Fostering Digital Health in Universities: An Experience of the First Junior Scientific Committee of the Brazilian Congress of Health Informatics.

OBJECTIVES: Digital health (DH) is a revolution driven by digital technologies to improve health. Despite the importance of DH, curricular updates in healthcare university programs are scarce, and DH remains undervalued. Therefore, this report describes the first Junior Scientific Committee (JSC) focusing on DH at a nationwide congress, with the aim of affirming its importance for promoting DH in universities. METHODS: The scientific committee of the Brazilian Congress of Health Informatics (CBIS) extended invitations to students engaged in health-related fields, who were tasked with organizing a warm-up event and a 4-hour session at CBIS. Additionally, they were encouraged to take an active role in a workshop alongside distinguished experts to map out the current state of DH in Brazil. RESULTS: The warm-up event focused on the topic "Artificial intelligence in healthcare: is a new concept of health about to arise?" and featured remote discussions by three professionals from diverse disciplines. At CBIS, the JSC's inaugural presentation concentrated on delineating the present state of DH education in Brazil, while the second presentation offered strategies to advance DH, incorporating viewpoints from within and beyond the academic sphere. During the workshop, participants deliberated on the most crucial competencies for future professionals in the DH domain. CONCLUSIONS: Forming a JSC proved to be a valuable tool to foster DH, particularly due to the valuable interactions it facilitated between esteemed professionals and students. It also supports the cultivation of leadership skills in DH, a field that has not yet received the recognition it deserves.

Is it possible to automate the discovery of process maps for the time-driven activity-based costing method? A systematic review.

OBJECTIVES: The main objective of this manuscript was to identify the methods used to create process maps for care pathways that utilized the time-driven activity-based costing method. METHODS: This is a systematic mapping review. Searches were performed in the Embase, PubMed, CINAHL, Scopus, and Web of Science electronic literature databases from 2004 to September 25, 2022. The included studies reported practical cases from healthcare institutions in all medical fields as long as the time-driven activity-based costing method was employed. We used the time-driven activity-based costing method and analyzed the created process maps and a qualitative approach to identify the main fields. RESULTS: A total of 412 studies were retrieved, and 70 articles were included. Most of the articles are related to the fields of orthopedics and childbirth-related to hospital surgical procedures. We also identified various studies in the field of oncology and telemedicine services. The main methods for creating the process maps were direct observational practices, complemented by the involvement of multidisciplinary teams through surveys and interviews. Only 33% of the studies used hospital documents or healthcare data records to integrate with the process maps, and in 67% of the studies, the created maps were not validated by specialists. CONCLUSIONS: The application of process mining techniques effectively automates models generated through clinical pathways. They are applied to the time-driven activity-based costing method, making the process more agile and contributing to the visualization of high degrees of variations encountered in processes, thereby making it possible to enhance and achieve continual improvements in processes.

Validation of targeted selective treatment (TST) methodology for gastrointestinal parasites of adult sheep in different physiological states.

We aimed to validate a targeted selective treatment (TST) methodology for treating parasitic gastrointestinal infections in ewes in different physiological states using parasitological and hematological parameters. Forty ewes were monitored from December 2021 to June 2022 and evaluated during various physiological stages in their life cycle. Before starting the experiment, a fecal egg count (FEC) reduction test was performed to evaluate the efficacy of the anthelmintic (AH) treatment. Weekly assessments were performed based on the Famacha© (F) system and body condition score (BCS), and ewes were subjected to AH treatment when necessary, with their physiological states recorded. Ewes were treated when they presented F ≥ 3, BCS ≤ 2.0 (when F = 2), or submandibular edema. Parasitological, i.e., FEC, and hematological, i.e., hematocrit (Ht), parameters were evaluated monthly to determine the efficiency of the TST methodology. Comparisons between the mean Ht and FEC values in ewes subjected to AH treatment and untreated ewes were performed using analysis of variance, followed by Tukey's test. Spearman's correlation was performed to determine the correlation between the variables, i.e., F scores, BCS, Ht, and FEC. All tests were performed at a significance level of 5 %. During the experimental period, 1138 evaluations were performed. The main reason for AH treatment was F ≥ 3. Ewes in early pregnancy, lactation and late pregnancy received comparatively more AH treatments than the other physiological states. Ewes in late pregnancy and lactation exhibited lower mean Ht values (23.5 % and 22.9 %) and higher mean FEC values (3269 and 1426) compared with those in early pregnancy (30.2 % and 727 EPG). In addition, a statistically significant difference was observed in the Ht and FEC values of ewes that presented submandibular edema (P < 0.001) compared with those that did not exhibit submandibular edema. The genus Haemonchus sp. showed a 96.4 % prevalence in coprocultures. A positive correlation existed between F scores and FEC (r = 0.3819) and a negative correlation between F scores and Ht (r = -0.4728). Ewes that needed AH treatment had lower mean Ht values than ewes that did not need the treatment (19.2 % × 29.3 %; P < 0.001) and higher mean FEC values (8747 × 1163; P < 0.001), confirming that these ewes needed AH treatment. The TST methodology based on F scores, BCS, and submandibular edema could effectively identify individuals in the herd needing AH treatment, identifying 13 % additional cases requiring treatment than using only the F score criterion.

