A Quality Improvement Project to Improve the Use of Mother's Own Milk (MOM) With Precision Oropharyngeal Therapy.

BACKGROUND: Bioprotective properties of mother's own milk (MOM) support the use of targeted MOM administration methods, including oropharyngeal therapy (OPT) with MOM, which may mimic the protective effects of swallowed amniotic fluid, thereby improving infant health outcomes. PURPOSE: To increase the use of MOM-OPT in premature infants in the first week of life. METHODS: Quality improvement methods were used to implement precision dosing of OPT. RESULTS: After changing processes and replacing the colostrum immune therapy practice with longer-term precision OPT, the percentage of ordered doses administered to infants in the first week of life increased from 24% to 64%. There was also a 15% increase in very low birth-weight infants who received MOM (from 50% to 65%) at discharge. There were no reported adverse events related to OPT administration. IMPLICATIONS FOR PRACTICE: Replacing the unit's short-term colostrum immune therapy protocol with the longer-term precision OPT increased the number of doses given in the first week of life and increased the number of very low birth-weight infants discharged receiving MOM. IMPLICATIONS FOR RESEARCH: Researchers should consider studying the reported positive effects of OPT related to infant response (positive oral stimulation, reduction in oral aversion, and improved oral feeding skills), parent participation in care, and maternal milk expression behaviors (longer milk expression duration).

A Novel Neonatal Feeding Intolerance and Necrotizing Enterocolitis Risk-Scoring Tool Is Easy to Use and Valued by Nursing Staff.

BACKGROUND: Preterm infants are at increased risk of developing feeding intolerance and necrotizing enterocolitis. Comprehensive, targeted nursing assessments can evaluate the risk for and identify early signs of these conditions in an effort to prevent their destructive sequela. PURPOSE: While the long-term goal is to develop a validated risk-scoring tool for the prediction of feeding intolerance and necrotizing enterocolitis, the objective of the preliminary phase presented here is to assess the ease of use and nurses' attitudes toward a novel feeding intolerance and necrotizing enterocolitis risk-scoring tool. METHODS: A novel risk-scoring nursing tool was implemented in a University of Illinois-affiliated 48-bed level III neonatal intensive care unit. Data were collected from the electronic medical record of all preterm infants with parental consent during the initial 6-month study period. Scoring accuracy (accuracy of selection of risk factors based on electronic medical record data), ease of use, and nurses' attitudes toward the tool were assessed at the study site and by evaluators at a national neonatal nursing conference. RESULTS: Fourteen nurses scored 166 tools on the 63 enrolled infants. Sixteen tools (9.6%) contained errors. Mean study site tool ease of use was 8.1 (SD: 2.2) on a 10-point scale. Ninety percent of conference evaluators agreed/strongly agreed that the tool addressed important knowledge gaps. IMPLICATIONS FOR PRACTICE: The tool is easy to use and valued by nurses. Following validation, widespread implementation is expected to be a clinically feasible means to improve infant clinical outcomes for minimal time and financial cost. IMPLICATIONS FOR RESEARCH: Tool validation and refinement based on nursing feedback will improve its broad applicability and predictive utility.

Prevention and early recognition of necrotizing enterocolitis: a tale of 2 tools--eNEC and GutCheckNEC.

BACKGROUND AND SIGNIFICANCE: Risk for neonatal necrotizing enterocolitis (NEC) is complex, reflecting its multifactorial pathogenesis. PURPOSE: To improve risk awareness and facilitate communication among neonatal caregivers, especially nurses, 2 tools were developed. DESIGN: GutCheck was derived and validated as part of a formal research study over 3 phases, evidence synthesis, expert consensus building, and statistical modeling. The Wetzel/Krisman tool, eNEC, was developed and tested as part of a quality improvement initiative in a single clinical setting using evidence synthesis, review by internal expert clinicians, and implementation and evaluation of its use by direct line neonatal staff. Refinement of both tools is under way to evaluate their effect on clinical decision making, early identification of NEC and surgical NEC. METHODS AND MAIN OUTCOMES: Clinicians can take an active role to reduce NEC in their units by focusing on modifiable risk factors such as adoption of standardized feeding protocols, preferential feeding of human milk, and antibiotic and histamine blocker stewardship. RESULTS: Feeding during transfusion remains controversial, but judicious use of transfusions, adoption of transfusion guidelines, and withholding feeding during transfusion are feasible measures with potential benefit to prevent NEC and confer little risk.

