Adherence to antiemetic guidelines and control of chemotherapy-induced nausea and vomiting (CINV) in a large hospital.

PURPOSE: The aim of the study was to determine the antiemetic prescription adherence both to the protocol of our hospital and to international recommendations, as well as to analyze the relationship between this adherence and the incidence of nausea and vomiting (NV) and between the adherence and patients' individual risk. METHODS: This is a four-month observational study which included antiemetic prescriptions for adult cancer patients. Prescriptions were considered adherent or not to hospital protocol and also to international guidelines. Patients were given a form to record the NV they suffered and this was to be returned at their next appointment. RESULTS: A total of 102 prescriptions were analyzed. Taking into account the hospital protocol, 59% and 54% were correct (acute and delayed phase, respectively). Of those considered outside the protocol, 24% and 13% did follow international guidelines. In the delayed phase, complete response was achieved in 76% and 72% of the patients, with compliant and non-compliant prescriptions, respectively (82% and 90% in the acute phase). Adherence to the hospital protocol was higher in patients under 50 years old (p = 0.015) and in those without previous experience of NV (p = 0.010). Adherence to international guidelines was higher in female patients (p = 0.023). CONCLUSION: Our study confirms low adherence with both local and international recommendations for antiemetic prescriptions. However, we could not prove that adherence involves a CINV reduction. Adherence did not seem to be influenced by the doctor's perception of the patient's risk of emesis.

Results of adrenal surgery. Data of a Spanish National Survey.

PURPOSE: Given the availability of laparoscopy and the rising detection of incidentalomas, indications for adrenalectomy may be changing. The Endocrine Surgery Section of the Spanish Association of Surgeons designed a survey to assess its indications, techniques, and results in Spanish Surgical Departments. METHODS: Collected data included hospital and department type, yearly hospital volume of procedures; location studies and preoperative preparation performed, indications, surgical approach and instruments used, and results in terms of morbidity and overall hospital stay. The analysis included a comparison between results of high- or low-volume centers and surgeons, using the Student's t test for quantitative and chi-square test for qualitative variables. Level of significance was set at 0.05. RESULTS: Nineteen centers returned the questionnaire, including 155 adrenalectomies performed in 2008. Most frequent indications were pheochromocytoma (23.2%), aldosteronoma (16.7%), incidentaloma (12.2%), metastasis (10.3%), Cushing adenoma (9.6%), and carcinoma (3.8%). Laparoscopy was performed in 83.9% of cases (9.4% required conversion to laparotomy). Four patients required urgent reoperation. Average hospital stay: 4.6 days (3.3 days after laparoscopy, 7 days after laparotomy). High-volume centers had a greater proportion of laparoscopically treated cases (p = 0.008), more malignant lesions treated (p = 0.03), a shorter overall stay (p < 0.0001), and a shorter stay after laparotomic adrenalectomy (p = 0.01). High-volume surgeons had similar results, and less in-hospital morbidity (p = 0.02). CONCLUSIONS: In Spain, adrenalectomy is performed in hospitals of varying complexity. Laparoscopic approach is the rule, with good results in terms of morbidity and stay. High-volume centers and surgeons had best results in terms of use of minimally invasive surgery and hospital stay.

Cost-Effectiveness Analysis of Tisagenlecleucel in the Treatment of Relapsed or Refractory B-Cell Acute Lymphoblastic Leukaemia in Children and Young Adults in Spain.

PURPOSE: Tisagenlecleucel, a chimeric antigen receptor T-cell (CAR-T) therapy, is a promising alternative for the management of children and young adults with relapsed and refractory B-cell acute lymphoblastic leukemia (r/r ALL). The aim of this study was to determine whether treatment with tisagenlecleucel is a cost-effective intervention compared with salvage chemotherapy in paediatric and young adult patients with r/r ALL in Spain. MATERIALS AND METHODS: A partitioned survival model of monthly cycles with three health states was used (event-free survival, progressive/relapsed disease and death). A lifetime time horizon and the Spanish National Health System perspective were adopted. During the first 5 years, permanence in the different health states was determined according to the results in the clinical studies. In successive years, mortality tables of the Spanish general population adjusted by standardized mortality rate for survivors of childhood cancer were used. Clinical, economic, and quality of life parameters were drawn from clinical trials and the literature. Only direct health costs (pharmacological costs and the costs derived from health resource use) were included. The robustness of the results was evaluated in a sensitivity analysis. RESULTS: This cost-effectiveness analysis showed a greater benefit (10.10 and 8.97 life-years gained [LYGs] and quality-adjusted life-years [QALYs] gained, respectively) and a higher cost (€ 258,378.40) for tisagenlecleucel compared to salvage chemotherapy. The resulting incremental cost-effectiveness and cost-utility ratios were € 25,576.80 per LYG and € 28,818.52 per QALY gained, respectively. In the sensitivity analysis, all the results were below € 50,000/QALY. CONCLUSION: Tisagenlecleucel would represent a cost-effective intervention for the treatment of children and young adults with r/r ALL in Spain.

