Assessment of Breast Pathology Reporting Needs and Development of Tumor Synoptic Templates in Sub-Saharan Africa.

CONTEXT.­: Breast pathology reports include many important details to guide clinical management. Reports with missing critical data elements are commonly seen in non-subspecialized pathology practices. The use of synoptic templates has been shown to improve pathology reports. Although synoptic templates are readily available by professional societies, many are not tailored to low-resource settings. OBJECTIVE.­: To perform an assessment of current breast pathology reporting at 3 referral hospitals in sub-Saharan Africa and design a locally adapted breast cancer synoptic template. DESIGN.­: We conducted semi-structured interviews with key stakeholders involved in breast cancer care including pathologists, radiologists, oncologists, and surgeons from Nigeria, Tanzania, and Mozambique. Moreover, each stakeholder reviewed a preliminary synoptic template that was compiled by using templates from the College of American Pathologists, Royal College of Pathologists, and International Collaboration on Cancer Reporting, and was asked to score each data element as essential, optional, or exclude. A locally adapted synoptic template was then designed from the needs assessment. Using the adapted templates, a retrospective review of breast cancer pathology reports from 2020 to 2022 was conducted to determine the completeness of reports at the 3 institutions. RESULTS.­: A total of 17 physicians were interviewed. Review of pathology reports revealed that none of the reports across all 3 sites contained all data elements considered essential by local physicians. CONCLUSIONS.­: There is an urgent need to improve breast pathology reporting in sub-Saharan Africa. Development and implementation of synoptic templates in collaboration with key stakeholders has the potential to improve pathology reporting practices in low-resource settings.

Post-mortem investigation of deaths due to pneumonia in children aged 1-59 months in sub-Saharan Africa and South Asia from 2016 to 2022: an observational study.

BACKGROUND: The Child Health and Mortality Prevention Surveillance (CHAMPS) Network programme undertakes post-mortem minimally invasive tissue sampling (MITS), together with collection of ante-mortem clinical information, to investigate causes of childhood deaths across multiple countries. We aimed to evaluate the overall contribution of pneumonia in the causal pathway to death and the causative pathogens of fatal pneumonia in children aged 1-59 months enrolled in the CHAMPS Network. METHODS: In this observational study we analysed deaths occurring between Dec 16, 2016, and Dec 31, 2022, in the CHAMPS Network across six countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in South Asia (Bangladesh). A standardised approach of MITS was undertaken on decedents within 24-72 h of death. Diagnostic tests included blood culture, multi-organism targeted nucleic acid amplifications tests (NAATs) of blood and lung tissue, and histopathology examination of various organ tissue samples. An interdisciplinary expert panel at each site reviewed case data to attribute the cause of death and pathogenesis thereof on the basis of WHO-recommended reporting standards. FINDINGS: Pneumonia was attributed in the causal pathway of death in 455 (40·6%) of 1120 decedents, with a median age at death of 9 (IQR 4-19) months. Causative pathogens were identified in 377 (82·9%) of 455 pneumonia deaths, and multiple pathogens were implicated in 218 (57·8%) of 377 deaths. 306 (67·3%) of 455 deaths occurred in the community or within 72 h of hospital admission (presumed to be community-acquired pneumonia), with the leading bacterial pathogens being Streptococcus pneumoniae (108 [35·3%]), Klebsiella pneumoniae (78 [25·5%]), and non-typeable Haemophilus influenzae (37 [12·1%]). 149 (32·7%) deaths occurred 72 h or more after hospital admission (presumed to be hospital-acquired pneumonia), with the most common pathogens being K pneumoniae (64 [43·0%]), Acinetobacter baumannii (19 [12·8%]), S pneumoniae (15 [10·1%]), and Pseudomonas aeruginosa (15 [10·1%]). Overall, viruses were implicated in 145 (31·9%) of 455 pneumonia-related deaths, including 54 (11·9%) of 455 attributed to cytomegalovirus and 29 (6·4%) of 455 attributed to respiratory syncytial virus. INTERPRETATION: Pneumonia contributed to 40·6% of all childhood deaths in this analysis. The use of post-mortem MITS enabled biological ascertainment of the cause of death in the majority (82·9%) of childhood deaths attributed to pneumonia, with more than one pathogen being commonly implicated in the same case. The prominent role of K pneumoniae, non-typable H influenzae, and S pneumoniae highlight the need to review empirical management guidelines for management of very severe pneumonia in low-income and middle-income settings, and the need for research into new or improved vaccines against these pathogens. FUNDING: Bill & Melinda Gates Foundation.

Clinicopathological discrepancies in the diagnoses of childhood causes of death in the CHAMPS network: An analysis of antemortem diagnostic inaccuracies.

