Implementação de melhorias na atenção primária à saúde: protocolo de enfermagem e gerenciamento de unidades / Implementation of improvements in primary health care: nursing protocol and unit management / Implementación de mejoras em la atención primaria de salud: protocolo de enfermería y gestión de la unidad

Objetivo: Descrever a experiência da elaboração do Protocolo de Enfermagem da Atenção Primária e o gerenciamento das Unidades Básicas de Saúde de Rio Branco ­ Acre. Métodos: Trata-se de um relato de experiência, sobre a elaboração de um Protocolo, instrumento potente para a implementação de melhorias e a gerência de Unidades Básicas de Saúde. A elaboração do protocolo foi realizada por etapas: Etapa 1: Composição da Comissão; Etapa 2: Pesquisa e Construção; Etapa 3: Consulta Pública; Etapa 4: Finalização da Construção. Resultados: Foi constituído uma comissão de elaboração do protocolo. Foi observado a implementação de melhorias na assistência prestada à população durante o período de execução do projeto. A frente do gerenciamento das Unidades Básicas de Saúde, foi possível vivenciar de perto o cenário da Atenção Primária à Saúde, (financiamentos, composição de equipes e atributos), conhecer a capacidade gerencial e política para organização da assistência à saúde, como também implementar melhorias relacionadas à gestão da clínica e diretrizes clínicas. Conclusão: A elaboração e implementação de um Protocolo de Enfermagem da Atenção Primária agrega não apenas conhecimento para a prática, vislumbra mais valorização profissional, onde possibilita o rompimento de uma barreira centrada na figura médica, ao atribuir à enfermagem papel relevante e conquistada, com protocolos de atendimento capazes de suprir as demandas existentes nas Unidades. Além de permitir o fortalecimento, visibilidade técnica, científica e a ampliação do acesso às pessoas à Atenção Primária à Saúde como parte significativa e resolutiva pela enfermagem. (AU)

Objective: To describe the experience of elaborating the Primary Care Nursing Protocol and the management of Basic Health Units in Rio Branco ­ Acre. Methods: This is an experience report on the elaboration of a Protocol, a powerful instrument for implementing improvements and managing Basic Health Units. The preparation of the protocol was carried out in stages: Stage 1: Composition of the Committee; Stage 2: Research and Construction; Stage 3: Public Consultation; Step 4: Completion of Construction. Results: A protocol drafting committee was set up. The implementation of improvements in the assistance provided to the population during the project execution period was observed. Ahead of the management of Basic Health Units, it was possible to experience the Primary Health Care scenario closely, (financing, composition of teams and attributes), to know the managerial and political capacity for the organization of health care, as well as to implement related improvements. clinic management and clinical guidelines. Conclusion: The elaboration and implementation of a Primary Care Nursing Protocol adds not only knowledge to practice, it envisions more professional appreciation, which makes it possible to break a barrier centered on the medical figure, by attributing a relevant and conquered role to nursing, with protocols services capable of meeting the existing demands in the Units. In addition to allowing the strengthening, technical and scientific visibility and the expansion of people's access to PHC as a significant and decisive part of nursing. (AU)

Objetivo: Describir la experiencia de elaboración del Protocolo de Enfermería de Atención Primaria y la gestión de Unidades Básicas de Salud en Rio Branco ­ Acre. Métodos: Este es un relato de experiencia sobre la elaboración de un Protocolo, un poderoso instrumento para implementar mejoras y gestionar Unidades Básicas de Salud. La elaboración del protocolo se realizó por etapas: Etapa 1: Composición del Comité; Etapa 2: Investigación y Construcción; Etapa 3: Consulta Pública; Paso 4: Finalización de la construcción. Resultados: Se constituyó una comisión de elaboración del protocolo. Se observó la implementación de mejoras en la asistencia prestada a la población durante el periodo de ejecución del proyecto. Frente a la gestión de las Unidades Básicas de Salud, fue posible vivir de cerca el cenário de la Atención Primaria de Salud (financiación, composición de equipos y atributos), conocer la capacidad gerencial y política para la organización de la asistencia a la salud, así como implementar mejoras relacionadas, con la gestión de la clínica y direcciones clínicas. Conclusión: La elaboración e implementación de un Protocolo de Enfermería de Atención Primaria aporta no sólo conocimiento a la práctica, sino que aporta mayor valorización profesional, al permitir el rompimiento de una barrera centrada en la figura médica, para atribuir a la enfermería un papel relevante y conquistado, con protocolos de atención capaces de superar las demandas existentes en las Unidades. Además de permitir el fortalecimiento, la visibilidad técnica y científica y la ampliación del acceso de las personas a la Atención Primaria de Salud como parte significativa y resolutiva por parte de la enfermería. (AU)

Adherence to sepsis protocol in a high-risk maternity reference center / Adhesion al protocolo de sepsis en una maternidad de referencia para alto riesgo / Adesão ao protocolo de sepse em uma maternidade de referência para alto risco

ABSTRACT Objective: To describe the adherence to the sepsis protocol by obstetric nurses in the obstetric triage of a high-risk maternity reference center. Methods: This was a quantitative, documental, and retrospective study involving 105 pregnant women treated in obstetric triage under sepsis criteria. Data were collected through electronic medical records using structured forms and were organized into tables employing descriptive statistics. This research adhered to ethical principles concerning human studies. Results: Of the checklists for initiating the SEPSIS protocol by obstetric nurses, 105 were identified. Regarding the protocol steps performed, lactate was collected in 97.1% of cases and blood cultures in 98.1%, antibiotic therapy was administered in 94.3%, and hydration was carried out in 51.4% of the cases. Conclusion: The initiation of the sepsis protocol for all women meeting the criteria was confirmed. However, the steps were not fully implemented as recommended by the institutional protocol, and the recommended broad-spectrum antibiotic was not administered.

