Construction and validation of nursing diagnoses for premature newborns.

OBJECTIVE: To build and validate nursing diagnoses based on the International Classification of Nursing Practice (ICNP®) for premature newborns admitted to the Neonatal Intensive Care Unit. METHOD: Methodological study based on the Brazilian method for developing subsets: use of specialized nursing language terms, construction of diagnostic statements and content validation of the statements by 40 specialist nurses. Those with a Content Validity Index (CVI) ≥ 0.80, organized according to Wanda Horta's basic human needs theory, were considered valid. RESULTS: 146 nursing diagnosis statements were constructed and 145 (93.3%) diagnoses were validated, with a predominance of the human need for cutaneous-mucosal integrity. CONCLUSION: The specificity of neonatal care is evident when these diagnoses are presented and validated in order to support nurses in their clinical reasoning and decision-making.

Tuberous Sclerosis Complex: Prenatal Diagnosis Using Ultrasound and Magnetic Resonance Imaging-A Report of Two Cases.

Tuberous sclerosis complex (TSC) is a multiple system neurocutaneous syndrome with a genetic disorder caused by different mutations in TSC1 or TSC2. Usually, TSC causes tumors in the heart, brain, kidneys, eyes, and lungs. However, tumors can also develop in any other organs. The prenatal diagnosis of TCS is based on the identification of fetal cardiac tumors by ultrasound and brain subependymal nodules, usually identified by fetal magnetic resonance imaging (MRI). We present two case reports of the prenatal diagnosis of TCS using both ultrasound and MRI, which were confirmed by clinical and radiological methods in the postnatal period accordingly.

Influence of COVID-19 pandemic on molar pregnancy and postmolar gestational trophoblastic neoplasia: An observational study.

OBJECTIVE: To assess whether the incidence and aggressiveness of molar pregnancy (MP) and postmolar gestational trophoblastic neoplasia (GTN) changed during the COVID-19 pandemic. DESIGN: Observational study with two separate designs: retrospective multicentre cohort of patients with MP/postmolar GTN and a cross-sectional analysis, with application of a questionnaire. SETTING: Six Brazilian Reference Centres on gestational trophoblastic disease. POPULATION: 2662 patients with MP/postmolar GTN treated from March-December/2015-2020 were retrospectively evaluated and 528 of these patients answered a questionnaire. METHODS: Longitudinal retrospective multicentre study of patients diagnosed with MP/ postmolar GTN at presentation and a cross-sectional analysis, with application of a questionnaire, exclusive to patients treated during the period of study, to assess living and health conditions during the COVID-19 pandemic compared with previous years. MAIN OUTCOME MEASURES: The incidence of MP/postmolar GTN. RESULTS: Compared with the last 5 pre-pandemic years, MP/postmolar GTN incidence remained stable during 2020 (COVID-19 pandemic). Multivariable logistic regression, adjusted for the patient age, showed that during 2020, presentation with MP was more likely to be >10 weeks of gestation (adjusted odds ratio [aOR] 2.50, 95% confidence interval [CI] 1.90-3.29, P < 0.001), have a pre-evacuation hCG level ≥100 000 iu/l (aOR 1.77, 95% CI 1.38-2.28, P < 0.001) and time to the initiation of chemotherapy ≥7 months (aOR 1.86, 95% CI 1.01-3.43, P = 0.047) when compared with 2015-2019. CONCLUSIONS: Although the incidence of MP/postmolar GTN remained stable during the COVID-19 pandemic in Brazil, the pandemic was associated with greater gestational age at MP diagnosis and more protracted delays in initiation of chemotherapy for postmolar GTN.

Construction and validation of nursing diagnoses for premature newborns / Construcción y validación de diagnósticos de enfermería para recién nacidos prematuros / Construção e validação de diagnósticos de enfermagem para recém-nascidos prematuros

ABSTRACT Objective: To build and validate nursing diagnoses based on the International Classification of Nursing Practice (ICNP®) for premature newborns admitted to the Neonatal Intensive Care Unit. Method: Methodological study based on the Brazilian method for developing subsets: use of specialized nursing language terms, construction of diagnostic statements and content validation of the statements by 40 specialist nurses. Those with a Content Validity Index (CVI) ≥ 0.80, organized according to Wanda Horta's basic human needs theory, were considered valid. Results: 146 nursing diagnosis statements were constructed and 145 (93.3%) diagnoses were validated, with a predominance of the human need for cutaneous-mucosal integrity. Conclusion: The specificity of neonatal care is evident when these diagnoses are presented and validated in order to support nurses in their clinical reasoning and decision-making.

