Pandemia: vivências de médicos da atenção primária à saúde e de mestrandos em Saúde da Família / Pandemic: experiences of primary health care doctors and master's degree students in family health

Resumo: Introdução: A Covid-19 trouxe uma série de desafios para o Sistema Único de Saúde. Na atenção primária à saúde (APS), tais desafios se somam aos já existentes. Objetivo: Este estudo teve como objetivo analisar a vivência de enfrentamento da pandemia de Covid-19 entre médicos do Programa Mais Médicos Brasil, mestrandos em Saúde da Família e atuantes na APS. Método: Trata-se de estudo qualitativo envolvendo oito médicos da APS de Alagoas que cursam o Mestrado Profissional em Saúde da Família (PROFSAÚDE). Foram elaboradas cinco questões, cujas respostas foram analisadas com base na teoria de Análise de Conteúdo. Resultado: Observaram-se três categorias e quatro subcategorias: categoria 1 - "Processo de estudo e de trabalho" (subcategoria 1.1 - "Características do PROFSAÚDE" - e subcategoria 1.2 - "Estratégias pessoais desenvolvidas"), categoria 2 - "Desafios no gerenciamento da vida" (subcategoria 2.1 - "Mudanças no cotidiano" - e subcategoria 2.2 - "Impacto nas emoções") e categoria 3 - "Crescimento pessoal e profissional". Conclusão: Em tempos de pandemia, os profissionais médicos vivenciam situações complexas e dinâmicas em razão de um duplo e acumulativo processo - o trabalho na APS e a condição de mestrando. Apesar de todas as dificuldades enfrentadas, o mestrado possibilitou o aprimoramento das habilidades em lidar com situações críticas.

Abstract: Introduction: COVID-19 has brought numerous challenges for the Health System in Brazil. In Primary Health Care, these challenges add to those that already exist. Objective: To analyze the experience of facing the COVID-19 pandemic among doctors of the Mais Médicos Brasil Program and master's degree students in Family Health and those working in Primary Health Care. Methods: Qualitative study involving eight doctors from Primary Health Care in Alagoas who are also studying the professional master's degree in Family Health (PROFSAÚDE). Five questions were developed, the answers to which were analyzed based on Content Analysis theory. Results: Three categories and four subcategories were observed: Category 1 - Study and work process (Subcategory 1.1- Characteristics of PROFSAÚDE; Subcategory 1.2 - Personal strategies developed); Category 2 - Challenges in Life Management (Subcategory 2.1 - Changes in daily life; Subcategory 2.2 - Impact on emotions) and Category 3 - Personal and Professional Growth. Conclusion: During the pandemic, medical professionals experience complex and dynamic situations due to a dual and cumulative process - working in PHC and studying for their master's degree. Despite all the difficulties faced, the master's degree allowed them to improve skills in dealing with critical situations.

Concepções sobre o processo de alta hospitalar: uma revisão crítica / Conceptions on patient discharge process: a critical review / Concepciones alta del paciente: una revisión crítica

Objetivamos discutir as concepções acerca do processo de alta hospitalar, a partir de uma revisão crítica da literatura científica em diálogocom a experiência vivenciada pelas autoras, no Programa de Residência Multiprofissional em Saúde do Adulto e do Idoso de um Estado da região Nordeste do Brasil. A busca das produções científicas foi realizada em bases de dados (Scielo; Bireme e PubMed), utilizando os descritores alta hospitalar e alta do paciente, separadamente. Foram encontrados um total de cinquenta e quatro produções, no entanto, vinte artigos nortearam a proposta deste trabalho. Para análise do material, fizemos uma leitura seletiva a qual categorizou e relacionou as produções norteada ao objetivo.Notamos predominância de pesquisas nas áreas de Enfermagem e Medicina, que estão publicadas em revistas das áreas correspondentes, durante o período de 2010 a 2013. Esses estudos, em sua maioria,caracterizam-se como epidemiológicos e descritivos, com utilização de escalas eforam realizados predominantementeno Estado de São Paulo. Identificamos que as mudanças na concepção de alta hospitalar produzem efeitos na maneira de desenvolver as práticas. Ao refletir sobre a literatura científica e nossas práticas, compreendemos a alta como um processo e não apenas, como a saída do paciente do hospital. Por fim, demarcamos que operar com um ou outro conceito, não é apenas uma questão teórica, e sim, o reflexo do modo como nossos saberes produzem formas de intervenção na realidade e de relação com os sujeitos. (AU)