RESUMEN Objetivo: Describir adhesión al protocolo de sepsis por enfermeras obstétricas en triaje obstétrico de una maternidad de referencia para embarazo de alto riesgo. Métodos: Estudio cuantitativo, documental y retrospectivo con 105 embarazadas atendidas en triaje obstétrico con critérios de sepsis. Realizada recolecta de datos mediante portuarios electrónicos utilizando formularios estructurados. Organizados los resultados en tablas, empleándose la estadística descriptiva. Esta investigación seguió los conceptos éticos que involucran estudios con seres humanos. Resultados: Identificados 105 checklists de apertura de protocolo de SEPSIS por enfermeras obstétricas. Cuanto a las etapas del protocolo de sepsis realizadas, recoletado lactato (97,1% de los casos) y hemocultura (98,1%), administrado antibioticoterapia (94,3%) y realizado hidratación (51,4%). Conclusion: Evidenciado apertura de protocolo de sepsis para todas las mujeres que rellenian los critérios. Aunque, las etapas no fueron efectuadas totalmente, como preconizado por protocolo institucional; y no fue administrado el antibiótico de amplio espectro recomendado.

RESUMO Objetivo: Descrever a adesão ao protocolo de sepse por enfermeiras obstétricas na triagem obstétrica de uma maternidade de referência para gestação de alto risco. Métodos: Estudo quantitativo, documental e retrospectivo com 105 gestantes atendidas na triagem obstétrica com critérios de sepse. Realizou-se coleta de dados mediante prontuários eletrônicos utilizando formulários estruturados. Organizaram-se os resultados em tabelas, empregando-se a estatística descritiva. Esta pesquisa seguiu os conceitos éticos que envolvem estudos com seres humanos. Resultados: Identificaram-se 105 checklists de abertura de protocolo de SEPSE por enfermeiras obstétricas. Quanto às etapas do protocolo de sepse realizadas, coletaram-se lactato (97,1% dos casos) e hemocultura (98,1%), administrou-se antibioticoterapia (94,3%) e realizou-se hidratação (51,4%). Conclusão: Evidenciou-se abertura de protocolo de sepse para todas as mulheres que preenchiam os critérios. No entanto, as etapas não foram efetivadas totalmente como preconizado pelo protocolo institucional; e não foi administrado o antibiótico de largo espectro recomendado.

Osteonecrosis of the jaws in patients under osteoporosis treatment: a nine-year experience report.

Objective: This study aimed to report the experience of medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients for nine years, and their associated initiating factors. Materials and methods: The numbers of invasive oral procedures (IOP) (tooth extraction, dental implant placement, and periodontal procedures) and removable prostheses performed from January 2012 to January 2021 were obtained from the digital records of a large public dental center. There were an estimated 6,742 procedures performed in patients under osteoporosis treatment. Results: Two cases (0.03%) of MRONJ were registered in nine years amongst patients with osteoporosis who had dental treatment at the center. From the 1,568 tooth extractions, one patient (0.06%) developed MRONJ. There was also one case from the 2,139 removable prostheses delivered (0.05%). Conclusion: The prevalence of MRONJ associated with osteoporosis treatment was very low. The protocols adopted seem to be adequate for the prevention of this complication. The findings of this study reinforce the rare frequency of MRONJ associated with dental procedures in patients submitted to the pharmacological management of osteoporosis. An integral analysis of systemic risk factors and oral preventive strategies may be considered regularly in the dental treatment of these patients.

Osteonecrosis of the jaws in patients under osteoporosis treatment: a nine-year experience report

ABSTRACT Objective: This study aimed to report the experience of medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients for nine years, and their associated initiating factors. Materials and methods: The numbers of invasive oral procedures (IOP) (tooth extraction, dental implant placement, and periodontal procedures) and removable prostheses performed from January 2012 to January 2021 were obtained from the digital records of a large public dental center. There were an estimated 6,742 procedures performed in patients under osteoporosis treatment. Results: Two cases (0.03%) of MRONJ were registered in nine years amongst patients with osteoporosis who had dental treatment at the center. From the 1,568 tooth extractions, one patient (0.06%) developed MRONJ. There was also one case from the 2,139 removable prostheses delivered (0.05%). Conclusions: The prevalence of MRONJ associated with osteoporosis treatment was very low. The protocols adopted seem to be adequate for the prevention of this complication. The findings of this study reinforce the rare frequency of MRONJ associated with dental procedures in patients submitted to the pharmacological management of osteoporosis. An integral analysis of systemic risk factors and oral preventive strategies may be considered regularly in the dental treatment of these patients.

Evidence-based protocol for diagnosis and treatment of hepatorenal syndrome is independently associated with lower mortality.

BACKGROUND: Hepatorenal syndrome (HRS) is the deadliest complication of cirrhosis. The purpose of this study is to analyze if the use of a protocol for HRS is associated with higher survival in these patients. METHODS: An evidence-based protocol for the diagnosis and treatment of HRS was instituted in 2013. Data from medical records from 2010 to 2016 were obtained by searching the hospital database for patients who received terlipressin, in the three years before and after the institution of the protocol. Data were reviewed to confirm the diagnosis of HRS and multiple variables were collected. Liver-specific scores were calculated and a stepwise Cox regression approach was used for univariate and multivariate analysis. RESULTS: The study included 46 patients, 20 from the pre-protocol period and 26 from the post-protocol period. Respectively, mortality at 30 days, 90 days and 365 days was 75%, 75% and 90% for the pre-protocol period, and 61%, 69% and 80% for the post-protocol period. In the multivariate analysis, an aspartate aminotransferase (AST) of <40U/L, the pre-protocol period and higher Child-Turcotte-Pugh scores were associated with higher 30-day and 90-day mortality. The total mean dose of terlipressin and human albumin used per patient was reduced from 27mg to 22mg and from 236g to 144g, respectively, after the institution of the protocol. This was not associated with higher mortality. CONCLUSION: The use of an evidence-based protocol for the treatment of HRS translated into a higher survival. The authors suggest that the use of evidence-based protocols for the diagnosis and treatment of HRS could reduce cost and mortality in tertiary hospitals.