Prediction of the occurrence of leprosy reactions based on Bayesian networks.

Introduction: Leprosy reactions (LR) are severe episodes of intense activation of the host inflammatory response of uncertain etiology, today the leading cause of permanent nerve damage in leprosy patients. Several genetic and non-genetic risk factors for LR have been described; however, there are limited attempts to combine this information to estimate the risk of a leprosy patient developing LR. Here we present an artificial intelligence (AI)-based system that can assess LR risk using clinical, demographic, and genetic data. Methods: The study includes four datasets from different regions of Brazil, totalizing 1,450 leprosy patients followed prospectively for at least 2 years to assess the occurrence of LR. Data mining using WEKA software was performed following a two-step protocol to select the variables included in the AI system, based on Bayesian Networks, and developed using the NETICA software. Results: Analysis of the complete database resulted in a system able to estimate LR risk with 82.7% accuracy, 79.3% sensitivity, and 86.2% specificity. When using only databases for which host genetic information associated with LR was included, the performance increased to 87.7% accuracy, 85.7% sensitivity, and 89.4% specificity. Conclusion: We produced an easy-to-use, online, free-access system that identifies leprosy patients at risk of developing LR. Risk assessment of LR for individual patients may detect candidates for close monitoring, with a potentially positive impact on the prevention of permanent disabilities, the quality of life of the patients, and upon leprosy control programs.

Deception detection with machine learning: A systematic review and statistical analysis.

Several studies applying Machine Learning to deception detection have been published in the last decade. A rich and complex set of settings, approaches, theories, and results is now available. Therefore, one may find it difficult to identify trends, successful paths, gaps, and opportunities for contribution. The present literature review aims to provide the state of research regarding deception detection with Machine Learning. We followed the PRISMA protocol and retrieved 648 articles from ACM Digital Library, IEEE Xplore, Scopus, and Web of Science. 540 of them were screened (108 were duplicates). A final corpus of 81 documents has been summarized as mind maps. Metadata was extracted and has been encoded as Python dictionaries to support a statistical analysis scripted in Python programming language, and available as a collection of Jupyter Lab Notebooks in a GitHub repository. All are available as Jupyter Lab Notebooks. Neural Networks, Support Vector Machines, Random Forest, Decision Tree and K-nearest Neighbor are the five most explored techniques. The studies report a detection performance ranging from 51% to 100%, with 19 works reaching accuracy rate above 0.9. Monomodal, Bimodal, and Multimodal approaches were exploited and achieved various accuracy levels for detection. Bimodal and Multimodal approaches have become a trend over Monomodal ones, although there are high-performance examples of the latter. Studies that exploit language and linguistic features, 75% are dedicated to English. The findings include observations of the following: language and culture, emotional features, psychological traits, cognitive load, facial cues, complexity, performance, and Machine Learning topics. We also present a dataset benchmark. Main conclusions are that labeled datasets from real-life data are scarce. Also, there is still room for new approaches for deception detection with Machine Learning, especially if focused on languages and cultures other than English-based. Further research would greatly contribute by providing new labeled and multimodal datasets for deception detection, both for English and other languages.

Applying process mining in health technology assessment.

Objective: Propose a process mining-based method for Health Technology Assessment. Methods: Articles dealing with prior studies in Health Technology Assessment using Process Mining were identified. Five research questions were defined to investigate these studies and present important points and desirable characteristics to be addressed in a proposal. The was defined method with five steps and was submitted to a case study for evaluation. Results: The Literature search identified six main characteristics. As a result, the five-step method proposed was applied in the radical prostatectomy surgical procedure between the robot assisted technique and laparoscopy. Conclusion: It was demonstrated in this article the creation of the proposal of an efficient method with its replication for other health technologies, coupled with the good interpretation of the specialists in terms of comprehensibility of the discovered patterns and their correlation with clinical protocols and guidelines.

SemClinBr - a multi-institutional and multi-specialty semantically annotated corpus for Portuguese clinical NLP tasks.

