Closed-loop stimulation in periods with less epileptiform activity drives improved epilepsy outcomes.

In patients with drug-resistant epilepsy, electrical stimulation of the brain in response to epileptiform activity can make seizures less frequent and debilitating. This therapy, known as closed-loop responsive neurostimulation (RNS), aims to directly halt seizure activity via targeted stimulation of a burgeoning seizure. Rather than immediately stopping seizures as they start, many RNS implants produce slower, long-lasting changes in brain dynamics that better predict clinical outcomes. Here we hypothesize that stimulation during brain states with less epileptiform activity drives long-term changes that restore healthy brain networks. To test this, we quantified stimulation episodes during low- and high-risk brain states-that is, stimulation during periods with a lower or higher risk of generating epileptiform activity-in a cohort of 40 patients treated with RNS. More frequent stimulation in tonic low-risk states and out of rhythmic high-risk states predicted seizure reduction. Additionally, stimulation events were more likely to be phase-locked to prolonged episodes of abnormal activity for intermediate and poor responders when compared to super-responders, consistent with the hypothesis that improved outcomes are driven by stimulation during low-risk states. These results support the hypothesis that stimulation during low-risk periods might underlie the mechanisms of RNS, suggesting a relationship between temporal patterns of neuromodulation and plasticity that facilitates long-term seizure reduction.

Delays in the diagnosis and surgical treatment of drug-resistant epilepsy: A cohort study.

OBJECTIVE: Delay in referral for epilepsy surgery of patients with drug-resistant epilepsy (DRE) is associated with decreased quality of life, worse surgical outcomes, and increased risk of sudden unexplained death in epilepsy (SUDEP). Understanding the potential causes of delays in referral and treatment is crucial for optimizing the referral and treatment process. We evaluated the treatment intervals, demographics, and clinical characteristics of patients referred for surgical evaluation at our level 4 epilepsy center in the U.S. Intermountain West. METHODS: We retrospectively reviewed the records of patients who underwent surgery for DRE between 2012 and 2022. Data collected included patient demographics, DRE diagnosis date, clinical characteristics, insurance status, distance from epilepsy center, date of surgical evaluation, surgical procedure, and intervals between different stages of evaluation. RESULTS: Within our cohort of 185 patients with epilepsy (99 female, 53.5%), the mean ± standard deviation (SD) age at surgery was 38.4 ± 11.9 years. In this cohort, 95.7% of patients had received definitive epilepsy surgery (most frequently neuromodulation procedures) and 4.3% had participated in phase 2 intracranial monitoring but had not yet received definitive surgery. The median (1st-3rd quartile) intervals observed were 10.1 (3.8-21.5) years from epilepsy diagnosis to DRE diagnosis, 16.7 (6.5-28.4) years from epilepsy diagnosis to surgery, and 1.4 (0.6-4.0) years from DRE diagnosis to surgery. We observed significantly shorter median times from epilepsy diagnosis to DRE diagnosis (p < .01) and epilepsy diagnosis to surgery (p < .05) in patients who traveled further for treatment. Patients with public health insurance had a significantly longer time from DRE diagnosis to surgery (p < .001). SIGNIFICANCE: Both shorter distance traveled to our epilepsy center and public health insurance were predictive of delays in diagnosis and treatment intervals. Timely referral of patients with DRE to specialized epilepsy centers for surgery evaluation is crucial, and identifying key factors that may delay referral is paramount to optimizing surgical outcomes.

Circadian changes in aperiodic activity are correlated with seizure reduction in patients with mesial temporal lobe epilepsy treated with responsive neurostimulation.

OBJECTIVES: Responsive neurostimulation (RNS) is an established therapy for drug-resistant epilepsy that delivers direct electrical brain stimulation in response to detected epileptiform activity. However, despite an overall reduction in seizure frequency, clinical outcomes are variable, and few patients become seizure-free. The aim of this retrospective study was to evaluate aperiodic electrophysiological activity, associated with excitation/inhibition balance, as a novel electrographic biomarker of seizure reduction to aid early prognostication of the clinical response to RNS. METHODS: We identified patients with intractable mesial temporal lobe epilepsy who were implanted with the RNS System between 2015 and 2021 at the University of Utah. We parameterized the neural power spectra from intracranial RNS System recordings during the first 3 months following implantation into aperiodic and periodic components. We then correlated circadian changes in aperiodic and periodic parameters of baseline neural recordings with seizure reduction at the most recent follow-up. RESULTS: Seizure reduction was correlated significantly with a patient's average change in the day/night aperiodic exponent (r = .50, p = .016, n = 23 patients) and oscillatory alpha power (r = .45, p = .042, n = 23 patients) across patients for baseline neural recordings. The aperiodic exponent reached its maximum during nighttime hours (12 a.m. to 6 a.m.) for most responders (i.e., patients with at least a 50% reduction in seizures). SIGNIFICANCE: These findings suggest that circadian modulation of baseline broadband activity is a biomarker of response to RNS early during therapy. This marker has the potential to identify patients who are likely to respond to mesial temporal RNS. Furthermore, we propose that less day/night modulation of the aperiodic exponent may be related to dysfunction in excitation/inhibition balance and its interconnected role in epilepsy, sleep, and memory.