Risk management: implementation of a clinical protocol for the prevention and management of pediatric falls / Gestión de riesgos: aplicación de un protocolo clínico para la prevención y gestión de caídas pediátricas / Gestão de riscos: implantação de protocolo clínico de prevenção e manejo de quedas pediátricas

ABSTRACT Objective To describe the process of elaboration and implementation of a protocol for the prevention and management of pediatric falls. Method This was an actionresearch developed at a public hospital in Southeast Brazil with 10 members of the multidisciplinary team from the pediatrics, maternity, neonatal intensive care sectors, and the patient safety center. To elaborate the protocol, literature review, three meetings with the group, and two rounds ofonline correction were carried out. Online training was carried out for all professionals and then the use of the protocol was started at the sectors. Results A pediatric fall prevention protocol was implemented. Educational materials were developed and the Humpty Dumpty Falls Scale was chosen to assess the risk of falling. Conclusion The process was conducted in a collective and participatory way. The protocol and the educational materials guide and standardize behavior based on the best evidence and involve users, family members and professionals in the management of the risk of falling.

RESUMEN Objetivo Describir el proceso de elaboración e implementación de un protocolo para la prevención y manejo de caídas pediátricas. Método Investigación-acción desarrollada en un hospital público del Sureste de Brasil, con 10 integrantes del equipo multidisciplinario de los sectores de pediatría, maternidad, cuidados intensivos neonatales y centro de seguridad del paciente. Para la elaboración del protocolo se realizó una revisión bibliográfica, tres encuentros con el grupo y dos rondas de corrección online. Se realizó capacitación en línea para todos los profesionales y luego se inició el uso del protocolo en los sectores. Resultados Se implementó un protocolo de prevención de caídas pediátricas. Se desarrollaron materiales educativos y se definió la escala Humpty Dumpty Falls Scale para evaluar el riesgo de caídas. Conclusión El proceso se llevó a cabo de manera colectiva y participativa. El protocolo y los materiales educativos guían y estandarizan el comportamiento en base a la mejor evidencia e involucran a los usuarios, familiares y profesionales en el manejo del riesgo de caídas.

RESUMO Objetivo Descrever o processo de elaboração e implantação de um protocolo de prevenção e manejo de quedas pediátricas. Método Pesquisa-ação desenvolvida em um hospital público do Sudeste do Brasil, com 10 membros da equipe multidisciplinar dos setores de pediatria, maternidade, terapia intensiva neonatal, e do núcleo de segurança do paciente. Para elaborar o protocolo realizou-se revisão de literatura, três encontros com o grupo e duas rodadas de correção online. Foi realizado treinamento online para todos os profissionais e, depois, iniciado o uso do protocolo nos setores. Resultados Implementado protocolo de prevenção de quedas pediátricas. Definiu-se a escala Humpty Dumpty Falls Scale para avaliação do risco e foram elaborados materiais educativos. Conclusão O processo foi realizado de forma coletiva e participativa. O protocolo e os materiais educativos orientam e padronizam as condutas baseadas nas melhores evidências e envolvem usuários, familiares e profissionais na gestão do risco de queda.

UnCovid: A versatile, low-cost, and open-source protocol for SARS-CoV-2 RNA detection.

Here, we describe a detailed step-by-step protocol to detect SARS-CoV-2 RNA using RT-PCR-mediated amplification and CRISPR/Cas-based visualization. The optimized assay uses basic molecular biology equipment such as conventional thermocyclers and transilluminators for qualitative detection. Alternatively, a fluorescence plate reader can be used for quantitative measurements. The protocol detects two regions of the SARS-CoV-2 genome in addition to the human RNaseP sample control. Aiming to reach remote regions, this work was developed to use the portable molecular workstation from BentoLab. For complete details on the use and execution of this protocol, please refer to Alcántara et al., 2021.

Estructuración del Protocolo Cubano de Actuación para la Atención de Casos COVID-19 / Structuring of the Cuban Protocol of Action for the care of COVID-19 Cases

Introducción: En presencia de la pandemia COVID-19 surge la necesidad de diseñar un protocolo cubano de actuación para la atención de estos casos, cuya elaboración requiere, fundamentalmente, de la selección de los contenidos, así como de una adecuada estructuración. Objetivo: Estructurar el Protocolo Cubano de Actuación para la Atención de Casos COVID-19. Métodos: Se aplicaron los métodos teóricos histórico lógico, análisis documental, sistematización, análisis síntesis y concreción abstracción. Se aplicó la técnica de revisión bibliográfica de documentos normativos, publicaciones científicas indexadas en bases de datos internacionales y sitios web, además de la consulta a especialistas. El proceso de estructuración del Protocolo cubano de actuación para la atención de casos COVID-19 se realizó en tres fases: preestructuración, estructuración y revisión. Resultados: La estructura final del protocolo quedó conformada por cuatro capítulos, bibliografía y anexos. Conclusiones: El diseño de un protocolo de actuación tiene dos procesos fundamentales: la selección de los contenidos y la estructuración, para lo cual se deben conformar los equipos de trabajo correspondientes. La estructuración del Protocolo Cubano de Actuación para la Atención de Casos COVID-19 constituye un proceso metodológico desarrollado en tres fases que facilita su perfeccionamiento mediante la revisión constante. Lo conforma cuatro capítulos que favorece su entendimiento y aplicación al ser un documento que contiene las generalidades, el manejo de casos según grupos y por niveles de atención y traslado, desde el escenario preventivo hasta la atención a los convalecientes e incluye el manejo del cadáver, así como bibliografía consultada y anexos(AU)