Fronteiras da Língua: Desarraigamento e Testemunho em Psicanálise / Borders of Language: Uprooting and Testimony in Psychoanalysis / Fronteras de la Lengua: Desarraigamiento y Testimonio en Psicoanálisis

Abordamos o problema da língua na psicanálise, apontando como esta lida com os limites nos quais esbarra em seu exercício linguageiro. Mostramos a relação entre letra, lugar e as fronteiras da língua. A partir da abordagem do exílio e do desarraigamento no campo da arte e da literatura, problematizamos o monolinguismo e situamos a importância do ato de recepção do testemunho em psicanálise. Como escutar o que escapa à representação? Apontamos a dimensão política da prática d'alíngua como via de reabitar a língua, recurso cuja escrita viabiliza novas leituras do mundo. A psicanálise encontra, assim, o desafio de fazer surgir/emergir aquilo que foi apagado/silenciado, contribuindo para a produção de novos territórios linguísticos que sejam respeitosos com a diferença e viabilizem o trânsito entre línguas. Ler com o translinguístico é uma maneira de grifar o movimento daqueles que estão à margem e fornece pistas para a reinvenção necessária do lugar de escuta.

We address the problem of language in psychoanalysis, pointing out how it deals with the limits it encounters in its language exercise. We show the relationship between letter, place, and language borders. From the approach of exile and uprooting in the field of art and literature, we problematize monolingualism and place the importance of the act of receiving testimony in psychoanalysis. How to listen to what escapes representation? We point out the political dimension of the practice of lalangue as a way to reinhabit the language, a resource whose writing enables new readings of the world. Psychoanalysis thus faces the challenge of bringing to light/emerging what has been erased/silenced, contributing to the production of new linguistic territories that are respectful of difference and make transit between languages possible. Reading with the translinguistic is a way of highlighting the movement of those who are on the margins and provides clues for the necessary reinvention of the place of listening.

Abordamos el problema de la lengua en psicoanálisis, señalando cómo lidia con los límites que encuentra en su ejercicio del lenguaje. Mostramos la relación entre letra, lugar y fronteras de la lengua. Desde el enfoque del exilio y del desarraigo en el campo del arte y la literatura, problematizamos el monolingüismo y ubicamos la importancia del acto de recibir testimonio en el psicoanálisis. ¿Cómo escuchar lo que escapa a la representación? Señalamos la dimensión política de la práctica del lenguaje como forma de rehabitar la lengua, recurso cuya escritura posibilita nuevas lecturas del mundo. El psicoanálisis enfrenta así el desafío de sacar a la luz/emerger lo borrado/silenciado, contribuyendo a la producción de nuevos territorios lingüísticos respetuosos de las diferencias y posibilitando el tránsito entre lenguas. Leer con el translingüístico es una forma de evidenciar el movimiento de los que están en los márgenes y da pistas para la necesaria reinvención del lugar de la escucha.

Bypassing the urgency in adolescence: the tenuous thread of the clinic in an institution / Contornando a urgência na adolescência: o fio tênue da clínica em instituição

RESUMO: Abordamos, no presente trabalho, a urgência subjetiva na adolescência, tendo como orientação a prática da psicanálise aplicada ao campo da saúde mental. Situamos a urgência subjetiva e apontamos impasses clínicos relativos ao seu manejo, relacionando-os ao modo como o mal-estar se apresenta na atualidade. A partir de fragmentos clínicos, discutimos a abordagem clínico-institucional, pontuamos a importância da escuta do detalhe e ressaltamos o lugar do analista como parceiro, ajudando a construir uma alteridade que dê suporte à travessia da adolescência.

ABSTRACT: We approach, in the present work, the subjective urgency in adolescence, having as orientation the practice of psychoanalysis applied to the field of mental health. We situate the subjective urgency and point out clinical impasses related to its management, relating them to the way in which the discontent presents itself today. From clinical fragments, we discuss the clinical-institutional approach, point out the importance of listening to the detail and emphasize the analyst's place as a partner, helping to build an alterity that supports the crossing of adolescence.

