prefer to carry out endodontic treatment in a single session, due to less wastage of material, as well as better mastery of the anatomy and treatment at a single time. The most common reason for endodontists and general practitioners to choose treatment with multiple visits is for teeth with a doubtful prognosis and cases in which the professional is waiting for symptoms to remit before filling. In conclusion, the majority of endodontists and general practitioners preferred to carry out endodontic treatment in a single session.

Aplicabilidade de protocolo odontológico de assistência materno-infantil na atenção básica à saúde / Applicability of a maternal and child dental care protocol in basic health care / Aplicabilidad de un protocolo dental de atención materno-infantil en la atención básica de salud

A atenção materno-infantil enfrenta diversos desafios na assistência odontológica. Assim, este estudo teve por objetivo desenvolver e analisar a aplicabilidade de um Protocolo Odontológico de Assistência Materno-Infantil (POAMI) em uma unidade básica de saúde do município de Mossoró/RN. Trata-se de um estudo transversal desenvolvido com trinta gestantes de fevereiro a dezembro de 2021. Inicialmente foram aplicados na primeira consulta os questionários "Investigação do Conhecimento das Gestantes sobre sua Saúde Bucal e a do seu Bebê" (ICGSBB) e o Oral Health Impact Profile (OHIP-14). Em seguida, o POAMI foi aplicado em consultas agendadas e na última consulta o questionário ICGSBB foi reaplicado. Observou-se na primeira consulta que apenas 3,33% (n=1) das gestantes tinham conhecimentos sobre a doença periodontal (27,27% (n=6) na última consulta), 10,34% (n=3) indicavam o uso do creme dental com flúor (95,45% (n=21) na última consulta) e 55,17% (n=16) da fralda molhada para higiene bucal do bebê (100% (n=22) na última consulta). Na avaliação do OHIP-14, 23,33% (n=7) das gestantes estão classificadas dentro do nível "Médio Impacto". O POAMI demonstrou ser aplicável na atenção básica e eficaz na melhoria dos conhecimentos das gestantes, no aumento considerável da cobertura e acesso, e na motivação de boas práticas de higiene oral.

Maternal and child care faces several challenges in dental care. This study aimed to develop and analyze the applicability of a Maternal and Child Dental Care Protocol in a basic health unit in Mossoró/RN. This cross-sectional study involved 30 pregnant women from February to December 2021. Initially, the "Investigação do Conhecimento das Gestantes sobre sua Saúde Bucal e a do seu Bebê" (ICGSBB) and the Oral Health Impact Profile (OHIP-14) questionnaires were applied in their first consultation. The protocol was then applied in scheduled consultations, and the ICGSBB questionnaire was reapplied in the last consultation. In the first consultation, only 3.33% (n=1) of the pregnant women had knowledge about periodontal disease (27.27% (n=6) in the last consultation), 10.34% (n=3) indicated the use of fluoride toothpaste (95.45% (n=21) in the last consultation), and 55.17% (n=16) knew to use a wet diaper for the oral hygiene of their children (100% (n=22) in the last consultation). The OHIP-14 evaluation showed that 23.33% (n=7) of the pregnant women fell within its "medium impact" level. The protocol proved to be applicable in basic care, effectively improving pregnant women's knowledge, increasing coverage and access, and motivating good oral hygiene.

La atención materno-infantil enfrenta desafíos en la atención dental. El objetivo de este estudio fue desarrollar y analizar la aplicabilidad de un Protocolo Dental de Atención Materno-Infantil (POAMI) en una unidad básica de salud en Mossoró (Rio Grande do Norte, Brasil). Se trató de un estudio transversal con 30 mujeres embarazadas, en el período de febrero a diciembre de 2021. En la primera consulta, se aplicaron los cuestionarios Investigación de los Conocimientos de las Embarazadas sobre su Salud Bucodental y la de su Bebé (ICGSBB) y el Oral Health Impact Profile (OHIP-14). Luego, el protocolo se aplicó en las consultas, y el cuestionario ICGSBB se volvió a aplicar en la última consulta. En la primera consulta, solo el 3,33% (n=1) de las embarazadas tenían conocimientos sobre enfermedad periodontal (27,27%, n=6, en la última consulta), el 10,34% (n=3) de las participantes reportaron usar pasta dental con flúor (95,45%, n=21, en la última consulta) y el 55,17% (n=16) utilizaban pañal húmedo para la higiene bucal del bebé (100%, n= 22, en la última consulta). En la evaluación del OHIP-14, el 23,33% (n=7) de las embarazadas se clasificaron en el nivel "Impacto Medio". El protocolo demostró ser aplicable debido a la mejora efectiva de los conocimientos de las embarazadas, aumentando la cobertura y el acceso, y motivando buenas prácticas de higiene bucal.

Protocolos para la interpretación de pruebas de bienestar fetal ante parto e intraparto / Protocols for the interpretation of fetal well-being tests before delivery and intrapartum

Los presentes protocolos contiene las disposiciones para la realización de las pruebas de bienestar fetal ante e intraparto con el objetivo de prevenir la hipoxia fetal aguda en los establecimientos de atención del Sistema Nacional Integrado de Salud (SNIS) tanto en el Primer Nivel de Atención, como a nivel hospitalario, cuenta además con las disposiciones para realizar el monitoreo, supervisión y evaluación en los diferentes niveles de atención y de esta forma ayudar a disminuir la mortalidad infantil

These protocols contain the provisions for carrying out prenatal and intrapartum fetal well-being tests with the objective of preventing acute fetal hypoxia in the care facilities of the National Integrated Health System (SNIS) both at the First Level of Care and At the hospital level, it also has the provisions to carry out monitoring, supervision and evaluation at different levels of care and in this way help reduce infant mortality