Chronic intracranial recordings after resection for epilepsy reveal a "running down" of epileptiform activity.

We describe an electrical "running down" phenomenon and also a consistent spectral change (in the aperiodic component of the power spectrum) derived from chronic interictal electrocorticography (ECoG) after surgery in a patient with drug-resistant epilepsy. These data were recorded using a closed-loop neurostimulation system that was implanted after resection. The patient has been seizure-free for 2.5 years since resection without requiring the neurostimulator to be turned on to stimulate. Concurrently, there was an exponential decrease in the number of epileptiform electrographic detections recorded by the device, particularly over the first 26 weeks, indicative of an electrical running down phenomenon as the brain adapted to an extended period of seizure freedom. We also find that the aperiodic exponent of the power spectrum gradually decreases over time. The aperiodic component of intracranial ECoG may represent a novel marker of epileptogenicity, independent of seizures.

Patient-specific structural connectivity informs outcomes of responsive neurostimulation for temporal lobe epilepsy.

OBJECTIVE: Responsive neurostimulation is an effective therapy for patients with refractory mesial temporal lobe epilepsy. However, clinical outcomes are variable, few patients become seizure-free, and the optimal stimulation location is currently undefined. The aim of this study was to quantify responsive neurostimulation in the mesial temporal lobe, identify stimulation-dependent networks associated with seizure reduction, and determine if stimulation location or stimulation-dependent networks inform outcomes. METHODS: We modeled patient-specific volumes of tissue activated and created probabilistic stimulation maps of local regions of stimulation across a retrospective cohort of 22 patients with mesial temporal lobe epilepsy. We then mapped the network stimulation effects by seeding tractography from the volume of tissue activated with both patient-specific and normative diffusion-weighted imaging. We identified networks associated with seizure reduction across patients using the patient-specific tractography maps and then predicted seizure reduction across the cohort. RESULTS: Patient-specific stimulation-dependent connectivity was correlated with responsive neurostimulation effectiveness after cross-validation (p = .03); however, normative connectivity derived from healthy subjects was not (p = .44). Increased connectivity from the volume of tissue activated to the medial prefrontal cortex, cingulate cortex, and precuneus was associated with greater seizure reduction. SIGNIFICANCE: Overall, our results suggest that the therapeutic effect of responsive neurostimulation may be mediated by specific networks connected to the volume of tissue activated. In addition, patient-specific tractography was required to identify structural networks correlated with outcomes. It is therefore likely that altered connectivity in patients with epilepsy may be associated with the therapeutic effect and that utilizing patient-specific imaging could be important for future studies. The structural networks identified here may be utilized to target stimulation in the mesial temporal lobe and to improve seizure reduction for patients treated with responsive neurostimulation.

Responsive neurostimulation as a treatment for super-refractory focal status epilepticus: a systematic review and case series.

OBJECTIVE: Super-refractory status epilepticus (SRSE) has high rates of morbidity and mortality. Few published studies have investigated neurostimulation treatment options in the setting of SRSE. This systematic literature review and series of 10 cases investigated the safety and efficacy of implanting and activating the responsive neurostimulation (RNS) system acutely during SRSE and discusses the rationale for lead placement and selection of stimulation parameters. METHODS: Through a literature search (of databases and American Epilepsy Society abstracts that were last searched on March 1, 2023) and direct contact with the manufacturer of the RNS system, 10 total cases were identified that utilized RNS acutely during SE (9 SRSE cases and 1 case of refractory SE [RSE]). Nine centers obtained IRB approval for retrospective chart review and completed data collection forms. A tenth case had published data from a case report that were referenced in this study. Data from the collection forms and the published case report were compiled in Excel. RESULTS: All 10 cases presented with focal SE: 9 with SRSE and 1 with RSE. Etiology varied from known lesion (focal cortical dysplasia in 7 cases and recurrent meningioma in 1) to unknown (2 cases, with 1 presenting with new-onset refractory focal SE [NORSE]). Seven of 10 cases exited SRSE after RNS placement and activation, with a time frame ranging from 1 to 27 days. Two patients died of complications due to ongoing SRSE. Another patient's SE never resolved but was subclinical. One of 10 cases had a device-related significant adverse event (trace hemorrhage), which did not require intervention. There was 1 reported recurrence of SE after discharge among the cases in which SRSE resolved up to the defined endpoint. CONCLUSIONS: This case series offers preliminary evidence that RNS is a safe and potentially effective treatment option for SRSE in patients with 1-2 well-defined seizure-onset zone(s) who meet the eligibility criteria for RNS. The unique features of RNS offer multiple benefits in the SRSE setting, including real-time electrocorticography to supplement scalp EEG for monitoring SRSE progress and response to treatment, as well as numerous stimulation options. Further research is indicated to investigate the optimal stimulation settings in this unique clinical scenario.