BACKGROUND: The high volume of research focusing on extracting patient information from electronic health records (EHRs) has led to an increase in the demand for annotated corpora, which are a precious resource for both the development and evaluation of natural language processing (NLP) algorithms. The absence of a multipurpose clinical corpus outside the scope of the English language, especially in Brazilian Portuguese, is glaring and severely impacts scientific progress in the biomedical NLP field. METHODS: In this study, a semantically annotated corpus was developed using clinical text from multiple medical specialties, document types, and institutions. In addition, we present, (1) a survey listing common aspects, differences, and lessons learned from previous research, (2) a fine-grained annotation schema that can be replicated to guide other annotation initiatives, (3) a web-based annotation tool focusing on an annotation suggestion feature, and (4) both intrinsic and extrinsic evaluation of the annotations. RESULTS: This study resulted in SemClinBr, a corpus that has 1000 clinical notes, labeled with 65,117 entities and 11,263 relations. In addition, both negation cues and medical abbreviation dictionaries were generated from the annotations. The average annotator agreement score varied from 0.71 (applying strict match) to 0.92 (considering a relaxed match) while accepting partial overlaps and hierarchically related semantic types. The extrinsic evaluation, when applying the corpus to two downstream NLP tasks, demonstrated the reliability and usefulness of annotations, with the systems achieving results that were consistent with the agreement scores. CONCLUSION: The SemClinBr corpus and other resources produced in this work can support clinical NLP studies, providing a common development and evaluation resource for the research community, boosting the utilization of EHRs in both clinical practice and biomedical research. To the best of our knowledge, SemClinBr is the first available Portuguese clinical corpus.

Análise de itinerário dos usuários para atendimento de serviços Básicos de Saúde, por meio de Mineração de Processos / Analysis of users' itinerary to service Basic Health services, through Process Mining / Análisis del itinerario de usuarios para el servicio de servicios Básicos de Salud, mediante Minería de Procesos

Objetivo: O objetivo deste trabalho foi analisar o itinerário e o perfil dos usuários, com demandas por atendimentos de saúde nas unidades básicas e de pronto atendimento, por meio da mineração de processos. Método: A base de dados foi extraída do Sistema Informatizado e-Saúde ­ Município de Curitiba, correspondente ao período entre janeiro e dezembro de 2019. Quatro distritos sanitários foram selecionados a partir de critérios de polarização. Para a descoberta do itinerário, foi adotado o software Disco®. Resultado: Foram identificadas situações que não seguem o preconizado pela atenção primária à saúde, desde a consulta médica como sendo o serviço básico de saúde mais frequente realizado nas unidades de pronto atendimento, bem como sendo o primeiro local de busca por atendimento. Conclusão: O critério de polarização para a seleção dos distritos, contribui para que o gestor reveja o processo de trabalho estabelecido para a atenção básica, conforme o respectivo perfil.

Objective: The objective of this study was to analyze the itinerary and profile of users, with demands for health care in primary and emergency care units, through process mining. Method: The database was extracted from the e-Saúde Computerized System ­ Municipality of Curitiba, corresponding to January and December 2019. Four health districts were selected based on polarization criteria. For the discovery of the itinerary, the Disco® software was adopted. Result: Situations that do not follow what is recommended by primary health care were identified since the medical consultation is the most frequent basic health service performed in emergency care units and the first place to seek care. Conclusion: The polarization criterion for selecting districts helps the manager review the work process established for primary care, according to the respective profile.

Objetivo: El objetivo de este estudio fue analizar el itinerario y perfil de los usuarios, con demandas de atención a la salud en las unidades de atención primaria y urgencias, a través de la minería de procesos. Método: La base de datos se extrajo del Sistema Computarizado e-Saúde - Municipio de Curitiba (enero a diciembre de 2019). Se seleccionaron cuatro distritos de salud con base en criterios de polarización. Para el descubrimiento del itinerario se adoptó el software Disco®. Resultado: Se identificaron situaciones que no siguen lo recomendado por la atención primaria de salud, ya que la consulta médica es el servicio básico de salud más frecuente que se realiza en las unidades de atención de emergencia y el primer lugar para buscar atención. Conclusión: El criterio de polarización para la selección de distritos ayuda al gestor a revisar el proceso de trabajo establecido para la atención primaria, según el perfil respectivo.

Clinical applicability of the terminological subset of palliative care for dignified dying.

OBJECTIVE: To evaluate the clinical applicability of the terminological subset of the international classification for the nursing practice of palliative care for a dignified dying, in oncology. METHOD: Prospective study evaluating the clinical applicability of 33 nursing diagnoses/outcomes and 220 nursing interventions. It used case studies of 20 cancer patients undergoing palliation. The nursing process steps were operated by two nurses. Descriptive statistics was used to present, according to the theoretical model, the nursing diagnoses/outcomes and interventions identified in the patients. All statements identified in patients at some point during care were considered applicable in clinical practice. RESULTS: Twenty-nine nursing diagnoses/outcomes and 197 nursing interventions from the subset were identified. CONCLUSION: In the context of palliative care in patients with cancer, the clinical applicability of 87.8% of the diagnoses/outcomes and 89.5% of the interventions that make up the palliative care terminological subset for dignified dying is affirmed.