Introduction: In presence of the COVID-19 pandemic emerges the need of designing a Cuban protocol of action for the care of these cases, which creation mainly requires the selection of contents, as well as a suitable structuring. Objective: Structure the Cuban Protocol of action for the care of COVID-19 cases. Methods: There were applied the following methods: theoretical historical logical, documental analysis, systematization, synthetic analysis and concreteness abstraction. It was applied the technique of bibliographic review of normative documents, scientific publications indexed in international databases and web sites, in addition to the consultation to specialists. The structuring process of the Cuban Protocol of action for the care of COVID-19 cases was carried out in three phases: pre-structuring, structuring and review. Results: The final structure of the protocol was formed by four chapters, bibliography and annexes. Conclusions: The design of a protocol of action has two main processes: the selection of the contents and the structuring, and for them, the pertinent work teams must be formed. The structuring of the Cuban protocol of action for the care of COVID-19 cases is a methodological process developed in three phases that facilitate its improvement through constant review. It is formed by four chapters that favour its understanding and application being a document that contain the generalities, the management of cases according to groups and by levels of care and transfer, from the preventive scenario to the care to convalescent patients; and includes the management of corpses, as well as consulted bibliography and annexes(AU)

Guía para el Trabajo Clínico en Odontología Durante Pandemia por SARS-CoV-2, en el Hospital Clínico Dra. Eloísa Díaz / Guide for clinical work in dentistry during SARS-CoV-2 pandemic, at the Hospital Clínico Dr. Eloísa Díaz

Un nuevo brote de coronavirus anunciado a principios de este año ha sido asociado a la renombrada enfermedad de "COVID-19" que se ha convertido en la más severa pandemia de este siglo. Tal como lo anunció en marzo del 2020, la Organización Mundial de la Salud (OMS), corresponde a una emergencia de salud pública que repercute fuertemente a nivel internacional (Meng et al., 2020). El siguiente artículo busca generar un documento que registre las orientaciones y medidas de prevención de COVID-19 en la odontología basado en la evidencia. Para esto cobra gran importancia las medidas de equipo de protección personal (EPP) que se deben utilizar. Aunque la evidencia es variada y se dice que las medidas estándares no son suficientes para prevenir la diseminación cuando se trabaja con aerosoles (Facultad de Odontología de la Universidad de Chile, 2020), es necesario, de forma paralela que avanza la propagación, ir generando consciencia con medidas muy cuidosas y claras en cada espacio sanitario. Por lo expuesto anteriormente y en consideración el contexto nacional, es necesario definir las medidas standard y específicas para la atención odontológica, en este caso dentro de la Unidad Dental del Hospital Clínico Dr. Eloísa Díaz (HLF).

A new coronavirus outbreak announced earlier this year has been associated with the renowned "COVID-19" disease that has become the most severe pandemic of this century. As announced in March 2020, by the World Health Organization (WHO) this corresponds to a public health emergency that has strong repercussions at the international level (Meng et al., 2020). The following article seeks to generate a document that records the guidance and prevention measures of COVID-19 in dentistry based on the evidence. For this, the personal protective equipment (PPE) measures that must be used are of great importance. Although the evidence is varied and it is said that standard measures are not sufficient to prevent dissemination when working with aerosols (Facultad de Odontología de la Universidad de Chile, 2020), it is necessary, as the virus spreads to generate awareness for extremely clear and careful measures for sanitary space in this context. Due to the above and in consideration of the national context, it is necessary to define the standard and specific measures for dental care and in this case within the Dental Unit of the Dr. Eloísa Díaz Clinical Hospital (HLF).

Validação de conteúdo do protocolo de manejo integrado entre tuberculose e diabetes no contexto da Atenção Primária à Saúde / Content validation of the integrated management protocol between tuberculosis and diabetes in the context of Primary Health Care

INTRODUÇÃO: a associação entre Tuberculose (TB) e Diabetes Mellitus (DM) tem representado um grande problema de saúde pública, no Brasil e no mundo. O manejo integrado diabetes-tuberculose é uma demanda da Organização Mundial de Saúde (OMS) e das sociedades científicas na tentativa de evitar as complicações que esta relação pode causar à saúde da população em geral e de contribuir para o controle dessas epidemias, em países, como o Brasil, nos quais as condições socioeconômicas são fatores de risco de grande impacto. OBJETIVO: elaborar e validar o conteúdo de um Protocolo de Manejo Integrado entre Tuberculose e Diabetes Mellitus para pessoas atendidas na Atenção Primária à Saúde. MÉTODOS: estudo desenvolvido em etapas com diferentes delineamentos: metodológico, pesquisa intervenção e avaliativa; de abordagem quantitativa. O local de estudo foi o município de Ribeirão das Neves, Minas Gerais, Brasil. 1) A primeira etapa, de elaboração do protocolo, correspondeu aos processos: - Aproximação do objeto de estudo com pesquisadores e especialistas na temática; - Revisão Integrativa da Literatura sobre os cuidados de manejo integrado; - Elaboração de um protocolo preliminar baseado na revisão e em outros documentos oficiais; - Validação e adequações do conteúdo do protocolo, com especialistas em TB e DM, por meio de quatro oficinas presenciais; - Avaliação do protocolo utilizando o instrumento "Appaisal of guidelines for research e evaluation"- AGREE II; - Avaliação autoreferida do estado de saúde dos pacientes, por meio de entrevista telefônica, selecionados por amostragem por conglomerado (pacientes com DM) e pela Ficha do Sistema de Informação de Agravos de Notificação (pacientes com TB); 2) Na segunda etapa procedeuse à capacitação dos profissionais de saúde, com diferentes abordagens e tecnologias: treinamento presencial e vídeo animação;o primeiro utilizou um instrumento de avaliação (pré e pós-teste) e no segundo a avaliação ocorreu por meio de questionário encaminhado por via eletrônica, no google forms. 3) Na terceira etapa ocorreu a implantação preliminar do protocolo, nas 10 Equipes de Saúde da Família selecionadas no município. A implantação ocorreu em dois momentos: T1- Três meses após a capacitação; T2- seis meses após a capacitação. RESULTADOS: durante a elaboração foram selecionados 20 artigos na revisão integrativa, 60% com baixa evidência científica; foi criado um protocolo de manejo integrado entre tuberculose-diabetes, elaborado por 11 especialistas e validado internamente por 04 avaliadores que atribuíram um índice de validade de concordância (IVC) de 85%, por meio do AGREE II; além da avaliação pelo Programa Nacional de Controle da Tuberculose; durante a capacitação foi realizado treinamento presencial com 86 profissionais apontando que 50% deles desconheciam sobre a associação tuberculose-diabetes; o vídeo animação obteve avaliação positiva de 60 profissionais (100%), como estratégia de educação remota. Na implantação, a avaliação autorreferida identificou 34% de pacientes com diabetes e tosse concomitantes; 37% dos pacientes com tuberculose realizaram glicemia de jejum nos três últimos meses e 12% do total de pacientes com tuberculose possuíam diabetes autodeclarada. CONCLUSÃO: a relevância deste estudo consiste em orientar os profissionais de saúde sobre a melhor assistência aos pacientes com ambos os agravos, a partir da criação de um Protocolo Assistencial para o Manejo Integrado da TB e DM, e avançar em sua implantação, visando a integração de ações interprogramáticas e a integralidade do cuidado. Ademais, este estudo pode contribuir para que o manejo integrado entre TB e DM se torne uma política pública instituída no Brasil.