Uma transição compartilhada: sobre o acolhimento em saúde mental em um ambulatório do processo transexualizador do SUS / A shared transition: on mental health care in an outpatient clinic aimed at the transsexualizing process of the Brazilian Integrated Health System / Une transition partagée: à propos de l'accueil en santé mentale d'une clinique externe pour le processus de transsexualisation du système de santé publique brésilien / Una transición compartida: sobre el acogimiento en salud mental en una consulta externa para el proceso de transexualización dentro del sistema público de salud brasileño

Este artigo aborda o acolhimento em saúde mental a pessoas que estão no processo transexualizador a partir de pesquisa qualitativa e faz uso do método da autoetnografia relacional. Discutimos, a partir das narrativas dos participantes, o processo de chegada ao acolhimento, a complexa transformação do corpo e da identidade de gênero e a função do acolhimento nesse percurso. Destacamos a prática narrativa e o compartilhamento de histórias pessoais como modo de produzir sentidos novos para a experiência singular de transição de gênero, aproveitando as diferenças como uma maneira de buscar uma abertura do olhar e a possibilidade de coexistência de múltiplas perspectivas. Por fim, salientamos a abordagem psicossocial como estratégia fundamental para a construção de um cuidado compartilhado, integral, horizontal, que favoreça a autonomia dos usuários e atenda suas necessidades.

This article addresses the reception in mental health of people undergoing transsexualization; it is based on a qualitative research that was conducted by using the relational autoethnography method. The narratives of the participants are analyzed to discuss the process of arriving at the reception, the complex physical transformation of both body and gender identity, and the function of the reception in that process. We highlight the narrative practice and the sharing of personal stories as a way of producing new meanings for the unique experience of gender transition, taking advantage of differences as a way of seeking a broader vision and the possibility of coexistence of multiple perspectives. To conclude, we emphasize the psychosocial approach as a fundamental strategy for building shared, comprehensive, horizontal care that favors users' autonomy and meets their needs.

Cet article analyse l'accueil en santé mentale de personnes en processus de transsexualisation ayant pour base une recherche qualitative et en utilisant la méthode de l'auto-ethnographie relationnelle. À partir des récits des sujets, nous discutons le processus d'arrivée à la réception, la transformation complexe du corps et de l'identité de genre, ainsi que la fonction de la réception pendant ce processus. Nous soulignons la pratique narrative et le partage d'histoires personnelles comme moyen de produire de nouvelles significations pour l'expérience unique de la transition entre les sexes, en tirant parti des différences comme moyen de chercher une vision plus ample et la possibilité de coexistence de perspectives multiples. Enfin, nous soulignons l'approche psychosociale comme stratégie fondamentale pour la construction de soins partagés, complets et horizontaux qui favorisent l'autonomie des usagers et satisfont leurs besoins.

Este artículo aborda el acogimiento en salud mental de personas que se encuentran en el proceso de transexualización a través de una investigación cualitativa y hace uso del método de autoetnografía relacional. Discutimos, a partir de las narrativas de los participantes, el proceso de llegada al servicio de acogimiento, la compleja transformación del cuerpo y de la identidad de género, y la función del acogimiento en esta jornada. Destacamos la práctica narrativa y el intercambio de historias personales como una forma de producir nuevos significados para la experiencia única de la transición de género, aprovechando las diferencias para buscar una visión más amplia y la posibilidad de coexistencia de múltiples perspectivas. Finalmente, destacamos el enfoque psicosocial como estrategia fundamental para construir una atención compartida, integral, horizontal, que favorezca la autonomía de los usuarios y que satisfaga sus necesidades.

Between anguish and act: challenges for the management of subjective urgency in the psychoanalytic clinic / Entre angústia e ato: desafios para o manejo da urgência subjetiva na clínica psicanalítica

RESUMO: A partir de questões suscitadas pela clínica da recepção em um ambulatório público de saúde mental, investigamos o manejo clínico da urgência subjetiva. Tendo em vista a recorrência do sofrimento psíquico relacionado à angústia e a manifestações ligadas ao ato, revisamos o lugar da angústia em psicanálise e sua relação com o acting out e a passagem ao ato. Verificamos como o psicanalista pode acolher a urgência subjetiva, permitindo que este momento de crise dê lugar ao trabalho psíquico e possibilite uma subjetivação do sofrimento.

Abstract: From issues raised by the reception clinic in a public mental health clinic, we investigated the clinical management of subjective urgency. In view of the recurrence of psychic suffering related to the anguish and manifestations associated with the act, we review the place of anguish in psychoanalysis and its relation to the acting out and the passage to the act. We verify how the psychoanalyst can take on the subjective urgency, allowing this moment of crisis to give way to psychic work and enable a subjectivation of suffering.