Long-Term Intracranial EEG Lateralization of Epileptogenicity in Patients With Confirmed or Suspected Bilateral Mesial Temporal Lobe Onsets During Epilepsy Surgical Evaluation.

PURPOSE: The data resulting from epilepsy surgical evaluation are occasionally unclear in cases of mesial temporal lobe (MTL) epilepsy. Long-term intracranial EEG (iEEG) collected by the Responsive Neurostimulation (RNS) System may be an approach for capturing additional seizure data while treating patients with neurostimulation. We reviewed iEEG seizure lateralization and clinical outcomes in bilateral MTL patients at University of Utah. METHODS: Long-term RNS System iEEG seizure lateralization was compared with pre-RNS System lateralization obtained during surgical evaluation. Safety and clinical outcomes were extracted retrospectively from patient records. RESULTS: Twenty-six patients received an RNS System with bilateral MTL leads. Fifteen of the patients had adequate follow-up to report clinical outcomes (>1 year), and 25 patients had enough recorded data (>6 months) to perform iEEG analysis. Median percent reduction in clinical seizures at last follow-up was 58%, and 40% reported being seizure-free at last follow-up, for variable durations. The electrographic seizure lateralization (unilateral vs. bilateral) differed between surgical evaluation and long-term iEEG in 44% of our patients. In the subset of eight patients (32%) who had only unilateral seizures recorded during surgical evaluation, but were implanted with bilateral MTL leads based on bilateral interictal epileptiform discharges, 62% (5/8) had bilateral seizures recorded on long-term iEEG. Interestingly, in the 18 patients who had bilateral seizures recorded during surgical evaluation, 28% (5/18) were found to be unilateral on long-term iEEG. CONCLUSIONS: Our data suggest that RNS System implantation in suspected bilateral MTL cases may be an option to assess a patient's true seizure lateralization on long-term iEEG. Responsive neuromodulation should be considered before resection or ablation in cases that have evaluation data suggesting bilaterality.

Non-invasive central nervous system assessment of a porcine model of neuropathic pain demonstrates increased latency of somatosensory-evoked potentials.

BACKGROUND: The study of chronic pain and its treatments requires a robust animal model with objective and quantifiable metrics. Porcine neuropathic pain models have been assessed with peripheral pain recordings and behavioral responses, but thus far central nervous system electrophysiology has not been investigated. This work aimed to record non-invasive, somatosensory-evoked potentials (SEPs) via electroencephalography in order to quantitatively assess chronic neuropathic pain induced in a porcine model. NEW METHOD: Peripheral neuritis trauma (PNT) was induced unilaterally in the common peroneal nerve of domestic farm pigs, with the contralateral leg serving as the control for each animal. SEPs were generated by stimulation of the peripheral nerves distal to the PNT and were recorded non-invasively using transcranial electroencephalography (EEG). The P30 wave of the SEP was analyzed for latency changes. RESULTS: P30 SEPs were successfully recorded with non-invasive EEG. PNT resulted in significantly longer P30 SEP latencies (p < 0.01 [n = 8]) with a median latency increase of 14.3 [IQR 5.0 - 17.5] ms. Histological results confirmed perineural inflammatory response and nerve damage around the PNT nerves. COMPARISON WITH EXISTING METHOD(S): Control P30 SEPs were similar in latency and amplitude to those previously recorded invasively in healthy pigs. Non-invasive recordings have numerous advantages over invasive measures. CONCLUSIONS: P30 SEP latency can serve as a quantifiable neurological measure that reflects central nervous system processing in a porcine model of chronic pain. Advancing the development of a porcine chronic pain model will facilitate the translation of experimental therapies into human clinical trials.

Neuropsychological evaluation in American Sign Language: A case study of a deaf patient with epilepsy.

In high-stake cases (e.g., evaluating surgical candidacy for epilepsy) where neuropsychological evaluation is essential to care, it is important to have culturally and linguistically appropriate and accessible neuropsychological instruments and procedures for use with deaf individuals who use American Sign Language (ASL). Faced with these ethical and professional issues, clinicians may be unable to provide equitable services without consulting with other psychologists and collaborating with the patient and interpreter. This is a case report describing a 43-year-old male with bilateral sensorineural deafness and a lifelong history of drug-resistant temporal lobe epilepsy who presented as a candidate for a comprehensive neurological workup to determine surgical candidacy. He was bilingual (ASL and written English). We describe all aspects of the evaluation, including functional magnetic resonance imaging (fMRI) and Wada testing, using an ASL interpreter. Results from the neuropsychological evaluation were not clearly lateralizing, but suggested greater compromise to the non-dominant right hemisphere. fMRI and Wada test results revealed language and verbal memory functions were lateralized to the left hemisphere. The patient was deemed to be an adequate candidate for surgical resection of portions of the right hemisphere. Comprehensive assessment of neuropsychological functioning in deaf persons who use ASL is feasible. This case report illustrates the important considerations relevant to neuropsychologists providing culturally and linguistically informed assessments to deaf ASL users with epilepsy. Additional research in this area will support future efforts to develop effective and efficient models that could be implemented across different settings. Moreover, clinical guidance is warranted to guide professionals interested in promoting access to high quality neuropsychological services.