RESUMEN Objetivo: Construir y validar diagnósticos de enfermería basados en la Clasificación Internacional de la Práctica de Enfermería (CIPE®) para recién nacidos prematuros ingresados en la Unidad de Cuidados Intensivos Neonatales. Método: Estudio metodológico basado en el método brasileño de elaboración de subconjuntos: utilización de términos del lenguaje enfermero especializado, construcción de enunciados diagnósticos y validación de contenido de los enunciados por 40 enfermeros especialistas. Se consideraron válidos aquellos con Índice de Validez de Contenido (IVC) ≥ 0,80, organizados según las necesidades humanas básicas de Wanda Horta. Resultados: Se construyeron 146 enunciados de diagnóstico de enfermería y se validaron 145 (93,3%) diagnósticos, con predominio de la necesidad humana de integridad cutáneo-mucosa. Conclusión: La especificidad de los cuidados neonatales es evidente desde el momento en que estos diagnósticos son presentados y validados con el objetivo de subsidiar a las enfermeras en su razonamiento clínico y toma de decisiones.

RESUMO Objetivo: Construir e validar diagnósticos de enfermagem fundamentados na Classificação Internacional da Prática de Enfermagem (CIPE®) para recém-nascidos prematuros internados em Unidade de Terapia Intensiva Neonatal. Método: Estudo metodológico sustentado pelo método brasileiro para desenvolvimento de subconjuntos: utilização de termos da linguagem especializada de enfermagem, construção dos enunciados de diagnósticos e validação de conteúdo dos enunciados por 40 enfermeiros especialistas. Foram considerados válidos aqueles com Índice de Validade de Conteúdo (IVC) ≥ 0.80, organizados conforme à teoria das necessidades humanas básicas de Wanda Horta. Resultados: Foram construídos 146 enunciados de diagnósticos de enfermagem, e ao final foram validados 145 (93,3%) diagnósticos, com predominância na necessidade humana de integridade cutâneo-mucosa. Conclusão: A especificidade do cuidado neonatal fica evidente a partir do momento em que se apresentam tais diagnósticos, e que são validados com o objetivo de subsidiar o enfermeiro no raciocínio clínico e na tomada de decisão.

Neutrophil/lymphocyte ratio and other blood cell component counts are not associated with the development of postmolar gestational trophoblastic neoplasia.

OBJECTIVE: To relate preevacuation platelet count and leukogram findings, especially neutrophil/lymphocyte ratios (NLR) and platelet/lymphocyte ratios with the occurrence of gestational trophoblastic neoplasia (GTN) after complete hydatidiform mole (CHM) among Brazilian women. METHODS: Retrospective cohort study of patients with CHM followed at Rio de Janeiro Federal University, from January/2015-December/2020. Before molar evacuation, all patients underwent a medical evaluation, complete blood count and hCG measurement, in addition to other routine preoperative tests. The primary outcome was the occurrence of postmolar GTN. RESULTS: From 827 cases of CHM treated initially at the Reference Center, 696 (84.15%) had spontaneous remission and 131 (15.85%) developed postmolar GTN. Using optimal cut-offs from receiver operating characteristic curves and multivariable logistic regression adjusted for the possible confounding variables of age and preevacuation hCG level (already known to be associated with the development of GTN) we found that ≥2 medical complications at presentation (aOR: 1.96, CI 95%: 1.29-2.98, p<0.001) and preevacuation hCG ≥100,000 IU/L (aOR: 2.16, CI 95%: 1.32-3.52, p<0.001) were significantly associated with postmolar GTN after CHM. However, no blood count profile findings were able to predict progression from CHM to GTN. CONCLUSION: Although blood count is a widely available test, being a low-cost test and mandatory before molar evacuation, and prognostic for outcome in other neoplasms, its findings were not able to predict the occurrence of GTN after CHM. In contrast, the occurrence of medical complications at presentation and higher preevacuation hCG levels were significantly associated with postmolar GTN and may be useful to guide individualized clinical decisions in post-molar follow-up and treatment of these patients.

Nursing diagnoses of newborns in rooming-in care using ICNP®.

OBJECTIVES: to create nursing diagnosis definitions for newborns in rooming-in care, using the International Classification for Nursing Practice (ICNP). METHODS: methodological study following the steps for the identification and validation of relevant terms to care for clients; cross-mapping of the terms identified with the terms of the ICNP® 2019; elaboration and validation of the nursing diagnostic definitions of ICNP® and later classification according with the Basic Human Needs described by Wanda Horta. RESULTS: from the terms extracted, 168 were validated through specialist consensus, subsidizing the elaboration of 27 diagnosis definitions. CONCLUSIONS: the most common diagnoses for the clients studied were: "Effective Feeding Behaviour", "Effective Urination", "Normal Respiration Rhythm", "Effective Swallowing", "Effective Peripheral Intravenous Access", and "Effective Parent Child Attachment". It was confirmed that the records of psychobiological needs are mainly made by nurses, which were responsible for 23 of the diagnoses in this study.

A population-based study of the relationship between advanced maternal age and premature/early-term birth in Brazil.