INTRODUCTION: Determining aetiology of severe illness can be difficult, especially in settings with limited diagnostic resources, yet critical for providing life-saving care. Our objective was to describe the accuracy of antemortem clinical diagnoses in young children in high-mortality settings, compared with results of specific postmortem diagnoses obtained from Child Health and Mortality Prevention Surveillance (CHAMPS). METHODS: We analysed data collected during 2016-2022 from seven sites in Africa and South Asia. We compared antemortem clinical diagnoses from clinical records to a reference standard of postmortem diagnoses determined by expert panels at each site who reviewed the results of histopathological and microbiological testing of tissue, blood, and cerebrospinal fluid. We calculated test characteristics and 95% CIs of antemortem clinical diagnostic accuracy for the 10 most common causes of death. We classified diagnostic discrepancies as major and minor, per Goldman criteria later modified by Battle. RESULTS: CHAMPS enrolled 1454 deceased young children aged 1-59 months during the study period; 881 had available clinical records and were analysed. The median age at death was 11 months (IQR 4-21 months) and 47.3% (n=417) were female. We identified a clinicopathological discrepancy in 39.5% (n=348) of deaths; 82.3% of diagnostic errors were major. The sensitivity of clinician antemortem diagnosis ranged from 26% (95% CI 14.6% to 40.3%) for non-infectious respiratory diseases (eg, aspiration pneumonia, interstitial lung disease, etc) to 82.2% (95% CI 72.7% to 89.5%) for diarrhoeal diseases. Antemortem clinical diagnostic specificity ranged from 75.2% (95% CI 72.1% to 78.2%) for diarrhoeal diseases to 99.0% (95% CI 98.1% to 99.6%) for HIV. CONCLUSIONS: Antemortem clinical diagnostic errors were common for young children who died in areas with high childhood mortality rates. To further reduce childhood mortality in resource-limited settings, there is an urgent need to improve antemortem diagnostic capability through advances in the availability of diagnostic testing and clinical skills.

Microablative fractional radiofrequency for sexual dysfunction and vaginal Trophism: A randomized clinical trial

Abstract Objectives: To evaluate Microablative Fractional Radiofrequency (MAFRF) as a possible option in treating vaginal atrophy. Methods: This was a randomized, controlled clinical trial with postmenopausal women diagnosed with vaginal atrophy. The treatment consisted of three sessions of MAFRF, compared to vaginal estrogen administration and an untreated control group. Assessments occurred at baseline and 90 days. The primary endpoints were sexual function, evaluated by the Female Sexual Function Index (FSFI), and vaginal health, assessed by the Vaginal Health Index (VHI). Secondary outcomes included vaginal microbiota composition (Nugent score) and epithelial cell maturation (Maturation Value ‒ MV). Results: One hundred and twenty women (40 in each group) were included. Concerning the FSFI, both groups, MAFRF (median 4.8 [3.6‒6.0]) and vaginal estrogen (mean 4.7 ± 1.1), experienced improved sexual desire when compared to the control group (median 3.6 [2.4‒4.8]). Regarding the total score of VHI, the authors observed an improvement in the mean of the MAFRF (23.7 ± 2.0) and vaginal estrogen groups (23.5 ± 1.9) when compared to the control (14.8 ± 2.9). The Nugent score was reduced in the MAFRF and estrogen groups (p < 0.01) compared to the control group. Lastly, the MV was modified after treatment with MAFRF (p < 0.01) and vaginal estrogen (p < 0.001). No differences existed between the MAFRF and vaginal estrogen groups in the studied variables. No adverse effects were reported following the MAFRF protocol. Conclusions: Radiofrequency was comparable in efficacy to estrogen administration for treating vulvovaginal atrophy. It deserves consideration as a viable option in managing this condition.

Difficulties in the Diagnosis of Gaucher Disease in a Low-Income Country: A Case Report from Mozambique