A promoção à saúde na experiência de jovens promotores da saúde / Promoción de la salud en la experiencia de jóvenes promotores de la salud / Health promotion in the experience of young health promoters

RESUMO O presente artigo se baseia em uma pesquisa de mestrado profissional e tem por objetivo conhecer e analisar a experiência de jovens e adolescentes que participam de um projeto de promoção à saúde, voltado ao público jovem e adolescente. A experiência de promoção à saúde e de vivência da adolescência e da juventude pelos participantes do projeto é abordada pela técnica do grupo focal. Realiza-se análise das narrativas, indicando a maneira como os participantes enfrentam os impasses inerentes a esta etapa da vida e a função que o grupo ocupa para eles nesta empreitada. Os resultados apontam que a experiência no grupo atua como estímulo para o aumento da capacidade narrativa entre os participantes, que percebem melhora nas formas de comunicação e de relação, como fonte de construção de um laço afetivo entre os participantes, constituindo-se como importante fator de suporte social e como possibilidade de estreitamento de laço com a unidade de saúde e com os profissionais que nela atuam. Destaca-se ainda a importância de sustentação por parte dos profissionais de saúde da função da alteridade junto aos jovens e adolescentes, de modo a garantir a circulação da palavra e a manutenção de um diálogo aberto e franco com eles.

RESUMEN El presente artículo se basa en una investigación de maestría profesional y tiene como objetivo conocer y analizar la experiencia de los jóvenes y adolescentes que participan en un proyecto de promoción a la salud, dirigido al público joven y adolescente. La experiencia de promoción a la salud y de la vivencia de la adolescencia y de la juventud por los participantes del proyecto son tratadas por intermedio de la técnica del grupo focal. Se realiza análisis de las narrativas, indicando la manera como los participantes enfrentan los impasses inherentes a esta etapa de la vida y la función que el grupo ocupa para ellos. Los resultados apuntan que la experiencia en el grupo actúa como estímulo para el aumento de la capacidad narrativa entre los participantes, que perciben una mejora en las formas de comunicación y de relación, como fuente de construcción de un lazo afectivo entre los participantes, constituyéndose como importante factor de soporte social y como posibilidad de estrechamiento de lazo con la unidad de salud y con los profesionales que actúan en ella. Se destaca la importancia de sostén por parte de los profesionales de salud de la función de la alteridad junto a los jóvenes y adolescentes, a fin de garantizar la circulación de la palabra y el mantenimiento de un diálogo abierto y franco con ellos.

ABSTRACT This article is based on a professional master's research that aimed to know and analyze the experience of young people and adolescents who participate in a health promotion project for young people and adolescents. The experience of health promotion, as well as the reality of youth and adolescence are addressed by project participants through the focus group technique. An analysis of narratives is carried out, indicating the ways through which participants face the inherent dilemmas of this particular stage of life, as well as the role that the group plays for them in this task. The results indicate that the group experience stimulates an increase of narrative capacity among participants - who perceive improved communication and relatedness - and acts also as a source of construction of an affective bond between participants, constituting an important social support factor, by also creating closer ties with the health unit and the professionals who work there. Also important is the critical role of the health professionals in sustaining alterity for these youngsters, ensuring the free circulation of words, and maintaining an open and frank dialogue with them.

Escrita, memória e cuidado - testemunhos de trabalhadores de saúde na pandemia / Writing, memory and care - testimonies by health workers in times of the pandemic / Escritura, memoria y cuidado - testimonios del trabajador de la salud en tiempos de pandemia / Écriture, mémoire et soins - témoignages des travailleurs de la santé en temps de pandêmie

Apresentamos, no presente artigo, o percurso teórico e prático que envolveu a criação do projeto Pausas e Pousos - Vivências do Trabalhador de Saúde em Tempos de Pandemia. A inciativa tem por objetivo conhecer as vivências dos trabalhadores de saúde na pandemia de COVID-19, no cenário nacional. Apresentamos o modo de conhecimento narrativo e o testemunho como uma modalidade particular de produção narrativa, examinando modalidades morais da recepção de testemunhos de profissionais de saúde. Discutimos ainda como o uso de plataformas digitais pode servir como recurso para a produção de memória. Por último, descrevemos a construção de um espaço de escrita, memória, cuidado e diálogo através de intervenções artísticas em ferramentas digitais, afirmando a aposta no poder que o compartilhamento de histórias pode exercer sobre as angústias e sofrimentos emocionais dos trabalhadores de saúde.