OBJECTIVE: To verify whether advanced maternal age (AMA), defined as women of ≥35 years, is associated with premature and early-term birth in Brazil, according to the onset of labor (spontaneous or provider-initiated). METHODS: Cross-sectional population-based study. The "Birth in Brazil" study interviewed 23 894 puerperal women between 2011 and 2012, in all regions of Brazil. The current analysis included 17 994 adult mothers and their newborns (15 448 aged between 20-34 years, and 2536 ≥ 35 years). A propensity score was used to assess the likelihood of AMA women giving birth to premature or early-term infants (spontaneous or provider-initiated) compared to women aged 20-34 years. To balance the groups, we used maternal, prenatal, and childbirth characteristics. RESULTS: The general prematurity rate was 10.24%, of which the majority of births were spontaneous (55.73%). Conversely, early-term births were more often provider-initiated (54.81%). AMA did not increase the chance of premature births, whether spontaneous or provider-initiated. However, AMA was associated with a higher rate of provider-initiated early-term birth (OR = 1.48; 95% CI: 1.23-1.77). CONCLUSION: AMA alone does not contribute to premature birth; AMA's independent association with provider-initiated early-term birth may not be based solely on clinical indications.

Nursing diagnoses of newborns in rooming-in care using ICNP® / Diagnósticos de enfermería de recién nacidos en alojamiento conjunto utilizando la CIPE® / Diagnósticos de enfermagem de recém-nascidos em alojamento conjunto utilizando a CIPE®

ABSTRACT Objectives: to create nursing diagnosis definitions for newborns in rooming-in care, using the International Classification for Nursing Practice (ICNP). Methods: methodological study following the steps for the identification and validation of relevant terms to care for clients; cross-mapping of the terms identified with the terms of the ICNP® 2019; elaboration and validation of the nursing diagnostic definitions of ICNP® and later classification according with the Basic Human Needs described by Wanda Horta. Results: from the terms extracted, 168 were validated through specialist consensus, subsidizing the elaboration of 27 diagnosis definitions. Conclusions: the most common diagnoses for the clients studied were: "Effective Feeding Behaviour", "Effective Urination", "Normal Respiration Rhythm", "Effective Swallowing", "Effective Peripheral Intravenous Access", and "Effective Parent Child Attachment". It was confirmed that the records of psychobiological needs are mainly made by nurses, which were responsible for 23 of the diagnoses in this study.

RESUMEN Objetivos: construir enunciados diagnósticos de enfermería para recién nacidos internados en alojamiento conjunto, utilizando Clasificación Internacional para la Práctica de Enfermería (CIPE®). Métodos: estudio metodológico siguiendo las etapas de identificación y validación de términos relevantes para el cuidado con la clientela; mapeo cruzado de los términos identificados con los términos de la CIPE® 2019; construcción y validación de los enunciados de diagnósticos de enfermería de la CIPE® y subsecuente clasificación segundo las Necesidades Humanas Básicas descritas por Wanda Horta. Resultados: de los términos extraídos, 168 fueron validados basados en el consenso (100%) entre especialistas, subsidiando la elaboración de 27 enunciados diagnósticos. Conclusiones: los diagnósticos más frecuentes para la clientela estudiada fueron: "Patrón de Ingestión de Alimentos, Eficaz" "Orina, Normal", "Ritmo Respiratorio, Normal", "Deglución, Eficaz, "Acceso Intravenoso Periférico, Eficaz" y "Relación Afectiva Padres-niño, Eficaz", confirmando el predominio del registro de las necesidades psicobiológicas por enfermeros, representadas por 23 diagnósticos del estudio.

RESUMO Objetivos: construir enunciados diagnósticos de enfermagem para recém-nascidos internados no alojamento conjunto, utilizando Classificação Internacional para a Prática de Enfermagem (CIPE®). Métodos: estudo metodológico seguindo as etapas de identificação e validação de termos relevantes para o cuidado com a clientela; mapeamento cruzado dos termos identificados com os termos da CIPE® 2019; construção e validação dos enunciados de diagnósticos de enfermagem da CIPE® e subsequente classificação segundo as Necessidades Humanas Básicas descritas por Wanda Horta. Resultados: dos termos extraídos, 168 foram validados com base no consenso (100%) entre especialistas, subsidiando a elaboração de 27 enunciados diagnósticos. Conclusões: os diagnósticos mais frequentes para a clientela estudada foram: "Padrão de Ingestão de Alimentos, Eficaz" "Urina, Normal", "Ritmo Respiratório, Normal", "Deglutição, Eficaz, "Acesso Intravenoso Periférico, Eficaz" e "Ligação Afetiva Pais-criança, Eficaz", confirmando o predomínio do registro das necessidades psicobiológicas pelos enfermeiros, representadas por 23 diagnósticos do estudo.

Factors associated with prematurity in reported cases of congenital syphilis.