Representation of Diagnosis and Nursing Interventions in OpenEHR Archetypes.

OBJECTIVE: The study aimed to represent the content of nursing diagnosis and interventions in the openEHR standard. METHODS: This is a developmental study with the models developed according to ISO 18104: 2014. The Ocean Archetype Editor tool from the openEHR Foundation was used. RESULTS: Two archetypes were created; one to represent the nursing diagnosis concept and the other the nursing intervention concept. Existing archetypes available in the Clinical Knowledge Manager were reused in modeling. CONCLUSION: The representation of nursing diagnosis and interventions based on the openEHR standard contributes to representing nursing care phenomena and needs in health information systems.

Domestic violence: a Rodger's evolutionist conceptual analysis.

OBJECTIVE: to analyze the concept of domestic violence based on its use in health sciences, humanities, and exact sciences according to Rodgers' evolutionary model. METHODS: this is a concept analysis based on Rodgers' evolutionary conceptual model. Ninety-six articles were included in Portuguese, English, Spanish, and French, which had a definition of domestic violence, having identified the antecedents, attributes and consequences and produced a model case. RESULTS: twenty-two attributes, ten antecedents and eight consequences were identified. FINAL CONSIDERATIONS: from antecedents, attributes and consequences, it was possible to identify the connection between domestic violence and gender issues, especially patriarchal, being seen in a normalized way by society and causing consequences to the victims' physical and psychological health.

Knowledge discovery in databases para apoio à decisão em atividades vinculadas à enfermagem / Knowledge discovery in databases para apoyar la decisión en actividades relacionadas con la enfermería / Knowledge discovery in databases for the support to decision-making in nursing-related activities

RESUMO Objetivo: relatar experiências de estratégias do uso da mineração de dados em dois cenários de práticas de Enfermagem. Descrição da experiência: em ambas as experiências foi utilizado o algoritmo Apriori para descoberta de regras de associação e identificado as situações de exceção. A primeira experiência utilizou dados provenientes de óbitos infantis da região metropolitana de Curitiba - PR. Na segunda experiência utilizaram-se prontuários de pacientes atendidos por enfermeiros na classificação de risco em um hospital particular de Curitiba - PR. O primeiro estudo identificou 374 regras gerais e o segundo, 108 regras gerais, ambos com suas respectivas regras de exceção. Conclusão: a aplicação do Knowledge Discovery in Databases pode ser demonstrada e efetivada em dois cenários distintos, a fim de contribuir para a tomada de decisão pelo gestor. Espera-se que o relato reforce a importância do ensino da informática em Enfermagem como ferramenta de apoio à decisão.

RESUMEN Objetivo: reportar experiencias de estrategias de uso de minería de datos en dos escenarios de prácticas de enfermería. Descripción del experimento: en ambos experimentos se utilizó el algoritmo Apriori para descubrir reglas de asociación e identificar situaciones excepcionales. El primer experimento utilizó datos de muertes infantiles en la región metropolitana de Curitiba-PR. En el segundo experimento, se utilizaron los registros médicos de los pacientes atendidos por enfermeros en la clasificación de riesgo en un hospital privado de Curitiba-PR. El primer estudio identificó 374 reglas generales y el segundo 108 reglas generales, ambas con sus respectivas reglas de excepción. Conclusión: la aplicación del Knowledge Discovery in Databases se puede demostrar e implementar en dos escenarios diferentes, con el fin de contribuir a la toma de decisiones por parte del gerente. Se espera que el informe refuerce la importancia de la enseñanza de la informática en enfermería como herramienta de apoyo a la toma de decisiones.

ABSTRACT Objective: to report experiences of data mining use strategies in two Nursing practice settings. Description of the experience: in both experiences, the Apriori algorithm was used to discover association rules and to identify exception situations. The first experience used data from infant deaths in the metropolitan region of Curitiba, PR. In the second experience, medical records of patients assisted by nurses were used in the risk classification at a private hospital in Curitiba -PR. The first study identified 374general rules and the second, 108, both with their respective exception rules. Conclusion: the application of Knowledge Discovery in Databases can be demonstrated and carried out in two different settings, in order to contribute to decision-making by the manager. It is expected that the report reinforces the importance of teaching Nursing Informatics as a decision-making support tool.

Domestic violence: a Rodger's evolutionist conceptual analysis / Violencia doméstica: análisis conceptual evolutivo de Rodgers / Violência doméstica: análise conceitual evolucionista de Rodgers

ABSTRACT Objective: to analyze the concept of domestic violence based on its use in health sciences, humanities, and exact sciences according to Rodgers' evolutionary model. Methods: this is a concept analysis based on Rodgers' evolutionary conceptual model. Ninety-six articles were included in Portuguese, English, Spanish, and French, which had a definition of domestic violence, having identified the antecedents, attributes and consequences and produced a model case. Results: twenty-two attributes, ten antecedents and eight consequences were identified. Final considerations: from antecedents, attributes and consequences, it was possible to identify the connection between domestic violence and gender issues, especially patriarchal, being seen in a normalized way by society and causing consequences to the victims' physical and psychological health.