[The network of mental health care from the family health strategy service]. / A rede de atenção à saúde mental a partir da Estratégia Saúde da Família.

The Family Health Strategy Service (FHSS) is an important ally in the mental health system, contributing to the completeness and effectiveness of care. This study aimed to discuss the mental health care network as compared to the daily routine of an FHSS. It is an evaluative study with a qualitative methodological approach. It was developed in an FHSS in Porto Alegre-RS, Brazil. Data was collected between July and December of 2010 through interviews with 16 workers and ten relatives. We identified important resources in primary health care, such as partnerships with academia. However, the constitution of this care is still based on specialty, following the logic of patient referral. Our intention for this study was to contribute to the operationalization of the mental health care network, consolidating the partnership with the FHSS and developing activities in the territorial space, raising awareness, demystifying health care service in the area, and countering the perception that it is uniquely specialized.

Fourth Generation Evaluation as a path for Knowledge Translation in mental health.

OBJECTIVE: To discuss the use of the Fourth Generation Evaluation methodology as a powerful theoretical-methodological path for the implementation of Knowledge Translation in child and adolescent mental health. METHOD: It comprises the description of the stages and fieldwork of a research that evaluated mental health practices aimed at adolescents in a Child and Adolescent Psychosocial Care Center, between August and December 2018, with the health care team. RESULTS: Using strategies to involve workers in all stages, a dialectical construction of knowledge, the adaptation of the path to the field - with the implementation of interventions suggested by the participants - and the research path itself, in its condition of product/result, enable the interface with Knowledge Translation. FINAL CONSIDERATIONS: The characteristics discussed allow to suggest using the Evaluation as an alternative to the implementation of Translation, especially in the field of mental health.

Permanent cosmetics.

Plastic surgery practices have become more accepting of the implantation of permanent cosmetics over the last few years. Many plastic surgery practices have added the implantation of permanent cosmetics into their offered services. Many clients who would not have considered having permanent cosmetics implanted because of having to go to a tattoo parlor are now having the procedures performed. The most popular procedures being performed are the implantation of permanent eyeliner followed by eyebrows and lip liner. Other implantations of permanent cosmetics are the full-lip applications, eye shadow application, cheek blush, and a beauty mark implantation. Micro pigmentation can be used for nipple coloration following reconstruction or camouflaging skin pigmentation problems due to trauma, birthmarks, cancer, etc. This article focuses on the use of micro pigmentation for the use of permanent cosmetics (WebMD, 2009).

Metagenomic profile of the fecal microbiome of preterm infants consuming mother's own milk with bovine milk-based fortifier or infant formula: a cross-sectional study.

BACKGROUND: Preterm (PT) infants harbor a different gut microbiome than full-term infants. Multiple factors affect gut microbial colonization of PT infants, including low gestational age, high rates of Cesarean section, exposure to antibiotics, and diet. Human milk, whether it's mother's own milk (MOM) or donor human milk, is the preferred feeding mode for PT infants but needs to be fortified to achieve adequate nutrient content. Infant formulas are introduced at later stages if human milk is insufficient or unavailable. How these dietary exposures affect the gut microbiome of PT infants is poorly understood. OBJECTIVES: The goal of this study was to evaluate the metagenomic potential of the fecal microbiome of PT infants consuming MOM with bovine milk-based fortifier compared with PT formula alone. METHODS: Forty-two stool samples, from 27 infants consuming MOM or formula (21 samples in each group) were included. Twelve infants had repeated sampling (2-3 samples). Shotgun genomic DNA sequencing was performed and analyzed using MetaPhlAn and HUMAnN2. Multivariate regression analysis, adjusting by the repeated sampling, was used to identify the features that differed between PT infants consuming MOM compared with formula. RESULTS: The primary function of the fecal microbiome of PT infants was characterized by a high abundance of biosynthesis pathways. A set of core features was identified; these belonged to pathways for amino acid metabolism and vitamin K-2 biosynthesis. Five pathways significantly differed between the MOM and formula group. Pathways for fatty acid and carbohydrate degradation were significantly higher in the MOM group. Taxonomically, members of the phylum Actinobacteria and the genus Bifidobacterium were higher in PT infants exposed to MOM. CONCLUSIONS: This study provides insight into the influence of feeding MOM compared with infant formula on the structure and function of the fecal microbiome of PT infants.