OBJECTIVE: To analyze the factors associated with prematurity in reported cases of congenital syphilis in the city of Fortaleza, Ceará, Brazil. METHODS: Cross-sectional study conducted in ten public maternity hospitals in Fortaleza, Ceará, Brazil. A total of 478 reported cases of congenital syphilis were included in 2015, and data were collected from notification forms, from mothers' and babies' medical records and from prenatal cards. For the bivariate analysis, Pearson's chi-squared and Fisher's exact tests were used, considering p < 0.05. Multiple logistic regression was conducted, presenting odds ratio (OR) with a 95% confidence interval. RESULTS: We found 15.3% prematurity in pregnant women with syphilis. The titration of the VDRL test > 1:8 at delivery (OR 2.46; 95%CI: 1.33-4.53; p = 0.004) and the non-treatment of the pregnant women or treatment with drugs other than penicillin during prenatal care (OR 3.52; 95%CI: 1.74-7.13; p< 0.001) were associated with higher chances of prematurity. CONCLUSION: The prematurity due to congenital syphilis is a preventable condition, provided that pregnant women with syphilis are treated appropriately. Weaknesses in prenatal care are associated with this outcome, which highlights the importance of public policies oriented to improve the quality of prenatal care.

Factors associated with prematurity in reported cases of congenital syphilis / Fatores associados à prematuridade em casos notificados de sífilis congênita

ABSTRACT OBJECTIVE: To analyze the factors associated with prematurity in reported cases of congenital syphilis in the city of Fortaleza, Ceará, Brazil. METHODS: Cross-sectional study conducted in ten public maternity hospitals in Fortaleza, Ceará, Brazil. A total of 478 reported cases of congenital syphilis were included in 2015, and data were collected from notification forms, from mothers' and babies' medical records and from prenatal cards. For the bivariate analysis, Pearson's chi-squared and Fisher's exact tests were used, considering p < 0.05. Multiple logistic regression was conducted, presenting odds ratio (OR) with a 95% confidence interval. RESULTS: We found 15.3% prematurity in pregnant women with syphilis. The titration of the VDRL test > 1:8 at delivery (OR 2.46; 95%CI: 1.33-4.53; p = 0.004) and the non-treatment of the pregnant women or treatment with drugs other than penicillin during prenatal care (OR 3.52; 95%CI: 1.74-7.13; p< 0.001) were associated with higher chances of prematurity. CONCLUSION: The prematurity due to congenital syphilis is a preventable condition, provided that pregnant women with syphilis are treated appropriately. Weaknesses in prenatal care are associated with this outcome, which highlights the importance of public policies oriented to improve the quality of prenatal care.

RESUMO OBJETIVO: Analisar os fatores associados à prematuridade em casos notificados de sífilis congênita no município de Fortaleza, Ceará, Brasil. MÉTODOS: Estudo transversal realizado em dez maternidades públicas de Fortaleza, Ceará, Brasil. Foram incluídos 478 casos notificados de sífilis congênita em 2015, e os dados foram coletados das fichas de notificação, dos prontuários das mães e dos bebês e do cartão de pré-natal. Para a análise bivariada, foram utilizados os testes do qui-quadrado de Pearson e exato de Fisher, considerando p < 0,05. Realizou-se regressão logística múltipla, apresentando razão de chances (OR) com intervalo de confiança de 95%. RESULTADOS: Encontrou-se 15,3% de prematuridade em gestantes com sífilis. A titulação do teste VDRL > 1:8 no parto (OR 2,46; IC95%: 1,33-4,53; p = 0,004), o não tratamento da gestante ou tratamento realizado com drogas diferentes da penicilina durante o pré-natal (OR 3,52; IC95%: 1,74-7,13; p < 0,001) estiveram associados a maiores chances de prematuridade. CONCLUSÃO: A prematuridade decorrente da sífilis congênita é um agravo evitável, desde que as gestantes com sífilis sejam tratadas adequadamente. As fragilidades na assistência pré-natal estão associadas a este desfecho, o que ressalta a importância de implementar políticas públicas voltadas a melhorar a qualidade do pré-natal.

Gestational trophoblastic neoplasia lethality among Brazilian women: A retrospective national cohort study.

OBJECTIVE: To investigate GTN lethality among Brazilian women comparing cases of death by GTN with those who survived, thereby identifying factors associated with GTN lethality. METHODS: We retrospectively reviewed medical records of women with GTN treated at ten Brazilian GTN Reference Centers, from January 1960 to December 2017. We evaluated factors associated with death from GTN and used Cox proportional hazards regression models to identify independent variables with significant influence on the risk of death. RESULTS: From 2186 patients with GTN included in this study, 2092 (95.7%) survived and 89 (4%) died due to GTN. When analyzing the relative risk (RR), adjusted for WHO/FIGO score, patients with low risk disease had a significantly higher risk of death if they had choriocarcinoma (RR: 12.40), metastatic disease (RR: 12.57), chemoresistance (RR: 3.18) or initial treatment outside the Reference Center (RR: 12.22). In relation to patients with high-risk GTN, these factors were significantly associated with death due to GTN: the time between the end of antecedent pregnancy and the initiation of chemotherapy (RR: 4.10), metastatic disease (RR: 14.66), especially in brain (RR: 8.73) and liver (RR: 5.76); absence of chemotherapy or initial treatment with single agent chemotherapy (RR: 10.58 and RR: 1.81, respectively), chemoresistance (RR: 3.20) and the initial treatment outside the Reference Center (RR: 28.30). CONCLUSION: The risk of mortality from low and high-risk GTN can be reduced by referral of these patients to a Reference Center or, if not possible, to involve clinicians in a Reference Center with consultation regarding management.