Abstract Introduction: Gaucher disease (GD) is one of the common lysosomal storage disorder (LSD) with an estimated frequency of one in 40,000 newborns globally. GD is an autosomal recessive condition, which results from mutations in the GBA1 gene, causing partial or complete deficiency of β-glucocerebrosidase enzyme activity, which leads to the widespread accumulation of the substrate glucosylceramide. Aims: This report presents different challenges of clinical management and communication between medical specialties to reach diagnose of any rare disease in Mozambique, a low-income country, which health system has limited infrastructure, trained personnel, and budget for diagnosis and to provide treatment for rare genetic disorders such as GD. Case Presentation: The patient was a 15-year old black female patient of Mozambican nationality born from non-consanguineous parents. Three of the four patient's siblings were healthy; one sister had died of a disease with a similar clinical features. Our patient presented with abdominal distention and hepatosplenomegaly. Blood tests revealed pancytopenia and a high level of ferritin. Liver biopsy and histologic examination revealed infiltration of the splenic parenchyma and portal area of the liver as well as enlarged histiocytic cells with granular cytoplasm. Magnetic resonance imaging showed liver enlargement, changes in the femoral heads without osteonecrosis, a pathological fracture of the third thoracic vertebrae (T3), with absence of brain and spinal cord neurological abnormalities. The biochemical investigation disclosed low levels of β-glucocerebrosidase (0.223 nmol/h/ml; normal: above 0.98) and increased levels of lyso-Gb1 (0.43 µg/ml; normal: up to 0.003). Genotyping of the GBA1 gene indicated the presence of the pathogenic variant p.Arg87Trp (R48W) in homozygosis. Discussion and Conclusion: To the best of our knowledge, this report describes the first case of GD type 1 confirmed via biochemical and molecular genetic testing in Mozambique. As awareness of the GD and rare genetic diseases among Mozambican health professionals is very limited, and resources for diagnosis are scarce in the national health system, it is possible that other cases remain undiagnosed in this low-income country.

O ato de cuidar em saúde mental: aspectos alinhados à cultura de segurança do paciente / The act of caring in mental health: aspects aligned to patient safety culture / El acto de cuidar en salud mental: aspectos alineados la cultura de seguridad del paciente

OBJETIVO: analisar o conhecimento sobre o cuidado prestado à pessoa que possui transtorno mental na perspectiva da segurança do paciente. MÉTODO: revisão integrativa da literatura, considerando-se a seguinte questão norteadora: “Como a Política de Segurança do Paciente pode ser incorporada na produção do cuidado às pessoas ou sujeitos em sofrimento psíquico?”. RESULTADOS: foram selecionados 12 artigos em língua inglesa nas bases de dados Scopus e MEDLINE. Predominaram os tipos de estudo revisão da literatura (42%), estudo crítico-reflexivo (17%) e análise de conteúdo (17%). CONCLUSÃO: a segurança do paciente no contexto da saúde mental é mais complexa quando comparada a de outros pacientes. Observa-se maior probabilidade de eventos adversos, violências, barreiras de acesso aos serviços e tratamentos, além de uma assistência de baixa qualidade, tardia e não planejada, tendo, como principal justificativa, o processo estigmatizador. A educação permanente e o cuidado centrado na pessoa são as principais ferramentas de solução desses casos.

OBJECTIVE: to analyze the knowledge about the care given to the person who has mental disorder from the perspective of the patient's safety. METHOD: Integrative literature review, considering the following guiding question: “How can the Patient Safety Policy be incorporated into the production of care for people or subjects in psychic suffering?” RESULTS: 12 English language articles were selected from the Scopus and MEDLINE databases. The types of study were: literature review (42%), critical-reflective study (17%) and content analysis (17%). CONCLUSION: patient safety in the context of mental health is more complex when compared to other patients. There is a higher probability of adverse events, violence, barriers to access to services and treatments, as well as low quality, late and unplanned care, having as main justification the stigmatization process. Permanent education and person-centered care are the main tools for solving these cases.

OBJETIVO: analizar el conocimiento sobre el cuidado prestado à la persona que posee trastorno mental en la perspectiva de la seguridad del paciente. MÉTODO: revisión integral de la literatura, considerándose la siguiente cuestión norteadora: cómo se puede incorporar la Política de seguridad del paciente en la producción de atención para personas con problemas psicológicos? RESULTADOS: se seleccionaron 12 artículos en inglés, en las bases de datos SCOPUS y MEDLINE. Predominaron los tipos de estudio Revisión de la literatura (42%), Estudio crítico-reflexivo (17%) y Análisis de contenido (17%). CONCLUSIÓN: la seguridad del paciente en el contexto de la salud mental es más compleja en comparación con otros pacientes, se observa mayor probabilidad de eventos adversos, violencias, barreras de acceso a los servicios y tratamientos, además de una asistencia de baja calidad, tardía y no planificada, teniendo como principal justificación el proceso estigmatizador. La educación permanente y el cuidado centrado en la persona son las principales herramientas de solución de estos casos.

