The TELEhealth Shared decision-making Coaching and Navigation in Primary carE (TELESCOPE) intervention: a study protocol for delivering shared decision-making for lung cancer screening by patient navigators.

Background: Lung cancer screening (LCS) can reduce lung cancer mortality but has potential harms for patients. A shared decision-making (SDM) conversation about LCS is required by the Centers for Medicare & Medicaid Services (CMS) for LCS reimbursement. To overcome barriers to SDM in primary care, this protocol describes a telehealth decision coaching intervention for LCS in primary care clinics delivered by patient navigators. The objective of the study is to evaluate the effectiveness of the intervention and its implementation potential, compared with an enhanced usual care (EUC) arm. Methods: Patients (n = 420) of primary care clinicians (n = 120) are being recruited to a cluster randomized controlled trial. Clinicians are randomly assigned to 1) TELESCOPE intervention: prior to an upcoming non-acute clinic visit, patients participate in a telehealth decision coaching session about LCS delivered by trained patient navigators and nurse navigators place a low-dose CT scan (LDCT) order for each TELESCOPE patient wanting LCS, or 2) EUC: patients receive enhanced usual care from a clinician. Usual care is enhanced by providing clinicians in both arms with access to a Continuing Medical Education (CME) webinar about LCS and an LCS discussion guide. Patients complete surveys at baseline and 1-week after the scheduled clinic visit to assess quality of the SDM process. Re-navigation is attempted with TELESCOPE patients who have not completed the LDCT within 3 months. One month before being due for an annual screening, TELESCOPE patients whose initial LCS showed low-risk findings are randomly assigned to receive a telehealth decision coaching booster session with a navigator or no booster. Electronic health records are abstracted at 6, 12 and 18 months after the initial decision coaching session (TELESCOPE) or clinic visit (EUC) to assess initial and annual LCS uptake, imaging results, follow-up testing for abnormal findings, cancer diagnoses, treatment, and tobacco treatment referrals. This study will evaluate factors that facilitate or interfere with program implementation using mixed methods. Discussion: We will assess whether a decision coaching and patient navigation intervention can feasibly support high-quality SDM for LCS and guideline-concordant LCS uptake for patients in busy primary care practices serving diverse patient populations. Trial Registration: This study was registered at ClinicalTrials.gov (NCT05491213) on August 4, 2022.

Vasculitis-related stroke in young as a presenting feature of novel coronavirus disease (COVID19) - Case report.

COVID-19 is the disease caused by Novel Coronavirus (SARS-CoV-2) infection and world current main public health problem, due to its easy transmissibility and multiple clinical presentations. The main symptoms reported worldwide are dry cough, dyspnea, and fever, as well as anosmia and ageusia. COVID-19 diagnosis is made with RT-PCR, but many other complementary exams may be used to guide clinical practice, such as Chest Computerized Tomography (CT), showing ground glass opacities; increase in inflammatory markers, as C-Reactive Protein and Erythrocyte Sedimentation Rate; hemogram might show hypoalbuminemia, thrombocytopenia. Severe cases may evolve to thromboembolic and atheroembolic events, leading to stroke, myocardial infarction, pulmonary thromboembolism. Male, 28 years old, went for neurological appointment after presenting episode of intense headache, dysarthria, deviation of lip rhyme on appointment's eve. Previously healthy, no comorbidities or risk factors. Underwent brain MRI and serum serological analysis. SARS-CoV-2 capacity of affecting brain homeostasis by breaking blood-brain barrier, makes it easier to develop ischemic or inflammatory damage, and invading central nervous system. Neurological symptoms and syndromes are the main consequences of COVID-19 pandemic and must be prevented through adequate clinical management.

Trabalho e sofrimento: desafios da saúde mental de profissionais da assistência social / Trabajo y sufrimiento: desafíos de la salud mental de profesionales de la asistencia social / Work and suffering: mental health challenges of social workers

RESUMO. Esta pesquisa teve como objetivo investigar a saúde mental da equipe de funcionários do Centro de Referência e Assistência Social (CREAS) de Corumbá-MS, no ano de 2014. Adotou-se a abordagem teórico-metodológica da psicodinâmica do trabalho para abordar as vivências de prazer e sofrimento no trabalho, partindo da hipótese de que o atendimento aos indivíduos em situação de vulnerabilidade e violação de direitos exige investimento cognitivo e emocional excessivo, gerando sofrimento e desgaste psíquico. Participaram dez profissionais do CREAS, com escolaridade de nível fundamental e superior, os quais foram submetidos a dez encontros de entrevista coletiva, que tiveram como proposta a discussão e a análise das condições, da organização e das relações no trabalho, o reconhecimento e a valorização, e os sentimentos gerados diante dos casos de violência. Verificou-se que as vivências de sofrimento foram atribuídas à falta de estrutura e equipamentos, sobrecarga de trabalho pela demanda advinda de outras instituições, decorrendo em sentimentos de angústia, impotência, tristeza e desvalorização profissional. O prazer no trabalho foi constatado pela valorização por parte dos usuários e identificação com o trabalho social. Foi possível concluir que o trabalho com a violação dos direitos afeta as relações sociais e pessoais dos trabalhadores, pois a discrepância entre o prescrito (concepção) e o real (execução) demonstrou reações de angústia, choro, tristeza, impotência e pensamento negativo.

