Desafios e perspectivas na atuação de estomaterapeutas durante a pandemia de COVID-19 / Challenges and perspectives in the work of stomatherapists during the COVID-19 pandemic

Objetivo: Analisar os desafios e perspectivas na atuação de estomaterapeutas durante a pandemia de COVID-19.Métodos: Pesquisa descritiva de abordagem qualitativa, por meio de entrevista semiestruturada com oito estomaterapeutas, selecionadas pela técnica snowball. Utilizou-se a Análise de Conteúdo, da qual emergiram três categorias: Desafios na atuação de estomaterapeutas durantea pandemia da COVID-19; Estratégias para viabilizar a assistência remota e presencial na estomaterapia; e Impacto da pandemia no cuidado de estomaterapia. Resultados: Os principais desafios citados foram: fechamento de ambulatórios e agravamento do quadro de saúde dos pacientes. As estratégias incluíram: adaptação da metodologia dos atendimentos, utilização de precauções-padrão e comunicação remota. Dentre as perspectivas futuras, destacam-se o crescimento da especialidade e valorização por outros profissionais da saúde. Conclusão: Houve diversos desafios na atuação de estomaterapeutas na pandemia, contornados, sobretudo, com a diversificação de estratégias assistenciais e modificações nos atendimentos. No entanto, destaca-se como perspectiva futura o aumento da visibilidade da especialidade. Descritores: Enfermagem; Estomaterapia; COVID-19

Objective: To analyze the challenges and perspectives in the work of stomatherapists during the COVID-19 pandemic. Methods: Descriptive research with a qualitative approach, through semi-structured interviews with eight stomatherapists, selected by the snowball technique. Content Analysis was used, emerging three categories: Challenges in the work of stomatherapists during the COVID-19 pandemic; Strategies to enable remote and face-to-face assistance in stomatherapy; and Impact of the pandemic on stomatherapy care. Results: The main challenges mentioned were: closure of outpatient clinics and worsening of the patients' health situation. The strategies included: adaptation of the care methodology, use of standard precautions and remote communication. Among the future perspectives, the growth of the specialty and appreciation by other health professionals stand out. Conclusion: There were several challenges in the work of stomatherapists in the pandemic, circumvented, above all, with the diversification of care strategies and modifications in care. However, the increased visibility of the specialty stands out as a future perspective. Descriptors:Nursing; Enterostomal Therapy; COVID-19.

Perfil de pacientes com incontinência urinária em um ambulatório de hospital universitário / Profile of patients with urinary incontinence in a university hospital outpatient clinic / Perfil de los pacientes con incontinencia urinaria en una clínica ambulatoria de un hospital universitário

Objetivo:conhecer o perfil sociodemográfico e clínico das pessoas com incontinência urinária em ambulatório de Hospital Universitário. Métodos: estudo transversal, em que se utilizou formulário semiestruturado com 63 mulheres que aguardavam atendimento nos ambulatórios de ginecologia e urologia, entre os meses de julho e agosto de 2019. Os dados foram processados no software Statistical Package for the Social Sciences ­ SPSS 20.0. Resultados: foram realizadas entrevistas com mulheres com idade entre 19 e 77 anos. Dessas, 55,6% mantinha vida sexual ativa; 85,7% apresentava doença preexistente; 69,8% presentou perda urinária ao tossir, espirrar, sorrir, colocar peso e/ou fazer esforços; 12,7% precisa urinar assim que sentem vontade; e 17,5% apresenta perda de urina nas duas situações. Cerca de 35% procurou consulta devido à bexiga baixa e/ou perda de urina; 27% teve de 4 a 5 gestações. Dentre os fatores de risco associado à incontinência urinária, 28,6% tinha diabetes mellitus, 61,9% hipertensão arterial, 82,5% fazia uso de medicação contínua, 11,1% era obesa, 34,9% relatou problemas de constipação e 74,6% fez cirurgias pélvicas. Conclusão: concluiu-se que todas as mulheres do estudo apresentaram mais de um fator de risco para desenvolver incontinência urinária, reforçando sua multifatorialidade, bem como a importância de um tratamento holístico e multiprofissional.