Gestational gigantomastia with fatal outcome

Gigantomastia is a rare disease defined by an extreme and rapid enlargement of the breast, generally bilateral. The majority of cases are reported in pregnant women. Ninety-eight cases of gestational gigantomastia have been identified in electronic databases, and those with fatal outcomes comprised only 2 cases (2%). Despite its benign nature, it can lead to severe complications and even death. Its etiology has not been fully elucidated, but it has been speculated that a hormonal component may play a role in the pathogenesis. Currently, treatment options are limited, and surgery is gaining importance, but it is often not feasible in low-resource settings. Herein, we describe a case of a 30-year-old HIV-positive female with no relevant past medical history, who died due to the complications of gestational gigantomastia at the Maputo Central Hospital, in Mozambique.

Impact of microablative fractional radiofrequency on the vaginal health, microbiota, and cellularity of postmenopausal women

OBJECTIVES: We aimed to evaluate the effectiveness of microablative fractional radiofrequency (MAFRF) in the non-hormonal treatment of genitourinary syndrome of menopause. METHODS: We examined the cases of 55 postmenopausal women before and after treatment with regard to their vaginal health index (VHI), vaginal microbiota, vaginal pH, and cell maturation. Three applications of MAFRF were performed in the vagina/vaginal introitus. During the treatment, six vaginal smears were obtained and stained with the Papanicolaou stain for determining the degree of cell maturation and with Gram stain for classification of vaginal flora, as per the criteria of Spiegel and Amsel. For vaginal pH determination, pH indicator strips were applied against the vaginal wall. Statistical analysis was performed using SPSS for Windows (version 17.0). Data were reported as mean±standard deviation. The differences were analyzed using the statistical method of generalized estimation equations with autoregressive correlation structure "1" and robust standard errors. RESULTS: The mean age was 59.8±4.2 years, and the mean time of menopause was 15.4±4.5 years. After treatment, there was an increase in the percentage of Lactobacillus spp. (p<0.001). Consequently, there was a progressive decrease in vaginal pH during the treatment (p<0.001). Regarding cell maturation, there was a decrease in the percentage of parabasal cells (p=0.001) and an increase in the rate of superficial cells (p<0.001). Additionally, there was an improvement in the VHI index. The mean VHI values before and after treatment were 13.2±5.6 and 22.5±3.7, respectively (p<0.001). CONCLUSION: MAFRF treatment is well tolerated and leads to improvement in the vaginal microenvironment.

Educação permanente no serviço de atendimento pré-hospitalar móvel de urgência: revisão integrativa / Permanent education in the emergency mobile pre-hospital care service: an integrative review / Educación permanente en el servicio de atención prehospitalaria móvil de urgencia: revisión integradora

OBJETIVO: identificar como a educação permanente em saúde vem sendo incorporada na prática de ensino em publicações acerca do serviço de atendimento móvel de urgência. MÉTODO: revisão integrativa em três bases de dados, com corte temporal de 2010 a 2020. RESULTADOS: três artigos selecionados, emergindo duas categorias: Necessidade da prática de educação para atender demandas no atendimento pré-hospitalar móvel; e Incorporação da educação permanente como estratégia para novas práticas no serviço de atendimento móvel de urgência. CONCLUSÃO: há grande demanda de atendimentos nas redes de urgência, sobretudo no componente pré-hospitalar. Porém, a incorporação da educação permanente como estratégia para novas práticas no serviço ainda não está bem clara, posto que apenas três artigos a referiram. Sugere-se novas pesquisas introduzindo a educação permanente na prática do serviço pré-hospitalar móvel de urgência, já que proporciona uma releitura crítica das práticas de trabalho e das necessidades advindas delas, para, assim, transformá-las.

AIM: identify how continuing health education has been incorporated into teaching practice in publications about the mobile emergency service. METHOD: integrative review in three databases, with a time cut from 2010 to 2020. RESULTS: three selected articles, emerging in two categories: Need for education practice to meet demands in mobile pre-hospital care; and Incorporation of continuing education as a strategy for new practices in mobile emergency care. CONCLUSION: there is a great demand for services in emergency networks, especially in the pre-hospital component. However, the incorporation of continuing education as a strategy for new practices in the service is still unclear, since only three articles have mentioned it. New research is suggested introducing permanent education into the practice of mobile pre-hospital emergency service, since it provides a critical re-reading of work practices and the needs arising from them, thus transforming them.