INTRODUCTION: the association between Tuberculosis (TB) and Diabetes Mellitus (DM) has represented a major public health problem, in Brazil and worldwide. Integrated diabetestuberculosis management is a demand of the World Health Organization (WHO) and scientific societies in an attempt to avoid the complications that this relationship can cause to the health of the general population and to contribute to the control of these epidemics, in countries, like Brazil, in which socioeconomic conditions are risk factors of great impact. OBJECTIVE: to elaborate and validate the content of an Integrated Management Protocol between Tuberculosis and Diabetes Mellitus for people assisted in Primary Health Care. METHODS: a study developed in stages with different designs: methodological, intervention and evaluative research; quantitative approach. The place of study was the city of Ribeirão das Neves, Minas Gerais, Brazil. 1) The first stage, of the elaboration of the protocol, corresponded to the processes: - Approximation of the object of study with researchers and specialists in the theme; - Integrative Literature Review on integrated management care; - Elaboration of a preliminary protocol based on the review and other official documents; - Validation and adaptation of the protocol content, with specialists in TB and DM, through four face-to-face workshops; - Evaluation of the protocol using the instrument "Appaisal of guidelines for research and evaluation" - AGREE II; - Self-reported assessment of the patients' health status, through telephone interviews, selected by cluster sampling (patients with DM) and the Notification Diseases Information System Form (patients with TB); 2) In the second stage, health professionals were trained, using different approaches and technologies: face-to-face training and video animation; the first used an evaluation instrument (pre and post-test) and in the second, the evaluation took place through a questionnaire sent via google forms. 3) In the third stage, the preliminary implementation of the protocol took place in the 10 Family Health Teams selected in the municipality. The implementation took place in two moments: T1 - Three months after the training; T2 - six months after training. RESULTS: during the elaboration, 20 articles were selected in the review, 60% with low scientific evidence; an integrated management protocol between tuberculosis-diabetes was created, elaborated by 11 specialists and validated internally by 04 evaluators who attributed an agreement validity index (CVI) of 85%, through AGREE II; in addition to the evaluation by the National Tuberculosis Control Program; during the training, face-to-face training was carried out with 86 professionals, pointing out that 50% of them were unaware of the tuberculosis-diabetes association; the video animation received a positive evaluation from 60 professionals (100%), as a remote education strategy. At implantation, the self-reported assessment identified 34% of patients with concomitant diabetes and cough; 37% of tuberculosis patients underwent fasting blood glucose in the last three months and 12% of all tuberculosis patients had self-reported diabetes. CONCLUSION: the relevance of this study consists of guiding health professionals on the best care for patients with both conditions, based on the creation of an Assistance Protocol for the Integrated Management of TB and DM, and advancing its implementation, aiming at integration interprogrammatic actions and comprehensive care. In addition, this study can contribute to the integrated management between TB and DM becoming a public policy instituted in Brazil.

Blood components requests at an orthopedic hospital: a critical survey

Abstract Introduction The correct completion of the blood components request form is the starting point to ensure good transfusion care. Many guidelines have been developed to search for hemoglobin values that trigger the need for transfusion and show the importance of Patient Blood Management, a scientific evidence-based approach in processes where transfusion is a possibility, such as in elective surgeries. Objective The cross-sectional study aimed to analyze the transfusion requests at a complex orthopedic hospital over a one-year period. Method The completion quality was classified as Good, Regular, Bad or Very Bad, according to the information given by the physician. Transfusion medicine professionals analyzed the transfusion indication reported on the request form and classified it as Correct, Not based on Patient Blood Management (PBM), in accordance or not with the institutional Maximum Surgical Blood Order Schedule, Impossible to evaluate due to lack of information on the form, and Incorrect. Results The study categorized the completion quality of 2011 requests as Good (8.80%), Regular (9.30%), Bad (72.75%) and Very Bad (9.15%). Analysis of the indications revealed that 54.90% of the requests were in accordance with the current blood transfusion recommendations, and on 23.12% of the forms this field had not been filled out. Conclusion The majority of blood components (63%) requests are in tune with current blood transfusion recommendations, despite the great number of incorrectly completed forms; nevertheless, it is mandatory to reach much better appropriateness rates.

Blood components requests at an orthopedic hospital: a critical survey.

