Cardiotoxicity and cancer: prudential judgment in medical practice / Cardiotoxicidad y cáncer: el juicio prudencial en la práctica médica

ABSTRACT The objective of this paper is to propose a conceptual tool for consideration by medical professionals and cardiologists, based on the concept of prudential judgment or Aristotelian phronesis to confront the problems of cardiotoxicity resulting from cancer treatments. We start by analyzing the case of a young female patient who received two types of therapies: the first with anthracyclines (adriamycin), which produces type I damage, as stated in the consensus of 2014; and the second treatment, one month later, with trastuzumab, an agent that produces type II damage not dependent on dose. In this case, the patient manifested acute cardiac insufficiency, with a decrease of LVEF to 28% on the echocardiogram and to 27% on magnetic resonance imaging. Reports have indicated that treatment with beta blockers and the suspension or decrease of the dose limits damage, but during preclinical stages. Awareness and early attention to subclinical damage have thus become extremely relevant to substantiate treatments based not only on clinical evidence but also on the ability of medical professionals to rely on prudential judgment--which moves away from the medical practices that are developed on a daily basis in order to influence and reduce the cases of irreversible heart failure known as cardiotoxicity.(AU)

RESUMEN Este trabajo tiene como objetivo proponer el juicio prudencial o phrónesis aristotélica como herramienta conceptual para la deliberación de los profesionales de la medicina y cardiólogos para afrontar la problemática que implica la cardiotoxicidad como resultado de los tratamientos contra el cáncer. Partimos desde el análisis de caso de una paciente joven que recibió dos tipos de terapias: la primera con antraciclinas (adriamicina) que produce daño por el mecanismo tipo I, propuesto en el consenso del 2014, y un mes después con trastuzumab, agente que produce daño tipo II no dependiente de dosis. En este caso la paciente presentó insuficiencia cardiaca aguda, con disminución de la FEVI a 28% por ecocardiograma y de 27% por resonancia magnética cardiaca. Se ha reportado que el tratamiento con betabloqueadores y la suspensión o disminución de la dosis limita el daño cuando se encuentra en etapas preclínicas. Por ello el pensamiento y el abordaje temprano en búsqueda de daño subclínico ha tomado extrema relevancia para fundamentar los tratamientos no solo desde la evidencia clínica, sino también en el juicio prudencial que dejan las prácticas médicas desarrolladas día a día para impactar y reducir estos casos de falla cardiaca irreversible conocidos como cardiotoxicidad.(AU)

Could legal requirements in nursing practice trigger actions that would change the rates of urinary tract infections? A case study in Brazil.

We evaluated the influence of a Brazilian resolution, published in 2013, that restricts the performing of urinary catheterization to nurses, as opposed to others from different nursing professional categories, on indicators of catheter-associated urinary tract infection in an intensive care unit. The resolution triggered actions such as the implementation of protocols and nursing staff training that led to behavior changes related to the reduction of catheter-associated urinary tract infection rates.

Relatório final: X Fórum interprofissional sobre violência contra a mulher e implementação do aborto previsto na lei / Final report: interprofessional forum on violence against women and implementation of legal abortion

Reconhecendo o importante papel dos Conselhos Profissionais na discussão sobre o atendimento da mulher que sofre violência sexual e solicita um aborto previsto na lei, o X Fórum foi dedicado a discutir o papel destes conselhos na ampliação do número de serviços e no fortalecimento das redes intersetoriais de prevenção da violência sexual e doméstica. Os participantes fizeram recomendações dirigidas a cada um dos vários Conselhos de Profissões da Saúde e também ao conjunto deles, assim como a outras instituições que podem colaborar com os conselhos. Considerando que o Congresso Nacional discutia o Projeto de Lei nº 1135/91, que "estabelece o direito à interrupção voluntária da gravidez e assegura a realização do procedimento no âmbito do SUS", discutiu-se a promoção do debate interno em cada associação ou conselho profissional sobre o Projeto de Lei. Após amplo debate os participantes do X Fórum interprofissional sobre violência sexual e aborto previsto na lei declararam, por consenso, seu apoio à necessidade de modificação da legistação no sentido de descriminalizar o aborto, ampliando as atuais condições de acesso, dentro de limites baseados em critérios técnicos e garantindo o aborto legal e seguro, conforme as recomendações de diversos acordos e convenções internacionais assinados pelo governo do Brasil

[Teaching at the secondary level and professional practice in the context of Brazilian nursing]. / O ensino médio e o exercício profissional no contexto da enfermagem brasileira.

The formation of nursing professionals has been a concern through nursing history in our country. Within the context of development of nursing history, authors analysed the evolution of the legislation about the formation of nursing professionals at the secondary level as well as the legislation about their practice.

[Nurses and the Mercosul regulations and control of professional practice]. / Enfermeiros e o Mercosul: regulamentação e controle do exercício profissional.

A study comparing the regulation and control of the professional practice of nurses in Brasil, Argentina, Uruguay and Paraguay, delineating their particularities, differences and similarities in the perspective of the implementation of the Cone Sul Common Market, which presupposes the free circulation of workers in the workplaces of the member-countries of the Ascnsion Treaty.