OBJETIVO: identificar en publicaciones sobre el servicio de atención móvil de urgencia, cómo la educación Permanente en salud está siendo incorporada a la práctica de enseñanza. MÉTODO: revisión integradora en tres bases de datos, con corte temporal de 2010 a 2020. RESULTADOS: tres artículos seleccionados, emergiendo dos categorías: Necesidad de la práctica de educación para atender demandas en la atención prehospitalaria móvil; e Incorporación de la educación Permanente como estrategia para nuevas prácticas en el servicio de atención móvil de urgencia. CONCLUSIÓN: Hay una demanda grande del número de atendimientos en las redes de urgencia, principalmente en el componente prehospitalario. Sin embargo, la incorporación de la educación Permanente como estrategia para nuevas prácticas en el servicio, todavía no está muy clara, ya que solo tres artículos la mencionaron. Se sugiere que se realicen nuevas investigaciones que introduzcan la educación Permanente en la práctica del servicio prehospitalario móvil de urgencia, lo que proporcionaría una relectura crítica de las prácticas de trabajo y de sus necesidades, para, así, poder transformarlas.

Educação permanente na reorganização do processo de trabalho no serviço de emergência / Continuing education in the reorganization of the work process in the emergency

Essa pesquisa deu origem a dois produtos, Banner e Folder, cuja intenção foi divulgar o rol de procedimentos odontológicos eleitos como urgência /emergência a ser encaminhado a equipe de odontologia do PSC, e que foram construídos pelos participantes da pesquisa, baseado no rol de procedimentos da ANS

Genética e meio ambiente: decorrências éticas e jurídicas da ecogenética / Genetics and environment: Legal and ethical derivations of ecogenetics

O presente trabalho tem por escopo analisar as decorrências éticas, sociais e jurídicas de um específico ramo da genética: a ecogenética. Para tanto, foi adotada pesquisa bibliográfica, com base em fontes doutrinárias interdisciplinares, para se revisar a literatura sobre o tema, que ainda é escassa. O objeto de estudo da ecogenética é a inter-relação entre o meio ambiente e as características genéticas individuais que alteram as condições gerais de saúde. O atual desenvolvimento da biociência provocou uma alteração no foco, do tratamento e cura para a prevenção das doenças, assim como despertou questionamentos éticos sobre a influência das características genéticas e da atuação do meio ambiente sobre elas. Desloca-se o agir humano para a perspectiva da responsabilidade conferida tanto ao indivíduo, isoladamente, quanto à coletividade, em relação às gerações presentes e futuras. A importância do estudo no campo da ecogenética espraia-se para além de interesses individuais e familiares e traduz-se também na importância da adoção de medidas governamentais de prevenção.(AU)

This paper analyzes the ethical, social and legal derivations of a specific branch of genetics ­ ecogenetics. For this, a bibliographic methodology was adopted, based on interdisciplinary doctrinal sources, to review the literature on the subject, which is still scarce. The study object of ecogenetics is the relationship between the environment and the individual genetic characteristics that alter the general health conditions. The current bioscience developments moved the focus from treatment and cure to disease prevention as well as raised ethical questions about the influence of knowledge of genetic traits and the environmental factors that act on them. Moves the human act to the perspective of responsibility, both for the individual, as the community in relation to present and future generations. The importance of the ecogenetics research spreads beyond the individual and family interests, converting into important preconditions for governmental adoption of preventive measures.(AU)

Educação permanente na escola sob o olhar de Paulo Freire: contribuições da educação física / Permanent education in school under Paulo Freire's look: contributions of physical education

Objetivo: analisar a inserção da educação permanente em saúde no âmbito escolar, por meio da Educação Física, sob a ótica de Paulo Freire e suas teorias, pautadas na construção do conhecimento e no processo de aprendizagem. Método: reflexão teórica, de abordagem qualitativa, com dados produzidos a partir da política nacional de educação permanente em saúde, de três obras de Paulo Freire e da base de dados LILACs, apresentadas de forma crítico-reflexiva, em duas categorias. Resultados: nas duas dimensões analisadas, o conhecimento constitui-se como algo não transmissível ou pertencente a alguém, mas construído de dúvidas e dificuldades advindas da prática, impactando significativamente a rede escolar. Conclusão: as duas abordagens caminham juntas na organização da problematização, essencial ao desenvolvimento da autonomia, atendendo às necessidades advindas da prática e nela refletidas, transformando e inovando a realidade na escola, pela atividade física. Limita-se pela carência de estudos que possibilitem, ao educador físico, empoderar-se de seu verdadeiro papel nessa construção.

Continuing education in health from the perspective of Augustine of Hippo / Educación continua en salud según la perspectiva de Agostinho de Hipona / Educação permanente em saúde sob a perspectiva de Agostinho de Hipona

ABSTRACT Objective: To reflect about continuing education from the perspective of Augustine of Hippo and his theories based on the construction of knowledge and the learning process. Method: This is a theoretical reflection study whose aim is to propose dimensions of analysis, emphasizing the history and challenges of continuing education. Such dimensions analyze the production of knowledge in Augustinian pedagogy, its historical aspects and its close relationship with lifelong education in health professions. Results: The results show the difficulty of continuing education to reach adequate importance in health services, and that of academia in appropriating the thoughts of renowned philosophers such as Augustine. This is a result of ignorance about the convergence of these principles and their relevance. Final considerations: Continuing education and Augustinian pedagogy walk hand in hand in terms of care, meeting the needs that originate from practice and that are reflected in it, challenging isolated knowledge and putting different areas of knowledge to work together.