INTRODUCTION: The correct completion of the blood components request form is the starting point to ensure good transfusion care. Many guidelines have been developed to search for hemoglobin values that trigger the need for transfusion and show the importance of Patient Blood Management, a scientific evidence-based approach in processes where transfusion is a possibility, such as in elective surgeries. OBJECTIVE: The cross-sectional study aimed to analyze the transfusion requests at a complex orthopedic hospital over a one-year period. METHOD: The completion quality was classified as Good, Regular, Bad or Very Bad, according to the information given by the physician. Transfusion medicine professionals analyzed the transfusion indication reported on the request form and classified it as Correct, Not based on Patient Blood Management (PBM), in accordance or not with the institutional Maximum Surgical Blood Order Schedule, Impossible to evaluate due to lack of information on the form, and Incorrect. RESULTS: The study categorized the completion quality of 2011 requests as Good (8.80%), Regular (9.30%), Bad (72.75%) and Very Bad (9.15%). Analysis of the indications revealed that 54.90% of the requests were in accordance with the current blood transfusion recommendations, and on 23.12% of the forms this field had not been filled out. CONCLUSION: The majority of blood components (63%) requests are in tune with current blood transfusion recommendations, despite the great number of incorrectly completed forms; nevertheless, it is mandatory to reach much better appropriateness rates.

Manejo de nuevos anticoagulantes orales en cirugía oral: Revisión de literatura / Management of new oral anticoagulants in oral surgery: literature review / Gestão de novos anticoagulantes orais na cirurgia oral: Revisão da literatura

En el año 2011 se introdujo una nueva generación de anticoagulantes orales cuyo manejo en cirugía oral aún no está completamente esclarecido. Objetivo: El objetivo de esta revisión fue describir los protocolos existen-tes sobre manejo de pacientes anticoagulados en cirugía oral. Método: Se realizó una búsqueda en PubMed, SCOPUS, EBSCO y BEIC, sin límite de idioma. Resultados: Se encontraron 4781 artículos, de los cuales 19 fueron seleccionados. Conclusión: Se debe evaluar el riesgo tromboembólico y la capacidad de control de un evento hemorrágico antes de suspender el anticoagulante.

In 2011, a new generation of oral anticoagulants was introduced, the management of which in oral surgery has not yet been fully clarified. Objective: The objective of this review was to describe the existing protocols for the management of anticoagulated patients in oral surgery. Method: A search was made in PubMed, SCO-PUS, EBSCO and BEIC, with no language limit. Results: 4781 articles were found, of which 19 were selected. Conclusion: The thromboembolic risk and the ability to control a bleeding event should be evaluated before suspension of the anticoagulant.

Em 2011, foi introduzida uma nova geração de anticoagulantes orais, cujo implicação em cirurgia oral ainda não foi totalmente esclarecida. Objetivo: O objetivo desta revisão foi descrever os protocolos existentes para a gestão de pacientes anticoagulados em cirurgia oral. Método: Foi realizada uma pesquisa no PubMed, SCOPUS, EBSCO e BEIC, sem limite de idioma. Resultados: Foram encontrados 4781 artigos, dos quais 19 foram selecionados. Conclusão: O risco tromboembólico e a capacidade de controlar um evento hemorrágico devem ser avaliados antes da interrupção do anticoagulante.

Distortion Correction Protocol for 3T Stereotactic Magnetic Resonance Imaging: A Clinical Study.

BACKGROUND: With application of 3T magnetic resonance imaging (MRI) to functional neurosurgery procedures and given the inherent requirement of millimetric precision, the need to develop a method for correction of geometric image distortion emerged. The aim of this study was to demonstrate clinical safety and practical viability of a correction protocol in patients scheduled to undergo stereotactic procedures using 3T MRI. METHODS: This prospective study comprised 20 patients scheduled to undergo computed tomography (CT) stereotactic functional procedures or encephalic brain lesion biopsies. The CT images were references for MRI geometric accuracy calculations. For each scan, 2 images were obtained: normal and reversed images. Eight distinct points on CT and MRI were selected summing 152 points that were based on a power analysis calculation value >0.999. One patient was excluded because of the inability to find reliable common landmark points on CT and MRI. RESULTS: The distortion range was 0-5.6 mm and increased proportionally with stereotactic isocenter distance, meaning the distortion was greater in the periphery. After correction, the minimum and maximum distortion found was 0 mm and 3.5 mm, respectively. There was no significant difference between CT and MRI corrected x-coordinates (P > 0.05). CONCLUSIONS: The proposed method can satisfactorily correct geometric distortions in clinical 3T MRI studies. Clinical use of the technique can be practical and efficient after software automation of the process. The method can be applied to all spin-echo MRI sequences.

Protocol for the functional evaluation of the stomatognathic system

Alterations in breathing, chewing and swallowing are considered risk factors for functional disorders on the stomatognathic system. Thus, there is a need to have a protocol for functional evaluation that contributes to systematize the processes and procedures, unifying criteria for diagnosis. The objective of this study was to design a Protocol for the functional evaluation of the stomatognathic system for the Postgraduate Clinic of Orthopedics of the School of Dentistry of the University of Zulia, Venezuela. In a first stage, a situational diagnosis was made. In a second stage, the documentary analysis technique was used, using the search engines Pubmed, Redalyc, SciELO and ScienceDirect. The third stage consisted in the elaboration of the protocol according to the consensus of the resident postgraduate professionals and the evidence found in the review of the scientific literature. The protocol was drawn up, defining its objectives, population, institutional resources and a systematic and detailed ordering of the procedures and tests to be applied for the evaluation of breathing, chewing and swallowing. This protocol will improve the quality of the evaluations and obtain reliable records of the patient's clinical condition

The effects of mental practice based on motor imagery for mobility recovery after subacute stroke: Protocol for a randomized controlled trial.