We aim to discuss the conceptions about the hospital discharge process, based on a critical review of the scientific literature in dialogue with the experience lived by the authors, in the Program of Multiprofessional Residency in Adult Health and the Elderly of a State in the Northeast region of Brazil. The research for the scientific productions was carried out in databases (Scielo; Bireme and PubMed), using the descriptors discharge hospital and discharge of the patient, separately. A total of fifty four productions were found, however, twenty articles guided the proposal of this work. For the analysis of the material, we made a selective reading that directly related and categorized the productions to the objective. We note the predominance of researches in the areas of Nursing and Medicine, and these are also published in journals in the corresponding areas with a higher concentration of publications during the period from 2010 to 2013. The methodology used in these research consisted mostly of epidemiological and descriptive studies, with the use of scales. As study sites research was dominant in the State of São Paulo. We have identified that changes in the conception of hospital discharge produce effects in the way of developing the practices. When we reflect on the scientific literature and our practices, we understand the discharge as a process and not only, when the patient leaves the hospital. Finally, we point out that to operate with one or another concept is not only a theoretical question, but a reflection of the way our knowledge produces forms of intervention in reality and in relation to the subjects. (AU)

El objetivo del estudio es discutir las concepciones del proceso de alta del hospital a partir de una revisión crítica de la literatura científica en diálogo con la experiencia vivida por los autores, en el Programa de Residencia Multidisciplinar en Salud del Adulto y el Anciano de un estado en la región noreste de Brasil. La búsqueda de la producción científica se llevó a cabo en bases de datos (Scielo, BIREME y PubMed), utilizando los descriptores de hospital y alta del paciente por separado. Se encontró un total de cincuenta y cuatro producciones, sin embargo, veinte artículos guían el propósito de este trabajo. Para el análisis del material, hicimos una lectura selectiva de la cual clasificase las producciones y producerelacionessegún el objetivo. Observamos el predominio de la investigación en enfermería y medicina, publicadas en las revistas de las áreas correspondientes en el período de 2010 a 2013. Estos estudios caracterizan se como epidemiológicos y descriptivos y por el uso de escalas, en su mayoría desarrollados en Sao Paulo. Hemos encontrado que los cambios en la conceptualización dealta del hospital tienen efecto sobre la manera de desarrollar las prácticas. Al reflexionar sobre la literatura científica y nuestras prácticas, entendemos el alta como un proceso y no sólo como salida de un paciente del hospital. Por último, resulta que trabajar con uno u otro concepto, no es sólo una cuestión teórica, sino más bien un reflejo de cómo nuestros conocimientos producen formas de intervención en la realidad y en la relación con el sujeto. (AU)

A Integração Ensino-Serviço e a Residência Multiprofissional em Saúde: um relato de experiência numa Unidade Básica de Saúde / The Service-Learning Integration and the Multiprofessional Residency in Health: an experience report in a Basic Health Unit / La Integración Enseñanza-Servicio y la Residencia Multiprofesional en la salud: un relato de experiencia en una Unidad Básica de Salud

Este estudo compreende um relato de experiência que tem como objetivo promover reflexões acerca da integração ensino-serviço no âmbito da Residência Multiprofissional em Saúde, no cenário de práticas de uma Unidade Básica de Saúde (UBS). Buscou-se analisar o modo como ocorreu a articulação das atividades realizadas pelos residentes com o cotidiano do serviço na UBS e descrever quais os desafios encontrados durante o período de atuação neste cenário, bem como as estratégias de enfrentamento desenvolvidas para lidar com tais dificuldades. Para realizar uma análise crítico-reflexiva das experiências vivenciadas, utilizou-se tanto a literatura científica existente sobre a temática da integração ensino-serviço, como a perspectiva do Construcionismo Social, na construção do conhecimento. A vivência da equipe de residentes corrobora com as experiências existentes na literatura científica acerca dos desafios enfrentados no contexto da integração ensino-serviço, apontando para a necessidade de uma maior aproximação entre os setores envolvidos nesse processo.