Diagnóstico humanizado: El paciente en el centro - la comunicación que cura / Diagnóstico humanizado: O paciente no centro - comunicação que cura / Humanized Diagnosis: The pacient at the center - communication that Heals

Este texto plantea la importancia de confeccionar protocolos de diagnóstico humanizado que permitan a los profesionales de la salud brindar información sobre patologías y/o discapacidades de manera clara y veraz, humana y delicadamente, facilitando su recepción por parte del paciente y su familia. El diagnóstico humanizado no forma parte únicamente de un protocolo de "urbanidad" en el vínculo médico ­ paciente: es parte integrante y relevante del procedimiento o tratamiento. Este abordaje exige una mirada interdisciplinar. En esta temática hay elementos que se vinculan a lo médico ­ científico; lo jurídico ­ legislativo ­ jurisprudencial y lo político.

Ao longo deste texto, discute-se a importância da elaboração de protocolos diagnósticos humanizados que permitam aos profissionais de saúde fornecerem informações sobre patologias e/ou incapacidades de forma clara e verdadeira, ao mesmo tempo em que humanizada e delicada, facilitando seu acolhimento pelo paciente e sua família. O diagnóstico humanizado não é apenas parte de um protocolo de "civilidade" na relação médico-paciente, mas parte integrante e relevante do procedimento para realizar o tratamento de uma doença ou deficiência. Essa abordagem requer uma abordagem interdisciplinar. Nessa disciplina há elementos que se vinculam ao médico-científico; as esferas jurídica, legislativa e política.

Throughout this text, the importance of creating humanized diagnostic protocols is discussed. These should allow healthcare professionals to provide clear and truthful information about pathologies and/or disabilities in a humane and delicate manner, facilitating their understanding by the patient and their family. Humanized diagnosis is not just part of a "politeness" protocol in the doctor-patient relationship, but an integral and relevant part of the procedure for treating a disease or disability. This approach requires an interdisciplinary perspective, as there are elements that are linked to the strictly medical-scientific, legal-legislative-jurisprudential, and political aspects of this topic.

Pancreas units within gastroenterology departments. Organizational and operational standards for a patient-centered service. / Las unidades de páncreas en los servicios de aparato digestivo. Estándares de organización y funcionamiento para un servicio centrado en el paciente.

The Asociación Española de Pancreatología (AESPANC), Asociación Española de Gastroenterología (AEG), and Sociedad Española de Patología Digestiva (SEPD) have developed a consensus document on the standards and recommendations they consider essential for the organization of pancreas units (PUs) within gastroenterology services (GSs) in order to conduct their activities in an efficient, high-quality manner. The consensus document defines PUs and lays down standards relating to their organization, structure, service portfolio, processes, and teaching and research activities. Standards have been categorized as mandatory (requirements to be met to qualify for certification by the scientific societies responsible for the standards) or recommendations. Standards should be updated at most within five years based on the experience gained in Spanish PUs and the advance of knowledge regarding pancreas disease. Development of health outcome indicators, including patient-reported outcome measures (PROMs), is considered a relevant challenge, as is evidence on the association of PU structure and activity standards with health outcomes.

Dental care in patients with periodontal disease and hearing impairment: a scoping review / Atención odontológica en pacientes con enfermedad periodontal y deficiencia auditiva: scoping review

Introduction: Literature shows that individuals with disabilities, including hearing impairment, often suffer from untreated dental caries, poor oral hygiene, and compromised periodontal health, leading to adverse effects on oral health. Objetive: This study aims to analyze current evidence concerning dental care strategies for controlling, managing, and preventing biofilm accumulation in patients with hearing impairment. Materials and Methods: A systematic search was conducted in the databases Scopus, Web of Science, SciELO and PubMed between April and May 2022 to identify articles establishing a relationship between periodontal disease and hearing disability. Full-text articles published in English or Spanish between 2012 and 2022 were included. Results: Seventeen articles met the inclusion criteria and were analyzed. These included cross-sectional studies, cohort studies, clinical trials, case reports, and case-control studies. Most studies reported fair to poor oral health status among individuals. Nine different interventions or management approaches for treating periodontal disease in patients with hearing impairment were identified. Conclusions: The current global evidence on the association between periodontal disease and hearing impairment is very limited. Dentists may need to employ various strategies to address communication barriers, as outlined in this study.

Introducción: Según la literatura, las personas en situación de discapacidad presentan caries dentales no tratadas, higiene bucal y estado periodontal deficiente, lo cual puede resultar en efectos negativos para su salud bucal. Objetivo: Analizar la evidencia existente con relación a la atención odontológica enfocada en el control, manejo y prevención de acumulación de biofilm en pacientes con deficiencia auditiva. Materiales y Métodos: Se realizó la búsqueda de artículos en las bases de datos y motor de búsqueda (Scopus, Web of Science, SciELO y PubMed) entre abril y mayo 2022, de acuerdo con la evidencia existente que relacione la enfermedad periodontal y la discapacidad auditiva en la atención odontológica. Se incluyeron artículos de texto completo en idioma inglés o español, con fecha de publicación entre 2012 a 2022. Resultado: Se seleccionó un total de 17 artículos para su análisis. Se encontró estudios transversales, estudios de cohorte, ensayos clínicos, reporte de caso y estudios de casos y controles. La salud oral fue catalogada en estado regular y deficiente en la mayoría de los estudios. Se encontró 9 tipos de intervenciones o manejos para el tratamiento de la enfermedad periodontal en pacientes con hipoacusia. Conclusión: La evidencia existente respecto a la enfermedad periodontal y la deficiencia auditiva es insuficiente a nivel global. Debido a lo anterior, el odontólogo puede abordar los obstáculos comunicativos de diferentes maneras de acuerdo a los métodos descritos en esta publicación.