[Qualitative evaluation of the work process in a psychosocial care center in Brazil]. / Avaliação qualitativa do processo de trabalho em um centro de atenção psicossocial no Brasil.

OBJECTIVE: This study's objective was to evaluate the work process in a psychosocial treatment center. We endeavored to identify areas of difficulty, gaps, deficiencies, potentialities, and experiences shared by the people involved in the service's day-to-day routine (users, family members, and health staff). METHODS: Qualitative evaluation study that used fourth-generation evaluation as the theoretical-methodological framework. RESULTS: We observed some basic characteristics that reveal the organization of the mental health work process from the perspective of the interest groups studied. The use of inclusive care technologies stands out, along with interdisciplinary team-based care management mechanisms centered on the user. CONCLUSIONS: The results contribute to a rereading of the consolidation of psychiatric reform in the brazilian context, raising questions about practice, knowledge, objectives, philosophies, and the goal of health work.

Human Milk-Based or Bovine Milk-Based Fortifiers Differentially Impact the Development of the Gut Microbiota of Preterm Infants.

Background: Preterm infants are exposed to different dietary inputs during their hospitalization in the neonatal intensive care unit (NICU). These include human milk (HM), with a human milk-based (HMF) or a bovine milk-based (BMF) fortifier, or formula. Milk consumption and the type of fortification will cause changes in the gut microbiota structure of preterm infants. This study aimed to characterize the gut microbiota of PT infant according to the type of feeding and the type of HM fortification and its possible association with infant's growth. Methods: Ninety-seven infants born ≤33 wks of gestation or <1,500 g were followed during the hospitalization period in the NICU after birth until discharge. Clinical and dietary information was collected, including mode of delivery, pregnancy complications, mechanical ventilation, use of antibiotics, weight, and type and amount of milk consumed. To characterize the gut microbiota composition, weekly stool samples were collected from study participants. The V3-V4 region of the 16S rRNA bacterial gene was Sequenced using Illumina MiSeq technology. Results: After birth, black maternal race, corrected gestational age (GA) and exposure to pregnancy complications, had a significant effect on gut microbial diversity and the abundance of Enterococcus, Veillonella, Bifidobacterium, Enterobacter, and Bacteroides. Over the course of hospitalization, corrected GA and exposure to chorioamnionitis remained to have an effect on gut microbial composition. Two different enterotypes were found in the gut microbiota of preterm infants. One enriched in Escherichia-Shigella, and another enriched in uncharacterized Enterobacteriaceae, Klebsiella and Clostridium sensu stricto 1. Overall, HM and fortification with HMF were the most common feeding strategies. When consuming BMF, PT infants had higher growth rates than those consuming HMF. Milk and type of fortification were significantly associated with the abundance of Clostridium sensu stricto 1, Bifidobacterium and Lactobacillus. Conclusions: This observational study shows the significant association between milk consumption and the exposure to HMF or BMF fortification in the fecal microbiota composition of preterm infants. Additionally, these results show the effect of other perinatal factors in the establishment and development of PT infant's gut microbiota.

Covid-19 and repercussions in mental health: a narrative review of literature.

OBJECTIVE: To identify the repercussions on mental health of groups and populations in the context of the new coronavirus pandemic. METHOD: Narrative review carired out in three databases, in March 2020, using the descriptors mental health and coronavirus. A total of 19 publications were analyzed, organized in a synoptic chart, containing type of publication, authors, country, sample, objective, and main results. From this analysis, two thematic axes emerged: identification of problems and vulnerable groups in mental health; and mental health interventions and actions. RESULTS: The first axis showed manifestations of suffering - anguish, insomnia, anger, stress, fear. The second revealed the need to build government policies and general guidelines; production of information and communication; and mental health care practices. CONCLUSIONS: The repercussions on mental health in the population intensified with the pandemic, identifying vulnerable groups, and the need to build coping strategies and policies aimed at mental health during epidemics.

The Effects of Genetic Relatedness on the Preterm Infant Gut Microbiota.