Terminological subsets of the International Classification for Nursing Practice: an integrative literature review. / Subconjuntos terminológicos da Classificação Internacional para Prática de Enfermagem: uma revisão integrativa da literatura.

OBJECTIVE: To characterize the scientific production available in the literature on the construction of terminological subsets of ICNP® with emphasis on the clientele and/or health priority to which the subsets are intended, the theoretical reference used and the validation process of constructed statements. METHOD: An integrative review of the literature with bibliometric approach of publications between 2008 and 2017. RESULTS: Thirty-five (35) publications were included for analysis. Most of the studies were linked to postgraduate programs of universities in Northeast Brazil. Regarding the attended clientele, there was a trend towards the care of cancer, older adult and child/adolescent patients. For the theoretical reference for constructing the subset, there was a trend towards using the Basic Human Needs model. The validation process was not described in all studies. CONCLUSION: The importance of constructing terminological subsets of ICNP® aimed at priority health clientele is reinforced in order to enhance the use of this terminology. The methodological course should be based on specific methodologies, and the construction process should be parallel to the validation process.

Respiratory muscle strength and lung function in the stages of Parkinson's disease.

OBJECTIVE: To investigate parameters of lung function and respiratory muscle strength in different stages of Parkinson's disease (PD), as well as to determine their correlation with motor function and quality of life. METHODS: This was a cross-sectional study conducted at a referral center for PD in the city of Recife, Brazil. Respiratory muscle strength and lung function, as well as their relationship with motor function and quality of life, were evaluated in patients with PD, stratified by the level of severity, and were compared with the data obtained for a control group. After confirming the normality of data distribution, we performed one-way ANOVA with a post hoc t-test. RESULTS: The sample comprised 66 individuals, in two groups: PD (n = 49) and control (n = 17). All of the parameters investigated showed inverse correlations with PD severity, and there were significant differences among the levels of severity, as well as between the PD and control groups, in terms of the MIP, MEP, FVC, FEV1, and FEF25-75%. The lung function parameters also showed moderate to weak inverse correlations with bradykinesia and rigidity. On a quality of life questionnaire, the total score and mobility domain score both presented a moderate inverse correlation with FVC, FEV1, PEF, and MEP. CONCLUSIONS: Respiratory muscle strength and some lung function parameters are impaired from the early stages of PD onward, bradykinesia and rigidity being the cardinal signs that correlate most strongly with impairment of those parameters. Such alterations negatively affect the quality of life of patients with PD.

Can carboplatin or etoposide replace actinomycin-d for second-line treatment of methotrexate resistant low-risk gestational trophoblastic neoplasia?

OBJECTIVE: To evaluate the impact of periodic shortage of actinomycin-d (Act-d) in the treatment of Brazilian patients with low-risk gestational trophoblastic neoplasia (GTN) after methotrexate and folinic acid rescue (MTX/FA) resistance, treated alternately with carboplatin or etoposide as a second-line regimen. METHODS: Retrospective cohort that included patients with failure of first-line MTX/FA regimen for low-risk GTN treated at Rio de Janeiro Federal University, Universidade Federal de São Paulo and Irmandade da Santa Casa de Misericórdia de Porto Alegre, from January/2010- December/2017. RESULTS: From 356 patients with low-risk GTN treated with MTX/FA, 75 (21.1%) developed resistance, of which 40 (53.3%) received Act-d, 23 (30.7%) carboplatin and 7 (9.3%) etoposide. Although patients treated with single-agent chemotherapy as a second-line regimen had comparable clinical and primary treatment characteristics, those treated with Act-d (80%, p = 0.033) or etoposide (71.4%, p = 0.025) had higher remission rates when compared with carboplatin (47.8%). Only 29% of patients treated with carboplatin received the chemotherapy cycles without delay compared to Act-d (98%, p < 0.001) or etoposide (85%, p = 0.009). Patients treated with carboplatin had significantly more hematological toxicity, notably anemia (30.4%, p = 0.008), lymphopenia (47.7%, p < 0.001) and thrombocytopenia (43.4%, p < 0.001), as well as a higher occurrence of febrile neutropenia (14.4%, p = 0.044) and vomiting (60%, p < 0.001) than those receiving Act-d (5%, none, 2.5%, none, 10%, respectively). CONCLUSION: Carboplatin did not have a satisfactory clinical response rate, likely due to severe hematological toxicity, which postponed chemotherapy. Our results reinforce the preference for Act-d as a second-line agent in patients with low-risk GTN after MTX/FA resistance.

