Avaliação da segurança do paciente neonatal: construção e validação de protocolo e checklist / Evaluación de la seguridad del paciente neonatal: construcción y validación de un protocolo y de un checklist / Neonatal patient safety assessment: construction and validation of a protocol and a checklist

Resumo Objetivo Construir e validar conteúdo e aparência de um protocolo gráfico e checklist para a avaliação da segurança do paciente em unidade de terapia intensiva neonatal. Métodos Pesquisa metodológica, desenvolvida no período de março a setembro de 2018, em duas etapas: construção do protocolo e checklist , e validação de conteúdo e aparência. Utilizou-se a técnica Delphi para avaliação das ferramentas, e o consenso entre os juízes foi mensurado pelo Coeficiente de Validade de Conteúdo. Considerou-se válido o item com mais de 80% de concordância. Resultados Os instrumentos apresentaram Coeficiente de validade de conteúdo de 0,97 na segunda rodada Delphi, para validade de conteúdo. A estimativa geral dos instrumentos para validação de aparência foi de 0,99 na Delphi II. Após inclusão de alterações sugeridas 100% dos juízes recomendaram o uso do protocolo e do checklist . Conclusão O protocolo e o checklist foram considerados válidos e sua utilização constitui importante meio para verificar as condições que comprometem o cuidado seguro ao neonato.

Resumen Objetivo Construir y validar contenido y la apariencia de un protocolo gráfico y de una checklist para la evaluación de la seguridad del paciente en una unidad de cuidados intensivos neonatal. Métodos Investigación metodológica, desarrollada en el período de marzo a septiembre de 2018, en dos etapas: construcción del protocolo y de una checklist , y validación de contenido y apariencia. Se utilizó la técnica Delphi para la evaluación de las herramientas y el consenso entre los jueces medido por medio del Coeficiente de Validez de Contenido. Se consideró válido el ítem con más del 80 % de consenso. Resultados Los instrumentos presentaron un Coeficiente de validez de contenido del 0,97 en la segunda ronda Delphi, para validez de contenido. La estimación general de los instrumentos para validación de la apariencia fue del 0,99 en Delphi II. Después de la inclusión de las alteraciones sugeridas, el 100 % de los jueces recomendaron el uso del protocolo y de la checklist . Conclusión El protocolo y la checklist fueron considerados válidos y su utilización constituye un medio importante para que se verifiquen las condiciones que comprometen el cuidado seguro con el neonato.

Abstract Objective To build and validate the content and appearance of a graph protocol and a checklist for patient safety assessment in the Neonatal Intensive Care Unit. Methods This is a methodological research, developed from March to September 2018, under construction of a protocol and a checklist and content and appearance validation. The Delphi technique was used to assess the instruments, and agreement among judges was measured by the Content Validity Coefficient. The item with more than 80% agreement was considered valid. Results The instruments presented a content validity coefficient of 0.97 in the second Delphi round, for content validity. The general estimate of the appearance validation instruments was 0.99 in Delphi II. After inclusion of suggested changes, all judges recommended the use of the protocol and the checklist. Conclusion The protocol and the checklist were considered valid and its use constitutes an important means to verify the conditions that compromise a safe newborn care.

Self-perceived evaluation of prenatal care: a hierarchical analysis by the users of Primary Health Care services in Brazil / Avaliação auto percebida do cuidado pré-natal: análise hierárquica segundo usuárias da Atenção Primária à Saúde no Brasil

Abstract Objective: to analyze the factors associated with positive self-perceived evaluation of prenatal care among users of Primary Health Care (PHC). Methods: the analytical cross-sectional study was carried out with secondary data from the 3rd Module of the 2nd cycle (2013 / 2014) of the External Evaluation of the Improvement of Access and Quality of Primary Care Program (PMAQ-AB - Portuguese acronym), collected from users in the Basic Health Units (BHU) that joined the PMAQ-AB in Brazil. The hierarchical analysis was performed using a theoretical model and logistic regression was performed between the self-perceived evaluation (positive - very good/good or negative - regular/poor/very bad) and the sociodemographic characteristics, prenatal care and health service evaluation (p<0.05). Results: the sample consisted of 9,922 women and 81.7% rated care as very good/good. In the final model, positive evaluation was associated to women with incomplete higher education or over (OR=1.05; CI95%=1.01-1.09; p=0.010), who underwent the VDRL exam (OR=1.07; CI95%=1.01-1.14; p=0.020), consultation with the same professional (OR=1.07; CI95%=1.02-1.12; p=0.010), received guidance on the gynecological preventive exam (OR=1.05; CI95%=1.01-1.08; p=0.007), believed that guidance helped with pregnancy and child care (OR=1.24; CI95%=1.05-1.46; p=0.012), evaluated the BHU structure as very good/good (OR=1.19; CI95%=:1.14-1.24; p<0.001) and would not change BHU or team (OR=1.62; CI95%=1.48-1.68; p<0.001). Conclusion: the positive evaluation of prenatal care was associated with sociodemographic factors, prenatal care and health service evaluation.