The preterm infant gut microbiota is influenced by environmental, endogenous, maternal, and genetic factors. Although siblings share similar gut microbial composition, it is not known how genetic relatedness affects alpha diversity and specific taxa abundances in preterm infants. We analyzed the 16S rRNA gene content of stool samples, ≤ and >3 weeks postnatal age, and clinical data from preterm multiplets and singletons at two Neonatal Intensive Care Units (NICUs), Tampa General Hospital (TGH; FL, USA) and Carle Hospital (IL, USA). Weeks on bovine milk-based fortifier (BMF) and weight gain velocity were significant predictors of alpha diversity. Alpha diversity between siblings were significantly correlated, particularly at ≤3 weeks postnatal age and in the TGH NICU, after controlling for clinical factors. Siblings shared higher gut microbial composition similarity compared to unrelated individuals. After residualizing against clinical covariates, 30 common operational taxonomic units were correlated between siblings across time points. These belonged to the bacterial classes Actinobacteria, Bacilli, Bacteroidia, Clostridia, Erysipelotrichia, and Negativicutes. Besides the influence of BMF and weight variables on the gut microbial diversity, our study identified gut microbial similarities between siblings that suggest genetic or shared maternal and environmental effects on the preterm infant gut microbiota.

Understanding culture, stigma and drug as a lifestyle in the life of people living in the streets. / Desvelando a cultura, o estigma e a droga enquanto estilo de vida na vivência de pessoas em situação de rua.

This research aimed to analyse how homeless people experience drug use and the intertwining between it and their cultural environment and life style. An etnographic study has been conducted which identified the macrosocial structures through the National Movement of the Homeless (Movimento Nacional da População de Rua) monitoring and the microsocial ones by means of its interlocutors' individual trajectories. Data were collected upon participant observation, registered in a research field journal and in semi-structured interviews. The analysis was carried out by data generation synthesis over the whole working process. Results reveal a street culture in which drug builds a collective life style that sets relationships and identities which withstand stigmas. Life stories unveil social suffering and exclusion besides non-adaptation to society conventional and formal aspects. Therefore, homeless people have their own social organisation that helps them to endure the difficulties in being accepted by society as well as the inadequacy of the social services that should assist them. Drug is part of this culture as a way of living and it needs to be understood and worked with by health professionals through a conscious and open approach.

O objetivo do estudo foi analisar como as pessoas em situação de rua vivenciam o uso de drogas e seus entrelaçamentos com suas culturas e estilos de vida. Realizou-se um estudo etnográfico, que identificou as estruturas macrossociais através do acompanhamento do Movimento Nacional da População de rua, e as microssociais, por meio das trajetórias individuais dos interlocutores. Os dados foram coletados mediante observação participante, registrada em diário de campo e entrevistas semiestruturadas. A análise foi realizada pela síntese da geração dos dados durante todo o processo de trabalho. Os resultados apontam uma cultura da rua, em que a droga surge como um estilo de vida coletivo, construindo relações e identidades de resistência aos estigmas. As histórias de vida revelaram o sofrimento social, a exclusão e a não adaptação ao sistema convencional e formal. Assim, as pessoas em situação de rua possuem uma organização social que ajuda a suportar as dificuldades de aceitação da sociedade e a inadequação dos serviços que as atendem. A droga faz parte dessa cultura, enquanto mais um modo de vida, que precisa ser compreendido e trabalhado de forma aberta e consciente pelos profissionais de saúde.

Nurse's means of work in the articulation of the psychosocial care network.

OBJECTIVE: To analyze nurses' means of work used in the articulation of the Psychosocial Care Network (PCN) Method: An exploratory-descriptive qualitative study conducted at the PCN of a District Health Management in Porto Alegre. The data collection technique used was the semi-structured interview held from October to December 2017. Data was subjected to thematic analysis under the Marxist theory of the Labor Process. RESULTS: The analysis resulted in two thematic categories: Care Management and Care Practices. The first consists of two means of work: team coordination and meetings with the other components of the territory. The second involves three means of work: telephone contacts with PCN services; user referrals in the PCN and matrix support. Final considerations: In view of overcoming the asylum model, nurses' means of work are instruments for producing dialogs aimed at expanding psychosocial care.

Assessment of components of crack users' attention network.