RESUMEN Objetivos: analizar el concepto de violencia intrafamiliar a partir de su uso en las áreas de ciencias de la salud, humanidades y ciencias exactas según el modelo evolutivo de Rodgers. Métodos: análisis de conceptos basado en el modelo conceptual evolutivo de Rodgers. se incluyeron 96 artículos en portugués, inglés, español y francés, los cuales tenían una definición de violencia doméstica, habiéndose identificado los antecedentes, atributos y consecuencias, y se realizó un caso modelo. Resultados: se identificaron 22 atributos, diez antecedentes y ocho consecuentes. Consideraciones finales: a partir de los antecedentes, atributos y consecuencias, se pudo identificar la conexión entre la violencia intrafamiliar y las cuestiones de género, especialmente de carácter patriarcal, siendo visto de manera normalizada por la sociedad, provocando consecuencias en la salud física y psicológica de la víctima.

RESUMO Objetivos: analisar o conceito de violência doméstica baseado em sua utilização nas áreas das ciências da saúde, ciências humanas e ciências exatas segundo o modelo evolucionista de Rodgers. Métodos: análise de conceito baseada no modelo conceitual evolucionista de Rodgers. Foram incluídos 96 artigos nos idiomas português, inglês, espanhol e francês, que apresentavam definição de violência doméstica, tendo sido identificados os antecedentes, atributos e consequentes, sendo confeccionado um caso modelo. Resultados: foram identificados 22 atributos, dez antecedentes e oito consequentes. Considerações finais: a partir dos antecedentes, atributos e consequentes, foi possível identificar a ligação da violência doméstica com questões de gênero, especialmente de cunho patriarcal, sendo vista de forma normalizada pela sociedade, causando consequências à saúde física e psicológica da vítima.

Early Identification of Patients at Risk of Sepsis in a Hospital Environment

Abstract Sepsis is a systematic response to an infectious disease, being a concerning factor because of the increase in the mortality ratio for every delayed hour in the identification and start of patient's treatment. Studies that aim to identify sepsis early are valuable for the healthcare domain. Further, studies that propose machine learning-based models to identify sepsis risk are scarce for the Brazilian scenario. Hence, we propose the early identification of sepsis considering data from a Brazilian hospital. We developed a temporal series based on LSTM to predict sepsis in patients considering a three-day timestep. The patients were selected using both criteria, ICD-10, and qSOFA, where we supplemented qSOFA with the additional identification of words referring to infections in the clinical texts. Additionally, we tested a Random Forest classifier to classify patients with sepsis with a single timestep before the sepsis event, evaluating the most relevant features. We achieved an accuracy of 0.907, a sensitivity of 0.912, and a specificity of 0.971 when considering a three-day timestep with LSTM. The Random Forest classifier achieved an accuracy of 0.971, a sensitivity of 0.611, and a specificity of 0.998. The features age, blood glucose, systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and admission days had the most influence over the algorithm classification, with age being the most relevant feature. We achieved satisfactory results compared with the literature considering a scenario of spaced measures and a high amount of missing data.

Clinical applicability of the terminological subset of palliative care for dignified dying / Aplicabilidad clínica del subconjunto terminológico cuidados paliativos para un morir con dignidad / Aplicabilidade clínica do subconjunto terminológico cuidados paliativos para um morrer com dignidade

ABSTRACT Objective: To evaluate the clinical applicability of the terminological subset of the international classification for the nursing practice of palliative care for a dignified dying, in oncology. Method: Prospective study evaluating the clinical applicability of 33 nursing diagnoses/outcomes and 220 nursing interventions. It used case studies of 20 cancer patients undergoing palliation. The nursing process steps were operated by two nurses. Descriptive statistics was used to present, according to the theoretical model, the nursing diagnoses/outcomes and interventions identified in the patients. All statements identified in patients at some point during care were considered applicable in clinical practice. Results: Twenty-nine nursing diagnoses/outcomes and 197 nursing interventions from the subset were identified. Conclusion: In the context of palliative care in patients with cancer, the clinical applicability of 87.8% of the diagnoses/outcomes and 89.5% of the interventions that make up the palliative care terminological subset for dignified dying is affirmed.