Feasibility of non-invasive recording of somatosensory evoked potential in pigs.

BACKGROUND: Non-invasive measurement of somatosensory-evoked potentials (SEP) in a large animal model is important to translational cognitive research. We sought to develop a methodology for neurophysiological recording via a transcranial electroencephalography (EEG) cap under an effective sedative regimen with dexmedetomidine, midazolam, and butorphanol that will produce sedation instead of anesthesia while not compromising data quality. RESULTS: Pigs received intramuscular dexmedetomidine, midazolam, and butorphanol for SEP assessment with peroneal nerve stimulation. Semi-quantitative sedation assessment was performed after the animal was sufficiently sedated and 30 min later, during the transcranial SEP recording. SEP data were analyzed with commercial software. Binary qualitative analysis of the recording was categorized by an experienced neurophysiologist. All four animals had adequate surface SEP recordings. Animals received 43 [21-47] mcg/kg of dexmedetomidine, 0.3 [0.2-0.3] mg/kg of midazolam, and 0.3 [0.3-0.3] mg/kg of butorphanol IM. All treatments resulted in moderate to deep sedation (Baseline median sedation score 11.5 [11-12]; median score at 30 min: 11.5 [10.5-12]). Heart rate (median [range]) (55 [49-71] beats per minute), respiratory rate (24 [21-30] breaths per minute), and hemoglobin oxygen saturation (99 [98-100]%) and body temperature (37.7 [37.4-37.9] °C) remained within clinically acceptable ranges. There were no undesirable recovery incidents. CONCLUSIONS: In this pilot study, we demonstrate the feasibility of SEP recording via a transcranial EEG cap under an effective sedative regimen in pigs. Our approach will expand the use of a large animal model in neurotranslational research.

Ethel Parsons' biographical characteristics: leadership in American and Brazilian nursing.

OBJECTIVE: to reconstruct Ethel Parsons' biographical aspects in the centenary of the technical cooperation mission for nursing development in Brazil. METHOD: biographical research, carried out using the historical sources analysis method, which consists of reading and interpreting the collected documents. RESULTS: from a renowned family, Ethel Parsons was head of public health services and worked for the American Red Cross before being appointed to coordinate the Rockefeller Foundation mission in Brazil, where she inaugurated the Anglo-American model of nursing. For ten years, Parsons dedicated herself to leading such a mission, which resulted in implementation and dissemination, by decree, of the Anglo-American model of nursing. In 1931, she returned to her country, where she died in 1953. CONCLUSION: Ethel Parsons stood out in the 20th century as a woman and a nurse, leading public health care services in the USA and Brazil. Her biography demonstrates an ideal of professionalization and science to be conquered by nursing in the care and educational scenario, which influenced the design of a collective identity for Brazilian nursing.

Working conditions of a nursing team in mental health facility.

OBJECTIVE: To analyze how the nursing team from a Psychosocial Care Center II relates its insertion in the service with the work process. METHODS: Descriptive, analytical research outlined as a case study with a qualitative approach. The data were collected through semi-structured interviews with nursing professionals and went through content analysis subsidized by Bardin's work. RESULTS: Two thematic categories emerged: a) Ways of intake in the nursing services at the Psychosocial Care Center; b) Setbacks in nursing routine at the Psychosocial Care Center. FINAL CONSIDERATIONS: The fact that the professionals have not planned to work in mental health nor have training impacts the rhythm of psychosocial care development at the Psychosocial Care Center, forcing them to seek training in the field after admission. Unmotivated by the working conditions, the nursing team suffers from the absence of an interdisciplinary partnership and goes to great lengths to approach psychosocial care.

A systematic exploration of parameters affecting evoked intracranial potentials in patients with epilepsy.

BACKGROUND: Brain activity is constrained by and evolves over a network of structural and functional connections. Corticocortical evoked potentials (CCEPs) have been used to measure this connectivity and to discern brain areas involved in both brain function and disease. However, how varying stimulation parameters influences the measured CCEP across brain areas has not been well characterized. OBJECTIVE: To better understand the factors that influence the amplitude of the CCEPs as well as evoked gamma-band power (70-150 Hz) resulting from single-pulse stimulation via cortical surface and depth electrodes. METHODS: CCEPs from 4370 stimulation-response channel pairs were recorded across a range of stimulation parameters and brain regions in 11 patients undergoing long-term monitoring for epilepsy. A generalized mixed-effects model was used to model cortical response amplitudes from 5 to 100 ms post-stimulation. RESULTS: Stimulation levels <5.5 mA generated variable CCEPs with low amplitude and reduced spatial spread. Stimulation at ≥5.5 mA yielded a reliable and maximal CCEP across stimulation-response pairs over all regions. These findings were similar when examining the evoked gamma-band power. The amplitude of both measures was inversely correlated with distance. CCEPs and evoked gamma power were largest when measured in the hippocampus compared with other areas. Larger CCEP size and evoked gamma power were measured within the seizure onset zone compared with outside this zone. CONCLUSION: These results will help guide future stimulation protocols directed at quantifying network connectivity across cognitive and disease states.