Objective:to know the sociodemographic and clinical profile of people with urinary incontinence in an outpatient clinic of a University Hospital. Methods: cross-sectional study, using a semi-structured form with 63 women who were awaiting care at the gynecology and urology outpatient clinics, between the months of July and August 2019. The data were processed in the software Statistical Package for the Social Sciences ­ SPSS 20.0. Results: interviews were carried out with women aged between 19 and 77 years. Of these, 55.6% maintained an active sex life; 85.7% had pre-existing disease; 69.8% presented urinary loss when coughing, sneezing, smiling, putting on weight and/or making efforts; 12.7% need to urinate as soon as they feel like it; and 17.5% had loss of urine in both situations. About 35% sought consultation due to low bladder and/or loss of urine; 27% had 4 to 5 pregnancies. Among the risk factors associated with urinary incontinence, 28.6% had diabetes mellitus, 61.9% had arterial hypertension, 82.5% used continuous medication, 11.1% was obese, 34.9% reported constipation problems and 74.6% underwent pelvic surgery. Conclusion: it was concluded that all women in the study had more than one risk factor for developing urinary incontinence, reinforcing their multifactoriality, as well as the importance of a holistic and multiprofessional treatment.

Objetivo:Conocer el perfil sociodemográfico y clínico de personas con incontinencia urinaria en una consulta externa de un Hospital Universitario. Métodos: El estudio transversal, se utilizó un formulario semiestructurado con 63 mujeres que se encontraban en espera de atención en las consultas externas de Ginecología y Urología, entre los meses de julio y agosto de 2019. Los datos se procesaron mediante el Paquete Estadístico de la Ciencias sociales: software SPSS. Resultados: Se realizaron entrevistas con mujeres,; edad entre 19 y 77 años; mantuvieron una vida sexual activa 55,6% y 85,7% tenían enfermedad preexistente. Presentaron pérdidas urinarias al toser, estornudar, sonreír, engordar y/o realizar esfuerzos 69,8%; El 12,7% necesita orinar tan pronto como le apetece y el 17,5% tiene pérdida de orina en ambas situaciones. Aproximadamente el 35% buscó consulta debido a la disminución de la vejiga y / o la pérdida de orina; El 27% tuvo de 4 a 5 embarazos. Entre los factores de riesgo asociados a la incontinencia urinaria, el 28,6% tenía diabetes mellitus, el 61,9% hipertensión arterial, el 82,5% usaba medicación continua; El 11,1% eran obesos; 34,9% informó problemas de estreñimiento; El 74,6% se sometió a cirugía pélvica. Conclusión: Se concluye que todas las mujeres del estudio tenían más de un factor de riesgo para desarrollar IU, reforzando su multifactorialidad, así como la importancia de un tratamiento holístico y multiprofesional

Tecnologias para educação em saúde no cuidado ao paciente com incontinência urinária: revisão integrativa / Technologies for health education in the care of patients with urinary incontinence: an integrative review / Tecnologías para la educación sanitaria en la atención de paciente con incontinencia urinaria: una revisión integradora

Objetivo:analisar as tecnologias disponíveis na literatura utilizadas para a educação em saúde no cuidado às pessoas com incontinência urinária. Métodos: revisão integrativa, com buscas nas bases: Índice Bibliográfico Espanhol de Ciências da Saúde (IBECS), Base de Dados em Enfermagem (BDENF) via Biblioteca Virtual em Saúde (BVS), Medical Literature Analysis and Retrieval System Online via Pubmed (MEDLINE/PubMed) da National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science e Embase. A coleta foi realizada em fevereiro de 2021, tendo como principais descritores: Incontinência urinária, Tecnologia educacional e Educação em saúde. Resultados: foram selecionados 91 artigos, após a análise dos critérios de inclusão e exclusão restaram 5 produções que foram selecionadas, apresentando como estratégia as tecnologias: curso de multimídia, vídeos, aplicativo móvel e livro/livreto. Os artigos foram publicados entre 1997 e 2020. As dimensões consideradas foram: desenvolvimento de tecnologias em saúde para o tratamento da incontinência urinária e conhecimento, adesão e efeito do uso de tecnologias em saúde para o tratamento da incontinência urinária. Conclusão: as tecnologias utilizadas foram diversificadas, sendo a adesão e o efeito diretamente proporcionais, e depende de como o indivíduo compreende a incontinência urinária e o impacto que ela traz na vida de cada um.