Implementação de melhorias na atenção primária à saúde: protocolo de enfermagem e gerenciamento de unidades / Implementation of improvements in primary health care: nursing protocol and unit management / Implementación de mejoras em la atención primaria de salud: protocolo de enfermería y gestión de la unidad

Objetivo: Descrever a experiência da elaboração do Protocolo de Enfermagem da Atenção Primária e o gerenciamento das Unidades Básicas de Saúde de Rio Branco ­ Acre. Métodos: Trata-se de um relato de experiência, sobre a elaboração de um Protocolo, instrumento potente para a implementação de melhorias e a gerência de Unidades Básicas de Saúde. A elaboração do protocolo foi realizada por etapas: Etapa 1: Composição da Comissão; Etapa 2: Pesquisa e Construção; Etapa 3: Consulta Pública; Etapa 4: Finalização da Construção. Resultados: Foi constituído uma comissão de elaboração do protocolo. Foi observado a implementação de melhorias na assistência prestada à população durante o período de execução do projeto. A frente do gerenciamento das Unidades Básicas de Saúde, foi possível vivenciar de perto o cenário da Atenção Primária à Saúde, (financiamentos, composição de equipes e atributos), conhecer a capacidade gerencial e política para organização da assistência à saúde, como também implementar melhorias relacionadas à gestão da clínica e diretrizes clínicas. Conclusão: A elaboração e implementação de um Protocolo de Enfermagem da Atenção Primária agrega não apenas conhecimento para a prática, vislumbra mais valorização profissional, onde possibilita o rompimento de uma barreira centrada na figura médica, ao atribuir à enfermagem papel relevante e conquistada, com protocolos de atendimento capazes de suprir as demandas existentes nas Unidades. Além de permitir o fortalecimento, visibilidade técnica, científica e a ampliação do acesso às pessoas à Atenção Primária à Saúde como parte significativa e resolutiva pela enfermagem. (AU)

Objective: To describe the experience of elaborating the Primary Care Nursing Protocol and the management of Basic Health Units in Rio Branco ­ Acre. Methods: This is an experience report on the elaboration of a Protocol, a powerful instrument for implementing improvements and managing Basic Health Units. The preparation of the protocol was carried out in stages: Stage 1: Composition of the Committee; Stage 2: Research and Construction; Stage 3: Public Consultation; Step 4: Completion of Construction. Results: A protocol drafting committee was set up. The implementation of improvements in the assistance provided to the population during the project execution period was observed. Ahead of the management of Basic Health Units, it was possible to experience the Primary Health Care scenario closely, (financing, composition of teams and attributes), to know the managerial and political capacity for the organization of health care, as well as to implement related improvements. clinic management and clinical guidelines. Conclusion: The elaboration and implementation of a Primary Care Nursing Protocol adds not only knowledge to practice, it envisions more professional appreciation, which makes it possible to break a barrier centered on the medical figure, by attributing a relevant and conquered role to nursing, with protocols services capable of meeting the existing demands in the Units. In addition to allowing the strengthening, technical and scientific visibility and the expansion of people's access to PHC as a significant and decisive part of nursing. (AU)

Objetivo: Describir la experiencia de elaboración del Protocolo de Enfermería de Atención Primaria y la gestión de Unidades Básicas de Salud en Rio Branco ­ Acre. Métodos: Este es un relato de experiencia sobre la elaboración de un Protocolo, un poderoso instrumento para implementar mejoras y gestionar Unidades Básicas de Salud. La elaboración del protocolo se realizó por etapas: Etapa 1: Composición del Comité; Etapa 2: Investigación y Construcción; Etapa 3: Consulta Pública; Paso 4: Finalización de la construcción. Resultados: Se constituyó una comisión de elaboración del protocolo. Se observó la implementación de mejoras en la asistencia prestada a la población durante el periodo de ejecución del proyecto. Frente a la gestión de las Unidades Básicas de Salud, fue posible vivir de cerca el cenário de la Atención Primaria de Salud (financiación, composición de equipos y atributos), conocer la capacidad gerencial y política para la organización de la asistencia a la salud, así como implementar mejoras relacionadas, con la gestión de la clínica y direcciones clínicas. Conclusión: La elaboración e implementación de un Protocolo de Enfermería de Atención Primaria aporta no sólo conocimiento a la práctica, sino que aporta mayor valorización profesional, al permitir el rompimiento de una barrera centrada en la figura médica, para atribuir a la enfermería un papel relevante y conquistado, con protocolos de atención capaces de superar las demandas existentes en las Unidades. Además de permitir el fortalecimiento, la visibilidad técnica y científica y la ampliación del acceso de las personas a la Atención Primaria de Salud como parte significativa y resolutiva por parte de la enfermería. (AU)

Antiviral treatment for SARS-CoV-2 infection in the current situation: a position paper of the Spanish Society of Emergency Medicine (SEMES). / Posicionamiento de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) ante el tratamiento antiviral frente al SARS-CoV-2 en la situación epidemiológica actual.

SUMMARY: COVID-19 continues to pose a significant threat: mortality stands at nearly twice that of influenza, and the incidence rate is growing as the population's vaccination rate decreases, particularly in Spain and other areas of Europe. Given this situation, it is vitally important know whether medical protocols are consistent and appropriately implemented by health care staff in the interest of preventing possible inefficiency or inequity. Physicians from hospital emergency departments met to study their hospitals' usual clinical practices for managing SARS-CoV-2 infection and to determine their expert opinions on the use of antiviral agents. The participating physicians then reached consensus on evidencebased recommendations for strategies that would optimize emergency treatment.