OBJECTIVE: Assess components of the Psychosocial Attention Network (RAPS) in crack user care in a Rio Grande do Sul municipality. METHOD: Qualitative study based on Fourth Generation Evaluation. Data collection occurred in 2014, through participating observation and interviews based on the Hermeneutic-Dialectic Circle. Ten uses, eleven family members, seven managers and eight workers at a Psychosocial Attention Center participated. The Constant Comparative Method was used for data analysis. RESULTS: Difficulties were observed in the network articulation with the general hospital, due to prejudice and the lack of structure of the team. SAMU's (Mobile Emergency Care Service) dependence on the Military Brigade for the service indicates a frailty of the network. The need to re-think the way therapeutic farms operate in the network is a consensus. CONCLUSION: RAPS is being implemented and its concretization depends on the involvement of professionals, managers and social control of users and family members.

[Using the Fourth Generation Evaluation in a Center of Psychosocial Attention]. / Utilização da Avaliação de Quarta Geração em um Centro de Atenção Psicossocial.

The study reports the use of the Evaluation of Fourth Generation in a Center of Psychosocial Attention (CAPS). A qualitative evaluation was carried through with the purpose of learning the service dynamics, the ways the actors interact and how the senses are built by those people in relation to their practice. The data collection was made in a CAPS in Porto Alegre, Rio Grande do Sul, Brazil, during the period between October and November of 2006. The applied methods were: observation, which made possible to experience the service context, interviews with 13 service users, 13 relatives and 13 mental health care professionals. The fieldwork experience allowed us to accomplish the joint of different methods of data collection in the search of service evaluation through a constructivist perspective. The evaluation allowed a problematization of mental care health in Centers of Psychosocial Attention and contributed to the emancipatory process of the involved subjects.

[Evaluation of a psychosocial care center in Foz do Iguaçú, Brazil]. / Avaliação de um Centro de Atenção Psicossocial: a realidade em Foz do Iguaçu.

This is an excerpt of the study An evaluation of the Psychosocial Care Centers in Southern Brazil. The objective is to evaluate the ambience of a Level II Psychosocial Care Center (CAPS, abbreviation in Portuguese) as a place for comfort. This case-study was performed using a qualitative approach and the Fourth Generation Evaluation. The following was used for data collection: interviews with 10 professionals from the health team, 11 patients, and 11 relatives, and 297 hours of field observation. The closed door and the reduced team had repercussions on the work process at the Care Center. These critical nodes have a direct effect on the ambience, producing tension and antagonism in services such as CAPS. The presented issuesarethemesthat demonstrate the commitment to a healthy environment, which implies comfort and subjectivity in the work at CAPS.

Fourth Generation Evaluation as a path for Knowledge Translation in mental health / La Evaluación de Cuarta Generación como camino para la Traslación del Conocimiento en salud mental / Avaliação de Quarta Geração enquanto percurso para a Translação do Conhecimento na saúde mental

ABSTRACT Objective: To discuss the use of the Fourth Generation Evaluation methodology as a powerful theoretical-methodological path for the implementation of Knowledge Translation in child and adolescent mental health. Method: It comprises the description of the stages and fieldwork of a research that evaluated mental health practices aimed at adolescents in a Child and Adolescent Psychosocial Care Center, between August and December 2018, with the health care team. Results: Using strategies to involve workers in all stages, a dialectical construction of knowledge, the adaptation of the path to the field - with the implementation of interventions suggested by the participants - and the research path itself, in its condition of product/result, enable the interface with Knowledge Translation. Final considerations: The characteristics discussed allow to suggest using the Evaluation as an alternative to the implementation of Translation, especially in the field of mental health.

RESUMEN Objetivo: Discutir el uso de la metodología de Evaluación de Cuarta Generación como un camino teórico-metodológico para la implementación de la Traducción del Conocimiento en salud mental del niño y del adolescente. Método: Comprende la descripción de las etapas y el trabajo de campo de una investigación que evaluó las prácticas de salud mental dirigidas a adolescentes en un Centro de Atención Psicosocial de Niños y Adolescentes, entre agosto y diciembre de 2018, con el equipo. Resultados: Utilizar estrategias para involucrar a los trabajadores en las etapas, construir conocimiento dialécticamente, la adecuación del camino al campo - implementar intervenciones sugeridas por los participantes- y el camino de la investigación, en su condición de producto/resultado, habilite la interfaz con Traducción del Conocimiento. Consideraciones finales: Las características discutidas permiten sugerir el uso de la Evaluación como una alternativa a la implementación de la Traducción, especialmente en el campo de la salud mental.