Objective:analyze the technologies available in the literature used for health education in the care of people with urinary incontinence. Methods: integrative review, with database searches: Índice Bibliográfico Espanhol de Ciências da Saúde (IBECS), Base de Dados em Enfermagem (BDENF) via Biblioteca Virtual em Saúde (BVS), Medical Literature Analysis and Retrieval System Online via Pubmed (MEDLINE/PubMed) from the National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and Embase. The collection was carried out in February 2021, with the main descriptors: Urinary Incontinence, Educational Technology and Health Education. Results: 91 articles were selected, after analyzing the inclusion and exclusion criteria, there were only 5 productions that were selected, presenting as a strategy the technologies: multimedia course, videos, mobile application and book/booklet. The articles were published between 1997 and 2020. The dimensions considered were: development of health technologies for the treatment of urinary incontinence and knowledge, adherence and the effect of using health technologies for the treatment of urinary incontinence. Conclusion: the technologies used were diversified, with the adherence and the effect being directly proportional, and it depends on how the individual understands urinary incontinence and the impact it brings on each person's life.

Objetivo:analizar las tecnologías disponibles en la literatura que se utilizan para la educación sanitaria en la atención a las personas con incontinencia urinaria. Métodos: revisión integradora, con búsquedas en las bases: Índice Bibliográfico Español de Ciencias de la Salud (IBECS), Base de Datos en Enfermería (BDENF) en la Biblioteca Virtual de la Salud (BVS), Medical Literature Analysis and Retrieval System Online vía Pubmed (MEDLINE/PubMed) de la National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Sciencey Embase. La recopilación se realizó en febrero de 2021, teniendo como principales descriptores: Incontinencia urinaria, Tecnología educativa y Educación sanitaria. Resultados: se seleccionaron 91 artículos, luego de analizar los criterios de inclusión y exclusión quedaron 5 producciones que fueron seleccionadas, presentando como estrategia las tecnologías: curso de multimedios, videos, aplicación móvil y libro/libreto. Los artículos fueron publicados entre 1997 y 2020. Las dimensiones consideradas fueron: desarrollo de tecnologías sanitarias para el tratamiento de la incontinencia urinaria y el conocimiento, adhesión y efecto del uso de tecnologías sanitarias para el tratamiento de la incontinencia urinaria. Conclusión: las tecnologías utilizadas fueron diversas, siendo la adhesión y el efecto directamente proporcionales, dependiendo de cómo el individuo comprende la incontinencia urinaria y el impacto que esta causa en la vida de cada uno.

Evaluation of progesterone receptor expression in low- and high-grade astrocytomas.

OBJECTIVE: Gliomas are tumors originating from glial cells. Gliomas are the most common primary neoplasms of the central nervous system, with astrocytomas being the most prevalent glioma subtype. Progesterone regulates several reproductive processes, such as ovulation and sexual behavior, and influences neuronal excitability, learning, and the neoplastic proliferation of glial cells. Progesterone functions mainly by interacting with intracellular progesterone receptors to modify the expression of the genes involved in cell proliferation, angiogenesis, and epidermal growth factor production. As not many studies on the hormone receptors in glial tumors have been reported, the objective of this study was to evaluate the expression of these proteins in astrocytomas and to determine whether their expression levels vary according to the tumor grade. METHODS: This was a retrospective study using glial tumor paraffin blocks obtained from the São Marcos Hospital Pathology Department archives. Forty cases were divided equally into two groups, based on histological types and the World Health Organization criteria (low- and high-grade tumors). Progesterone receptor expression was analyzed by immunohistochemistry. The data were statistically analyzed using the Mann-Whitney U test and Spearman's correlation coefficient; results with p<0.05 were considered statistically significant. RESULTS: There were no statistically significant differences between the mean nuclear progesterone receptor expression of low-grade (0.1495) and high-grade (0.0937) astrocytomas (p=0.2). CONCLUSION: Progesterone receptors are present in both low- and high-grade gliomas; however, there is no significant difference in the levels of progesterone receptor expression between the tumor grades.