RESUMEN Objetivo Reflexionar sobre la educación permanente según la perspectiva de Agostinho de Hipona y sus teorías basadas en la construcción del conocimiento y el proceso de aprendizaje. Método: Reflexión teórica apuntando a proponer dimensionas de análisis, destacando la historia y los desafíos de la educación continua. Dichas dimensiones analizan la producción del conocimiento en la pedagogía agostiniana, sus aspectos históricos y su relación cercana a la educación continua en salud. Resultados: Revelan la dificultad de la educación continua para que su dimensión se alcance en el servicio de salud, y la de que los académicos se apropien del pensamiento de filósofos renombrados como Agostinho, merced al desconocimiento de la convergencia de tales presupuestos y su relevancia. Consideraciones finales: La educación continua y la pedagogía agostiniana caminan juntas en el cuidar, atendiendo las necesidades devenidas de la práctica reflejada en ella, confrontando los saberes aislados y operando conjuntamente con ellos.

RESUMO Objetivo: Refletir sobre a educação permanente na perspectiva de Agostinho de Hipona e suas teorias pautadas na construção do conhecimento e no processo de aprendizagem. Método: Trata-se de uma reflexão teórica cujo intuito é propor dimensões de análise, enfatizando a história e os desafios da educação permanente. Tais dimensões analisam a produção do conhecimento na pedagogia agostiniana, seus aspectos históricos e sua relação próxima com a educação permanente em saúde. Resultados: Revela a dificuldade da educação permanente em ter sua dimensão alcançada noserviço de saúde, tal qual a da academia de apropriar-se do pensamento de filósofos renomados como Agostinho, fruto do desconhecimento da convergência desses pressupostos e de sua relevância. Considerações Finais: Considera-se que a educação permanente e a pedagogia agostiniana caminham juntas no cuidar, atendendo às necessidades advindas da prática e nela refletida, confrontando os saberes isolados e com eles operando em conjunto.

Educação permanente no atendimento pré-hospitalar móvel: perspectiva de Emerson Merhy / Permanent education in mobile pre-hospital care: Emerson Merhy's perspective / Educación permanente en el atendimiento pré-hospitlar móvil: perspectiva de Emerson Merhy

Objetivo: refletir, teórica e filosoficamente, sobre a importância da educação permanente como açãotransformadora das práticas individuais e coletivas no serviço de atendimento pré-hospitalar móvel deurgência, sob a perspectiva de Emerson Merhy. Método: estudo descritivo, tipo análise reflexiva, sobre aPolítica de Educação Permanente em Saúde, a partir dos conceitos estabelecidos por Emerson Merhy.Resultados: revela que a educação permanente acontece no cotidiano da prática, em um movimentoconstante de formação no mundo do trabalho. O processo de formação do trabalhador ocorre no mundo dotrabalho e o próprio ato do trabalho e é um ato formativo no atendimento pré-hospitalar. Conclusão:em Merhy, a educação permanente adquire potencialidade, visto que é identificada nas várias maneiras de seproduzir saúde. O atendimento pré-hospitalar móvel é um campo de possibilidades para a implementaçãodesta prática educativa.(AU)

Objective: to reflect, theoretically and philosophically, on the importance of permanent education as a transforming action of individual and collective practices in emergency pre-hospital care services, from the perspective of Emerson Merhy. Method: a descriptive study, like reflexive analysis, on the Permanent Education Policy in Health, based on the concepts established by Emerson Merhy. Results: reveals that the permanent education happens in the daily practice, in a constant movement of training in the world of work. The process of worker training occurs in the world of work and the work itself and is a formative act in prehospital care. Conclusion: in Merhy, the permanent education acquires potentiality, since it is identified in the various ways of producing health. Pre-hospital mobile care is a field of possibilities for the implementation of this educational practice.(AU)