RESUMEN. Esta investigación tuvo como objetivo investigar la salud mental del personal del Centro de Referencia y Asistencia Social (CREAS) en Corumbá-MS en el año 2014. Se adoptó la psicodinámica del trabajo y el estudio se centró en las experiencias de placer y sufrimiento en el trabajo, partiendo de la hipótesis de que el cuidado de personas en situaciones vulnerables y de violación de sus derechos requiere una sobreinversión cognitiva y emocional, causando sufrimiento y desgaste psíquico. Diez categorías profesionales del CREAS participaron de las reuniones, que tenían educación primaria y superior, y se sometieron a diez sesiones de entrevista colectiva, que siguieron las cuestiones de debate: condiciones, organización y relaciones laborales, reconocimiento y aprecio y sentimientos generados en casos de violencia. Se encontró que las experiencias de sufrimiento se atribuían a la falta de infraestructura y aparato y a la carga de trabajo exigida por otras instituciones, surgiendo sentimientos de ansiedad, desamparo, tristeza y devaluación profesional. El placer en el trabajo fue observado por la apreciación por el trabajo realizado por los usuarios y la identificación con el trabajo social. Llegamos a la conclusión de que el trabajo con la violación de los derechos afecta a los trabajadores sociales y las relaciones personales, ya que la discrepancia entre el prescrito y la realidad (aplicación) mostró reacciones de ansiedad, lágrimas, tristeza, impotencia y pensamiento negativo.

ABSTRACT. This research aimed to investigate the staff mental health at the Specialized Reference Center for Social Assistance (CREAS), Corumbá, State of Mato Grosso do Sul, in 2014. For this, we adopted the theoretical-methodological approach of work psychodynamics to focus on the experiences of pleasure and suffering at work, starting from the hypothesis that the care of individuals in vulnerable situations and violation of rights requires a cognitive and emotional over-investment, causing suffering and psychic wear. Ten professionals of CREAS with elementary and higher education participated in ten meetings for collective interview, which proposed the following questions for discussion and analysis: conditions, organization and labor relations, recognition and valuation, and feelings generated on cases of violence. The experiences of suffering were attributed to lack of infrastructure and equipment, the work overload caused by the demand from other institutions, leading to feelings of anguish, helplessness, sadness and professional devaluation. The pleasure at work was observed by the appreciation for the work done on the part of the users and identification with social work. We concluded that working with the violation of rights affects social and personal relationships of workers, as the discrepancy between prescribed (design) and the actual (implementation) showed reactions of anguish, tearfulness, sadness, helplessness and negative thinking.

Efeito do treinamento resistido em paciente com fibromialgia: estudo de caso / Effect of resistance training in patients with fibromyalgia: a case report

A fibromialgia (FM) é uma doença idiopática de ordem reumatológica e incurável que causa dores crônicas e possui tratamento complexo e multifatorial. O exercício físico pode fazer parte do tratamento por atenuar parte dos sintomas da FM, porém a literatura ainda carece de informações sobre tipo, intensidade, duração e frequência ótimos contra os sintomas da FM. O objetivo do presente estudo foi verificar o efeito de 12 semanas de treinamento resistido em uma paciente com FM que não fazia tratamento farmacológico. Os resultados indicaram que 12 semanas de treinamento resistido foi capaz de reduzir as dores, melhorar a capacidade funcional, o bem-estar geral e a qualidade de vida da paciente. O treinamento resistido pareceu atenuar os efeitos negativos da FM e parece ser uma ferramenta promissora para pacientes com FM que gostem desse tipo de atividade.

Fibromyalgia (FM) is an idiopathic rheumatological order and incurable desease that causes chronic pain and has complex and multifactorial treatment. Exercise may be a part of treatment by relieving some of the symptoms of FM, but the literature still lacks optimal information about type, intensity, duration and frequency against the symptoms of FM. The aim of this study was to verify the effect of 12 weeks of resistance training in a patient with FM that had no pharmacological treatment. The results indicated that 12 weeks of resistance training was able to reduce pain, improve functional capacity, general well-being and quality of life of the patient. Resistance training appeared to attenuate the negative effects of FM and seems to be a promising tool for patients with FM who enjoy this kind of activity.