Evaluation of progesterone receptor expression in low- and high-grade astrocytomas

SUMMARY OBJECTIVE: Gliomas are tumors originating from glial cells. Gliomas are the most common primary neoplasms of the central nervous system, with astrocytomas being the most prevalent glioma subtype. Progesterone regulates several reproductive processes, such as ovulation and sexual behavior, and influences neuronal excitability, learning, and the neoplastic proliferation of glial cells. Progesterone functions mainly by interacting with intracellular progesterone receptors to modify the expression of the genes involved in cell proliferation, angiogenesis, and epidermal growth factor production. As not many studies on the hormone receptors in glial tumors have been reported, the objective of this study was to evaluate the expression of these proteins in astrocytomas and to determine whether their expression levels vary according to the tumor grade. METHODS: This was a retrospective study using glial tumor paraffin blocks obtained from the São Marcos Hospital Pathology Department archives. Forty cases were divided equally into two groups, based on histological types and the World Health Organization criteria (low- and high-grade tumors). Progesterone receptor expression was analyzed by immunohistochemistry. The data were statistically analyzed using the Mann-Whitney U test and Spearman's correlation coefficient; results with p<0.05 were considered statistically significant. RESULTS: There were no statistically significant differences between the mean nuclear progesterone receptor expression of low-grade (0.1495) and high-grade (0.0937) astrocytomas (p=0.2). CONCLUSION: Progesterone receptors are present in both low- and high-grade gliomas; however, there is no significant difference in the levels of progesterone receptor expression between the tumor grades.

Relationship between the implementation of primary nursing model and the reduction of missed nursing care.

AIMS: To evaluate and predict the relationship between the implementation of the primary nursing model and the reduction of missed nursing care. BACKGROUND: Primary nursing can provide hospital leaders and nursing staff with guidance in implementing safe, patient-centred care, with responsibility and accountability during the nursing process. The implementation can be measured in terms of missed nursing care. METHODS: A predictive correlational study was used. The study was conducted in four inpatient units at the University Hospital, Northeast, Brazil. Data were collected from 96 nursing professionals, using the MISSCARE instrument at four and seven months after the implementation of the primary nursing model. RESULTS: Missed nursing care was reduced by 78.5%. Job title and staff satisfaction showed significant associations with decreased missed care (p < .05). CONCLUSION: The predictive effect between efficacy in reducing missed nursing care and reasons and efficiency in the management of nursing care, using the primary nursing model, was verified. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing staff and managers should consider adopting a Primary Nursing Model of care to reduce missed nursing care.

Lipomatose epidural idiopática familiar: relato de três casos e revisão da literatura / Familiar Idiopathic Spinal Epidural Lipomatosis: Report of Three Cases and Review of the Literature

Lipomatose epidural é a doença causada pelo aumento da quantidade de gordura no espaço epidural da coluna vertebral, levando à compressão medular ou radicular. A medula toracolombar é a mais comumente envolvida. É geralmente encontrada em homens. As principais causas são a obesidade, altos níveis de corticoides exógenos ou endógenos e hipotireoidismo. A forma idiopática é rara, correspondendo a 17% dos casos. Manifesta-se como mielopatia compressiva ou das raízes da cauda equina. A ressonância magnética é o exame de escolha; sugere-se o diagnóstico quando a espessura da camada de gordura epidural ultrapassa 6 mm. Nós adotamos neste caso a laminectomia com ressecção da gordura epidural, citada como uma das possíveis formas de tratamento. A maioria dos trabalhos demonstramelhora gradual, acentuada ou completa, do déficit neurológico nos primeiros 2 anos após a cirurgia.

Epidural lipomatosis is a disease caused by increased fat content in the epidural space of the spine, leading to root or spinal cord compression. The thoracolumbar spinal cord is themost commonly involved. It is usually found in men. Themain causes are obesity, high levels of exogenous or endogenous steroids and hypothyroidism. The idiopathic form is rare, accounting for 17% of cases. It manifests as compressive myelopathy or radiculopathy. MRI is the test of choice, suggests the diagnosis when the thickness of the epidural fat exceeds 6mm. We adopt in this case laminectomy with fat resection, cited as one of the possible forms of treatment. Most studies show a gradual improvement, marked or complete neurological recovery in the first two years after surgery.

