Serendipitous Pathways and Elusive Definitions: Leadership in Continuing Professional Development.

INTRODUCTION: Although the Continuing Professional Development (CPD) field has rapidly expanded in scope, breadth, and depth, there is a gap in how we understand CPD leadership and the role of the leader. Previous scholarship indicates that there is neither an agreed on set of competencies for CPD leadership roles nor a distinct pathway towards those roles. This study is aimed at answering the following question: How is leadership described or defined in CPD and what are the contextual issues that are and/or should be shaping its evolution? METHODS: Conducted between 2020 and 2022, CPD leadership program learners and CPD leaders with a range of leadership expertise were identified using convenience and purposive sampling and invited to participate in this study. Semistructured interviews were conducted with consenting participants. Interviews were recorded, transcribed, and analyzed using a qualitative thematic template analysis approach. RESULTS: Seventeen interviews were conducted. There were multiple components identified that were important to CPD leadership, such as being visionary, or having strong collaboration skills with some components, such as adaptability and flexibility appearing more unique to the CPD context. The role of CPD leadership and the pathway to CPD leadership remain highly variable. DISCUSSION: Attaining a CPD leadership position predominantly involves some degree of "serendipity." While CPD leaders may fundamentally need basic and common leadership skills, an essential attribute of the CPD leader is to effectively respond to the context and the unique needs of the health system. We recommend better articulating and valuing the role of the CPD leader within the health system.

Perspectivism and Health Professions Assessment.

ABSTRACT: This article aims to outline perspectivism and perspectival thinking by drawing on established scholarship from the philosophy of science and to demonstrate its relevance to health professions education. Perspectivism embraces the notion that knowledge always inherently arises from particular perspectives. "Truth" always depends on an evaluative background. Perspectivism is a form of epistemic humility that sees epistemic claims (relating to knowledge) as fundamentally historically and contextually situated. This article contends that perspectivism is a fruitful and relevant lens to apply to health professions assessment. It is a way of thinking that is all around us, even if we do not realize it. It extends discourse around the value of subjectivity in assessment and may cut through many prevailing debates on assessment practice. Perspectivism is a sort of middle-ground that is not meant to be another idea or "-ism" to add to a list of ideas, but constitutes a shift in how philosophy can be applied by adopting a broader, more holistic perspective. Applying a perspectival lens to health professions education embraces the imperative to make interpretive processes in assessment philosophically explicit. This opens the possibility of adopting multiple philosophical stances concurrently and allows actors to appreciate different methodological viewpoints with more charity. This scholarly perspective encourages the assessment community to continue to innovate through an appreciation of the importance of a wide range of assessment perspectives by uncovering the drivers of specific commitments to philosophical positions. Although the focus is on assessment in the health professions, perspectival thinking has the potential to advance medical education discourse and practice more generally beyond assessment. The hope with this essay is that by encouraging more critical reflection, this description of perspectival thinking will further aid researchers and practitioners in health professions education to better understand what is happening philosophically with more frequency.

Identifying Features of a System of Practice to Inform a Contemporary Competency Framework for Paramedics in Canada.

INTRODUCTION: Paramedic practice is highly variable, occurs in diverse contexts, and involves the assessment and management of a range of presentations of varying acuity across the lifespan. As a result, attempts to define paramedic practice have been challenging and incomplete. This has led to inaccurate or under-representations of practice that can ultimately affect education, assessment, and the delivery of care. In this study, we outline our efforts to better identify, explore, and represent professional practice when developing a national competency framework for paramedics in Canada. METHODS: We used a systems-thinking approach to identify the settings, contexts, features, and influences on paramedic practice in Canada. This approach makes use of the role and influence of system features at the microsystem, mesosystem, exosystem, macrosystem, supra-macrosystem, and chronosystem levels in ways that can provide new insights. We used methods such as rich pictures, diagramming, and systems mapping to explore relationships between these contexts and features. FINDINGS: When we examine the system of practice in paramedicine, multiple layers become evident and within them we start to see details of features that ought to be considered in any future competency development work. Our exploration of the system highlights that paramedic practice considers the person receiving care, caregivers, and paramedics. It involves collaboration within co-located and dispersed teams that are composed of other health and social care professionals, public safety personnel, and others. Practice is enacted across varying geographical, cultural, social, and technical contexts and is subject to multiple levels of policy, regulatory, and legislative influence. CONCLUSION: Using a systems-thinking approach, we developed a detailed systems map of paramedic practice in Canada. This map can be used to inform the initial stages of a more representative, comprehensive, and contemporary national competency framework for paramedics in Canada.

Validating the Emergency Department Avoidability Classification (EDAC): A cluster randomized single-blinded agreement study.

INTRODUCTION: The Emergency Department Avoidability Classification (EDAC) retrospectively classifies emergency department (ED) visits that could have been safely managed in subacute primary care settings, but has not been validated against a criterion standard. A validated EDAC could enable accurate and reliable quantification of avoidable ED visits. We compared agreement between the EDAC and ED physician judgements to specify avoidable ED visits. MATERIALS AND METHODS: We conducted a cluster randomized, single-blinded agreement study in an academic hospital in Hamilton, Canada. ED visits between January 1, 2019, and December 31, 2019 were clustered based on EDAC classes and randomly sampled evenly. A total of 160 ED visit charts were randomly assigned to ten participating ED physicians at the academic hospital for evaluation. Physicians judged if the ED visit could have been managed appropriately in subacute primary care (an avoidable visit); each ED visit was evaluated by two physicians independently. We measured interrater agreement between physicians with a Cohen's kappa and 95% confidence intervals (CI). We evaluated the correlation between the EDAC and physician judgements using a Spearman rank correlation and ordinal logistic regression with odds ratios (ORs) and 95% CIs. We examined the EDAC's precision to identify avoidable ED visits using accuracy, sensitivity and specificity. RESULTS: ED physicians agreed on 139 visits (86.9%) with a kappa of 0.69 (95% CI 0.59-0.79), indicating substantial agreement. Physicians judged 96.2% of ED visits classified as avoidable by the EDAC as suitable for management in subacute primary care. We found a high correlation between the EDAC and physician judgements (0.64), as well as a very strong association to classify avoidable ED visits (OR 80.0, 95% CI 17.1-374.9). The EDACs avoidable and potentially avoidable classes demonstrated strong accuracy to identify ED visits suitable for management in subacute care (82.8%, 95% CI 78.2-86.8). DISCUSSION: The EDAC demonstrated strong evidence of criterion validity to classify avoidable ED visits. This classification has important potential for accurately monitoring trends in avoidable ED utilization, measuring proportions of ED volume attributed to avoidable visits and informing interventions intended at reducing ED use by patients who do not require emergency or life-saving healthcare.

Decision making in continuing professional development organisations during a crisis.

INTRODUCTION: Early in COVID-19, continuing professional development (CPD) providers quickly made decisions about program content, design, funding and technology. Although experiences during an earlier pandemic cautioned providers to make disaster plans, CPD was not entirely prepared for this event. We sought to better understand how CPD organisations make decisions about CPD strategy and operations during a crisis. METHODS: This is a descriptive qualitative research study of decision making in two organisations: CPD at the University of Toronto (UofT) and the US-based Society for Academic Continuing Medical Education (SACME). In March 2021, using purposive and snowball sampling, we invited faculty and staff who held leadership positions to participate in semi-structured interviews. The interview focused on the individual's role and organisation, their decision-making process and reflections on how their units had changed because of COVID-19. Transcripts were reviewed, coded and analysed using thematic analysis. We used Mazmanian et al.'s Ecological Framework as a further conceptual tool. RESULTS: We conducted eight interviews from UofT and five from SACME. We identified that decision making during the pandemic occurred over four phases of reactions and impact from COVID-19, including shutdown, pivot, transition and the 'new reality'. The decision-making ability of CPD organisations changed throughout the pandemic, ranging from having little or no independent decision-making ability early on to having considerable control over choosing appropriate pathways forward. Decision making was strongly influenced by the creativity, adaptability and flexibility of the CPD community and the need for social connection. CONCLUSIONS: This adds to literature on the changes CPD organisations faced due to COVID-19, emphasising CPD organisations' adaptability in making decisions. Applying the Ecological Framework further demonstrates the importance of time to decision-making processes and the relational aspect of CPD. To face future crises, CPD will need to embrace creative, flexible and socially connected solutions. Future scholarship could explore an organisation's ability to rapidly adapt to better prepare for future crises.

Resiliência de pessoas com Diabetes Mellitus após cirurgia de amputação / Resilience people with mellitus diabetes after amputation surgery

Objetivo:Identificar as características de resiliência de pessoas com DM após cirurgia de amputação, e a relação entre as características identificadas e o tempo de amputação. Metodologia: Estudo descritivo, transversal, de abordagem quantitativa, realizado em um hospital de emergência, envolvendo 80 pessoas. Foram utilizados questionário sociodemográfico para caracterização da amostra e a Escala de Resiliência para Adultos. No estudo de relação, foi aplicado o Teste de Correlação de Spearman. Resultados: Predomínio do sexo masculino, média de idade (58±10,4), casados, etnia parda, trabalhador formal/aposentado, baixa escolaridade. A escala apresentou alfa de Cronbach (α=0,849), com escore global (M=4,9), competência social (M=5.2±1,4), coesão familiar (M=5.1±1,3), percepção de si mesmo (M=5.0±1,0), recursos sociais (M=5.0±1,3), estilo estruturado (M=4.4±1,4) e futuro planejado (M=4.3±1,4). Conclusão: Evidenciado nível de resiliência elevado para as características competência social, coesão familiar, percepção de si mesmo e recursos sociais, pois apresentaram maior média, embora todos os fatores tenham apresentado média acima do ponto de corte da escala, sugerindo um nível de resiliência equânime em todos. No entanto, as características de resiliência não apresentaram relação com o tempo de amputação. (AU)

Objective: To identify the resistance characteristics of people with Diabetes Mellitus submitted to amputation surgery, and the relationship between the identified characteristics and the time of amputation. Methods: Descriptive, cross-sectional study with a quantitative approach, carried out in an emergency hospital, involving 80 people. A sociodemographic questionnaire was used to characterize the Resilience Scale for Adults. No relationship studies were applied or the Spearman Correlation Test. Results: Male predominance, Middle age (58 ± 10.4), married, mixed race, formal / residential worker, high school. On Cronbach's alpha scale (α = 0.849), with global score (M = 4.9), social competence (M = 5.2 ± 1.4), family relationship (M = 5.1 ± 1.3), perception of being equal (M = 5.0 ± 1.0), social resources (M = 5.0 ± 1.3), structured style (M = 4.4 ± 1.4) and planned future (M = 4 , 3 ± 1.4). Conclusion: Evidence of a high level of resilience for the characteristics of social competence, family cooperation, perception of the same social resources, presented by the highest media, incorporates all the parents presented by the cut-off point of the scale, suggesting a level of equity. resilience. in all. However, the characteristics of resilience will not be related to the time of the amputation. (AU)

Objetivo: Identificar las características de resistencia de las personas con Diabetes Mellitus sometidas a cirugía de amputación, y la relación entre las características identificadas y el momento de la amputación. Métodos: Estudio descriptivo, transversal con enfoque cuantitativo, realizado en un hospital de urgencias, con 80 personas. Se utilizó un cuestionario sociodemográfico para caracterizar la Escala de Resiliencia para Adultos. No se aplicaron estudios de relación ni la prueba de correlación de Spearman. Resultados: Predominio masculino, edad media (58 ± 10.4), casado, mestizo, trabajador formal / residencial, bachillerato. En la escala alfa de Cronbach (α = 0.849), con puntaje global (M = 4.9), competencia social (M = 5.2 ± 1.4), relación familiar (M = 5.1 ± 1.3), percepción de ser igual (M = 5.0 ± 1.0), recursos sociales (M = 5.0 ± 1.3), estilo estructurado (M = 4.4 ± 1.4) y futuro planificado (M = 4 , 3 ± 1.4). Conclusión: La evidencia de un alto nivel de resiliencia para las características de competencia social, cooperación familiar, percepción de los mismos recursos sociales, presentada por los medios de comunicación más altos, incorpora a todos los padres presentados por el punto de corte de la escala, lo que sugiere un nivel de equidad. resiliencia en todos. Sin embargo, las características de la resiliencia no estarán relacionadas con el momento de la amputación. (AU)

Programa de tratamento fora de domicílio: análise à luz da integralidade / Out-of-house treatment program: analysis in the light of integrality

Objetivo: Analisar a percepção dos usuários sobre o atendimento às necessidades de saúde ofertadas pelo Programa de Tratamento Fora de Domicílio no Estado do Amapá à luz do princípio da integralidade. Método: Estudo exploratório com abordagem qualitativa. Realizado no polo de referência do Programa de Tratamento Fora de Domicílio da cidade de Macapá, AP, Brasil, no segundo semestre de 2018, com 17 usuários. Para a coleta de dados realizaram-se entrevistas. Os dados foram analisados por meio da análise de conteúdo temático categorial. Resultados: Emergiram três categorias de análise: Necessidades de saúde e processo de busca pelo tratamento; Viagens, dificuldades e facilidades; Necessidades familiares e sociais. Conclusão: O programa apresenta fragilidades e soluções de continuidade, que permite afirmar o prejuízo ao cumprimento do princípio da integralidade. (AU)

Objective: To analyze the perception of users about meeting the health needs offered by the Out-of-Home Treatment Program in the State of Amapá in the light of the principle of integrality. Method: Exploratory study with a qualitative approach. Held at the reference pole of the Out of Home Treatment Program in the city of Macapá, AP, Brazil, in the second half of 2018, with 17 users. For data collection, interviews were conducted. The data were analyzed through the analysis of categorical thematic content. Results: Three categories of analysis emerged: Health needs and the process of seeking treatment; Travel, difficulties and facilities; Family and social needs. Conclusion: The program presents weaknesses and solutions for continuity, which makes it possible to affirm the damage to compliance with the principle of integrality. (AU)

Objetivo: Analizar la percepción de los usuarios sobre la satisfacción de las necesidades de salud que ofrece el Programa de Tratamiento Fuera del Hogar en el Estado de Amapá a la luz del principio de integralidad. Método: Estudio exploratorio con enfoque cualitativo. Celebrada en el polo de referencia del Programa de tratamiento fuera del hogar en la ciudad de Macapá, AP, Brasil, en la segunda mitad de 2018, con 17 usuarios. Para la recopilación de datos, se realizaron entrevistas. Los datos se analizaron mediante el análisis de contenido temático categórico. Resultados: Surgieron tres categorías de análisis: Necesidades de salud y el proceso de búsqueda de tratamiento; Viajes, dificultades e instalaciones; Necesidades familiares y sociales. Conclusión: El programa presenta debilidades y soluciones para la continuidad, lo que permite afirmar el daño al cumplimiento del principio de integralidad. (AU)

Doença Oncológica: Perfil Epidemiológico em Unidade de Referência na Amazônia / Oncological disease: epidemiological profile in a reference unit in the amazon

Objetivo: Identificar o perfil epidemiológico, sociodemográfico, clínico e os cuidados de enfermagem no seguimento de pessoas com doença oncológica no estado do Amapá. Metodologia: Estudo transversal, descritivo, documental. Os dados foram coletados dos prontuários, por roteiro sistematizado, na amostra de 320 prontuários, no período de 2014 a 2018. Resultados: Predomínio do sexo feminino (55%), faixa etária entre 60 ­ 69 anos (21%), escolaridade ensino fundamental incompleto (40%). O câncer de colo uterino (33%) foi predominante no sexo feminino, e o de próstata (30%) no sexo masculino. Conclusão: O perfil identificado no Amapá para a população masculina foi o câncer de próstata, que se semelhou ao perfil nacional, já para a população feminina, fugiu do perfil nacional, onde o câncer de mama responde pelo topo do ranking, enquanto no Amapá é o de colo uterino. (AU)

Objective: To identify the epidemiological, sociodemographic, clinical profile and the nursing care in the follow up of peoples with oncological disease in the state of Amapá. Methodology: cross-sectional, descriptive, documentary study. The data were collected from the medical records by a systematized script, with a sample of 320 records of interventions that occurred in the period from 2014 to 2018. Results: The predominance was female (55%), aged over 60 (21% ), incomplete primary schooling (40%). Cervical cancer was the most identified (33%) in the female sex, and the prostate cancer (30%) in the male sex. Conclusion: The profile identified in Amapá for the male population admits prostate cancer, a characteristic similar to the national profile, already for the female population, runs away from the national profile, where breast cancer is at the top of the ranking, while in Amapá it is the uterine cervix. (AU)

Objetivo: Identificar el perfil epidemiológico, sociodemográfico, clínico y la atención de enfermería en el seguimiento de personas con enfermedad oncológica en el estado de Amapá. Metodología: Estudio transversal, descriptivo, documental. Los datos fueron recolectados de los prontuarios, por itinerario sistematizado, teniendo una muestra de 320 prontuarios, de intervenciones ocurridas en el período de 2014 a 2018. Resultados: Ocurrió el predominio del sexo femenino (55%), del grupo de edad superior a los 60 (21%) de la escolaridad escolar incompleta (40%). El cáncer de cuello uterino fue el más identificado (33%) en el sexo femenino, y el de próstata (30%) en el sexo masculino. Conclusión: El perfil identificado en Amapá para la población masculina admite el cáncer de próstata, característica similar al perfil nacional, ya para la población femenina, huye del perfil nacional, donde el cáncer de mama es el que está en la cima del ranking, en el Amapá es el de cuello uterino. (AU)

Elaboração de um instrumento de sistematização da assistência de enfermagem: relato de experiência / Elaboración de un instrumento de sistematización de la asistencia de enfermería: relato de experiencia / Elaboration of a nursing assistance systematization instrument: experience report

OBJETIVO: descrever a experiência do enfermeiro residente de enfermagem cirúrgica na elaboração de um instrumento de sistematização da assistência de enfermagem baseado na teoria das necessidades humanas básicas de Wanda Aguiar Horta. MÉTODOS: trata-se de uma pesquisa descritiva, exploratória com abordagem qualitativa, do tipo relato de experiência realizada em hospital púbico. RESULTADOS: criação de um instrumento que contempla todas as fases do processo de enfermagem baseado na teoria das necessidades humanas básicas, onde a assistência de enfermagem seria sistematizada e documentada e, assim, arquivada no prontuário do paciente. CONCLUSÃO: o instrumento elaborado é uma importante estratégia para a organização das ações e operacionalização do processo de enfermagem.

OBJECTIVE: to describe resident nurse experience of surgical nursing in the elaboration of a nursing assistance systematization instrument based on Wanda Aguiar Horta’s basic human needs theory. METHODOLOGY: This is a descriptive, exploratory research with a qualitative approach, of the type of experience report performed in a public hospital. RESULTS: creation of an instrument that contemplates all phases of the nursing process based on basic human needs the theory, where nursing care would be systematized and documented and thus, stored in the patient's chart. CONCLUSION: the instrument developed is an important strategy for the actions organization and the nursing process operationalization.

OBJETIVO: describir la experiencia del enfermero residente de enfermería quirúrgica en la elaboración de un instrumento de sistematización de la asistencia de enfermería basado en la teoría de las necesidades humanas básicas de Wanda Aguiar Horta. METODOLOGÍA: Se trata de una investigación descriptiva exploratoria con enfoque cualitativo, del tipo de informe de experiencia realizado en un hospital público. RESULTADOS: creación de un instrumento que contemple todas las fases del proceso de enfermería basado en la teoría de las necesidades humanas básicas, donde la atención de enfermería sería sistematizada y documentada y, por lo tanto, almacenada en el cuadro del paciente. CONCLUSIÓN: el instrumento desarrollado es una estrategia importante para la organización de acciones y operacionalización del proceso de enfermería.

Curativos utilizados no tratamento de queimaduras: uma revisão integrativa / Curaciones utilizadas en el tratamiento de quemaduras: una revisión integradora / Dressing used in the treatment of burns: an integrative review

Descrever os curativos utilizados no tratamento de queimaduras evidenciados em artigos científicos publicados entre os anos de 2005 a 2015. Método: Revisão Integrativa da Literatura, cujos dados foram coletados nas bases de dados LILACS e MEDLINE, sendo selecionados e analisados na íntegra 11 artigos. Resultados: Vários curativos são utilizados no tratamento de queimaduras. Dentre eles, estão os curativos com prata, os hidrogéis, os substitutos de pele, espuma de silicone, curativo úmido e petrolato. Todos aceleram o processo cicatricial e são eficazes no tratamento de queimaduras, sendo que os mais utilizados são os curativos com prata. Conclusão: Existem várias alternativas relacionadas ao curativo para o tratamento da queimadura, cabendo ao profissional que a cuidará decidir qual será melhor para o tratamento, levando em consideração a realidade local e custo-benefício...

To describe the dressing used to treat burns, evident in scientific articles between 2005 and 2015. Methods: Integrative literature review, whose data were collected in the LILACS and MEDLINE databases, and were selected and analyzed 11 articles in its whole. Results: A number of dressing are used in the treatment of burns, including silver dressing, hydrogels, skin substitutes, silicone foam, moist dressing and petrolatum. All accelerate the healing process and are effective in the treatment of burns, where the most used are silver dressings. Conclusion: There are several alternatives related to dressing for the treatment of burns, accounting professional to decide what will be best for treatment, taking into account local conditions and cost-effective...

Describir las curaciones utilizadas para tratar las quemaduras, evidentes en artículos científicos entre los años 2005 a 2015. Métodos: Revisión integradora de la literatura, cuyos datos se recogieron en las bases de datos LILACS y MEDLINE, y se seleccionaron y analizaron 11 artículos en su totalidad. Resultados: Una serie de curaciones se utilizan en el tratamiento de quemaduras, incluyendo curaciones con plata, hidrogeles, los sustitutos de la piel, espuma de silicona, vendaje húmedo y vaselina. Todos aceleran el proceso de cicatrización y son eficaces en el tratamiento de quemaduras, donde los más utilizados son los vendajes con plata. Conclusión: Hay varias alternativas relacionadas al vendaje para el tratamiento de quemaduras, correspondiéndole al profesional decidir lo que será mejor para el tratamiento, teniendo en cuenta las condiciones locales y el costo-beneficio...

Expansion of vicceral leishmaniasis in the stat of rio de janeiro, Brazil: repport of the first autochthonous case in the municipality of volta redonda and the difficulty of diagnoiis / Expansão da leishmaniose visceral no estado do Rio de Janeiro, Brasil: relato do primeiro caso autóctone no município de Volta Redonda e a dificuldade de diagnóstico

Visceral Leishmaniasis has been showing remarkable epidemiological changes in recent decades, with marked expansion and an emergence of cases in urban areas of the North, Southeast and Midwest regions of Brazil. The Kala-azar cases reported here, despite being very characteristic, presented a great difficulty of diagnosis, because the disease is not endemic in Volta Redonda. The child underwent two hospitalizations in different hospitals, but got the correct diagnosis only after 11 months of symptom onset. In this report we discuss the main differential diagnoses and call attention to the suspected symptoms of visceral leishmaniasis in patients with prolonged fever, hepatosplenomegaly and pancytopenia, even in areas not traditionally endemic for the disease.

A leishmaniose visceral vem apresentando mudanças epidemiológicas marcantes nas últimas décadas, com acentuada expansão e surgimento de casos em áreas urbanas do Norte, Sudeste e Centro-Oeste do Brasil. O caso de Calazar aqui relatado, apesar de ser muito característico, apresentou grande dificuldade de diagnóstico, por se tratar de doença não-endêmica em Volta Redonda. A criança passou por duas internações em hospitais diferentes, porém, só obteve o diagnóstico correto após 11 meses do início dos sintomas. Neste relato são discutidos os principais diagnósticos diferenciais e chama-se a atenção de sempre considerar a hipótese de leishmaniose visceral em todo paciente com febre prolongada, hepatoesplenomegalia e pancitopenia, mesmo em áreas tradicionalmente não endêmicas.

Infecção por Clostridium tetani no recém-nascido: revisão sobre o tétano neonatorum / Clostridium tetani infections in newborn infants: a tetanus neonatorum review

A despeito de ser uma doença imunoprevenível, o tétano permanece ceifando vidas em diferentes regiões do planeta. Se para a doença de origem acidental a ocorrência de novos casos reflete a insuficiente imunização da população, no caso do tétano neonatorum o problema tem dupla natureza: a precária cobertura vacinal dos adultos e as dificuldades de acesso ao pré-natal de qualidade, situação agudizada pela extrema gravidade da moléstia nesta faixa etária, cuja letalidade pode chegar a 80 por cento. Deste modo, ainda que seja importante o reconhecimento precoce do tétano no recém-nato para seu pronto e adequado tratamento, o aspecto de maior relevância é, indubitavelmente, a implementação de adequadas medidas de profilaxia e controle. Com base nestas premissas, propõe-se, neste artigo, uma atualização sobre o tétano neonatorum, enfatizando-se, com mais vigor, o tratamento e a prevenção da moléstia.

Although tetanus is a preventable disease by vaccination, it continues to claim lives around the world. Whereas cases of accidental origin reflect insufficient population immunization, tetanus neonatorum reveals a double-nature fault-poor vaccination coverage of adults coupled with difficulties accessing appropriate prenatal care; this situation is aggravated by the extreme severity of tetanus in this age group in which the mortality rate can reach up to 80 percent. The early detection of tetanus in neonates is essential for immediately initiating the proper therapy. Therefore, although reaching an early diagnosis of tetanus is important, the most relevant aspect is related to the appropriate management and prophylaxis of this disease. Consequently, the aim of this article is to review neonatorum tetanus with an emphasis on its therapy and prevention.