This study comprises an experience report that aims to promote reflections about the teaching-service integration in the context of the Multiprofessional Residency in Health, in the practice scenario of a Basic Health Unit (BHU). It sought to analyze the way the residents carried out the coordination of activities with the daily routine of the service at the BHU, as well as to describe the challenges encountered during the operation period in this scenario and the coping strategies developed to deal with such difficulties. In order to perform a critical and reflective analysis of the experiences, both the existing scientific literature on the subject of teaching and service integration, as the perspective of social constructionism were used. The experience of this resident team corroborates existing experiences in the scientific literature about the challenges faced in the context of teaching-service integration, pointing to the need for a closer relationship among the sectors involved in this process.

Este estudio comprende un relato de experiencia cuyo objetivo es promover reflexiones sobre la integración enseñanza-servicio dentro de Residencia Multiprofesional en Salud en el escenario de prácticas de una Unidad Básica de Salud (UBS). Se trató de analizar cómo fue la articulación de las actividades llevadas a cabo por los residentes con la rutina de servicio de UBS, y para describir lo que los retos encontrados durante el período de operación en este escenario y las estrategias de supervivencia desarrolladas para hacer frente a estas dificultades. Para realizar un análisis crítico y reflexivo de las experiencias pasadas, se utilizó tanto en la literatura científica existente sobre el tema de la integración enseñanza y el servicio, ya que el punto de vista del Construccionismo Social. La experiencia de este equipo residente corrobora las experiencias existentes en la literatura científica acerca de los desafíos que enfrentan en el contexto de la integración enseñanza-servicio, que apunta a la necesidad de estrechar los vínculos entre los sectores involucrados en este proceso.

Development and validation of a rapid and sensitive LC-ESI-MS/MS method for ondansetron quantification in human plasma and its application in comparative bioavailability study.

The validation of a high throughput and specific method using a high-performance liquid chromatography coupled to electrospray (ES+) ionization tandem triple quadrupole mass spectrometric (LC-ESI-MS/MS) method for ondansetron quantification in human plasma is described. Human plasma samples were extracted by liquid-liquid extraction (LLE) using methyl tert-butyl ether and analyzed by LC-ESI-MS/MS. The limit of quantification was 0.2 ng/mL and the method was linear in the range 0.2-60 ng/mL. The intra-assay precisions ranged from 1.6 to 7.7%, while inter-assay precisions ranged from 2.1 to 5.1%. The intra-assay accuracies ranged from 97.5 to 108.2%, and the inter-assay accuracies ranged from 97.3 to 107.0%. The analytical method was applied to evaluate the relative bioavailability of two pharmaceutical formulations containing 8 mg of ondansetron each in 25 healthy volunteers using a randomized, two-period crossover design. The geometric mean and respective 90% confidence interval (CI) of ondansetron test/reference percent ratios were 90.15% (81.74-99.44%) for C(max) and 93.11% (83.01-104.43%) for AUC(0-t). Based on the 90% confidence interval of the individual ratios (test formulation/reference formulation) for C(max) and AUC(0-inf), it was concluded that the test formulation is bioequivalent to the reference one with respect to the rate and extent of absorption of ondansetron.

O humanismo na perspectiva de estudantes de Medicina da UFAL / Humanism from the perspective of medical students at UFAL

Este artigo apresenta uma pesquisa que analisa as concepções de humanismo e suas contribuições para a formação médica, na ótica discente, no âmbito do curso de Medicina da Universidade Federal de Alagoas, no período compreendido de novembro de 2006 a julho de 2007. A metodologia escolhida foi a de realização de cinco grupos focais, nos quais foram coletados os depoimentos de 73 estudantes, analisados posteriormente por meio de referencial sobre as práticas discursivas. Os resultados encontrados destacam três aspectos acerca do que o estudante observa e vivencia: na relação com a instituição, o curso e os sentimentos que surgem no seu processo como aprendiz; sobre a relação aluno-professor no curso médico; e, por fim, sobre a relação médico-paciente e demais pessoas com quem o médico interage em seu exercício profissional. Surgiram elementos indicativos de um aprendizado entremeado de sinais de contrariedade, irritação, impaciência e intolerância com os professores e seus métodos e com a instituição. A humanização não é sentida nas práticas pedagógicas da formação médica, embora seja priorizada nos espaços formais iniciais do curso médico.