BACKGROUND AND PURPOSE: Mental practice of motor imagery has shown beneficial effects in stroke recovery. However, there are few clinical trials investigating it on the subacute phase. This study will investigate the effects of mental practice in the mobility of patients with subacute stroke. MATERIALS AND METHODS: Randomized controlled trial including persons with subacute stroke (<3 months). All participants will receive physical exercises and will be randomly allocated into an experimental group (Mental Practice) or into a control group (cognitive training) for 4 weeks(12 sessions). RESULTS: Primary outcomes will be assessed at baseline and after intervention and will be related to mobility, using Timed Up and Go test and 5 m walking speed test. Whereas secondary outcomes will be muscular strength, biomechanical strategies, mental health and quality of life. CONCLUSION: The beneficial effects that may be found in this trial can be greatly relevant in clinical practice, justifying this scientific question.

Development of a clinical protocol for detection of cervical cancer precursor lesions / Desenvolvimento de protocolo clínico para detecção de lesões precursoras do câncer de colo uterino / Desarrollo de protocolo clínico para detección de lesiones precursoras del cáncer de cuello uterino

ABSTRACT Objective: to develop and validate the content of a clinical protocol aimed at prevention of cervical cancer in primary care. Method: technological research according to the steps: (1) submission of the project to the research ethics committee; (2) bibliographic survey; (3) elaboration of the clinical protocol; and (4) content validation. In the third step, the information was collected through bibliographic research and gynecology specialists were consulted. For the final step, four judges were selected to evaluate the clinical protocol according to AGREE 2. Domains that reached the minimum level of agreement of 75% in the scores were considered validated. Results: the scores obtained in each domain of the instrument were as follows: domain 1 (scope and purpose) = 87.5%; domain 2 (stakeholder involvement) = 83.3%; domain 3 (development rigor) = 79.7%; domain 4 (clarity of presentation) = 76.3%; domain 5 (applicability) = 78.1%; and domain 6 (editorial independence) = 85.4. Conclusion: the clinical protocol proved to be a validated material with scores above the minimum required. The protocol obtained positive recommendations with modifications and went through adjustments in order to make it more effective.

RESUMO Objetivos: desenvolver e validar o conteúdo de um protocolo clínico direcionado à prevenção do câncer cervical na atenção primária. Método: Trata-se de uma pesquisa de desenvolvimento tecnológico em saúde(8) realizada em quatro etapas: (1) submissão do projeto ao comitê de ética em pesquisa; (2) levantamento bibliográfico; (3) elaboração do protocolo clínico; e (4) validação de conteúdo. Na terceira etapa, as informações foram levantadas mediante pesquisa bibliográfica e consultados especialistas em ginecologia. Para a etapa final, foram selecionados quatro juízes que avaliaram o protocolo clínico segundo o AGREE 2. Foram considerados validados os domínios que obtiveram nível de concordância mínimo de 75% nas pontuações. Resultados: as pontuações obtidas, em cada domínio do instrumento, foram as seguintes: domínio 1 (escopo e finalidade)=87,5%; domínio 2 (envolvimento das partes interessadas)=83,3%; domínio 3 (rigor do desenvolvimento)=79,7%; domínio 4 (clareza da apresentação)=76,3%; domínio 5 (aplicabilidade)=78,1%; e domínio 6 (independência editorial)=85,4. Conclusão: o protocolo clínico mostrou-se um material validado com pontuações superiores ao mínimo exigido. Obteve recomendações positivas com modificações e passou por ajustes a fim de torná-lo mais efetivo.

RESUMEN Objetivos: desarrollar y validar el contenido de un protocolo clínico dirigido a la prevención del cáncer cervical en atención primaria. Método: investigación tecnológica conforme a las etapas: (1) sujeción del proyecto al comité de ética en investigación; (2) levantamiento bibliográfico; (3) elaboración del protocolo clínico; y (4) validación de contenido. En la tercera etapa, las informaciones fueron levantadas mediante investigación bibliográfica y consultados especialistas en ginecología. Para la etapa final, fueron seleccionados cuatro jueces que evaluaron el protocolo clínico según el AGREE 2. Fueron considerados válidos los dominios que obtuvieron nivel de concordancia mínimo de 75% en las puntuaciones. Resultados: las puntuaciones obtenidas, en cada dominio del instrumento, fueron las siguientes: dominio 1 (alcance y finalidad) = 87,5%; dominio 2 (implicación de las partes interesadas) - 83,3%; dominio 3 (rigor del desarrollo) = 79,7%; dominio 4 (claridad de la presentación) = 76,3%; dominio 5 (aplicabilidad) = 78,1% y dominio 6 (independencia editorial) = 85,4. Conclusión: el protocolo clínico se mostró como un material válido con puntuaciones superiores al mínimo exigido. Obtuvo recomendaciones positivas con modificaciones y pasó por ajustes a fin de hacerlo más efectivo.

Guía para trabajos de investigación en muerte súbita cardiovascular: Propuesta cubana / Guidelines for research work on sudden cardiac death: A Cuban proposal

Las enfermedades cardiovasculares constituyen actualmente la causa más frecuente de muerte prematura e invalidez en el mundo y las proyecciones futuras indican que debe seguir siendo la primera causa en los países industrializados. En Cuba existe un subregistro estadístico de esta enfermedad y a partir de las estimaciones realizadas se prevé una tasa específica de fallecimiento inesperado de 105,2 por cada 100 mil habitantes, lo que equivale aproximadamente al 12,3% de las muertes naturales (un episodio cada 45 minutos). En la mayoría de las naciones, la ausencia de protocolos, directrices, guías y algoritmos diagnósticos, que orienten metodológicamente la recogida de los datos, resulta una importante limitante; además, la no estandarización de criterios, en los países donde existen guías para su estudio, contribuye a las diferencias observadas en los informes actuales de series individuales. Por estas razones se presenta una guía para trabajos de investigación sobre muerte súbita cardiovascular, que muestra la sistemática a desarrollar y contiene las principales variables (estudios necrópsicos e investigaciones complementarias), para ser empleada en los trabajos de investigación sobre esta enfermedad en Cuba. Ello permitirá contar con el dato para el registro de la muerte súbita y de las enfermedades que la provocan (cuando se puedan identificar), sin que se produzca otro tipo de subregistro