RESUMO Objetivo: Discutir o uso da metodologia da Avaliação de Quarta Geração como um percurso teórico-metodológico potente para implementação da Translação do Conhecimento na saúde mental infantojuvenil. Método: Compreende a descrição das etapas e do trabalho de campo de uma pesquisa que avaliou as práticas em saúde mental voltadas aos adolescentes em um Centro de Atenção Psicossocial infantojuvenil, entre agosto e dezembro de 2018, com a equipe assistencial do serviço. Resultados: A utilização de estratégias para envolver os trabalhadores em todas as etapas, a construção do conhecimento de maneira dialética, a adaptação do percurso ao campo - com a realização de intervenções sugeridas pelos participantes - e o próprio percurso da pesquisa,em sua condição de produto/resultado, viabilizam a interface com a Translação do Conhecimento. Considerações finais: As características discutidas possibilitam sugerir que se utilize a Avaliação como alternativa à implementação da Translação, sobretudo no campo da saúde mental.

Avaliação do acesso e acolhimento no Centro de Atenção Psicossocial / Evaluation of access and welcoming at the center of psychosocial attention / Evaluación del acceso y acogida en el centro de atención psicosocial

Objetivo: compreender as percepções dos acompanhantes que aguardam notícias de seus entes queridos que estão em cirurgia, sobre a utilização da música como estratégia para promover saúde no hospital. Método: estudo descritivo, exploratório, qualitativo, fundamentado nos pressupostos teóricos da Promoção da Saúde, com a participação de 15 acompanhantes que aguardavam notícias de seus entes queridos em uma sala de espera no ambiente hospital. Realizaram-se entrevistas semiestruturadas e os dados foram organizados e analisados conforme análise de conteúdo. Resultados: os participantes destacaram algumas possibilidades para promover saúde na sala de espera de cirurgia do hospital, como a música, a qual proporciona distração da realidade preocupante, felicidade, vida, alegria, esperança, sensações boas, ânimo e tranquilidade. Considerações finais: a música destaca-se como tecnologia para promover saúde, despertando sentimentos positivos durante as intervenções musicais no hospital. Portanto, faz-se necessário ampliar a discussão e utilização da música como estratégia para promover saúde no âmbito hospitalar

Objective: to evaluate the user's access from the reception process in a Psychosocial Care Center. Method: qualitative case study, based on the Fourth Generation Assessment. Data collection took place in 2019, through methods of document analysis, participant observation and interviews based on the Hermeneutic-Dialectical Circle. Ten users, ten family members and nine service professionals participated in the research. For data analysis, the Constant Comparative Method was used. Results: the service provides resolute and fast reception, which can reduce psychiatric hospitalizations. It identified the need to break out of outpatient actions in the service, review the user embracement and access process at CAPS and the implementation of permanent education spaces. Conclusion: the contributions of this research can support workers and managers to reduce barriers to access and to effect care in specialized and strategic services such as CAPS

Objetivo: evaluar el acceso del usuario desde el proceso de acogida en un Centro de Atención Psicosocial. Método: estudio de caso cualitativo, basado en la Evaluación de Cuarta Generación. La recolección de datos ocurrió en 2019, a través de métodos de análisis de documentos, observación participante y entrevistas basadas en el Círculo Hermenéutico-Dialéctico. Participaron de la investigación diez usuarios, diez familiares y nueve profesionales del servicio. Para el análisis de los datos se utilizó el Método Comparativo Constante. Resultados: el servicio proporciona una recepción resolutiva y rápida, lo que puede reducir las hospitalizaciones psiquiátricas. Identificó la necesidad de romper con las acciones ambulatorias en el servicio, revisar el proceso de acogida y acceso de los usuarios en los CAPS y la implementación de espacios de educación permanente. Conclusión: los aportes de esta investigación pueden apoyar a los trabajadores y gestores a reducir las barreras de acceso y efectuar la atención en servicios especializados y estratégicos como los CAPS

NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis.