RESUMEN: Actualmente, la COVID-19 sigue representando una amenaza significativa, con una mortalidad cercana al doble de la ocasionada por la gripe y con una incidencia variable debido a una disminución en la tasa de vacunación de la población, especialmente en el contexto europeo y español. Ante este panorama, es de vital importancia comprobar que los protocolos médicos están consolidados y son debidamente implementados por los profesionales sanitarios, con la finalidad de evitar posibles ineficiencias o inequidades. A través de reuniones con profesionales de urgencias se han observado las prácticas clínicas habituales en los servicios de urgencias hospitalarios para pacientes con infección por SARS-CoV-2, con la finalidad de comprender la perspectiva de estos profesionales acerca del uso de antivirales y, tras un consenso de expertos basados en la evidencia actual, se han generado estas de recomendaciones para poder enfocar estrategias que optimicen el tratamiento de los pacientes en estos servicios.

[Utility of the AGREE tool for the development and evaluation of clinical protocols: From theory to clinical practice]. / Utilidad del instrumento AGREE para la elaboración y la evaluación de protocolos clínicos: de la teoría a la práctica clínica.

INTRODUCTION AND OBJECTIVE: Clinical protocols are tools for the delivery of optimal and quality healthcare. However, there are often shortcomings in the quality of their design that invalidate their implementation. The aim of this study is to describe a systematic evaluation of clinical protocols, to analyse their quality in order to enable their implementation. MATERIALS AND METHODS: Descriptive study that included the clinical protocols assessed by the Committee of Reviewers of Clinical Practice Recommendations and Health Technologies of a tertiary hospital during 11years of its existence between 2013 and 2023. The AGREE instrument was used to assess the quality of the protocols received, calculating standardised scores by item and domain, and categorising them into: a)excellent (90-100%), b)good (70-89%), c)improvable (50-69%), d)very improvable (30-49%), e)deficient (10-29%), and f)very deficient: 0-9%. RESULTS: Of the 59 documents received by the Commission, 32 were subsidised for AGREE evaluation. The highest scoring domain was «Scope and objective¼, with excellent scores for 29 protocols; the remaining domains had scores ranging from 58.5%-100% for «Rigour in elaboration¼ and 0-100% for «Independence¼. By items, scores ranged from 85.7-100% for «Target users of the protocol are clearly defined¼ to 0-100% for the items «Potential costs of implementing recommendations¼ and «Conflict of interest¼. Of the 32 protocols, 9 were highly recommended, 22 were recommended with modifications/conditions and one was not recommended. CONCLUSIONS: The AGREE tool makes it possible to systematize both the drafting of clinical protocols by the authors and their evaluation by the Clinical Practice Recommendations and Health Technologies Review Committee. This makes it possible to have applicable and quality protocols in our hospital, which results in an improvement in the quality of healthcare.

Interevaluator reliability of a tool for measuring body height in adult intensive care patients.

BACKGROUND: The calculation of body height in the intensive care unit is essential for obtaining the ideal body weight, which is used to program the tidal volume and establish objective and effective pulmonary ventilation. The objective of the study was to determine the interrater reliability of a tool for measuring body height in adult patients in an intensive care unit (ICU) in southwestern Colombia. METHODS: This cross-sectional observational study was conducted between January and May 2021, following the recommendations of the COSMIN protocol. Two physiotherapists in the roles of observer/evaluator measured the heights of 106 patients upon admission to the ICU with a previously designed. The sample size was calculated based on Pearson's correlation coefficient. For interrater reliability, the intraclass correlation coefficient (ICC) was used, and Bland-Altman analysis was used to assess concordance. The 95% confidence interval was established, and a P value <0.05 indicated statistical significance. RESULTS: A total of 106 individuals with a mean age of 59.3 years were included; the mean body height was 158.5 cm for women. The interrater reliability of the measurement of height was excellent (global ICC of 0.99, P = 0.000), and an almost perfect positive correlation was obtained between the raters for both women and men (R = 0.99). CONCLUSIONS: Excellent interrater/interobserver reliability was obtained for the measurement of body height in the ICU. This research highlights the importance of protocolizing the measurement of height in critical patients with valid and reliable instruments.

Nuevos paradigmas en atrofia muscular espinal de presentación temprana: siempre es bueno recordar / New paradigms in early-onset spinal muscular atrophy: a reminder is always beneficial

La atrofia muscular espinal (AME) de presentación temprana representa la variante más severa, con una expectativa de vida generalmente no mayor a dos años sin soporte ventilatorio, debido a la insuficiencia respiratoria y la dificultad para toser. Tradicionalmente, el manejo respiratorio en muchos países ha incluido la traqueostomía para proporcionar asistencia ventilatoria invasiva de manera continua. No obstante, la introducción de medicamentos de precisión ha modificado la progresión natural de la enfermedad, evidenciando mejoras significativas en los hitos motores y beneficiando también la función respiratoria. A pesar de estas mejoras, en muchos casos sigue siendo necesaria la ventilación intermitente y/o continua, además de la facilitación de la tos. Estas necesidades pueden abordarse de forma no invasiva mediante el soporte ventilatorio no invasivo (SVN), la in-exsuflación mecánica (IEM) y el reclutamiento de volumen pulmonar (RVP), que son considerados pilares del tratamiento respiratorio en enfermedades neuromusculares. Estas estrategias promueven el desarrollo y mantenimiento de la función respiratoria, reduciendo el riesgo de exacerbaciones respiratorias que podrían llevar a intubaciones evitables. Comúnmente, los pacientes con AME experimentan intentos fallidos de extubación siguiendo protocolos tradicionales, siendo catalogados como no extubables y potenciales candidatos a traqueostomía. No obstante, existen protocolos de extubación específicos para AME que emplean SVN e IEM con un alto porcentaje de éxito, evitando traqueostomías innecesarias que pueden complicar la progresión de la enfermedad y afectar la calidad de vida. El enfoque respiratorio no invasivo es una opción de manejo segura tanto en el hospital como en el hogar, ofreciendo una mejor calidad de vida para los pacientes y sus familias.