Enfermera visitadora modelo vanguardista de cuidados de salud en España / Enfermeira de saúde pública modelo vanguardista de cuidados na Espanha / The public health nurse cutting-edge care model in Spain

Resumen Objetivo analizar la figura de la enfermera visitadora española en el periodo comprendido entre 1921 y 1953. Método estudio histórico-social, cualitativo, a partir de fuentes documentales primarias y secundarias. Se utilizó el Modelo Estrutural Dialético de Atención (MEDC), como soporte al proceso de gestión y análisis de datos. Resultados las enfermeras visitadoras españolas tenían el título de especialistas en salud pública, adquirido en Bedford College, en Inglaterra, o en la Fundación Rockefeller, en Estados Unidos. Actuaban en entornos rurales y urbanos, realizando su trabajo en Centros Primarios y Secundarios de Higiene Rural, lugares donde educaban a la población en las normas de higiene personal y salud pública. Conclusión e implicaciones para la práctica la enfermera visitadora española consiguió extender la educación sanitaria por todo el país, promover los hábitos higiénicos y nutricionales de la población en general, reducir la incidencia de las enfermedades infecto-contagiosas y promover las reformas sanitarias que se iniciaron a principios del siglo XX. En la actualidad, la figura de la enfermera visitadora puede ser considerada como precursora de la enfermera especialista en atención familiar y comunitaria.

Resumo Objetivo analisar a figura da enfermeira visitadora espanhola no período de 1921 a 1953. Método estudo histórico-social, qualitativo, a partir de fontes documentais primárias e secundárias. Utilizou-se o Modelo Estrutural Dialético de Atenção (MEDC) como suporte ao processo de gerenciamento e análise de dados. Resultados as enfermeiras visitadoras espanholas tinham o título de especialistas em saúde pública, adquirido no Bedford College, na Inglaterra, ou na Fundação Rockefeller, nos Estados Unidos. Atuavam em ambientes rurais e urbanos, realizando seu trabalho em Centros de Higiene Rural Primários e Secundários, locais onde educavam a população sobre as regras de higiene pessoal e de saúde pública. Conclusão e implicações para a prática a enfermeira visitadora espanhola conseguiu expandir a educação em saúde em todo o país, promover hábitos higiênicos e nutricionais para a população em geral, reduzir a incidência de doenças infectocontagiosas e promover reformas sanitárias iniciadas no início do século XX. Atualmente, a figura da enfermeira visitadora pode ser considerada como precursora da enfermeira especialista em cuidados familiares e comunitários.

Abstract Objective to analyze the figure of the Spanish visiting nurse from 1921 to 1953. Method This is a historical-social, qualitative study based on primary and secondary documentary sources. The Dialectical Structural Model of Care (DSSM) was used to support the data management and analysis process. Results Spanish visiting nurses had specialization in public health, acquired at Bedford College, in England, or at the Rockefeller Foundation, in the United States. They worked in rural and urban environments, performing their work in Primary and Secondary Centers of Rural Hygiene, where they educated the population about personal hygiene and public health rules. Conclusion and implications for practice Spanish nurse visitors were able to expand health education throughout the country, promote hygienic and nutritional habits for the general population, reduce the incidence of infectious-contagious diseases, and promote sanitary reforms that began at the beginning of the 20th century. Currently, the figure of the visiting nurse can be considered a forerunner of the specialist nurse in family and community care.

Repercussões psicoemocionais em estudantes de enfermagem na pandemia do covid-19: estudo descritivo-exploratório / Psycho-emotional repercussions in nursing students during the covid-19 pandemic: a descriptive-exploratory study

OBJETIVO: Identificar as repercussões psicoemocionais da pandemia da Covid-19 em estudantes do último ano do curso de Enfermagem e as estratégias de enfrentamento adotadas por eles. MÉTODO: Trata-se de uma pesquisa qualitativa descritiva exploratória realizada por meio de entrevista com questionário semiestruturado composto por questões abertas sobre o tema. RESULTADOS: Foram criadas duas categorias temáticas: Repercussões da pandemia da Covid-19 na dimensão psicoemocional de estudantes do último ano do curso de Enfermagem e Estratégias de enfrentamento adotadas, durante a pandemia da Covid-19, pelos estudantes do último ano do curso de Enfermagem. Os resultados apontaram um aumento significativo das crises de ansiedade, desmotivação, dificuldade de concentração, distúrbios do sono e do repouso. CONCLUSÃO: Faz-se necessário o desenvolvimento de estratégias intersetoriais de promoção da saúde e prevenção relacionadas à saúde mental em parceria com as instituições de ensino.

