Pandemia do COVID-19 e implementação de telefonoaudiologia para pacientes em domicílio: relato de experiência / The COVID-19 pandemic and the implementation of telehealth in speech-language and hearing therapy for patients at home: an experience report

RESUMO Apresentamos um relato de experiência de implementação de telefonoaudiologia em tempo real para pacientes que anteriormente eram atendidos em ambulatório em um serviço de atenção primária em saúde. No total, 25 usuários estavam sendo acompanhados pela equipe de fonoaudiologia quando da notificação dos primeiros casos de COVID-19 no sul do Brasil. Destes, julgou-se que 12 pacientes demandavam teleatendimento, pelo menos, quinzenalmente. A teleconsulta disponibilizada nesta primeira etapa, em caráter emergencial na implementação do projeto neste formato, a fim de garantir a manutenção dos atendimentos de pacientes que poderiam sofrer agravamento ou mesmo comorbidades associadas à suspensão da fonoterapia, foram realizadas por telefone, com vídeo, por estudantes de fonoaudiologia, extensionistas do projeto e supervisionadas por um fonoaudiólogo, de forma síncrona. Todas as conversas e orientações durante a teleconsulta são encaminhadas com a maior calma possível e, no caso de pacientes infantis, permeadas por algumas atividades lúdicas. A telessaúde tem se mostrado um recurso eficiente para atendimento de pacientes com demandas fonoaudiológicas, possibilitando o atendimento remoto com a mesma qualidade que o atendimento presencial. Além disso, tem potencial relevante, considerando que há um número significativo de pacientes que precisam de avaliação fonoaudiológica e residem em regiões nas quais há escassez de profissionais qualificados.

ABSTRACT We present an experience report on the implementation of real-time telehealth in speech-language and hearing therapy for patients who were previously seen on an outpatient basis in a primary health care service. The Speech-Language Therapy (SLT) team was monitoring twenty-five users when the first cases of COVID-19 were notified in southern Brazil. Of these, it was judged that twelve patients required at least a monitoring call every two weeks. Teleconsultations were available in this first stage, on an emergency basis, during the implementation of the project in this format. The idea was to guarantee, due to the suspension of the SLT sessions, the maintenance of the care service for patients who could suffer worsening of their cases or even comorbidities. The appointments were carried out by video calls by SLT students, therapists of the extension project, and supervised by a speech-language therapist, synchronously. All conversations and orientations during the teleconsultation were conducted as calmly as possible and, in the case of infant patients, permeated by some playful activities. Telehealth has shown to be an efficient resource for the care of patients with SLT demands, enabling remote care with the same quality as face-to-face care. Besides, it has relevant potential, once there is a significant number of patients, who need SLT assessment and live in regions where there is a shortage of qualified professionals.

¿Cuál es la relación entre el síndrome de burnout, el sentido de la vida y el proyecto de vida laboral en los médicos residentes?: una perspectiva logoterapéutica / What is the relationship between burnout syndrome, the meaning of life and the project of working life in resident physicians ?: a logotherapeutic perspective

Introducción: el síndrome de burnout (BO) suele afectar a médicos residentes, debido al estrés laboral crónico. Desde un marco logoterapéutico, la pérdida de un sentido de la vida (SV) es el denominador más común de todas las formas de perturbación emocional, y el BO podría enmarcarse dentro de un proyecto de vida laboral (PVL) con enrolamiento enajenante. El objetivo principal del trabajo es evaluar la relación entre el BO, el SV y el PVL, en los programas de residencia del Hospital Italiano de Buenos Aires. Población y métodos: se evaluaron residentes de 6 programas de residencia del Hospital Italiano de Buenos Aires, a través de un cuestionario. El BO se midió con el "Maslach Burnout Inventory" (MBI). El SV se midió con el "Purpose in Life Test" (PIL Test). El PVL se midió con la Escala de PVL de la Dra. Isabel Pérez Jáuregui. Resultados: participaron 104 residentes. El 28,8% de los evaluados mostraron BO, el 18,3% falta de SV y el 30,8% un PVL inauténtico con sobreadaptación. Tanto la falta de SV como el PVL inauténtico con sobreadaptación se asociaron en forma estadísticamente significativa con BO (p < 0,01), y la presencia de cualquiera de estas alteraciones aumentó en casi 18 veces (odds ratio [OR] crudo) la probabilidad de presentar el síndrome. Los OR ajustados de falta de SV (6,28) y PVL inauténtico (9,57) para la presencia de BO continuaron siendo estadísticamente significativos. Por último, en esta investigación pudimos determinar que las subescalas del MBI agotamiento y despersonalización se correlacionaron negativamente con el PIL Test (r=-0,41 y r=-0,53, respectivamente) y la Escala de PVL (r=-0,45 y r=-0,42, respectivamente), mientras que la subescala de realización se correlacionó positivamente en forma significativa con estas dos últimas (r=0,63 y r=0,61, respectivamente). Conclusiones: se encontró una relación estadísticamente significativa entre BO, falta de SV y PVL inauténtico, en la residencia. (AU)

Introduction: The Burnout Syndrome (BO) usually affects medical residents because they are exposed to chronic labour stress. From a logotherapeutic view, the loss of meaning and purpose in life (ML) is the common denominator of all types of emotional distress, and the BO could belong to an altered labour life project (LLP) with overadaptation. The objective of this study was to evaluate the relationship between the BO, the ML, and the LLP, in residency programs at a university hospital. Population and methods: residents from six programs at Hospital Italiano de Buenos Aires were evaluated. The BO was measured with the Maslach Burnout Inventory (MBI). The ML was measured with the Purpose in Life Test (Pil Test). The LLP was measured with the LLP Scale created by Doctor Isabel Pérez Jáuregui. Results: one hundred and four residents participated. Out of the evaluated residentes, 28.8% showed BO. The loss of ML was observed in 18.3%, and an altered LLP with overadaptation affected the 30.8% of the sample. Loss of ML and altered LLP with overadaptation were associated in a statistically significant way with BO (p<0.01), and the presence of any of this alterations increased the odds ratio almost 18 times to suffer BO. The adjusted odds ratio of loss of ML (6.28) and altered LLP (9.57) to suffer BO, were also statistically significant. Finally, a negative correlation was observed between exhaustion and despersonalization (MBI) and the Pil Test (r=-0.41 and r=-0.53, respectively) and the LLP Scale (r=-0.45 and r=-0.42, respectively), while a positive significant correlation was observed between the personal accomplishment (MBI) and the Pil Test and LLP Scale (r=0.63 and r=0.61, respectively). Conclusions: in the residency, we found a statistically significant relationship between BO, loss of ML and altered LLP. (AU)