Heart diseases are nowadays the most frequent cause of premature death and disability in the world and future projections indicate that it should continue to be the leading cause in industrialized countries. There is a statistical underregistration of this disease in Cuba and from the existing estimates, a specific unexpected death rate of 105.2 per 100 thousand inhabitants is expected, equivalent to nearly 12.3% of natural deaths (one episode each 45 minutes). In most nations, the absence of protocols, strategies, guidelines and diagnostic algorithms, which methodologically guide data collection, remains an important limitation. Moreover, the non-standardization of criteria, in countries where there are guidelines for their study, contributes to the differences observed in the current reports of individual series. Hence practice guidelines for research work on sudden cardiac death are presented; showing the systematics to be developed and containing the main variables (necropsy studies and complementary investigation), to be used for research work on this disease in Cuba. This will allow data recording of sudden death and diseases that cause it (when they can be identified), with no other type of under-reporting

Challenges With Implementation of a Respiratory Therapist-Driven Protocol of Spontaneous Breathing Trials in the Pediatric ICU.

BACKGROUND: Timely ventilator liberation is crucial in the pediatric ICU. In many pediatric ICUs, the decision to initiate weaning is driven by the physician, which may lead to delays in ventilator liberation. The objectives of this quality improvement project were to develop and implement a respiratory therapist (RT)-led protocol for screening for spontaneous breathing trial (SBT) readiness, to test protocol feasibility, and to evaluate its impact on SBT timing. METHODS: A retrospective chart review was performed on all intubated patients in the pediatric ICU for 18 months prior to protocol institution. An RT-driven protocol was developed and implemented, enabling consistent screening for SBT readiness. When criteria were met, an SBT was initiated after order placement. The difference in the timing of the first SBT between physician-directed screening and the RT-driven protocol was evaluated. RESULTS: A total of 219 subjects were included in this project (128 pre-intervention; 91 intervention). Baseline demographic data, including mortality risk and endotracheal tube size, were similar in both groups. The time of the first SBT (median [25th, 75th percentile]) was not significantly different between the intervention and preintervention groups (39.5 [25.3, 85.2] vs 42.6 [26.4, 81.3], respectively). There was no difference in mechanical ventilation duration, or length of hospital and ICU stay. The odds of being placed on noninvasive respiratory support were higher in the intervention group at 1 h (odds ratio [95% CI]: 2.29 [1.10, 4.78], P = .03) and 12 h (odds ratio 2.53 [1.23, 5.20], P = .01) postextubation, but the odds of re-intubation did not reach statistical significance (odds ratio 2.60 [0.73, 9.27], P = .14). RT adherence with patient screening was 56.4%. CONCLUSIONS: An RT-driven protocol was successfully introduced in an academic pediatric ICU. However, it did not impact time of SBT initiation, potentially due to the difficulty in maintaining adherence over time. RT-driven protocols require further study.

Apresentação de um Protocolo Assistencial para Pacientes com Distúrbios da Deglutição / Presentation of a Clinical Practice Protocol for Patients with Swallowing Disorders

RESUMO Objetivo Descrever o processo de implantação de Protocolo Assistencial para os Distúrbios da Deglutição em unidade hospitalar pública de alta densidade tecnológica no Distrito Federal. Método Trata-se de um estudo descritivo do tipo Relato de Experiência com descrição do processo de implantação de Protocolo Assistencial para os Distúrbios da Deglutição em unidade hospitalar pública de alta densidade tecnológica no Distrito Federal. Resultados A implantação do Protocolo consistiu em três etapas de trabalho: Etapa 1 - busca na literatura sobre os procedimentos que caracterizariam as melhores práticas propedêuticas e terapêuticas; Etapa 2 - discussão com equipe multidisciplinar para ajustes necessários à execução da proposta de implantação de um Protocolo Assistencial para os Distúrbios da Deglutição; e Etapa 3 - proposta final do Protocolo Assistencial para os Distúrbios da Deglutição considerando as particularidades do serviço. Conclusão A proposta final do Protocolo Assistencial para os Distúrbios da Deglutição (PADD) apresenta um método sistematizado pré-definido para acompanhar os pacientes com alteração da deglutição de unidades de saúde de alta densidade tecnológica. O PADD propõe-se a favorecer a detecção precoce do distúrbio, a tomada de decisões terapêuticas uniformes, a utilização de métodos propedêuticos e terapêuticos de baixo custo e a auxiliar gestores no processo de avaliar a qualidade do serviço ofertado através da mensuração de indicadores.

ABSTRACT Purpose To describe the implementation process of a Clinical Practice Protocol for Patients with Swallowing Disorders (CPSD) in a public hospital of high technological density in the Federal District of Brazil. Methods This is an Experience Report study which describes the implementation process of a Clinical Practice Protocol for Patients with Swallowing Disorders in a public hospital of high technological density in the Federal District. Results The protocol was implemented in three stages: Stage 1 - literature search on the procedures that characterize the best propaedeutic and therapeutic practices; Stage 2 - discussion with a multidisciplinary team about the adjustments needed to implement the CPSD; and Stage 3 - Final proposal for the protocol implementation considering the particularities of the service. Conclusion The final proposal of the Clinical Practice Protocol for Patients with Swallowing Disorders (CPSD) provides a predefined, systematic method to monitor patients with swallowing disorders in high technological density health facilities. In addition to being inexpensive, the CPSD fosters decision-making, favors early detection of disorders, and assists managers with evaluating the quality of the service offered.