Experiência de pessoas adultas e idosas frente à adesão aos cuidados com a úlcera varicosa

Objetivo: Compreender a experiência de pessoas adultas e idosas frente à adesão aoscuidados com a úlcera varicosa.Método: Pesquisa qualitativa fundamentada em pressupostos da Fenomenologia Social deAlfred Schütz, com 12 pessoas adultas e idosas, em tratamento de úlcera varicosa em ServiçoEspecializado, em Minas Gerais. Os depoimentos foram obtidos de outubro a novembro de2015 e analisados, categorizados e discutidos a partir do referencial teórico-filosófico adotadoe literatura temática.Resultados: Dos depoimentos emergiram as categorias temáticas: “Crenças, atividadespessoais e sociais dificultando a adesão ao cuidado”; “Ser protagonista na relação de cuidadocom a úlcera varicosa” e “Motivação para aderir ao cuidado”.Conclusões: A relação intersubjetiva estabelecida entre as pessoas com úlcera varicosa e osprofissionais de saúde emergiu como força potencializadora da adesão ao cuidado. Valorizar a relação de reciprocidade de perspectivas entre estes atores sociais pode promover maioradesão ao cuidado com a úlcera varicosa.Palavras-chave: Úlcera varicosa. Cuidados de enfermagem. Relações interpessoais.Enfermagem. Pesquisa qualitativa

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Avaliação da satisfação com o atendimento ambulatorial em uma liga de hipertensão na perspectiva da aceitabilidade do usuário

INTRODUCTION: Hypertension (SAH) is a major public health problem because it is a risk factor modifiable for cardiovascular diseases (CVD). User satisfaction is believed to affect adherence to treatment, which is an important aspect. Satisfaction assessment allows understanding user expectations regarding the care and treatment provided. However, few scientific works have been published focusing on the satisfaction of hypertension treatment users. OBJECTIVE: This study aimed to assess the acceptability of the service provided to hypertensive patients at the outpatient clinic of the Hypertension Division of Nephrology Service of the Medicine College of the Universidade Federal de Juiz de Fora. METHODS: This exploratory-descriptive study focused on a quantitative-qualitative approach, and analyzed 80 hypertensive patients of the Hypertension League. A semi-structured interview was used and the following analytical dimensions were assessed: infrastructure, accessibility, relationship between users and health care staff and problem solving ability. The quantitative data analysis was performed using the SAEG software system, while the qualitative data were analyzed through content analysis, according to the focus of this research work. In this study, satisfaction was used as a synonym of acceptability. RESULTS: User satisfaction can be observed mainly in the dimension relationship between users and the health team, in both analyses. The dimension infrastructure showed slight dissatisfaction in to the analyses. Geographical accessibility generated most dissatisfaction, also in both analyses. As for organization accessibility, the nucleus time of waiting presented a split sample for satisfaction and dissatisfaction. However, the qualitative analysis showed user dissatisfaction with this aspect. The dimension problem-solving ability was analyzed only through the qualitative approach, and showed high rate of user satisfaction. CONCLUSION: The analysis of user satisfaction based on the selected dimensions identified strengths in care, including humanized care, ambience and problem solving ability. It was also possible to identify some weak aspects in care, such as geographical accessibility and organizational accessibility. Some dimensions suggest slight dissatisfaction, but it did not affect final satisfaction. Users demonstrated high acceptability of the service provided.INTRODUÇÃO: A Hipertensão Arterial Sistêmica (HAS) constitui um importante problema de saúde pública, por ser um fator de risco modificável para as doenças cardiovasculares (DCV). Uma questão importante é a aderência do paciente ao tratamento. Acredita-se a satisfação do usuário também possa interferir na aderência e a avaliação da satisfação possibilita a compreensão das expectativas dos usuários quanto ao atendimento e tratamento. Contudo, ainda é escassa a produção científica publicada voltada à satisfação dos usuários tratamento da HAS. OBJETIVO: Este estudo teve como objetivo geral avaliar a aceitabilidade dos pacientes hipertensos atendidos no ambulatório da Liga de Hipertensão Arterial do serviço de Nefrologia da Faculdade de Medicina da Universidade Federal de Juiz de Fora relacionado aos serviços que lhe são prestados. MÉTODOS: Tratou-se de um estudo exploratório-descritivo centrado em uma abordagem quantitativa e qualitativa, onde foram analisados 80 usuários hipertensos da Liga de Hipertensão. Foi utilizado a entrevista semi-estruturada e avaliado as dimensões analíticas: infra-estrutura, acessibilidade, relação usuário-equipe de saúde e o item resolutividade. Para análise dos dados quantitativos foi utilizado o software SAEG e os dados qualitativos, analisados através da análise de conteúdo segundo a vertente temática em estudo. Neste estudo a satisfação foi utilizada como um sinônimo da aceitabilidade. RESULTADOS: A satisfação do usuário pode ser observada principalmente na dimensão relação do usuário e equipe de saúde em ambas. A dimensão infraestrutura demonstrou uma leve insatisfação quanto às análises e a acessibilidade geográfica foi a que mais gerou insatisfação, também em ambas as análises. Quanto à acessibilidade organizacional, o núcleo tempo de espera registrou uma amostra dividida quanto à satisfação e insatisfação. Entretanto, a análise qualitativa comprovou a insatisfação do usuário com este aspecto. A dimensão resolutividade foi analisada somente através da abordagem qualitativa, com alto nível de satisfação pelos usuários. CONCLUSÃO: A análise da satisfação dos usuários a partir das dimensões selecionadas permitiu identificar pontos fortes do atendimento, como à assistência humanizada, a ambiência e a resolutividade. Também foi possível identificar alguns aspectos frágeis do atendimento como à acessibilidade geográfica e acessibilidade organizacional. Apesar de algumas dimensões apontarem uma leve insatisfação, esta não influenciou na satisfação final. Comprovou-se uma alta aceitabilidade por parte dos usuários em relação ao serviço prestado.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