OBJECTIVE: To determine the psycho-emotional impact of the Covid-19 pandemic on final-year nursing students and their coping strategies. METHOD: This is a qualitative, descriptive, exploratory research conducted through interviews with a semi-structured questionnaire consisting of open-ended questions on the topic. RESULTS: Two thematic categories were identified: Repercussions of the Covid-19 pandemic on the psycho-emotional dimension of final-year nursing students and coping strategies adopted by final-year nursing students during the Covid-19 pandemic. The results indicated a significant increase in anxiety crises, demotivation, concentration difficulties, sleep disturbances, and rest-related problems. CONCLUSION: Developing interdisciplinary health promotion and prevention strategies related to mental health in partnership with educational institutions becomes necessary.

Ethel Parsons' biographical characteristics: leadership in American and Brazilian nursing / Rasgos biográficos de Ethel Parsons: liderazgo en la enfermería americana y brasileña / Traços biográficos de Ethel Parsons: uma liderança na enfermagem norte-americana e brasileira

ABSTRACT Objective: to reconstruct Ethel Parsons' biographical aspects in the centenary of the technical cooperation mission for nursing development in Brazil. Method: biographical research, carried out using the historical sources analysis method, which consists of reading and interpreting the collected documents. Results: from a renowned family, Ethel Parsons was head of public health services and worked for the American Red Cross before being appointed to coordinate the Rockefeller Foundation mission in Brazil, where she inaugurated the Anglo-American model of nursing. For ten years, Parsons dedicated herself to leading such a mission, which resulted in implementation and dissemination, by decree, of the Anglo-American model of nursing. In 1931, she returned to her country, where she died in 1953. Conclusion: Ethel Parsons stood out in the 20th century as a woman and a nurse, leading public health care services in the USA and Brazil. Her biography demonstrates an ideal of professionalization and science to be conquered by nursing in the care and educational scenario, which influenced the design of a collective identity for Brazilian nursing.

RESUMEN Objetivo: reconstruir aspectos biográficos de Ethel Parsons en el centenario de la misión de cooperación técnica para el desarrollo de la enfermería en Brasil. Método: investigación biográfica, realizada mediante el método de análisis de fuentes históricas, que consiste en la lectura e interpretación de los documentos recopilados. Resultados: de una familia renombrada, Ethel Parsons fue jefa de servicios de salud pública y trabajó para la Cruz Roja Americana antes de ser designada para coordinar la misión de la Fundación Rockefeller en Brasil, donde inauguró el modelo angloamericano de enfermería. Durante diez años, Parsons se dedicó a liderar tal misión, que resultó en la implementación y difusión, por decreto, del modelo angloamericano de enfermería. En 1931 regresó a su país, donde falleció en 1953. Conclusión: Ethel Parsons se destacó en el siglo XX como mujer y enfermera, al frente de los servicios públicos de salud en EUA y Brasil. Su biografía demuestra un ideal de profesionalización y ciencia a ser conquistado por la enfermería en el escenario asistencial y educativo, lo que influyó en el diseño de una identidad colectiva para la enfermería brasileña.

RESUMO Objetivo: reconstruir aspectos biográficos de Ethel Parsons no centenário da missão de cooperação técnica para o desenvolvimento da enfermagem no Brasil. Método: pesquisa biográfica, realizada pelo método de análise de fontes históricas, que consiste em leitura e interpretação dos documentos coletados. Resultados: de família renomada, Ethel Parsons ocupou chefias de serviços de saúde pública e atuou na Cruz Vermelha Americana antes de ser indicada para coordenar a missão da Fundação Rockefeller no Brasil, onde inaugurou o modelo anglo-americano de enfermagem. Por dez anos, Parsons se dedicou a liderar tal missão, que resultou na implantação e difusão, por força de decreto, do modelo anglo-americano de enfermagem. Em 1931, retornou a seu país, onde faleceu em 1953. Conclusão: Ethel Parsons se destacou no século XX como mulher e enfermeira, liderando serviços assistenciais de saúde pública nos EUA e no Brasil. Sua biografia demonstra um ideal de profissionalização e ciência a ser conquistado pela enfermagem no cenário assistencial e educacional, que influenciou no delineamento de uma identidade coletiva da enfermagem brasileira.