Early-onset spinal muscular atrophy (SMA) is the most severe variant, with a life expectancy generally not exceeding two years without ventilatory support due to respiratory insufficiency and difficulty in coughing. Traditionally, respiratory management in many countries has included tracheostomy to provide continuous invasive ventilatory support. However, the introduction of precision medicine has altered the natural progression of the disease, showing significant improvements in motor milestones and also benefiting respiratory function. Despite these improvements, many cases still require intermittent and/or continuous ventilation, as well as cough facilitation. These needs can be addressed non-invasively through non-invasive ventilatory support (NIV), mechanical insufflation-exsufflation (MIE), and lung volume recruitment (LVR), which are considered the pillars of respiratory treatment in neuromuscular diseases. These strategies promote the development and maintenance of respiratory function, reducing the risk of respiratory exacerbations that could lead to avoidable intubations. Commonly, SMA patients experience failed extubation attempts following traditional protocols, being labeled as non-extubatable and potential candidates for tracheostomy. Nevertheless, there are specific extubation protocols for SMA that employ NIV and MIE with a high success rate, avoiding unnecessary tracheostomies that can complicate disease progression and impact quality of life. The non-invasive respiratory approach is a safe management option both in the hospital and at home, offering a better quality of life for patients and their families.

Cuidar da pessoa em situação critica no serviço de urgência: contributos do enfermeiro especialista para a qualidade dos cuidados / Caring for the critically ill person in the emergency department: the specialist nurse's contribution to the quality of care

Este relatório de estágio surge no âmbito do curso de Mestrado em Enfermagem Médico- Cirúrgica e pretende evidenciar as experiências e atividades desenvolvidas no sentido de adquirir e desenvolver competências especializadas. A estrutura do relatório teve como linha orientadora os domínios de competências definidas para o Enfermeiro Especialista pela Ordem dos Enfermeiros, enquadradas nos domínios académicos preconizados pela Instituição de Ensino. O perfil de conhecimentos e competências do Enfermeiro Especialista na área da pessoa em situação crítica deve responder de forma competente à frágil e complexa situação clínica, sendo o seu papel suportado por um quadro de competências diferenciadas enquadradas no respeito pelo Ser Humano e pelos seus direitos inalienáveis. Focados no crescimento e desenvolvimento de competências especificas na área da pessoa em situação crítica, bem como no contributo da visão diferenciada do Enfermeiro Especialista na melhoria da qualidade dos cuidados, procuramos dar resposta aos problemas encontrados na prática clínica. Das atividades desenvolvidas destacamos a criação de um fluxograma de apoio ao enfermeiro triador no encaminhamento interno dos doentes e de um protocolo terapêutico de atuação no adulto com febre na triagem de manchester. Evidenciamos também, o investimento resiliente no desenvolvimento e implementação de um protocolo complexo, no âmbito da prestação de cuidados em contexto de urgência, ao doente em estado de agitação/agressividade que visa mitigar um problema recorrente. No domínio académico da investigação desenvolvemos um estudo qualitativo com recurso à técnica de Focus Group, com o objetivo de construir um modelo de documentação padronizado, simplificado e facilitador do registo de enfermagem que documente a atuação do enfermeiro na avaliação e intervenção ao doente, durante o transporte inter-hospitalar. As conclusões deste estudo de investigação validaram um modelo de registo sustentado numa mnemónica, uniformizadora e facilitadora dos registos de enfermagem durante o transporte inter-hospitalar do doente crítico. Consideramos que as experiências que decorreram deste estágio foram fundamentais e permitiram o desenvolvimento das competências inerentes ao Enfermeiro Especialista.

This internship report appears within the scope of the Master's degree in Medical-Surgical Nursing and aims to highlight the experiences and activities developed in order to acquire and develop specialized skills. The structure of the report was guided by the domains of competences defined for the Specialist Nurse by the Order of Nurses, framed in the academic domains recommended by the Educational Institution. The profile of knowledge and skills of the Specialist Nurse in terms of people in critical situations must respond competently to the fragile and complex clinical situation, with their role supported by a framework of differentiated skills framed in respect for the Human Being and their inalienable rights . Focused on the growth and development of specific skills in the area of people in critical situations, as well as the contribution of the Specialized Nurse's differentiated vision to improving the quality of care, we seek to respond to problems encountered in clinical practice. The activities developed highlight the creation of a flowchart to support the triage nurse in the internal referral of patients and a therapeutic protocol for working with adults with fever in the manchester triage. We also highlight the resilient investment in the development and implementation of a complex protocol, within the scope of providing care in an emergency context, to patients in an agitated/aggressive state that aims to mitigate a recurring problem. In the academic domain of research, we developed a qualitative study using the Focus Group technique, with the objective of building a standardized, simplified documentation model that facilitates the nursing record that documents the nurse's role in evaluating and intervening with the patient, during the inter-hospital transport. The conclusions of this research study validated a recording model based on a mnemonic, standardizing and facilitating nursing records during the inter-hospital transport of critically ill patients. We consider that the experiences that took place during this internship were fundamental and allowed the development of skills inherent to Specialist Nurses.