This article presents the theoretical and practical path involving the creation of the Pausas e Pousos (Pauses and Landings) Project - Health Worker Experiences in Times of the Pandemic. The initiative aims to take a closer look at the experiences of health workers in the Brazilian scenario of the COVID-19 pandemic. Narrative knowledge and testimony are presented as special modalities of narrative production, analyzing the moral modalities of receiving the health professionals' testimonies. The use of digital platforms as a resource for the production of memories was also discussed. Last, we describe the creation of a space for writing, memories, care and dialogue through artistic interventions using digital tools and highlight the power that sharing stories may have on coping with fear and emotional distress of health workers.

Cet article décrit le cheminement théorique et pratique qui a impliqué la création du projet Pauses et Poses - Expériences de travailleurs de la santé en temps de pandémie. L'initiative vise à connaître les expériences des travailleurs de la santé pendant la pandémie de COVID-19 au Brésil. Nous présentons le mode de connaissance narrative et de témoignage comme un mode particulier de production narrative en examinant les modalités morales de réception des témoignages de professionnels de santé. Ensuite, nous décrivons comment l'utilisation des plateformes digitales peut servir de ressource pour la production de mémoire. Pour finir, nous présentons la construction d'un espace d'écriture, de mémoire, de soins et de dialogue à partir d'interventions artistiques sur les outils numériques, affirmant le pari sur le pouvoir que le partage d'histoires peut exercer sur l'angoisse et la souffrance émotionnelle des travailleurs de la santé.

En este artículo presentamos el camino teórico y práctico de la creación del Proyecto Pausas y Aterrizajes - Experiencias del Trabajador de la Salud en Tiempos de Pandemia. La iniciativa tiene como objetivo conocer las experiencias de los trabajadores de la salud durante la pandemia de COVID-19, en el escenario brasileño. Presentamos el modo de conocimiento narrativo y el testimonio como modalidad particular de producción narrativa, examinando modalidades morales de la recepción de testimonios de los profesionales de la salud. También discutimos cómo el uso de plataformas digitales puede servir como recurso para la producción de memoria. Finalmente, describimos la construcción de un espacio de escritura, memoria, cuidado y diálogo mediante intervenciones artísticas en herramientas digitales, reafirmando el poder que el intercambio de historias puede ejercer sobre la angustia y el sufrimiento emocional de los trabajadores de la salud.

Testemunho e construção: sobre o ensino da psicanálise na universidade / Testimony and construction: the psychoanalysis teaching at the university

O presente artigo aborda o ensino da clínica na universidade, visando apontar os limites e as possiblidades de transmissão do saber psicanalítico na experiência de estágio de graduação em psicologia. A construção analítica é retomada em suas aproximações com a função do testemunho em psicanálise, indicando o modo de operar com o saber parcial e lacunar da experiência clínica como uma pista interessante para inspirar metodologias de trabalho, tanto para o ensino universitário quanto para a prática de profissionais com percursos heterogêneos. O testemunho é por sua vez pensado em relação com uma crise na verdade, aproximando os campos da literatura e da psicanálise a partir da constatação da impossibilidade de sua plena representação. Essa perspectiva abre uma via de acesso que leva a experimentar os limites do saber em circunscrever o valor sempre inédito da experiência clínica. Concluímos sobre a possibilidade de pensar o ensino e a transmissão da psicanálise através do que se testemunha na posição de aprendizes da clínica.(AU)

This paper approach the clinical teaching at the university, aiming to identify the limits and possibilities of transmission of psychoanalytic knowledge in trainees graduate experience in psychology. The analytical construction is taken up in its relationship to the function of testimony in psychoanalysis, indicating the mode of operation with knowledge partial and incomplete clinical experience as an interesting clue to inspire working methods both for the university and for the practice professionals with heterogeneous routes. The testimony is in turn approached in relation to a crisis in truth, bringing the fields of literature and psychoanalysis from the finding of the impossibility of its full representation. This perspective opens a way of access that leads to experiencing the limits of knowledge in circumscribing the ever new value of clinical experience. We conclude about the possibility of thinking about teaching and transmission of psychoanalysis by that witness in the learners clinical position.(AU)

Influence of pharmaceutical care on the delayed emesis associated with chemotherapy.

BACKGROUND: Complete control of emesis during chemotherapy remains to be achieved. This could be improved by increasing adherence to medicines and recommendations. OBJECTIVE: The aim of this study was to analyse the effects of pharmaceutical care on the incidence of delayed chemotherapy-induced nausea and vomiting (CINV) in adult cancer outpatients. METHOD: This is a longitudinal prospective intervention study. Patients included were those who received a new cancer intravenous treatment. We compared complete response (no vomiting and no rescue treatment) and the incidence of nausea in the control group (CG) and in the intervention group (IG), as well as patients' adherence. Pharmaceutical intervention consisted of: reviewing the antiemetic protocol and giving some recommendations to the patients. RESULTS: 102 patients were studied. In the delayed phase complete response was achieved in 84.8 % of the patients in the IG, compared with 69.6 % in the control group [absolute risk reduction (ARR), 15.2 %; p = 0.144]. Regarding absence of vomiting, the difference was higher (71.0 CG vs 97.0 % IG, ARR, 26.0%; p = 0.002). Absence of delayed nausea were also better in the IG (61 vs. 52 %). Compliant patients increased from 59 to 76 %. CONCLUSION: The intervention of a pharmacist reduced the incidence of delayed CINV and improved medication adherence.