This article presents the results of a study on humanist concepts and their contribution to medical training from the students' perspective in the School of Medicine at the Federal University in Alagoas, Brazil, from November 2006 to July 2007. The methodology included five focus groups in which statements by 73 students were recorded and subjected subsequently to discourse analysis. The results feature three aspects in: students' observations and experiences in the relationship to the institution and course and the feelings that emerge in their learning process; the student-faculty relationship during medical school; and the physician-patient relationship and physicians' interaction with others during their professional practice. The study detected elements that indicate a learning process interspersed with signs of dissatisfaction, irritation, impatience, and intolerance towards professors and their teaching methods and the institution. Humanization is not perceived in the teaching practices during medical training, although it is prioritized in the initial formal spaces of medical school.

Simultaneous determination of losartan and hydrochlorothiazide in human plasma by LC/MS/MS with electrospray ionization and its application to pharmacokinetics.

A method based on a simple liquid-liquid extraction (LLE) followed by high-performance liquid chromatography with negative ion electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS) detection was developed for the simultaneous determination of losartan (LOS) and hydrochlorothiazide (HCTZ) in human plasma, using valsartan (VAL) and chlorthalidone (CHTD) as an internal standard, respectively. The acquisition was performed in multiple reactions monitoring (MRM) and the limit of quantification was 4 ng/mL for both LOS and HCTZ. The method was linear in the studied range (4-800 ng/mL for LOS and 4-500 ng/mL for HCTZ). The intra-assay precisions ranged from 2.6-11.9% for LOS and 1.4-8.2% for HCTZ, while the inter-assay precisions ranged from 1.0-8.0% for LOS and 2.5-7.7% for HCTZ. The intra-assay accuracies ranged from 91.3 to 107.6% for LOS and 91.5 to 105.8% for HCTZ, while the inter-assay accuracies ranged from 99.9 to 106.4% for LOS and 97.4 to 101.4% for HCTZ. The analytical method was applied to a bioequivalence study, in which 28 healthy adult volunteers (14 men) received single oral doses (100 mg LOS + 25 mg HCTZ) of reference and test formulations, in an open, two-period, balanced randomized, crossover protocol. Based on the 90% confidence interval of the individual ratios for Cmax and AUC0-inf, it was concluded that the test formulation is bioequivalent to the reference Hyzaar formulation with respect to the rate and extent of absorption of both LOS and HCTZ.

A regulamentação do acesso aos recursos genéticos e aos conhecimentos tradicionais associados no Brasil / Regulation to access to genetic resources and associated traditional knowledge in Brazil

A implementação, em nível nacional, da Convenção sobre Diversidade Biológica, especialmente dos artigos 8j e 15, que tratam respectivamente do conhecimento tradicional e do acesso aos recursos genéticos e da repartição dos benefícios provenientes da sua utilização, tem gerado intenso debate quanto ao seu impacto sobre a pesquisa. No Brasil vigora atualmente a Medida Provisória 2.186-16/01 (MP) que instituiu as regras para o acesso a e a remessa de componentes do patrimônio genético e o acesso a conhecimentos tradicionais associados. Essa norma previu a criação da autoridade nacional competente o Conselho de Gestão do Patrimônio Genético (CGEN) no âmbito do Ministério do Meio Ambiente, o qual iniciou suas atividades em abril de 2002. Em 2003, com o novo governo, a implementação da MP buscou atender, na medida do possível, as demandas de setores da sociedade, editando atos que esclareceram conceitos básicos para sua implementação, diminuindo a burocracia para a aplicação da norma e dando maior transparência às ações do CGEN. Entretanto essas ações estão limitadas pelo texto legal vigente, assim foi elaborado um anteprojeto de lei para, após sua análise pela casa Civil, ser encaminhado pelo Executivo Federal ao Congresso Nacional. A retomada do processo legislativo, iniciado em 1995 e interrompido em 2000 com a primeira edição da referida MP, dará a sociedade uma nova chance para que participe da discussão dessa matéria, agora com mais conhecimento de causa.