Objetivo: reflexionar teorica y filosóficamente, sobre la importancia de la educación permanente como acción transformadora de las prácticas individuales y colectivas en el servicio móvil de atención prehospitalaria de urgencia, sob la perspectiva Emerson Merhy. Método: estudio descriptivo, de análisis reflexivo, sobre la Política de Educación Permanente en Salud, desde los conceptos establecidos por Emerson Merhy. Resultados: muestra que la educación permanente ocurre en la práctica diaria, en un constante movimiento de formación en el mundo del trabajo. El proceso de formación del trabajor ocurre en el mundo del trabajo y el acto mismo del trabajo y es un acto formativo en atención pre-hospitalaria. Conclusión: en Merhy, la educación permanente adquiere potencialidad, una vez que es identificada en las varias formas de se producir salud. La atención prehospitalaria es un campo de posibilidades para la implementación de esta práctica educativa.(AU)

Estratégia de educação permanente para o apoio aeromédico / Permanent education strategy for aeromedical support / Estrategia de educación permanente para el apoyo aeromédico

Objetivo: identificar estratégias educativas para o esclarecimento das equipes de APH terrestre quanto àsindicações de acionamento do socorro aeromédico. Método: estudo descritivo, com abordagem qualitativa.Utilizou a confrontação entre as Normas Gerais de Ação do Atendimento pré-hospitalar e as notas publicadassobre acionamento do serviço aeromédico, sendo estas validadas pelos participantes do estudo mediantequestionário estruturado que contou com a participação de 14 integrantes do Grupamento de OperaçõesAéreas. Resultados: mostram índice no acionamento do serviço aeromédico abaixo da capacidade deatendimento do Grupamento de Operações Aéreas do Rio de Janeiro (RJ), Brasil. A insegurança noacionamento por parte dos profissionais do atendimento pré-hospitalar foi destacada como o principal motivopara a ocorrência deste fato. Conclusão: a aplicação da educação permanente em saúde e a reestruturaçãodo processo de acionamento do aeromédico poderiam desmistificar este serviço entre os profissionais doatendimento pré-hospitalar e ampliar a utilização deste recurso à população Carioca.(AU)

Objective: to identify educational strategies for the clarification of terrestrial APH teams, regarding the indications for the activation of aeromedical assistance. Method: descriptive study with a qualitative approach. It used the confrontation between the General Standards of Pre-hospital Care Action and the published notes on the activation of the aeromedical service, which were validated by the study participants through a structured questionnaire, which was carried out by 14 members of the Air Operations Group. Results: show index in the activation of the aeromedical service below the capacity of attendance of the Air Group of Operations from Rio de Janeiro (RJ), Brazil. The insecurity in the activation by the professionals of the prehospital care was highlighted as the main reason for occurrence of this fact. Conclusion: the application of continuing education in health and the restructuring of the aeromedical activation process could demystify this service among prehospital care professionals and extend the use of this resource to the Carioca population.(AU)

Objetivo: identificar estrategias educativas aclaración de los equipos de APH terrestre, cuanto a las indicaciones de accionamiento de ayuda. Método: estudio descriptivo con un enfoque cualitativo. Utiliza la confrontación entre las Normas Generales de Acción de la Atención pre-hospitalaria y las notas publicadas sobre activación del servicio aeromédico, siendo estas validadas por los participantes del estudio a través de cuestionario estructurado, con la participación de 14 miembros del Agrupación de Operaciones Aéreas. Resultados: muestran índice en el accionamiento de servicio aeromédico abajo de la capacidad del grupo de operaciones aéreas en Rio de Janeiro (RJ), Brasil. La inseguridad en la unidad de profesionales de la atención pre-hospitalaria se destacó como la principal razón para la ocurrencia de este hecho. Conclusión: la implementación de la educación permanente en salud y de la reestructuración del proceso de accionamiento aeromédico podrían desmitificar este servicio entre los profesionales de la atención pre-hospitalaria y extender el uso de este recurso a la población del Rio de Janeiro.(AU)

Educação permanente na reorganização do processo de trabalho no serviço de emergência / Continuing education in the reorganization of the work process at emergency department