BACKGROUND: Although decades have focused on unraveling its etiology, necrotizing enterocolitis (NEC) remains a chief threat to the health of premature infants. Both modifiable and non-modifiable risk factors contribute to varying rates of disease across neonatal intensive care units (NICUs). PURPOSE: The purpose of this paper is to present a scoping review with two new meta-analyses, clinical recommendations, and implementation strategies to prevent and foster timely recognition of NEC. METHODS: Using the Translating Research into Practice (TRIP) framework, we conducted a stakeholder-engaged scoping review to classify strength of evidence and form implementation recommendations using GRADE criteria across subgroup areas: 1) promoting human milk, 2) feeding protocols and transfusion, 3) timely recognition strategies, and 4) medication stewardship. Sub-groups answered 5 key questions, reviewed 11 position statements and 71 research reports. Meta-analyses with random effects were conducted on effects of standardized feeding protocols and donor human milk derived fortifiers on NEC. RESULTS: Quality of evidence ranged from very low (timely recognition) to moderate (feeding protocols, prioritize human milk, limiting antibiotics and antacids). Prioritizing human milk, feeding protocols and avoiding antacids were strongly recommended. Weak recommendations (i.e. "probably do it") for limiting antibiotics and use of a standard timely recognition approach are presented. Meta-analysis of data from infants weighing <1250 g fed donor human milk based fortifier had reduced odds of NEC compared to those fed cow's milk based fortifier (OR = 0.36, 95% CI 0.13, 1.00; p = 0.05; 4 studies, N = 1164). Use of standardized feeding protocols for infants <1500 g reduced odds of NEC by 67% (OR = 0.33, 95% CI 0.17, 0.65, p = 0.001; 9 studies; N = 4755 infants). Parents recommended that NEC information be shared early in the NICU stay, when feedings were adjusted, or feeding intolerance occurred via print and video materials to supplement verbal instruction. DISCUSSION: Evidence for NEC prevention is of sufficient quality to implement. Implementation that addresses system-level interventions that engage the whole team, including parents, will yield the best impact to prevent NEC and foster its timely recognition.

A clínica no Centro de Atenção Psicossocial Infantojuvenil: na adolescência, o diagnóstico se escreve a lápis / Clinics at Psychosocial Care Center for Children and Adolescents: diagnoses on adolescence is written in pencil

RESUMO O artigo tem como objetivo analisar a prática da clínica com adolescentes na atenção psicossocial, em um Centro de Atenção Psicossocial Infantojuvenil. Utilizou-se a Avaliação de Quarta Geração como percurso teórico-metodológico, tendo como parâmetros avaliativos os seguintes aspectos das práticas em saúde mental, na perspectiva da atenção psicossocial: o cuidado em liberdade, intersetorial, territorial, multiprofissional, e singular, buscando como resultados a inserção social, a autonomia e a cidadania. Foram realizadas entrevistas com os profissionais do serviço, e observação participante. A análise ocorreu mediante o Método Comparativo Constante. Evidencia-se a tarefa de construir uma clínica que supere os saberes e as práticas da psiquiatria tradicional, que incorpore o contexto dos adolescentes, e que não tenha como eixo central o diagnóstico. Os resultados sugerem o deslocamento do foco da atenção na doença para o adolescente, considerando seus desejos, suas relações e os sentidos que atribuem às possíveis perspectivas e aos caminhos resultantes dos saberes da clínica. Conclui-se, sobre a necessidade da manutenção do processo de constante questionamento em relação à clínica psicossocial com adolescentes, sua repercussão e sua incorporação enquanto uma possibilidade terapêutica transitória e singular.

ABSTRACT This article aims to analyze the practice of the clinic with adolescents in psychosocial care, in Psychosocial Care Center for Children and Adolescents. The Fourth Generation Evaluation was used as a theoretical-methodological approach, having as evaluative parameters the following aspects of health practices, from the perspective of psychosocial care: care in freedom, intersectoral, territorial, multi-professional and singular, seeking as results social inclusion, autonomy and citizenship. Interviews were conducted with service professionals and participant observation. The analysis was performed by Constant Comparative Method. The task of building a clinic that overcomes the knowledge and practices of traditional psychiatry is evident, which incorporates the adolescents' context, and that does not have diagnosis as its central axis. There is essential to change the attention from the disease to the adolescent, considering their desires, relationships and the meanings attributed by them to possible perspectives and paths resulting from clinic's knowledge. It is important to maintain the process of constant wondering regarding the psychosocial clinic with adolescents, its repercussion and its incorporation as a transitory and singular therapeutic possibility.