The nationwide enforcement of the Convention on Biological Diversity, particularly articles 8j and 15 which address respectively traditional knowledge and access to genetic resources and distribution of the benefits deriving from it's utilization, has generated an intense debate regarding it's impact on research. Today, in Brazil, Provisional Measure 2.186-16/01 (MP), which established the rules for the access and sending of genetic patrimony components and the access to associated traditional knowledge, is in effect. This norm foresaw the creation inside the Ministry of the Environment of a national competent authority the Genetic Heritage Management Council (CGEN), whose activities began in April 2002. In 2003, with the new government, enforcement of the MP tried to address, as far as possible, the demands of sectors of society, publishing acts that clarify concepts which are fundamental for it's enforcement, reducing bureaucracy in the application of the norm and giving greater transparency to the actions of the CGEN. However, as these actions are limited by the legal text in force, a preliminary draft was made for a law to be sent by the Federal Executive Government to the National Congress, after being analyzed by the competent government department. Taking up again the legislative process, began in 1995 and interrupted in 2000 with the first edition of the above MP mentioned, society will have a new opportunity to participate in the discussion of this matter, with deeper understanding.

Determination of bromazepam in human plasma by high-performance liquid chromatography with electrospray ionization tandem mass spectrometric detection: application to a bioequivalence study.

A simple method using a one-step liquid-liquid extraction (LLE) followed by high-performance liquid chromatography (HPLC) with positive ion electrospray ionization tandem mass spectrometric (ESI-MS/MS) detection was developed for the determination of bromazepam in human plasma, using lorazepam as internal standard. The acquisition was performed in the multiple reaction monitoring mode, monitoring the transitions: m/z 316 > 182 for bromazepam and m/z 321 > 275 for lorazepam. The method was linear over the studied range (1-100 ng ml(-1)), with r(2) > 0.98, and the run time was 2.5 min. The intra- and inter-assay precisions were 2.7-14.6 and 4.1-17.3%, respectively and the intra- and inter-assay accuracies were 87-111 and 75.8-109.5%, respectively. The mean recovery was 73.7%, ranging from 64.5 to 79.7%. The limit of quantification was 1 ng ml(-1). At this concentration the mean intra- and inter-assay precisions were 14.6 and 7.1%, respectively, and the mean intra- and inter-assay accuracies were 102.5 and 104%, respectively. Bromazepam stability was evaluated and the results showed that the drug is stable in standard solution and in plasma samples under typical storage and processing conditions. The method was applied to a bioequivalence study in which 27 healthy adult volunteers (14 men) received single oral doses (6 mg) of reference and test bromazepam formulations, in an open, two-period, randomized, crossover protocol. The 90% confidence interval of the individual ratios (test formulation/reference formulation) for C(max) (peak plasma concentration), AUC(0-96) and AUC(0-inf) (area under the plasma concentration versus time curve from time zero to 96 h and to infinity, respectively) were within the range 80-125%, which supports the conclusion that the test formulation is bioequivalent to the reference formulation regarding the rate and extent of bromazepam absorption.

Combined chromatographic methodology for antidoping control in horse urine

A combination of chromatographic techniques is described for the screening of drugs in horse urine for antidoping control purposes. The procedure consists of liquid-liquid base extraction with analysis by HPTLC and GC-NPD and liquid-liquid acidic extraction followed by HPTLC and HPLC. The results of 86 drugs analyzed by these procedures, as well as limits of detection of the drugs in each technique are presented, The use of ELISA tests are recommended for the screening of drugs which would not be detected by the chromatographic proposed procedure. The results show that the proposed combination of techniques enables an efficient antidoping control of racing horses.