Usuários de substâncias psicoativas: desafios à assistência de enfermagem na Estratégia Saúde da Família / Usuarios de sustancias psicoactivas: desafíos para la atención de enfermería en la Estrategia de Salud de la Familia / Users of psychoactive substances: challenges to nursing care in the Family Health Strategy

RESUMO Objetivo analisar a assistência de Enfermagem ao usuário de substâncias psicoativas na Estratégia Saúde da Família. Método estudo descritivo e qualitativo realizado com sete enfermeiros da Estratégia Saúde da Família de Juiz de Fora, Minas Gerais. Os dados foram obtidos por meio de entrevistas guiadas por um roteiro semiestruturado e a Análise Temática de Conteúdo foi utilizada para o seu tratamento. Resultados a assistência prestada pelos entrevistados é pautada na demanda espontânea, sem estratégias de busca ativa, com a valorização de práticas orientadas pela medicalização da pessoa e o encaminhamento aos serviços especializados. A inclusão da família no processo de reabilitação, o atendimento imediato e o exercício da escuta terapêutica foram mencionados como estratégias que podem ser adotadas para uma assistência integral. Os desafios mencionados referiram-se à falta de formação em saúde mental, à fragmentação do conhecimento acerca da especialidade, à ausência de capacitações e ao desejo do paciente em participar do tratamento. Considerações finais e implicações para a prática os enfermeiros referiram um cuidado insuficiente para a garantia da integralidade da assistência permeado pela falta de conhecimentos e habilidades para lidar com esse público, o que leva ao encaminhamento para serviços especializados como principal intervenção, reforçando a necessidade de capacitação desses profissionais.

RESUMEN Objetivo analizar la atención de Enfermería a usuarios de sustancias psicoactivas en la Estrategia Salud de la Familia. Método estudio descriptivo y cualitativo realizado con siete enfermeros de la Estrategia Salud de la Familia en Juiz de Fora, Minas Gerais. Los datos fueron obtenidos a través de entrevistas guiadas por un guion semiestructurado y se utilizó el Análisis de Contenido Temático para su tratamiento. Resultados la asistencia proporcionada por los entrevistados se basa en la demanda espontánea, sin estrategias de búsqueda activa, con la valoración de prácticas guiadas por la medicalización de la persona y la derivación a servicios especializados. La inclusión de la familia en el proceso de rehabilitación, la atención inmediata y el ejercicio de la escucha terapéutica fueron mencionadas como estrategias que pueden ser adoptadas para la atención integral. Los desafíos mencionados se refirieron a la falta de formación en salud mental, la fragmentación del conocimiento sobre la especialidad, la falta de formación y el deseo del paciente de participar en el tratamiento. Consideraciones finales e implicaciones para la práctica los enfermeros mencionaron cuidados insuficientes para garantizar una atención integral permeada por la falta de conocimientos y habilidades para el trato con este público, lo que lleva a la derivación a servicios especializados como principal intervención, reforzando la necesidad de formación de estos profesionales.

ABSTRACT Objective to analyze the nursing care provided to users of psychoactive substances in the Family Health Strategy. Method a descriptive and qualitative study carried out with seven nurses from the Family Health Strategy of Juiz de Fora, Minas Gerais. Data was obtained through interviews guided by a semi-structured script and the Thematic Content Analysis was used for its treatment. Results the care provided by the interviewees is based on spontaneous demand, without active search strategies, with the valorization of practices guided by the medicalization of the person and the referral to specialized services. The inclusion of the family in the rehabilitation process, immediate care, and therapeutic listening were mentioned as strategies that can be adopted for an integral assistance. The challenges mentioned referred to the lack of training in mental health, the fragmentation of knowledge about the specialty, the absence of training, and the patient's desire to participate in the treatment. Final considerations and implications for the practice the nurses reported insufficient care to ensure comprehensive care permeated by a lack of knowledge and skills to deal with this public, which leads to referral to specialized services as the main intervention, reinforcing the need to train these professionals.

Signos do vestuário de enfermeira na formatura / Señales de ropa de enfermería en la formatura / Signs of the nurse's clothing at graduation

Resumo Objetivo Analisar os uniformes usados na cerimônia de formatura de enfermeiras e seus significados para a identidade profissional. Método Estudou-se uma escola de enfermagem de Minas Gerais, no período de 1947 até 1964. Pesquisa qualitativa, histórico-social, mediante a qual foram analisados documentos escritos, fotográficos e orais, considerando as bases conceituais de identidade profissional, do sociólogo Claude Dubar, e de vestuário e seus significados simbólicos, de Roland Barthes. Resultados O uniforme das enfermeiras, usado na formatura, possuía signos de identidade institucional e profissional. Foi constituído pelo clássico vestido branco, com touca e outros acessórios. Conclusões e implicações para a prática O uniforme de formatura de enfermeiras correspondeu aos avanços da moda e da cientificidade, configurando-se uma marca na construção do papel e consolidação da identidade profissional, contribuindo para a identificação de uma categoria profissional em formação.

Resumen Objetivo Analizar los uniformes utilizados en la ceremonia de graduación de enfermeras y sus significados para la identidad profesional. Método Se estudió una escuela de enfermería de Minas Gerais, relativo al periodo de 1947 a 1964. Investigación cualitativa, histórico-social, en la que se analizaron documentos escritos, fotográficos y orales, considerando las bases conceptuales de la identidad profesional, del sociólogo Claude Dubar, y de vestuario y sus significados simbólicos, de Roland Barthes. Resultados El uniforme de las enfermeras, utilizado en la graduación, presentaba señales de identidad institucional y profesional. Consistía en el clásico vestido blanco, con gorra y otros complementos. Conclusiones e implicaciones para la práctica El uniforme de graduación de enfermeras correspondió a los avances de moda y cientificidad, convirtiéndose en una marca en la construcción y consolidación de la identidad profesional, contribuyendo para la identificación de una categoría profesional en formación.