Além da compulsão e da escolha: autonomia, temporalidade e recuperação pessoal / Beyond compulsion and choice: autonomy, temporality and personal recovery / Au-delà de la contrainte et du choix: autonomie, temporalité et rétablissement personnel / Mas allá de la compulsión y la elección: autonomía, temporalidad y recuperación

Este artigo discute a autonomia da pessoa que faz uso problemático de substâncias psicoativas (UPSP). Após o exame da ideia de autonomia de quem faz UPSP, a partir dos paradigmas médico, psicológico e moral, que oscilam entre as compreensões do uso como compulsão ou escolha, discute-se os aspectos psicopatológicos envolvidos no UPSP, em especial a experiência da temporalidade e suas implicações para o debate da autonomia dessas pessoas e para o seu processo de recuperação pessoal.

This paper discusses the autonomy of subjects engaged in substance misuse (SM). After examining the concept of autonomy of subjects engaged in SM, based on medical, psychological and moral paradigms that range between understanding SM either as a compulsion or a choice, we discuss the psychopathological aspects involved in SM, i.e., the experience of temporality and its implications regarding the autonomy of these subjects and their recovery process.

Cet article discute l'autonomie de personnes sujettes à l'utilisation problématique de substances psychoactives (UPSP). Après avoir élaboré la notion d'autonomie de ces sujets à partir de paradigmes médicaux, psychologiques et moraux qui comprennent l'UPSP soit comme une contrainte, soit comme un choix, on discute les aspects psychopathologiques liés à l'UPSP, en particulier l'expérience de la temporalité et ses implications pour le débat sur l'autonomie de ces personnes et leur processus de rétablissement.

Este artículo discute la autonomía de la persona que sufre con el consumo problemático de sustancias psicoactivas (CPSP). Después examinar la idea de autonomía en quien tiene un CPSP, a partir de los paradigmas médico, psicológico y moral, que oscilan entre las comprensiones del uso como compulsión o elección, se discuten los aspectos psicopatológicos involucrados en el CPSP, en especial en la experiencia de la temporalidad, y sus implicaciones para el debate de la autonomía de esas personas y para su proceso de recuperación personal.

Dieser Artikel ergründet die Autonomie von Personen, die einen problematischen Gebrauch von psychoaktiven Stoffen machen. Wir analysieren den Begriff der Autonomie dieser Subjekte basierend auf medizinischen, psychologischen und moralischen Paradigmen, die den Drogenkonsum entweder als Zwang oder Wahl verstehen. Nachfolgend diskutieren wir dann die psychopathologischen Aspekte des Drogenkonsums, vornehmlich die Erfahrung der Temporalität und ihren Einfluss auf die Debatte über die Autonomie dieser Subjekte während ihres Rehabilitationsprozesses.

Should we follow the 9th ACCP guidelines for VTE prevention in surgical patients?

The 9th edition of the American College of Chest Physicians (ACCP) guidelines on antithrombotic therapy and prevention, includes relevant changes compared to previous versions. In the 9th ACCP, leadership of most chapters was given to methodologists who were familiar with the GRADE methodology. All topic panelists underwent a selection process paying particular attention to their financial and intellectual conflicts of interests. In the 9th ACCP guidelines, evidence has been explicitly presented in many evidence profiles and summary of evidence tables. In order to get a more balanced trade-off between desirable and undesirable effects of the alternative prevention and therapeutic interventions, there has been an increased emphasis on clinically relevant events, as opposed to previous surrogate asymptomatic outcomes. In addition, there has been a systematic review and survey on patient values and preferences for thrombotic and bleeding outcomes. As a result of the above changes, the strength of most recommendations has been downgraded compared to previous editions. The main changes regarding prevention on nonorthopedic surgical patients include the adoption of two risk assessment models. The only recommendation that has been upgraded is to extend prophylaxis with low molecular weight heparins (LMWH) for four weeks after abdominal or pelvic cancer surgery. A controversial modification in orthopedic patients is recommendation in favor of the use of aspirin after hip or knee arthroplasty. New oral anticoagulants are recommended, but LMWH are suggested as the preferred option. Extending pharmacological prophylaxis for up to 35days rather than 10-14days is now suggested for patients undergoing major orthopedic surgery.