O presente trabalho tem como objeto de estudo a educação permanente como estratégia de reorganização do processo de trabalho, no serviço de emergência de um pronto socorro. Seu objetivo geral foi utilizar a educação permanente como reorganizadora do processo de trabalho no serviço de emergência de um pronto socorro tendo como objetivos específicos: Identificar as dificuldades dos funcionários do pronto socorro no seu processo de trabalho quanto ao encaminhamento de usuários ao serviço de emergência odontológica; Descrever a compreensão dos funcionários acerca do papel do odontólogo no serviço de emergência; Analisar estratégias ou formas de colaboração para atingir a integralidade da assistência e; Elaborar produtos que colaborem na educação permanente dos funcionários envolvidos no atendimento ao paciente, de acordo com a legislação específica, em prol da integridade da assistência. A metodologia utilizada foi a pesquisa convergente assistencial, tipo de pesquisaação na qual o pesquisador está envolvido em ações de assistência enquanto pesquisa. O cenário da pesquisa foi o setor de emergência de um pronto socorro localizado em São Gonçalo, cidade do Estado do Rio de Janeiro. A pesquisa contou com três etapas e os instrumentos de coleta de dados utilizados foram: Na primeira etapa, observação participante, na segunda etapa, questionário semi-estruturado e na terceira etapa, grupos educativos; Na primeira etapa, foi construído um fluxo de encaminhamento ao setor de emergência odontológica. Na segunda etapa, construíram-se quatro categorias, após análise de conteúdo de Bardin. São elas: 1) O modelo biomédico ainda refletido no pensar e no agir, evidenciado, diante da análise das respostas, que parte dos funcionários não compreenderem trabalho em equipe multidisciplinar e ainda fazerem alusão ao modelo biomédico; 2) A odontologia do dente por dente: Código de Hamurabi e Tiradentes, revelando que a maioria dos trabalhadores atribui significado bucal ao atendimento odontológico; 3) O que estou fazendo aqui? Construindo a identidade do odontólogo. Demonstrou-se que muitos dos participantes não compreendem o papel do dentista no processo de trabalho em emergência, ao atribuírem significado fora do contexto odontológico a ele, ou mesmo não responderem admitindo não sabê-lo; 4) Construindo pontes para a integralidade, apontando que poucos participantes compreendem os conceitos da EP e sua capacidade de transformar as situações problemas no cotidiano de sua vida profissional. Na terceira etapa, os participantes foram convidados aos grupos educativos, local de diálogo, reflexão e elaboração de hipóteses de soluções, seguindo a proposta da metodologia da problematização. Nesses grupos, discutiu-se a legislação acerca do serviço de emergência, refletiu-se sobre as dificuldades em cumpri-la no serviço e construiu-se o rol de procedimentos eleitos como de urgência /emergência no pronto socorro. Concluiu-se que pouco conhecimento se tinha acerca da legislação vigente sobre o assunto e que o desconhecimento do sentido pleno de educação permanente limitava às tomadas de decisões. Porém, as soluções encontradas pelo grupo, mesmo que este não tenha se constituído uniformemente ao longo dos encontros, foram um somatório de experiências reunidas, o que proporcionou o que Agostinho chama de sabedoria à pesquisa convergente assistencial, de despertar do pensamento crítico e à política nacional de educação permanente em saúde de empoderamento

The object of study of this paper is the continuing education as a strategy to reorganize the work process in the emergency room at emergency department. The general aims of this study was to use the permanent education as a strategy to reorganize the work process in the emergency room at emergency department. The specifics aims were: to identify the difficulties faced by the staff workers of the emergency settings related to the process of guiding patients to the emergency dental service ; to describe the understanding of the staff workers about the dentist's role in na emergency service; to analyze strategies or manners of collaboration for achieving comprehensive care and; to develop products that can collaborate in continuing education of staff workers involved in patient care, according to the specific laws related to the intregrity of care. The methodology used was the the kind of research which the researcher get involved in the assistance activities while observe. The setting of the study was the emergency department of an emergency room located in Sao Goncalo, State of Rio de Janeiro city. It had three stages and the data collection instruments used were: the first stage was a participatory observation, the second stage was a semi-structured questionnaire and the third stage was na educational focal groups. In the first stage was built a forwarded flow to the dental emergency section. On the second stage, after analysis of contente according to Bardin, it was built four following classes: 1) The biomedical model still reflected on the thinking and action, evidenced on the analysis of the responses, which the employees do not understand working in a multidisciplinary team and also mentioned the biomedical model; 2) Tooth for a tooth: The Code of Hammurabi and Tiradentes, revealing that most workers assign meaning to oral dental care; 3) What am I doing here? Building the identity of the dentist. The study reveals that many of the participants do not understand the dentist's role in emergency work process and they do not respond admitting not knowing it when asked for assign a meaning outside the dental contexto.4) Building up bridges for completeness, noting that few participants understood the concepts of the continuing education and its ability to transform problems situations in their daily professional life. In the third stage, the participants were invited to educational groups, opened for dialogue, reflection and solutions, following the proposal of the problematization methodology. Theese groups discussed the legislations about emergency service, reflected on the difficulties of fulfilling the laws during work and, built up the list of procedures elected as urgent / emergency in the emergency room. In conclusion that little knowledge about the current legislation on the topic and the lack of the full understanding about continuing education can limit the process of decision making. However, the solutions found by the group were a combination and summation of gathered experiences which provided what Augustine calls wisdom of convergent care research awakening the critical thinking and politics national continuing education in health empowerment