Abstract Objective to analyze the uniforms used in the graduation ceremony of nurses and their meanings for professional identity. Method A nursing school in Minas Gerais was studied from the period of 1947 to 1964. Qualitative, social-historical research, through which written, photographic and oral documents were analyzed, considering the conceptual bases of professional identity, by the sociologist Claude Dubar, and of clothing and its symbolic meanings, by Roland Barthes. Results The nurses' uniform used at graduation had institutional and professional identity signs. It consisted of the classic white dress, with a cap and other accessories. Conclusions and implications for practice The nurse's graduation uniform corresponded to the advances in fashion and scientificity, becoming a mark in the construction of the role and a consolidation of professional identity, contributing to the identification of a professional category in training.

Protocolos para atendimento de saúde mental na atenção primária: subsídios para transformação da assistência / Protocols for mental health care in primary-level services: subsidies for transforming the assistance provided / Protocolos para la atención de la salud mental en la atención primaria: contribuciones para transformar la atención

RESUMO Objetivo: analisar as repercussões no atendimento em saúde mental pela implantação de Protocolos de Conduta Assistencial em Unidade Básica de Saúde, em Juiz de Fora - MG - BR. Método: estudo histórico-social, realizado no ano de 2018, tendo por fontes diretas, documentos escritos e depoimentos orais, analisadas pelos pressupostos da Reforma Psiquiátrica. Resultados: apresentam-se as categorias: a) Reorganização da assistência em saúde mental por implantação de Protocolos de Conduta; b) Processo de referência e contrarreferência entre Unidade Básica de Saúde e serviços de atenção especializada em saúde mental; c) Transformação da assistência em saúde mental. Conclusão: protocolos organizaram a rede de atenção em saúde mental, sustentando a capacitação multiprofissional, introduzindo atenção primária à saúde como porta de entrada para acolhimento, tratamento e acompanhamento em saúde mental territorial.

ABSTRACT Objective: to analyze the repercussions on mental health care due to the implementation of Care Conduct Protocols in a Basic Health Unit from Juiz de Fora (Minas Gerais - Brazil). Method: a historical-social study carried out in 2018, having as direct sources written documents and oral testimonies analyzed according to the assumptions of the Psychiatric Reform. Results: the following categories are presented: a) Reorganization of mental health care through the implementation of Conduct Protocols; b) Referral and counter-referral process between Basic Health Units and specialized mental health care services; and c) Transformation of mental health care. Conclusion: the protocols organized the mental health care network, supporting multiprofessional training, introducing Primary Health Care as a gateway to welcoming, treatment and monitoring in territorial mental health.

RESUMEN Objetivo: analizar las repercusiones que tiene sobre la atención en salud mental la implantación de Protocolos de Conducta Asistencial en una Unidad Básica de Salud de Juiz de Fora (Minas Gerais - Brasil). Método: estudio histórico-social, realizado en 2018, cuyas fuentes directas son los documentos escritos y testimonios orales analizados según los presupuestos de la Reforma Psiquiátrica. Resultados: se presentan las categorías: a) Reorganización de la atención en salud mental a través de la implantación de Protocolos de Conducta; b) Proceso de derivación y contraderivación entre la Unidad Básica de Salud y los servicios de atención especializada en salud mental; c) Transformación de la atención en salud mental. Conclusión: los protocolos organizaron la red de atención en salud mental, apoyando la formación multidisciplinaria, instaurando la Atención Primaria de la Salud como puerta de entrada para la recepción, el tratamiento y seguimiento de la salud mental del territorio.

Rapidly Progressive Quadriplegia and Encephalopathy.

A woman aged 77 years was transferred to our neurocritical care unit for evaluation and treatment of rapidly progressive motor weakness and encephalopathy. Examination revealed an ability to follow simple commands only and abnormal movements, including myoclonus, tongue and orofacial dyskinesias, and opsoclonus. Imaging study findings were initially unremarkable, but when repeated, they demonstrated enhancement of the cauda equina nerve roots, trigeminal nerve, and pachymeninges. Cerebrospinal fluid examination revealed mildly elevated white blood cell count and protein levels. Serial electrodiagnostic testing demonstrated a rapidly progressive diffuse sensory motor axonopathy, and electroencephalogram findings progressed from generalized slowing to bilateral periodic lateralized epileptiform discharges. Critical details of her recent history prompted a diagnostic biopsy. Over time, the patient became completely unresponsive with no further abnormal movements and ultimately died. The differential diagnosis, pathological findings, and diagnosis are discussed with a brief review of a well-known yet rare diagnosis.