RESUMEN Objetivo: Evaluar la aplicabilidad clínica del subconjunto terminológico de la CIPE para la práctica de enfermería cuidados paliativos para un morir con dignidad, en oncología. Método: Estudio prospectivo, para evaluar la aplicabilidad clínica de 33 diagnósticos/resultados y 220 intervenciones de enfermería. Fueron utilizados estudios de caso de 20 pacientes oncológicos sometidos a paliación. Las etapas del proceso de enfermería fueron operacionalizadas por dos enfermeras. Se utilizó la estadística descriptiva para presentar, de acuerdo con el modelo teórico, los diagnósticos/resultados e intervenciones de enfermería identificados en los pacientes. Fueron considerados aplicables en la práctica clínica todos los enunciados identificados en los pacientes en algún momento de la asistencia. Resultados: Se identificaron 29 diagnósticos/resultados de enfermería y 197 intervenciones de enfermería del subconjunto. Conclusión: En el contexto de los cuidados paliativos en pacientes con enfermedad oncológica se puede afirmar la aplicabilidad clínica de 87,8% de los diagnósticos/resultados y 89,5% de las intervenciones que componen el subconjunto terminológico cuidados paliativos para un morir con dignidad.

RESUMO Objetivo: Avaliar a aplicabilidade clínica do subconjunto terminológico da classificação internacional para a prática de enfermagem cuidados paliativos para um morrer com dignidade, em oncologia. Método: Estudo prospectivo, de avaliação de aplicabilidade clínica de 33 diagnósticos/resultados e 220 intervenções de enfermagem. Usou estudos de caso de 20 pacientes oncológicos em paliação. As etapas do processo de enfermagem foram operacionalizadas por duas enfermeiras. Utilizou-se estatística descritiva para apresentar, conforme o modelo teórico, os diagnósticos/resultados e intervenções de enfermagem identificados nos pacientes. Foram considerados aplicáveis na prática clínica todos os enunciados identificados nos pacientes em algum momento da assistência. Resultados: Foram identificados 29 diagnósticos/resultados de enfermagem e 197 intervenções de enfermagem do subconjunto. Conclusão: No contexto dos cuidados paliativos em pacientes com doença oncológica afirma-se a aplicabilidade clínica de 87,8% dos diagnósticos/resultados e 89,5% das intervenções que compõem o subconjunto terminológico cuidados paliativos para um morrer com dignidade.

Workflow and decision making of operating room nurses: integrative review.

OBJECTIVE: Identify workflow factors in the operating room and their implications, which influence nurses' decision making. METHOD: Integrative review of the literature conducted through searches in the databases: Latin American and Caribbean Literature in Health Sciences; Nursing Database; Pubmed; Scopus and Cumulative Index to Nursing and Allied Health Literature. The results were organized into factors related to positive, negative and positive and negative implications. RESULTS: The sample of 18 articles included examples of factors with positive implications, such as preoperative data collection, negative outcomes, such as lack of human, material and structural resources, and positive and negative outcomes, as preparation for certification. CONCLUSIONS: Factors that influence the decision-making process of nurses are associated to different conditions: client- related conditions and those conditions that go beyond the domain and organization of the surgical environment.

Physiotherapy access for children and adolescents with physical disabilities in public institutions. / Acesso à fisioterapia de crianças e adolescentes com deficiência física em instituições públicas.

This study aims to identify the factors that hinder physically disabled children and adolescent's access to physiotherapy in establishments accredited by the Unified Health System in Curitiba, Paraná, Brazil. This is a cross-sectional study that interviewed managers, physiotherapists, parents or guardians of children with physical disabilities. The perception of difficulties of each interviewed group was compared through descriptive statistics, considering the following realms: availability, purchasing power, information and acceptability. Considering the realm of availability, we identified the following hindrances: distance between the physiotherapy location and user's residence, inadequate supply of services and waiting list. Regarding the purchasing power, we observed the lack of financial resources among parents. Regarding information and acceptability, the lack of information about diagnosis and denial were reported by participants. We can conclude that the physiotherapy service has not been timely assured to children's motor development, so it is necessary to review the organization and distribution of services, and effective policies are required to ensure their use.

Este estudo objetiva identificar os fatores que dificultam o acesso de crianças e adolescentes com deficiência física ao tratamento fisioterapêutico, em estabelecimentos credenciados ao Sistema Único de Saúde em Curitiba, Paraná, Brasil. Trata-se de um estudo transversal que entrevistou gestores, fisioterapeutas, pais e/ou responsáveis por crianças com deficiência física. A percepção de dificuldades de cada um dos grupos de entrevistados foi comparada por meio de estatísticas descritivas, considerando as dimensões: disponibilidade, poder de pagamento, informação e aceitabilidade. Considerando a dimensão disponibilidade, identificaram-se como dificuldades: distância entre o estabelecimento e a residência dos usuários, pouca oferta de serviços e fila de espera. Em relação ao poder de pagamento, observou-se a falta de recursos financeiros entre os pais. Nas dimensões informação e aceitabilidade, a falta de informação acerca do diagnóstico e a negação foram referidas pelos participantes. Conclui-se que o serviço de fisioterapia não tem sido garantido em tempo favorável ao desenvolvimento motor das crianças, de modo que se faz necessário rever a organização e distribuição dos serviços, bem como são essenciais políticas efetivas que garantam a sua utilização.