Incorporando histórias: a recomposição do corpo próprio na perspectiva de usuários de serviços de saúde mental / Incorporating stories: recomposing the body from the perspective of users health service / L'incorporation d'histoires: la recomposition du corps propre dans la perspective des usagers de services de santé mentale / Incorporando historias: la recuperación del cuerpo en la perspectiva de usuarios de servicios de salud mental

O presente estudo acompanha as incidências da experiência de adoecimento na vivência de corpo próprio em pessoas que realizam tratamento em serviços de saúde mental. Por meio de abordagem clínico-qualitativa, interroga-se o papel do cuidado, do ponto de vista dos usuários, em uma possível vivificação da relação com o corpo próprio e sua contribuição na produção de novo modo de existência no cotidiano. Analisam-se as transformações vividas na relação com o corpo e as soluções encontradas para a sua recomposição.

This study is about experiences of physical illness in persons treated at public mental health clinics. Through a qualitative clinical approach the role of care is questioned from the users' point of view in a possible participation in the relationship with their own bodies and its contribution in producing new ways of existence in everyday life. We analyze the changes experienced in relationships with the users' own bodies and solutions found for recomposing it.

Cette étude accompagne l'expérience de la maladie et de ses effets sur le corps de patients qui suivent un traitement dans un service de santé mentale. À l'aide d'une approche clinique qualitative, nous étudions le rôle des soins du point de vue des usagers, dans une possible recomposition du rapport avec le corps, ainsi que sa contribution à la production d'un nouveau mode d'existence dans la vie quotidienne. Nous abordons les transformations qui résultent du rapport avec le corps et les solutions qui visent sa reconstruction.

Este estudio analisa el efecto de la experiencia de enfermarse en la vivencia del propio cuerpo en personas que reciben tratamiento en servicios de salud mental. A través de un enfoque clínico-cualitativo, cuestionamos el papel del cuidado en la visión de los usuarios, en una posible vivificación de la relación con el propio cuerpo y su contribución en la producción de um nuevo modo de existencia en la vida cotidiana. Se analizan las transformaciones vividas en la relación con el cuerpo y las soluciones encontradas para su recomposición.

Discordant short- and long-term outcomes associated with diabetes in patients with heart failure: importance of age and sex: a population study of 5.1 million people in Scotland.

BACKGROUND: Diabetes and heart failure frequently coexist. Our aim was to assess the association between diabetes and short- and long-term outcomes in all patients admitted to the hospital for the first time with heart failure in Scotland between 1986 and 2003. METHODS AND RESULTS: A total of 116 556 patients were studied, of whom 13% (n=15 161) had a diagnosis of diabetes. At 30 days, diabetes was associated with a lower case fatality. By 1 year, the association between diabetes and better outcome was reversed, and diabetes was a significant independent predictor of higher case fatality. The longer term risk of death associated with diabetes was greatest in younger patients. In patients aged 65 years or younger, the hazard ratio for mortality at 5 years associated with diabetes was 1.41 (95% CI, 1.31 to 1.52) for men and 1.64 (1.50 to 1.79) for women. The risk associated with diabetes was less in patients aged 75 years or older: a hazard ratio in men 1.16 (1.10 to 1.22) and in women 1.15 (1.10 to 1.20). In the younger age group the risk associated with diabetes was significantly greater in women than in men (P=0.005 for diabetes-sex interaction). Diabetes was also a significant independent predictor of heart failure readmission, and again the risk was greatest in younger women. CONCLUSIONS: Although diabetes was associated with a lower case fatality at 30 days, by 1 year it was a significant independent predictor of higher case fatality. The risk associated with diabetes was greatest in young patients, and in young patients the risk was greatest in women.

Instituindo a flexibilidade: o trabalho clínico de passagem da internação psiquiátrica à vida na comunidade / Introducing flexibility: clinical work with the transition from psychiatric hospitalization to community life

O presente artigo versa sobre as especificidades de um trabalho clínico que visa a produzir a passagem do psicótico de um dispositivo hospitalar à vida na comunidade. Consideramos que esse dispositivo pode ocupar uma função que não é estática para os usuários, mas que se modifica de acordo com o percurso de cada um. Fazemos menção aos conceitos oriundos da psicoterapia institucional francesa e à psiquiatria democrática italiana, que auxiliarão a pensar na possibilidade de circulação de pessoas com transtornos mentais. Citamos ainda autores que trabalham na perspectiva do campo freudiano, levando-se em conta a leitura lacaniana. Dois casos clínicos aqui apresentados ilustrarão a questão exposta de como um psicótico pode prescindir de uma instituição, servindo-se dela.