Respiratory muscle strength and lung function in the stages of Parkinson's disease / Força muscular respiratória e função pulmonar nos estágios da doença de Parkinson

ABSTRACT Objective: To investigate parameters of lung function and respiratory muscle strength in different stages of Parkinson's disease (PD), as well as to determine their correlation with motor function and quality of life. Methods: This was a cross-sectional study conducted at a referral center for PD in the city of Recife, Brazil. Respiratory muscle strength and lung function, as well as their relationship with motor function and quality of life, were evaluated in patients with PD, stratified by the level of severity, and were compared with the data obtained for a control group. After confirming the normality of data distribution, we performed one-way ANOVA with a post hoc t-test. Results: The sample comprised 66 individuals, in two groups: PD (n = 49) and control (n = 17). All of the parameters investigated showed inverse correlations with PD severity, and there were significant differences among the levels of severity, as well as between the PD and control groups, in terms of the MIP, MEP, FVC, FEV1, and FEF25-75%. The lung function parameters also showed moderate to weak inverse correlations with bradykinesia and rigidity. On a quality of life questionnaire, the total score and mobility domain score both presented a moderate inverse correlation with FVC, FEV1, PEF, and MEP. Conclusions: Respiratory muscle strength and some lung function parameters are impaired from the early stages of PD onward, bradykinesia and rigidity being the cardinal signs that correlate most strongly with impairment of those parameters. Such alterations negatively affect the quality of life of patients with PD.

RESUMO Objetivo: Investigar a repercussão de parâmetros de função pulmonar e de força muscular respiratória nos diversos estágios da doença de Parkinson (DP) e suas correlações com a funcionalidade e a qualidade de vida desses pacientes. Métodos: Estudo de corte transversal realizado em um serviço de referência para DP em Recife (PE). Foram avaliadas a força muscular respiratória e a função pulmonar, assim como suas relações com a funcionalidade e a qualidade de vida, em pacientes com DP estratificados por gravidade da DP e comparados a um grupo controle. Após a verificação da normalidade da amostra, foi realizada one-way ANOVA e teste t post hoc. Resultados: A amostra foi composta por 66 indivíduos, sendo 49 no grupo DP e 17 no grupo controle. Houve reduções nos parâmetros investigados com a progressão da doença, em comparação com o grupo controle, sendo encontradas diferenças significativas em PImáx, PEmáx, CVF, VEF1 e FEF25-75% em todos os estágios da DP. Houve correlações inversas (de fraca a moderada) de alguns parâmetros estudados com bradicinesia e rigidez. Os escores totais do questionário de qualidade de vida e de seu domínio mobilidade apresentaram moderada correlação inversa com CVF, VEF1, PFE e PEmáx. Conclusões: A força muscular respiratória e alguns parâmetros de função pulmonar encontram-se reduzidos desde os estágios iniciais da DP, sendo a bradicinesia e a rigidez os sinais cardinais mais correlacionados ao prejuízo desses parâmetros. Essas alterações repercutem negativamente na qualidade de vida desses pacientes.

O processo de trabalho de um time de medicação na perspectiva de uma pesquisa-ação / The work process of a medication team from an action research perspective

Objetivou-se descrever e analisar o processo de trabalho do time de medicação na unidade de terapia intensiva neonatal. Pesquisa-ação realizada com 21 enfermeiros de uma unidade neonatal de um hospital universitário. Foram realizadas entrevistas, pesquisa documental, observação sistemática e seminários para a coleta e análise temática dos dados. O estudo apontou três categorias: dificuldades encontradas no processo de trabalho do time de medicação; caracterização dos recursos materiais e ambiente de trabalho; padronização do processo de trabalho do time de medicação. As principais barreiras apontadas foram a falta de padronização do processo de trabalho e a ausência e/ou atualização de instrumentos que subsidiam sua prática. Desta forma, a partir das ações do grupo foram elaborados os seguintes produtos: fluxograma do processo de trabalho; construção e padronização de impressos; atualização de Protocolos Operacionais Padrão e atribuições da equipe de enfermagem; padronização de material de almoxarifado, farmácia e apoio.

This study aimed to describe and analyze the work process of the medication team in a neonatal intensive care unit. This action research was carried out with the participation of 21 nurses at a university hospital neonatal unit. Interviews were conducted, along with documental research, systematic observation and workshops for data collection and thematic analysis. The study indicated three categories: difficulties encountered in the work process of the medication team; description of material resources and working environment; and standardization of the work process of the medication team. The principal barriers indicated were lack of standardization of the work process and the absence and/or updating of instruments supporting work practices. As such, the following products were elaborated from the group actions: work process flowchart; development and standardization of printouts; updating of Standard Operational Protocols and duties of the nursing team; and standardization of storeroom, pharmacy and support material.

Assistance flowchart for pain management in a Neonatal Intensive Care Unit.