Acesso à fisioterapia de crianças e adolescentes com deficiência física em instituições públicas / Physiotherapy access for children and adolescents with physical disabilities in public institutions

Resumo Este estudo objetiva identificar os fatores que dificultam o acesso de crianças e adolescentes com deficiência física ao tratamento fisioterapêutico, em estabelecimentos credenciados ao Sistema Único de Saúde em Curitiba, Paraná, Brasil. Trata-se de um estudo transversal que entrevistou gestores, fisioterapeutas, pais e/ou responsáveis por crianças com deficiência física. A percepção de dificuldades de cada um dos grupos de entrevistados foi comparada por meio de estatísticas descritivas, considerando as dimensões: disponibilidade, poder de pagamento, informação e aceitabilidade. Considerando a dimensão disponibilidade, identificaram-se como dificuldades: distância entre o estabelecimento e a residência dos usuários, pouca oferta de serviços e fila de espera. Em relação ao poder de pagamento, observou-se a falta de recursos financeiros entre os pais. Nas dimensões informação e aceitabilidade, a falta de informação acerca do diagnóstico e a negação foram referidas pelos participantes. Conclui-se que o serviço de fisioterapia não tem sido garantido em tempo favorável ao desenvolvimento motor das crianças, de modo que se faz necessário rever a organização e distribuição dos serviços, bem como são essenciais políticas efetivas que garantam a sua utilização.

Abstract This study aims to identify the factors that hinder physically disabled children and adolescent's access to physiotherapy in establishments accredited by the Unified Health System in Curitiba, Paraná, Brazil. This is a cross-sectional study that interviewed managers, physiotherapists, parents or guardians of children with physical disabilities. The perception of difficulties of each interviewed group was compared through descriptive statistics, considering the following realms: availability, purchasing power, information and acceptability. Considering the realm of availability, we identified the following hindrances: distance between the physiotherapy location and user's residence, inadequate supply of services and waiting list. Regarding the purchasing power, we observed the lack of financial resources among parents. Regarding information and acceptability, the lack of information about diagnosis and denial were reported by participants. We can conclude that the physiotherapy service has not been timely assured to children's motor development, so it is necessary to review the organization and distribution of services, and effective policies are required to ensure their use.

Estratégias para previsão da demanda por serviços odontológicos: uma revisão integrativa / Strategies for predicting demand for dental services: an integrative review / Estrategias para pronosticar la demanda de servicios dentales: una revisión integradora

ntrodução:A previsão da demanda por serviços de saúde possibilita melhorias no processo de tomada de decisões gerenciais nas organizações de saúde.Objetivo:O estudo buscou identificar, na literatura, as metodologias utilizadas para prevera demanda por serviçosodontológicos. Metodologia:Trata-se de uma revisão integrativa conduzida de acordo com o método PRISMA. A expressão de busca (((forecast* OR "prediction" OR "prevision") AND ("demand" OR trend*) AND ("dental services"))) foi aplicada em campos determinados para os repositórios Scopus Elsevier, Pubmed, BVS e IEEE Xplore.As metodologias empregadas foram categorizadas conforme a temporalidade e o instrumento empregado nosestudos. Resultados:Após aplicação do processo de seleção-exclusão baseado na recomendação PRISMA, foram selecionados 34 documentos, classificados conforme a dependência da colaboração do paciente, a procedência de auto avaliações, o direcionamento a um grupo populacional ou demanda específica, e a relação com o setor público, privado ou ambos. As metodologias identificadas foram: estudos de temporalidade transversal em que o instrumento foi a aplicação de questionário; estudos de temporalidade transversal nos quais o instrumento foi a observação; e estudo de temporalidade longitudinal onde o instrumento foi a aplicação de questionário. Conclusões:A partir dos resultados dessa revisão, foi gerado conhecimento capaz de apoiar o delineamento de estudos com potencial para aprimorar a previsibilidade da demanda por serviços odontológicos (AU).

Introduction:Forecasting the demand for health services enables improvements in the decision-makingprocess in healthcareorganizations.Objective:The present study aimed to identify in the literature the methodologies used to predict the demand for dental services.Methodology:This was an integrative review conducted in accordance with the PRISMA method. The search expression (((forecast* OR "prediction" OR "prevision") AND ("demand" OR trend*) AND ("dental services"))) was applied to fields determined for the Scopus Elsevier, PubMed, VHL, and IEEE Xplore databases.The identified methodologies were categorized according to temporality and instrument used in the studies.Results:After applying the selection-exclusion process based on Prisma, 34documents were selected, classifiedaccording to patient's collaboration dependence, self-assessments, the targeting of a specific group or demand and the relationship with public, private or both sectors. The methodologies identified were transversal temporality in which the instrument was the application of a questionnaire or observation and longitudinal temporality where the instrument was the application of a questionnaire. Conclusions:From the results of this review, insights were generatedcapable of supporting studies with potential to improve the forecast of dental services (AU).