Protocolos para la atención prehospitalaria del Sistema de Emergencias Médicas / Protocols for pre-hospital care of the Medical Emergency System

Los protocolos de atención prehospitalaria del Sistema de Emergencias Médicas (SEM), proporcionan la información necesaria para aplicarla en distintas situaciones de emergencia que se presentan cotidianamente en el país, permitiendo al personal gestionar de forma adecuada la atención, que conllevan a la salvaguardar la vida de la población, y así unificar los procesos de atención a la población, factor necesario para contribuir a la calidad de la atención sanitaria y garantizar el derecho a la salud

The pre-hospital care protocols of the Medical Emergency System (SEM) provide the necessary information to apply it in different emergency situations that occur daily in the country, allowing personnel to adequately manage care, which leads to safeguarding life. of the population, and thus unify the processes of care for the population, a necessary factor to contribute to the quality of health care and guarantee the right to health

Validated medication deprescribing instruments for patients with palliative care needs: a systematic review.

OBJECTIVES: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS: Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.

Validated medication deprescribing instruments for patients with palliative care needs palliative care: A systematic review. / [Artículo traducido] Instrumentos validados de desprescripción de medicamentos para los pacientes con necesidades de cuidados paliativos: una revisión sistemática.

OBJECTIVES: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by two independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS: Out of the 5,791 studies retrieved, after excluding duplicates (n = 1,050), conducting title/abstract screening (n = 4,741), and full reading (n = 41), only one study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to two groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only one of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.

Implantação de protocolo assistencial voltado a pessoas com úlceras venosas na atenção primária a saúde / Implementation of assistant protocol tailored to people with venous ulcers in primary health care / Implementación de protocolo asistente a la medida de personas con úlceras venosas en atención primaria de salud

Objetivo: Relatar a experiência da implantação de um protocolo assistencial voltado a pessoas com úlceras vasculares com foco nas úlceras venosas na atenção primária a saúde. Método:Trata-se de um estudo descritivo, realizado de março a julho de 2023, no Distrito Sanitário do Subúrbio Ferroviário, Salvador/BA. Resultados: A elaboração de um protocolo assistencial para pessoas com úlceras vasculares, com foco nas úlceras venosas, contou com apoio da enfermeira distrital, duas enfermeiras da assistência e um médico clínico e com a implementação dor referido protocolo por meio de reuniões online e presenciais para treinamento da verificação do índice tornozelo-braquial. Considerações finais:A elaboração do protocolo poderá favorecer a organização das unidades da atenção primária de modo que as pessoas portadoras de úlceras venosas possam receber um cuidado prestado de forma integral, holística e humanizada pelos profissionais que compõem a atenção primária a saúde.

Objective: To report the experience of implementing a care protocol aimed at people with vascular ulcers with a focus on venous ulcers in primary health care. Methodology: This is a descriptive study, carried out from March to July 2023, in the Health District of Subúrbio Ferroviário, Salvador/BA. Results: The development of a care protocol for people with vascular ulcers, focusing on venous ulcers, had the support of the district nurse, two care nurses and a clinical doctor and the implementation of this protocol through online and in-person meetings to training in checking the ankle-brachial index. Final considerations: The development of the protocol may favor the organization of primary care units so that people with venous ulcers can receive care provided in an integral, holistic and humanized manner by professionals who make up primary health care.

Objetivo: Reportar la experiencia de implementación de un protocolo de atención dirigido a personas con úlceras vasculares con enfoque en úlceras venosas en la atención primaria de salud. Metodología:Se trata de un estudio descriptivo, realizado de marzo a julio de2023, en el Distrito de Salud del Subúrbio Ferroviário, Salvador/BA. Resultados:El desarrollo de un protocolo de atención a personas con úlceras vasculares, con foco en las úlceras venosas, contó con el apoyo de la enfermera distrital, dos enfermeras asistenciales y un médico clínico y la implementación de este protocolo a través de reuniones online y presenciales para capacitaciones en comprobando el índice tobillo-brazo. Consideraciones finales: El desarrollo del protocolo puede favorecer la organización de las unidades de atención primaria para que las personas con úlceras venosas puedan recibir una atención brindada de manera integral, holística y humanizada por los profesionales que integran la atención primaria de salud.

Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain / Programa de tratamento multidisciplinar para melhora da dor e incapacidade associada a dor crônica lombar inespecífica

ABSTRACT BACKGROUND AND OBJECTIVES: Lumbar disorders, which contribute to significant workplace absenteeism and chronic disability, are associated with a considerable financial and social burden. Although a conservative approach provides satisfactory pain relief, biomechanical improvement and is associated with a low risk of adverse effects, there is lack of consensus in the literature regarding the best therapeutic strategy in such cases. METHODS: This retrospective longitudinal study used secondary data from the institutional medical records of patients who completed a multidisciplinary program for the treatment of low back pain between 2019 and 2021. Data regarding pain levels and motor skills were obtained from patients who completed the care program at a private hospital in Bento Gonçalves, RS. The following step-wise treatment algorithm was used: evaluation by a specialist physician for the etiological diagnosis of pain, pharmacological management and dry needling, followed by standard rehabilitation intervention performed by the physiotherapy team and exercises by the physical education team. The visual analogue scale (VAS) was used to measure pain at the start and at the completion of the intervention, and the Oswestry Disability Index (ODI) was used to measure motor skills at the start and at 6 and 12 months following the multiprofessional intervention for rehabilitation. RESULTS: A reduction in pain and motor disability in patients who completed all stages of the treatment program was observed. Pain by the VAS presented the following scores: baseline 7 [5-8] and after treatment 2 [0-4]; and the scores of the ODI were: at baseline 0.34 [0.26 - 0.40], at 6 months 0.16 [0.08 - 0.26] and after treatment 0.12 [0.04 - 0.21]. CONCLUSION: The treatment program reduced the pain and disability associated with low back pain and can serve as the basis for further studies carried out to confirm the effectiveness of this intervention.

RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças lombares, que contribuem para um absenteísmo significativo no local de trabalho e para a incapacidade crônica, estão associadas a um encargo financeiro e social considerável. Embora a abordagem conservadora proporcione alívio satisfatório da dor, melhore a biomecânica e esteja associada a baixo risco de efeitos adversos, não há consenso na literatura sobre a melhor estratégia terapêutica nesses casos. MÉTODOS: Neste estudo longitudinal retrospectivo, foram utilizados dados secundários dos prontuários médicos institucionais de pacientes que completaram um programa multidisciplinar para tratamento de dor lombar entre 2019 e 2021. Dados sobre níveis de dor e habilidades motoras foram obtidos de pacientes que completaram o programa assistencial de um hospital privado de Bento Gonçalves, RS. Foi utilizado o seguinte tratamento passo a passo: avaliação por médico especialista para diagnóstico etiológico da dor, manejo farmacológico e agulhamento a seco, seguido de intervenção de reabilitação padrão realizada pela equipe de fisioterapia e exercícios pela equipe de educação física. A escala analógica visual (EAV) foi utilizada para medir a dor no início e após a conclusão da intervenção, e o Índice de Incapacidade de Oswestry (ODI) foi usado para medir as habilidades motoras no início e aos 6 e 12 meses após a intervenção multiprofissional para reabilitação. RESULTADOS: Observou-se redução na dor e na incapacidade motora em pacientes que completaram todas as etapas do programa de tratamento. A intensidade da dor medida pela EAV apresentou as seguintes pontuações: basal 7 [5-8] e após tratamento 2 [0-4]; enquanto o ODI apresentou as pontuações: basal 0,34 [0,26 - 0,40], até 6 meses 0,16 [0,08 - 0,26] e após o tratamento 0,12 [0,04 - 0,21]. CONCLUSÃO: O programa de tratamento reduziu a dor e a incapacidade associadas à dor lombar e pode servir de base para novos estudos realizados para confirmar a eficácia desta intervenção.

Autopercepção do Impacto Imediato na Voz de Cantores Gospel após uma Apresentação de uma hora / Self-perception of the Immediate Impact on the Voice of Gospel Singers after a one-hour Presentation

RESUMO Objetivo Investigar o impacto imediato na voz de cantores gospel com e sem queixa vocal após uma apresentação individual de uma hora. Método Aplicação de um questionário online que abordou os seguintes aspectos: 1 - Dados sociodemográficos; 2 - Autoavaliação da habilidade de cantar pelo protocolo Evaluation of the Ability to Sing Easily (EASE-BR); 3 - Autoavaliação de sintomas de fadiga vocal pelo Índice de Fadiga Vocal (IFV); e 4 - Autoavaliação da desvantagem vocal pelo protocolo Índice de Desvantagem Vocal 10 (IDV-10). Os participantes foram divididos em dois grupos: Grupo Com Queixa (CQ) e Grupo Sem Queixa (SQ) com base no escore total do IDV-10. Os dados passaram por análise estatística descritiva e inferencial considerando o nível de significância de 5%. Resultados Participaram 43 cantores gospel com idade mediana de 34 anos, divididos entre 32 do grupo SQ e 11 do grupo CQ. O grupo CQ autorrelatou rouquidão e maior dificuldade ao cantar no EASE e maiores escores nos protocolos IDV-10 e IFV. Foi evidenciada correlação positiva entre a dificuldade ao cantar e a desvantagem vocal com a fadiga de cantores amadores gospel, sendo que essa correlação foi maior para o grupo SQ. Conclusão Cantores com queixa vocal apresentaram maiores índices de fadiga vocal, desvantagem vocal e maior dificuldade para cantar após uma hora de apresentação. Cantores sem queixa podem ter a habilidade de cantar prejudicada pela fadiga vocal. Variações na habilidade ao cantar e desvantagens vocais de cantores amadores gospel podem ter relação direta com a fadiga vocal.

ABSTRACT Purpose To investigate the immediate impact on the voice of gospel singers with and without vocal complaints after a one-hour individual presentation. Methods Application of an online questionnaire that addressed the following aspects: 1 - Sociodemographic data; 2 - Self-assessment of the ability to sing using the Evaluation of the Ability to Sing Easily (EASE-BR) protocol; 3 - Self-assessment of vocal fatigue symptoms using the Vocal Fatigue Index (VFI) protocol; and 4 - Self-assessment of voice handicap using the Voice Handicap Index 10 (VHI-10) protocol. Participants were divided into two groups: Group with Vocal Complaint (WVC) and Group with no Vocal Complaint (WnVC) based on the total score of the IDV-10. Data underwent descriptive and inferential statistical analysis with a significance level of 5%. Results The study included 43 gospel singers with a median age of 34 years: 32 were in the WnVC group and 11 were in the WVC group. The WVC group reported hoarseness and experienced more difficulty while singing in the EASE, resulting in higher scores in both the VHI-10 and VFI protocols. A positive correlation was observed between singing difficulty and vocal handicap due to fatigue in amateur gospel singers, with this correlation being stronger within the WnVC group. Conclusion After one hour of performance, singers with vocal complaints exhibited higher rates of vocal fatigue, vocal disadvantage, and greater difficulty in singing. Singers without complaints may have their ability to sing impaired by vocal fatigue. Variations in singing ability and vocal handicaps in amateur gospel singers may be directly related to vocal fatigue.