Resumo Objetivos: analisar os fatores associados a avaliação positiva auto percebida do cuidado pré-natal entre usuárias da Atenção Primária à Saúde. Métodos: o estudo transversal analítico foi realizado com dados secundários do Módulo III do 2º ciclo (2013/2014) da Avaliação Externa do Programa Melhoria de Acesso e Qualidade da Atenção Básica (PMAQ-AB), coletado com usuários nas próprias Unidades Básicas de Saúde (UBS) que aderiram ao PMAQ-AB no Brasil. A análise hierárquica foi realizada com modelo teórico adaptado e regressão logística entre a avaliação autopercebida (positiva - muito bom/bom ou negativa - regular/ruim/muito ruim) e os fatores sociodemográficos, assistência pré-natal e avaliação do serviço de saúde (p<0,05). Resultados: a amostra foi composta por 9.922 mulheres, sendo que 81,7% avaliaram o cuidado pré-natal como muito bom/bom. No modelo final, a avaliação positiva foi associada a mulheres com ensino superior incompleto ou mais (OR=1,05;IC95%=1,01-1,09; p=0,010), que realizou o exame de VDRL (OR=1,07; IC95%=,01-1,14;p=0,020), consulta com o mesmo profissional (OR=1,07; IC95%=1,02-1,12; p=0,010), recebeu orientação sobre o exame preventivo (OR=1,05; IC95%=1,01-1,08; p=0,007), acreditava que a orientação ajudou na gravidez e cuidados com a criança (OR=1,24;IC95%=1,05-1,46;p=0,012), avaliou a estrutura da UBS como muito boa/boa (OR=1,19;IC95%=1,14-1,24; p<0,001) e não trocaria de UBS ou equipe (OR=1,62; IC95%=1,48-1,68;p<0,001). Conclusão: a avaliação positiva do cuidado pré-natal foi associada aos fatores sociodemográficos, assistência pré-natal e avaliação do serviço de saúde.

Percepção da equipe de enfermagem acerca da assistência à saúde no sistema prisional / Perception of Tthe nursing team about health care in the prison system / Percepción del equipo de enfermería acerca de la asistencia a la salud en el sistema prisional

Objetivo: Compreender como a equipe de enfermagem percebe a assistência da saúde no Sistema Prisional. Métodos: Trata-se de uma pesquisa qualitativa, referenciada pela análise de conteúdo proposto por Laurence Bardin e foram entrevistados 03 enfermeiras e 08 técnicos de enfermagem, sendo 03 do sexo masculino, atuantes no Sistema Prisional da região Metropolitana de Belo Horizonte/MG. Resultados: Demonstrou-se pela fala da equipe de enfermagem que o pensamento centrado no modelo médico-curativista ainda é presente, e que, existem fragilidades nos processos de organização administrativa. Conclusão: O estudo esclareceu que é importante que haja um processo de organização administrativa básica, para melhorar os recursos organizacionais, capacitar os profissionais, logo trazer condições de saúde dignas ao indivíduo privado de liberdade

Objective: The research's purpose has been to understand how the nursing team perceives health care in the Prison System. Methods: This is a qualitative study, referenced by the content analysis proposed by Laurence Bardin. The investigation includes 03 nurses and 08 nursing technicians, being 03 male, working in the Prison System of the Metropolitan Region of Belo Horizonte city, Minas Gerais State. Results: It was demonstrated by the speech of the nursing team that the thought centered on the medico-curativist model is still present and that there are weaknesses in the processes of administrative organization. Conclusions: The study clarified that it is important to exist a basic administrative organization process, to improve organizational resources, to empower professionals, and thus to bring dignified health conditions to the individual deprived of liberty