Introducción: La predicción de la demanda de servicios de salud permite mejorar el procesode decisiones em organizaciones de salud.Objetivo: El estudio buscó identificar, en la literatura, las estrategias utilizadas para predecirla demanda deserviciosdentales.Metodología: Esta es una revisión integradora realizada de acuerdo con el método PRISMA. La expresión de búsqueda (((pronóstico * O "predicción" O "previsión") Y ("demanda" O tendencia *) Y ("servicios dentales"))) se aplicó a los campos determinados para repositorios Scopus Elsevier, Pubmed, BVS y IEEE Xplore.Las metodologías identificadas se categorizaron según la temporalidady el instrumento utilizado em los estudios.Resultados:Tras aplicar el procesode selección-exclusión basado emPrisma, se seleccionaron 34documentos, clasificadossegún la dependencia de colaboración del paciente, las autoevaluaciones a, la focalización de un grupo o demanda específica y la relación con el sector público, privado o ambos. Las metodologíasidentificadas fueron: latemporalidad transversal en los cuales el instrumento era la aplicación de un cuestionario; estudios de temporalidad transversal en los cuales la observación era el instrumento; y estudio de temporalidad longitudinal donde el instrumento fue la aplicación de un cuestionario. Conclusiones: A partir de los resultados de esta revisión se generó conocimiento capaz de sustentar el diseño de estudios con potencial para mejorar la predictibilidad de la demanda de servicios odontológicos (AU).

Workflow and decision making of operating room nurses: integrative review / Flujo de trabajo y toma de decisión del enfermero de centro quirúrgico: revisión integradora / Fluxo de trabalho e tomada de decisão do enfermeiro de centro cirúrgico: revisão integrativa

ABSTRACT Objective: Identify workflow factors in the operating room and their implications, which influence nurses' decision making. Method: Integrative review of the literature conducted through searches in the databases: Latin American and Caribbean Literature in Health Sciences; Nursing Database; Pubmed; Scopus and Cumulative Index to Nursing and Allied Health Literature. The results were organized into factors related to positive, negative and positive and negative implications. Results: The sample of 18 articles included examples of factors with positive implications, such as preoperative data collection, negative outcomes, such as lack of human, material and structural resources, and positive and negative outcomes, as preparation for certification. Conclusions: Factors that influence the decision-making process of nurses are associated to different conditions: client- related conditions and those conditions that go beyond the domain and organization of the surgical environment.

RESUMEN Objetivo: Identificar los factores de flujo de trabajo en centro quirúrgico y sus implicaciones, que influyen en la toma de decisiones de las enfermeras. Método: Revisión integradora de literatura realizada por medio de la consulta en la base de datos: Literatura Latinoamericana y del Caribe en Ciências de la Salud; Base de Datos de Enfermería; Pubmed; Scopus y Cumulative Index to Nursing and Allied Health Literature. Los resultados se organizaron en factores relacionados con implicaciones positivas, negativas y positivas y negativas. Resultados: La muestra de 18 artículos, hubo ejemplos de factores con implicaciones positivas, como la recopilación de datos preoperatorios, implicaciones negativas, como la falta de recursos humanos, materiales y estructurales, y implicaciones positivas y negativas, como preparación para certificación. Conclusiones: Los factores que influyen en la toma de decisiones de las enfermeras están vinculados a diferentes condiciones: las del cliente, las que van más allá del dominio y de la organización del entorno quirúrgico.

RESUMO Objetivo: Identificar fatores do fluxo de trabalho em centro cirúrgico e suas implicações, os quais influenciam a tomada de decisão do enfermeiro. Método: Revisão integrativa da literatura, realizada por buscas nas bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde; Base de Dados de Enfermagem; Pubmed; Scopus e Cumulative Index to Nursing and Allied Health Literature. Os resultados foram organizados em fatores relacionados a implicações positivas, negativas e positivas e negativas. Resultados: Pela amostra de 18 artigos, verificaram-se exemplos de fatores com implicações positivas, como coleta de dados no pré-operatório, negativas, como a falta de recursos humanos, materiais e estruturais, e positivas e negativas, como preparação para a certificação. Conclusões: Fatores que influenciam a tomada de decisão do enfermeiro estão atrelados a distintas condições: as do cliente e as que extrapolam o domínio e a organização do ambiente cirúrgico.