Protocolo assistencial de acolhimento em unidade de pronto atendimento no contexto da Covid-19 (2020-2021) / Care protocol for reception in an emergency care unit in the context of COVID-19 (2020-2021)

Resumo Pesquisa qualitativa tipo pesquisa-ação cujo objetivo foi descrever o processo de reorganização do fluxo assistencial de uma UPA para o enfrentamento da pandemia de Covid-19, a partir da implantação de protocolos assistenciais. O problema coletivo foi a organização do fluxo de atendimento de pessoas com síndrome gripal (SG). O estudo considerou os ciclos da pesquisa-ação propostos por Tripp (2005). Na fase de planejamento foi desenvolvido o fluxo de atendimentos de pacientes com SG mediante análise de normativas, estrutura física e recursos disponíveis. Durante a implementação, foram estabelecidas parcerias intersetoriais para adequação física, capacitação dos profissionais e redimensionamento da equipe. A descrição do processo de planejamento e implementação deu-se por meio de relatórios e dados coletados dos equipamentos de gestão da unidade e da Secretaria Municipal de Saúde. A avaliação foi realizada de forma contínua, com base na retroalimentação da literatura e da prática refletida. A reorganização da unidade com implantação de protocolos assistenciais e divisão de fluxos evidenciou pontos positivos, como participação e envolvimento da equipe, revisão de processos, busca por evidências e parcerias intersetoriais; e negativos, como a dificuldade na segregação do paciente com SG dentro da estrutura física da UPA.

Abstract Qualitative action-research research aimed to describe the process of reorganizing the care flow of a UPA to face the COVID-19 pandemic, based on the implementation of care protocols. The collective problem was the organization of the care flow for people with the flu syndrome (FS). The study considered the action-research cycles proposed by Tripp (2005). In the planning phase, the flow of care for patients with FS was developed through the analysis of regulations, physical structure, and available resources. During implementation, intersectoral partnerships were established for physical adaptation, training of professionals, and resizing of the team. The planning and implementation process was described based on reports and data were collected from the unit's management equipment and the Municipal Health Department. The evaluation was carried out continuously, based on feedback from the literature and reflected practice. The reorganization of the unit with the implementation of protocols and division of flows showed positive points, such as participation and involvement of the team, review of processes, search for evidence, and intersectoral partnerships; and negative, such as the difficulty in separating FS patients within the physical structure of the UPA.

Implementation of the Fast-track Protocol for Total Hip Arthroplasty in a Public Hospital in the State of São Paulo - Brazil / Implantação do protocolo de recuperação rápida para artroplastia total do quadril em hospital público do estado de São Paulo - Brasil

Abstract Objective Evaluate the results of the implementation of the Fast Track Protocol (FTP), a medical practice based on scientific evidence, for elective total hip arthroplasty surgery, mainly comparing the National Average Hospital Admission Rate of 7.1 days. Methods 98 patients who underwent elective total hip arthroplasty surgery via the direct anterior approach, anterolateral approach and posterior approach were included in the FTP from December 2018 to March 2020, being followed up preoperatively, intraoperatively and immediately postoperatively. Results The average length of hospital stay was 2.8 days, being 2.1 days for the direct anterior approach, 3.0 days for the anterolateral access approach and 4.1 days for the posterior access approach. The average surgery time was 90 minutes, 19 (19.39%) of the patients were referred to the ICU in the postoperative period, however, none of them underwent surgery using the direct anterior approach. We had no cases of deep vein thrombosis (DVT), pulmonary embolism (PTE) or neurological injury, 19 (19.39%) patients had postoperative bleeding requiring dressing change, 4 (4.08%) needed blood transfusion, 2 (2.04%) patients had implant instability, 1 (1.02%) patient had a fracture during surgery and 1 (1.02%) patient died of cardiac complications. Conclusion FTP may be a viable alternative to reduce the length of stay and immediate postoperative complications for elective total hip arthroplasty surgery decreasing the length of stay of patients by 2 to 3 times when compared to the national average of 7.1 days.

Resumo Objetivo Avaliar os resultados da implantação do Protocolo de Recuperação Rápida (PRR), prática médica baseada em evidências científicas, para cirurgia eletiva de artroplastia total do quadril principalmente comparando à Taxa Média de Internação Hospitalar nacional de 7.1 dias. Métodos 98 pacientes submetidos a cirurgia eletiva de artroplastia total do quadril pela via direta anterior, via anterolateral e via posterior foram incluídos no PRR no período de dezembro de 2018 a março de 2020 sendo acompanhados no pré-operatório, intraoperatório e pós-operatório imediato. Resultados a Taxa Média de Permanência Hospitalar foi de 2,8 dias, sendo 2,1 dias para a Via de Acesso Anterior, 3,0 dias para via de acesso anterolateral e 4,1 dias para via de acesso posterior. O tempo médio de cirurgia foi de 90 minutos, 19 (19,39%) dos pacientes foram encaminhados à UTI no pós-operatório, no entanto nenhum deles operado pela via direta anterior. Não tivemos casos de trombose venosa profunda (TVP), embolia pulmonar (TEP) ou lesão neurológica, 19 (19,39%) pacientes tiveram sangramento pós-operatório com necessidade de troca de curativo, 4 (4,08%) necessidade de transfusão sanguínea, 2 (2,04%) pacientes apresentaram instabilidade do implante, 1(1,02%) paciente teve fratura durante a cirurgia e 1(1,02%) paciente faleceu por complicações cardíacas. Conclusão O PRR pode ser uma alternativa viável para diminuir o tempo de internação e as complicações pós-operatórias imediatas para a cirurgia eletiva de artroplastia total do quadril diminuindo 2 a 3 vezes o tempo de internação dos pacientes quando comparado com a média nacional de 7,1 dias.