Piptadenia gonoacantha-based natural dermocosmetic: a clinical trial

The use of phytotherapy expands the possibility of therapeutic resources for the population, often offering reduced costs when compared to the pharmaceutical industry. In this perspective, the JACBIO® dermocosmetic ointment revealed, in non-clinical trials, its antibacterial and healing potential, with a great stimulating effect in increasing the production of images. This work aimed to carry out the clinical phase study on dermal toxicity, in serious humans, by applying JACBIO®, based on extracts from the leaves of Piptadenia gonoacantha (Pau Jacaré). The phase I randomized clinical trial was carried out with 28 clinically healthy patients at a public university in Minas Gerais, with no period from August to December 2018. The toxicological trial was developed with the intervention group that received a JACBIO® dermatological ointment and the Placebo group. From the experimental protocol, participants were followed for four weeks. An analysis between the ointment and placebo groups, without reference to anticholinergic and cardiovascular events, showed no statistically significant difference. Likewise, there was no difference in laboratory results performed before and after treatment, both for the placebo group and for the intervention group. A low toxicity of the product indicates that this adjustment is safe and serves as a basis for phase II clinical trials in patients with lesions

Antimicrobial activity of dermocosmetic formulations based on Piptadenia gonoacantha

The search for herbal innovations with medicinal properties has intensified. As for this matter, the extracts of Piptadenia gonoacantha, present antimicrobial, anti-inflammatory and antinociceptive action, as well as absence of proven toxicity. The objective was to evaluate the antibacterial action of formulations containing extracts of Piptadenia gonoacantha. The extract was prepared and characterized by liquid chromatography coupled to mass spectrometry (UPLC-MS/MS). This was used for the development of cream, ointment, gel, balm and liquid soaps formulations, being submitted to evaluation, along with the extracts, for antibacterial activity. The characterization of the extract revealed the presence of rutin, ferulic acid, p-coumaric acid, quercitrin, canferol, apigenin and 6-hydroxycoumarin in their constitution. The formulations presented inhibition halos against strains of S. aureus and S. epidermides, with mean efficiency, relative to the positive control, of 47% to 99%. The best results were found for the S. epidermides strain with a mean of 91.5% efficiency in relation to the control. The presence of the metabolites observed in the characterization of the extract justifies the antibacterial action observed in its evaluation, as well as to the formulations. The formulations evaluated have promising antibacterial activity as natural therapeutic alternatives for the treatment of infectious processes

Experiência de pessoas adultas e idosas frente à adesão aos cuidados com a úlcera varicosa

Objetivo: Compreender a experiência de pessoas adultas e idosas frente à adesão aoscuidados com a úlcera varicosa.Método: Pesquisa qualitativa fundamentada em pressupostos da Fenomenologia Social deAlfred Schütz, com 12 pessoas adultas e idosas, em tratamento de úlcera varicosa em ServiçoEspecializado, em Minas Gerais. Os depoimentos foram obtidos de outubro a novembro de2015 e analisados, categorizados e discutidos a partir do referencial teórico-filosófico adotadoe literatura temática.Resultados: Dos depoimentos emergiram as categorias temáticas: “Crenças, atividadespessoais e sociais dificultando a adesão ao cuidado”; “Ser protagonista na relação de cuidadocom a úlcera varicosa” e “Motivação para aderir ao cuidado”.Conclusões: A relação intersubjetiva estabelecida entre as pessoas com úlcera varicosa e osprofissionais de saúde emergiu como força potencializadora da adesão ao cuidado. Valorizar a relação de reciprocidade de perspectivas entre estes atores sociais pode promover maioradesão ao cuidado com a úlcera varicosa.Palavras-chave: Úlcera varicosa. Cuidados de enfermagem. Relações interpessoais.Enfermagem. Pesquisa qualitativa

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt