ABSTRACT
ABSTRACT Objective analyze the nurse's perception about nursing teleconsultation in Primary Health Care through the workflows characterization, potential, challenges and teleconsultation in nursing feasibility. Method exploratory-descriptive study with a qualitative approach. Data were collected, between the months of May and June 2021, with 19 nurses from four health districts of a capital in south of Brazil, using digital questionnaire. Data were systematized in Microsoft ExcelⓇ and analyzed following the criteria of the Discourse of the Collective Subject. This process was carried out with the support of the DSCsoftⓇ Program. Results the results were organized into five thematic categories: Nursing teleconsultation flow in Primary Health Care; Teleconsultation process; Instruments used during the teleconsultation; Potentialities and challenges identified during the teleconsultation in the Primary Health Care; and, Applicability: services that can be resolved through teleconsultation. Among the challenges are the inherent problems of communication and internet connectivity and the distrust of users in relation to this new consultation modality. Conclusion telecare in nursing is a recent technological innovation, with several challenges as: the possible failure in communication between the professional and the user; internet connection problems; lack of ability to travel from new tools; lack of privacy and excessive noise and distrust of users about the service provided. With the teleconsultation, there was an extension of the users' access to the health services, there was greater agility and efficiency in the services provided to the population.
RESUMEN Objetivo analizar la percepción de los enfermeros en relación a la teleconsulta de enfermería en la atención inicial de salud a través de la caracterización de los flujos de trabajo, potenciales, desafíos y la viabilidad de la teleconsulta en enfermería. Método estudio exploratório-descriptivo, con abordaje cualitativa. Los datos son colectados con 19 enfermeros que actúan en cuatro distritos sanitarios de una capital del sur del Brasil, utilizando un cuestionario digital. La colecta de los datos fue realizada entre los meses de mayo a junio de 2021 de forma totalmente online; los datos fueron sistematizados en el Microsoft Excel y analizados según los criterios del Discurso del sujeto colectivo, que utiliza las representaciones sociales y el senso común retratado la manifestación o posicionamento de cada individuo y posibilita agrupamientos de pensamientos y/o opiniones individuales sobre determinado asunto. Ese proceso fue realizado con el apoyo del Programa DSCsoft. Resultados los resultados fueron organizados en cinco categorías temáticas: Flujo de la teleconsulta de enfermería en la Atención Inicial de Salud; Proceso de realización de la teleconsulta; Instrumentos utilizados a lo largo de la realización de la teleconsulta; Potencialidades y desafíos identificados a lo largo de la teleconsulta en la Atención Inicial de Salud; y, Aplicabilidad: atendimientos pasibles de resoluciones por medio de la teleconsulta. Entre los desafíos están los problemas inherente a la comunicación y la conectividad con la internet y la desconfianza de los usuarios en relación a esta nueva modalidad de consulta: Conclusión el teleatendimiento en la área de la enfermería es una innovación tecnológica reciente, con diversos desafíos, como: la posible falla en la comunicación entre el profesional y el usuário; problemas de la conexión con la internet; falta de habilidad para manejo de las nuevas herramientas; falta de privacidad, exceso de ruidos y desconfianza de los usuarios a los servicios de salud, ocurre mayor agilidad y eficacia de los atendimientos realizados a la población.
RESUMO Objetivo analisar a percepção dos enfermeiros sobre teleconsulta de enfermagem na Atenção Primária de Saúde através da caracterização dos fluxos de trabalhos, potenciais, desafios e viabilidade da teleconsulta em enfermagem. Método estudo exploratório-descritivo, com abordagem qualitativa. Os dados foram coletados, entre os meses de maio a junho de 2021, com 19 enfermeiros que atuam em quatro distritos sanitários de uma capital do Sul do Brasil, utilizando um questionário digital. Os dados foram sistematizados no Microsoft Excel Ⓡ e analisados segundo os critérios do Discurso do Sujeito Coletivo. Esse processo foi realizado com o apoio do Programa DSCsoftⓇ. Resultados os resultados foram organizados em cinco categorias temáticas: Fluxo da teleconsulta de enfermagem na Atenção Primária à Saúde; Processo de realização da teleconsulta; Instrumentos utilizados durante a realização da teleconsulta; Potencialidades e desafios identificados durante a teleconsulta na Atenção Primária à Saúde; e, Aplicabilidade: atendimentos passíveis de resolução por meio da teleconsulta. Entre os desafios estão os problemas inerentes à comunicação e à conectividade com a internet e a desconfiança dos usuários em relação a esta nova modalidade de consulta. Conclusão o teleatendimento na área da enfermagem é uma inovação tecnológica recente, com diversos desafios, como: a possível falha na comunicação entre o profissional e o usuário; problemas de conexão com a internet; falta de habilidade para manuseio das novas ferramentas; falta de privacidade, excesso de ruídos e desconfiança dos usuários sobre o atendimento realizado. Com a teleconsulta ocorreu a ampliação do acesso dos usuários aos serviços de saúde, houve maior agilidade e eficácia dos atendimentos realizados à população.
ABSTRACT
ETHNOPHARMACOLOGICAL RELEVANCE: Casearia sylvestris is a tree found in tropical America. In Brazil it is known mainly as Guaçatonga. Literature reports suggest that the leaves and other plant parts have been used by indigenous populations from South America in preparations, mainly aqueous or hydroethanolic macerations or decoctions, most times taken orally for the primary treatment of several diseases, including cancer. AIM OF THE STUDY: This article reports the results of an investigation about the antiproliferative effects of Casearia sylvestris on tumor cells in vitro and in vivo. MATERIAL AND METHODS: Aqueous ethanolic maceration and column chromatography were done to obtain a crude aqueous ethanolic extract (CAE) and a chloroform fraction (f-CHCl3). The human breast cancer cell line MCF-7 was used in culture. In vitro, non-cytotoxic concentrations were determined by MTT assay and the antiproliferative effect was assessed by the colony forming unit assay using non-cytotoxic concentrations. Effects on the cell cycle were observed through flow cytometry using a propidium iodide kit. Casearin C was identified in f-CHCl3 by chromatography and H(1) nuclear magnetic resonance. The effect on some key proteins of DNA damage (phosphorylation on the histone H2AX) and cell cycle control (p53, p16, cdk2) was evaluated through immunoblot. Antiproliferative effects in vivo were measured in tumor tissue from Ehrlich ascites-bearing mice through the (3)H-thymidine uptake assay and the trypan blue exclusion method. RESULTS: In vitro, EC50 values found at 24 h on MCF-7 cells were 141 µg/mL for CAE and 66 µg/mL for f-CHCl3. Inhibition on proliferation was recorded at concentrations as low as 4 µg/mL in the case of the f-CHCl3 (up to 40%) and up to 50% when CAE was added at 9 µg/mL. The cell cycle arrest was demonstrated by the reduction in terms of number of cells in phases G2/M and S, up to 38.9% and 51.9% when cells were treated with CAE, and 53.9% and 66.2%, respectively, when cells were treated with f-CHCl3. The number of cells in G1 was increased when the cells were treated with CAE (21.4%) or f-CHCl3 (27.8%). Key proteins of cell cycle control were affected. The treatments caused activation of p53, p16 and DNA damage found by the appearance of bands corresponding to γ-H2AX. The treatments caused inhibition of cdk2. CAE and particularly f-CHCl3 caused significant inhibition on tumor growth in mice (40% and 60%, respectively). Uptake of (3)H-thymidine, thus proliferation was reduced in tumor cells from mice treated with CAE (>30%) or f-CHCl3 (up to 50%) compared to cells from control animals. Data from the trypan blue assay indicating a lower number of tumor cells in treated animals. From the overall, data from this study are in line with the traditional claims for the antitumor effect of Casearia sylvestris. CONCLUSIONS: This investigation suggests that whether the extracts from Casearia sylvestris are cytotoxic at high concentrations, lower concentrations have antiproliferative effect and could be useful to complement conventional cytotoxic chemotherapy, and should be evaluated further.