Objetivo: Comprender cómo el equipo de enfermería percibe la asistencia de la salud en el Sistema Penitenciario. Métodos: Se trata de una investigación cualitativa, referenciada por el análisis de contenido propuesto por Laurence Bardin y fueron entrevistados a tres enfermeras y 08 técnicos de enfermería, siendo 03 del sexo masculino, actuantes en el Sistema Prisional de la región Metropolitana de Belo Horizonte / MG. Resultados: Se demostró por el habla del equipo de enfermería que el pensamiento centrado en el modelo medico-curativista todavía está presente, y que, existen fragilidades en los procesos de organización administrativa. Conclusión: El estudio aclaró que es importante que haya un proceso de organización administrativa básica, para mejorar los recursos organizacionales, capacitar a los profesionales, luego traer condiciones de salud dignas al individuo privado de libertad

Pharmacological and toxicological assessment of innovative self-assembled polymeric micelles as powders for insulin pulmonary delivery.

AIM: Explore the use of polymeric micelles in the development of powders intended for pulmonary delivery of biopharmaceuticals, using insulin as a model protein. MATERIALS & METHODS: Formulations were assessed in vitro for aerosolization properties and in vivo for efficacy and safety using a streptozotocin-induced diabetic rat model. RESULTS: Powders presented good aerosolization properties like fine particle fraction superior to 40% and a mass median aerodynamic diameter inferior of 6 µm. Endotracheally instilled powders have shown a faster onset of action than subcutaneous administration of insulin at a dose of 10 IU/kg, with pharmacological availabilities up to 32.5% of those achieved by subcutaneous route. Additionally, micelles improved the hypoglycemic effect of insulin. Bronchoalveolar lavage screening for toxicity markers (e.g., lactate dehydrogenase, cytokines) revealed no signs of lung inflammation and cytotoxicity 14 days postadministration. CONCLUSION: Developed powders showed promising safety and efficacy characteristics for the systemic delivery of insulin by pulmonary administration.

Biological assessment of self-assembled polymeric micelles for pulmonary administration of insulin.

Pulmonary delivery of drugs for both local and systemic action has gained new attention over the last decades. In this work, different amphiphilic polymers (Soluplus®, Pluronic® F68, Pluronic® F108 and Pluronic® F127) were used to produce lyophilized formulations for inhalation of insulin. Development of stimuli-responsive, namely glucose-sensitive, formulations was also attempted with the addition of phenylboronic acid (PBA). Despite influencing the in vitro release of insulin from micelles, PBA did not confer glucose-sensitive properties to formulations. Lyophilized powders with aerodynamic diameter (<6 µm) compatible with good deposition in the lungs did not present significant in vitro toxicity for respiratory cell lines. Additionally, some formulations, in particular Pluronic® F127-based formulations, enhanced the permeation of insulin through pulmonary epithelial models and underwent minimal internalization by macrophages in vitro. Overall, formulations based on polymeric micelles presenting promising characteristics were developed for the delivery of insulin by inhalation. FROM THE CLINICAL EDITOR: The ability to deliver other systemic drugs via inhalation has received renewed interests in the clinical setting. This is especially true for drugs which usually require injections for delivery, like insulin. In this article, the authors investigated their previously developed amphiphilic polymers for inhalation of insulin in an in vitro model. The results should provide basis for future in vivo studies.

Safety assessment of yerba mate (Ilex paraguariensis) dried extract: results of acute and 90 days subchronic toxicity studies in rats and rabbits.

Acute toxicity of yerba mate dried extract (YMDE) was investigated in Wistar rats (6/sex/group) from single dose of 2g/kg body weight by intragastric administration and 14days monitoring. Subchronic toxicity was investigated in Wistar rats, by intragastric administration (10/sex/group), and in New Zealand rabbits by oral administration (3/sex/group) of 2g/kg body weight for 12weeks. Toxicological parameters included clinical signs, body weight, water, and food consumption, hematological and serum parameters, and histopathological assessment. Acute YMDE administration showed no effects on survival, clinical observations, macroscopic examination of organs, body weight or food, and water consumption. Sub-chronic administration of YMDE did not change behavior, body weight, and histopatological assessment of stomach, kidney, liver, and small gut. Moreover, most of biochemical and hematological parameters remained unchanged. In summary, the results of our preclinical toxicological investigation are indicative that the YMDE is well tolerated for both single and chronic administration.