This article discusses the specificities of a clinical study that aims to analyze the transition of a psychotic person who was being treated in a mental health hospital to community life. We consider that this institution can hold a function that is not static for users, but instead changes according to each person´s route. To discuss it, we will use concepts coming from the French institutional psychotherapy and the Italian democratic psychiatry, which will help to consider the possibility of people with mental disorders to circulate in society. Authors that use Freud´s theory, considering the Lacan´s reading of Psychoanalysis, will also be cited. Two clinical cases will be presented to illustrate the question of how a psychotic person can dispense with and take advantage of the institution.

Rapid diagnosis of Brucella epididymo-orchitis by real-time polymerase chain reaction assay in urine samples.

PURPOSE: We studied the diagnostic yield of a real-time polymerase chain reaction assay in urine samples for the rapid diagnosis of brucella epididymo-orchitis compared to that of conventional microbiological techniques. MATERIALS AND METHODS: We used an SYBR Green I LightCycler based real-time polymerase chain reaction to retrospectively study 10 urine samples from patients with Brucella epididymo-orchitis. The assay amplifies a 223 bp sequence of a gene that codes for the synthesis of an immunogenetic membrane protein specific for Brucella genus (BCSP31). After amplifying this 223 bp sequence we performed melting curve analysis to verify the specificity of polymerase chain reaction products. RESULTS: Brucella melitensis was isolated from blood cultures in 9 cases (90%). Wright's seroagglutination was negative or inconclusive in 30% of cases. Brucella was isolated from urine in only 1 case, whereas real-time polymerase chain reaction assay in urine was positive in 9 (90%). Also, results were available in 4 hours, whereas mean time to availability of the final blood culture results was 5.8 days (range 4.5 to 7). CONCLUSIONS: SYBR Green I LightCycler based real-time polymerase chain reaction assay in urine samples is highly sensitive and specific, and easy to perform. It could provide the clinician with results in less than 5 hours. The technique could be a practical and useful tool for the rapid diagnosis of genitourinary complications of human brucellosis.

Pesquisa clínica em saúde mental: o ponto de vista dos usuários sobre a experiência de ouvir vozes / Clinical research in Mental Health: the pacients'point of view on the experience of hearing voices

Trata-se de pesquisa clínica acerca da experiência de ouvir vozes, centrada na análise do funcionamento de um grupo de ouvidores de vozes em um Centro de Atenção Psicossocial (CAPS). Verificamos que o exercício de construção de narrativas sobre o ouvir vozes aplicado em um dispositivo grupal produz como efeito um aumento do engajamento dos participantes nos desafios decorrentes de seu adoecimento, auxiliando na criação de alternativas que promovam a sustentação do cotidiano. O grupo se assevera, consequentemente, como um meio profícuo de avançar, coletivamente, na elaboração de soluções singulares e de criar uma comunidade de trabalho voltada para uma experiência que se caracteriza essencialmente por não ser passível de ser compartilhada.

This is a qualitative clinical research on the hearing voices experience, based on the analysis of a hearing-voices group functioning in a Psychosocial Care Center (CAPS). We verified that the practice of patients narratives construction about their hearing voices experiences, in a group context, provides the raise of participants engagement in coping with the challenges of the mental illness process and helping them to create alternative ways that gives support to daily life. Consequently, the group assures a proficuous way of, collectively, developing singular solutions and creating a voice-hearing network dedicated to an experience essentially characterized as not passible for being shareable.

[Care plan versus care protocol. Comparative analysis in patients subjected to cardiac catheterism]. / Plan de cuidados frente a protocolo asistencial. Análisis comparativo en pacientes sometidos a cateterismo cardíaco.

The nursing product marks the present and future of the nursing staff. The tools used in the nursing staff should be complete and favor their work. The importance of the cares, during the stay of the patients in the intensive care units, is justified by the obtaining of results and some levels of quality that are adequate for the health care setting. The project aims to know the efficacy of the registered nursing care procedure, care plan or care protocol in an intensive care unit, with a system of computerized clinical records. The resulting information shows a value for the time dedicated to work with the plan greater than that used with the protocol (p = 0.01). In turn, the quality indicators used in both systems are graded as acceptable, although they obtain better results in the care plan. The nursing staff that participate in the study consider that the utility of the care plan in the unit is limited or null for 42.9% and 21.4%, respectively. It should be remembered that the work system in forced in the unit for the nursing care is a care protocol In conclusion, we state that the care plan has better quality in the records than the care protocol, while it requires greater time to fill out the nursing records.