OBJECTIVE: To describe and discuss the process of developing a flowchart collectively constructed by the health team of a Neonatal Intensive Care Unit for the management of neonatal pain. METHOD: This is a descriptive and an exploratory study with a qualitative approach that used Problem-Based Learning as a theoretical-methodological framework in the process of developing the assistance flowchart for the management of neonatal pain. RESULTS: Based on this methodology, there was training in service and the discussion of key points of pain management by the health team, which served as input for the construction of the flowchart. FINAL CONSIDERATIONS: The assistance flowchart for pain management, based on scientific evidence, provided means to facilitate the decision-making of the health team regarding the pain of the newborn. It is suggested to use the flowchart frequently to promote the permanent education of the team and identify possible points to be adjusted.

Protocolo de agendamento de cirurgias eletivas de uma maternidade escola: estudo metodológico / Protocol of scheduling of elective surgeries of a maternity school: a methodological study / Protocolo para programar las cirugías electivas en una maternidad escuela: estado metodológico

OBJETIVO: construir um protocolo de agendamento e o fluxo assistencial de programação de cirurgias eletivas para o Centro Obstétrico de uma maternidade. MÉTODO: pesquisa metodológica, descritiva, qualitativa, do tipo estudo de caso, operacionalizada em 2015 em uma maternidade do município do Rio de Janeiro. Empregou-se o Planejamento Estratégico Situacional proposto por Carlos Matus, a partir dos momentos explicativo, normativo, estratégico e tático-operacional. RESULTADOS: no momento explicativo procedeu-se com o diagnóstico da realidade de agendamentos do setor cirúrgico; no normativo foram propostas as estratégias de solução para o enfrentamento do problema; no estratégico construiu-se a viabilidade das estratégias de solução a partir de planos de ação; no tático-operacional foram operacionalizadas as ações: construção do protocolo e de um fluxograma de agendamento cirúrgico. CONCLUSÃO: acredita-se que esses instrumentos, que ainda precisam ser testados e validados no cenário do estudo, auxiliarão a gestão dos processos assistenciais do setor.

AIM: to construct a scheduling protocol and the assistance flow of elective surgeries to the Obstetric Center of a maternity ward. METHOD: this is a methodological, descriptive, qualitative research, of the case study type, operationalized in 2015 in a maternity hospital in the city of Rio de Janeiro. The Situational Strategic Planning proposed by Carlos Matus was used, starting from the explanatory, normative, strategic and tactical-operational moments. RESULTS: in the explanatory moment the diagnosis of the reality of scheduling of the surgical sector was performed; in the normative moment the strategies of solution to the confrontation of the problem were proposed; in the strategic moment the viability of the strategies of solution was constructed from action plans; in the tactical-operational moment the following actions were operationalized: construction of the protocol and a flow chart of surgical scheduling. CONCLUSION: it is believed that these instruments, which still need to be tested and validated in the study scenario, will help manage the healthcare processes of the sector.

OBJETIVO: construir un protocolo de programación y el flujo asistencial de programación de cirugías electivas para el Centro Obstétrico de una maternidad. MÉTODO: investigación metodológica, descriptiva, cualitativa, tipo estudio de caso, realizada en el 2015 en una maternidad del municipio de Rio de Janeiro. Se utilizó el Planeamiento Estratégico Situacional propuesto por Carlos Matus, a partir de los momentos explicativo, normativo, estratégico y táctico-operativo. RESULTADOS: en el momento explicativo se procedió con el diagnóstico de la realidad de la programación del sector quirúrgico; en el normativo se propusieron las estrategias de solución para enfrentar el problema; en el estratégico se construyó la viabilidad de las estrategias de solución a partir de planes de acción; en el táctico-operativo se realizaron las acciones: construcción del protocolo y de un diagrama de flujo de la programación quirúrgica. CONCLUSIÓN: se cree que esos instrumentos, que todavía necesitan probarse y validarse en el escenario del estudio, auxiliarán la gestión de los procesos asistenciales del sector.

Validação de instrumento para histórico de enfermagem materno-infantil utilizando Horta: estudo metodológico / Validation of an instrument for the history of maternal and child nursing using Horta: a methodological study / Validación de instrumento para histórico de enfermería materno-infantil utilizando Horta: estudio metodológico

OBJETIVO: elaborar um instrumento para a etapa de histórico de enfermagem voltado ao serviço materno-infantil. MÉTODO: estudo metodológico, com validação de conteúdo de um instrumento para o histórico de enfermagem para o serviço materno-infantil, com base no referencial de Wanda Horta. RESULTADOS: o formulário contém as informações: identificação; sinais vitais,glicemia e dados antropométricos; dados clínicos e exames laboratoriais; entrevista e observação da paciente; exame físico e necessidades humanas básicas; impressões. Foram agregadas outras necessidades relacionadas à área (reprodução/crescimento e desenvolvimento) não previstas pela teoria de base que fundamentou o estudo. Verificou-se um índice de validade de conteúdo global de 0,81 para clareza, 0,85 para pertinência, 0,92 para abrangência e 0,81 para organização. CONCLUSÃO: instrumento construído e validado com base na teoria de Wanda Horta, voltado para clientela materno-infantil, fornecendo um instrumento importante para documentar a primeira etapa do processo de enfermagem