Cisto neuroentérico espinhal: relato de um caso e revisão da literatura / Spinal Neuroenteric Cyst: Report of a Case and Review of the Literature

Cistos neuroentéricos espinhais são anomalias do desenvolvimento, mais comumente encontrados no mediastino posterior e raramente presentes no sistema nervoso central. Geralmente localizados na coluna cervicotorácica. Principalmente encontrados em pacientes jovens e com predomínio no sexo masculino (2:1). Várias hipóteses têmsido sugeridas para explicar a embriogênese dos cistos neuroentéricos, entre elas a mais aceita seria uma incompleta separação entre o ectoderma e o endoderma. Manifesta-se principalmente como dorsalgia e déficit neurológico progressivo. Alguns pacientes apresentam surtos de dor e déficits transitórios. A ressecção completa da lesão, com esvaziamento do cisto e remoção do envoltório, é o tratamento de eleição. As principais complicações pósoperatórias são a recidiva da lesão, aracnoidite e piora do déficit neurológico.

Developmental abnormalities aremore commonly found in the posterior mediastinum and rarely present in the central nervous system. Usually located in the cervical and thoracic spine. Mainly found in young patients with predominance in males (2:1). Several hypotheses have been suggested to explain the embryogenesis of neuroentéricos cysts, including the most accepted would be an incomplete separation between the ectoderm and endoderm. It manifests primarily as back pain and progressive neurological deficits. Some patients experience bouts of pain and transient deficits. Complete resection of the lesion with dissection of the cyst and removing the wrap, is the treatment of choice. The main postoperative complications are recurrence of injury, arachnoiditis and worsening of neurological deficit.

Pacientes com traumatismo cranioencefálico tratados cirurgicamente no serviço de neurocirurgia do Hospital de Base do Distrito Federal (Brasília-Brasil) / Patients with brain injury surgically treated in neurosurgery service at Hospital de Base do Distrito Federal (Brasilia, Brazil)

Objetivo: O traumatismo cranioencefálico (TCE) é uma agressão ao encéfalo causada por uma força física externa. No Brasil, é a principal causa de morte de crianças acima de 5 anos de idade e adolescentes. Apresentamos as características epidemiológicas de 194 pacientes com TCE operados no serviço de neurocirurgia do Hospital de Base do Distrito Federal. Métodos: Trata-se de um estudo descritivo, tipo corte transversal, baseado na revisão de prontuários médicos de pacientes com TCE tratadoscirurgicamente no período de julho de 2007 a julho de 2012. Resultados: Predomínio do sexo masculino (82,99%); a faixa etária mais comum é de 21-40 anos (67); a maioria apresentava TCE grave (108) e o principal mecanismo do trauma foi agressão física (57) seguida por queda da própria altura (49). Hematoma subdural crônico (63), hematoma extradural agudo (49) e fratura com afundamento (38) foram os principais achados tomográficos. Há uma relação entre hematoma subdural crônico (p < 0,05/OR = 1,272/IC 95%: 1,163-1,391), hematoma subdural agudo (p = 0,008/OR = 3,271/IC 95%: 1,309-8,172) e atropelamento (p < 0,05/OR = 8,804/IC 95%: 2,203-35,185) com TCE grave. Conclusão: A maioria dos pacientes era do sexo masculino, na faixa etária entre 21-40 anos, vítima de agressão física e admitida com TCE grave. Há relação entre atropelamento, hematoma subdural agudo e crônico com a gravidade do TCE.

Objective: Traumatic brain injury is an injury to the brain caused by an external physical force. In Brazil, it is the leading cause of death in children over 5 years old and teenagers. We present the epidemiologicalcharacteristics of 194 patients with traumatic brain injury treated at the Serviço de Neurocirurgia do Hospital de Base do Distrito Federal. Methods: This is a descriptive, cross-sectional type, based on review of medical records of patients with traumatic brain injury treated surgically in the period July 2007 to July 2012. Results: There was a predominance of males (82.99%), the most common age group is 21-40 years (67), the majority had severe traumatic brain injury (108), the main mechanism of traumawas physical assault (57) and followed by fall from height (49). Chronic subdural hematoma (63), acute epidural hematoma (49) and fracture dip (38) were the main CT findings. There is a relationship betweenchronic subdural hematoma (p < 0.05/OR = 1,272/95% CI: 1.163 to 1.391), acute subdural (p = 0.008/ OR = 3,271/95% CI: 1.309 to 8.172) and trampling (p < 0.05/OR = 8,804/95% CI: 2.203 to 35.185) with severe traumatic brain injury. Conclusion: Most patients were male, age range between 21-40 years, victims of physical assault and admitted with severe traumatic brain injury. There is a relationship between trampling, acute and chronic subdural hematoma with the severity of traumatic brain injury.