AIM: to elaborate an instrument for the nursing history stage focused on maternal and child health service. METHOD: methodological study, with validation of content of an instrument for the nursing history for maternal and child service, based on the reference of Wanda Horta. RESULTS: the form contains the following information: identification; vital signs, blood glucose and anthropometric data; clinical data and laboratory tests; interview and observation of the patient; physical examination and basic human needs; printouts. Other needs related to the area (reproduction/growth and development) not provided for by the underlying theory that gave grounds for the study were added. There was an overall content validity index of 0.81 for clarity, 0.85 for relevance, 0.92 for comprehensiveness, and 0.81 for organization. CONCLUSION: instrument built and validated based on Wanda Horta's theory, aimed at the maternal and child clientele, providing an important instrument to document the first stage of the nursing process

OBJETIVO: elaborar un instrumento para la etapa de histórico de enfermería direccionado al servicio materno-infantil. MÉTODO: estudio metodológico, con validación de contenido de un instrumento para el histórico de enfermería para el servicio materno-infantil, basado en el referencial de Wanda Horta. RESULTADOS: el formulario contiene las informaciones: identificación; signos vitales, glucemia y datos antropométricos; datos clínicos y exámenes de laboratorios; entrevista y observación de la paciente; examen físico y necesidades humanas básicas; impresiones. Fueron agregadas otras necesidades relacionadas al área (reproducción/crecimiento y desarrollo) no previstas por la teoría de base que fundamentó el estudio. Se verificó un índice de validad de contenido global de 0,81 para clareza, 0,85 para pertinencia, 0,92 para alcance y 0,81 para organización. CONCLUSIÓN: instrumento construido y validado con base en la teoría de Wanda Horta, direccionado a la clientela materno-infantil, forneciendo un instrumento importante para documentar la primera etapa del proceso de enfermería

Assistance flowchart for pain management in a Neonatal Intensive Care Unit / Flujograma asistencial para manejo del dolor en Unidad de Terapia Intensiva Neonatal / Fluxograma assistencial para manejo da dor em Unidade de Terapia Intensiva Neonatal

ABSTRACT Objective: To describe and discuss the process of developing a flowchart collectively constructed by the health team of a Neonatal Intensive Care Unit for the management of neonatal pain. Method: This is a descriptive and an exploratory study with a qualitative approach that used Problem-Based Learning as a theoretical-methodological framework in the process of developing the assistance flowchart for the management of neonatal pain. Results: Based on this methodology, there was training in service and the discussion of key points of pain management by the health team, which served as input for the construction of the flowchart. Final considerations: The assistance flowchart for pain management, based on scientific evidence, provided means to facilitate the decision-making of the health team regarding the pain of the newborn. It is suggested to use the flowchart frequently to promote the permanent education of the team and identify possible points to be adjusted.

RESUMEN Objetivo: Describir y discutir el proceso de desarrollo de un diagrama de flujo construido colectivamente por el equipo de salud de una Unidad de Terapia Intensiva Neonatal para el manejo del dolor neonatal. Método: Se trata de un estudio descriptivo, exploratorio, con un abordaje cualitativo que utilizó el Aprendizaje Basado en Problemas como referencial teórico-metodológico en el proceso de desarrollo del diagrama de flujo asistencial del manejo del dolor neonatal. Resultados: A partir de esta metodología ocurrió una capacitación en servicio y la discusión de puntos claves del manejo del dolor por el equipo de salud, los cuales sirvieron de subsidios para la construcción del diagrama de flujo. Consideraciones finales: El flujograma asistencial del manejo del dolor, construido a partir de evidencias científicas, proporcionó medios para facilitar la toma de decisión del equipo de salud frente al dolor del recién nacido. Se sugiere la aplicación del diagrama de flujo con frecuencia para promover la educación permanente del equipo e identificar posibles puntos a ser ajustados.

RESUMO Objetivo: Descrever e discutir o processo de desenvolvimento de um fluxograma construído coletivamente pela equipe de saúde de uma Unidade de Terapia Intensiva Neonatal para o manejo da dor neonatal. Método: Trata-se de um estudo descritivo, exploratório, com abordagem qualitativa que usou a Aprendizagem Baseada em Problemas como referencial teórico-metodológico no processo de desenvolvimento do fluxograma assistencial do manejo da dor neonatal. Resultados: A partir desta metodologia ocorreu uma capacitação em serviço e a discussão de pontos chaves do manejo da dor pela equipe de saúde, que serviram de subsídios para construção do fluxograma. Considerações finais: O fluxograma assistencial do manejo da dor, construído a partir de evidências científicas, forneceu meios para facilitar a tomada de decisão da equipe de saúde frente à dor do recém-nascido. Sugere-se a aplicação do fluxograma com frequência para promover a educação permanente da equipe e identificar possíveis pontos a serem ajustados.