Metodologia de atenção à gestante e família: relato de experiência com grupo operativo

Academic extension experience report, developed with pregnat women and their family members. This report aims to share the experience and discuss, according to Pichonian theory, about the reason that justifies the use of thematic triggers in pregnant women and family members. The activity is interdisciplinary, congregating teachers and students of Nursing, Nutrition, Physiotherapy and Psychology, who use the operative groups’ methodology. The use of the thematic triggers, in pregnant women and family members, has contributed to carry out the task, for therapeutic support to people who experience event that contributes to change their lives – the pregnancy. Because its interdisciplinary characteristic, the accounted activity, has stimulated the work in group and contributed to the formation of a new Operative Reference Conceptual Scheme to each teacher and student and to the group as a wholeRelato de experiencia de extensión universitaria desarrollado con grupos de gestantes y familiares. El objetivo del relato es compartir experiencias y discutir, a la luz del referencial de la Teoría Pichoniana, sobre los motivos que justifican el uso de disparadores temáticos en las mujeres embarazadas y sus familiares. La actividad es interdisciplinar y reúne los profesores y académicos de Enfermería, Nutrición, Fisioterapia y Psicología, mediante el empleo de la metodología de los grupos operativos. El uso de los disparadores temáticos a lo largo de los grupos de gestantes y sus familias ha contribuido para dar soporte terapéutico a estas personas cuando viven un acontecimiento que contribuye a cambiar sus vidas - el embarazo de un hijo. Debido a la naturaleza interdisciplinar, esta actividad ha fomentado el trabajo en equipo y contribuyó a la formación de un nuevo Esquema Conceptual Referencial Operativo para cada profesor y el alumno y para el grupo en su conjunto.Relato de experiência de extensão universitária, desenvolvida com grupos de gestantes e familiares. O objetivo do relato é compartilhar a experiência e discutir, à luz da teoria Pichoniana, acerca dos motivos que justificam o uso de disparadores temáticos em grupos de gestantes e familiares. A atividade é interdisciplinar, reunindo docentes e acadêmicos de Enfermagem, Nutrição, Fisioterapia e Psicologia, por meio do emprego da metodologia de grupos operativos. O uso dos disparadores temáticos junto aos grupos de gestantes e familiares tem contribuído para dar suporte terapêutico a essas pessoas quando vivenciam acontecimento que contribui para mudar-lhes a vida – a gestação de um filho. Em virtude do caráter interdisciplinar, a atividade tem estimulado o trabalho em grupo e contribuído para a formação de um novo Esquema Conceitual Referencial Operativo para cada professor e estudante e para o grupo como um todo

Metodologia de atenção à gestante e família: relato de experiência com grupo operativo

Academic extension experience report, developed with pregnat women and their family members. This report aims to share the experience and discuss, according to Pichonian theory, about the reason that justifies the use of thematic triggers in pregnant women and family members. The activity is interdisciplinary, congregating teachers and students of Nursing, Nutrition, Physiotherapy and Psychology, who use the operative groups’ methodology. The use of the thematic triggers, in pregnant women and family members, has contributed to carry out the task, for therapeutic support to people who experience event that contributes to change their lives – the pregnancy. Because its interdisciplinary characteristic, the accounted activity, has stimulated the work in group and contributed to the formation of a new Operative Reference Conceptual Scheme to each teacher and student and to the group as a wholeRelato de experiencia de extensión universitaria desarrollado con grupos de gestantes y familiares. El objetivo del relato es compartir experiencias y discutir, a la luz del referencial de la Teoría Pichoniana, sobre los motivos que justifican el uso de disparadores temáticos en las mujeres embarazadas y sus familiares. La actividad es interdisciplinar y reúne los profesores y académicos de Enfermería, Nutrición, Fisioterapia y Psicología, mediante el empleo de la metodología de los grupos operativos. El uso de los disparadores temáticos a lo largo de los grupos de gestantes y sus familias ha contribuido para dar soporte terapéutico a estas personas cuando viven un acontecimiento que contribuye a cambiar sus vidas - el embarazo de un hijo. Debido a la naturaleza interdisciplinar, esta actividad ha fomentado el trabajo en equipo y contribuyó a la formación de un nuevo Esquema Conceptual Referencial Operativo para cada profesor y el alumno y para el grupo en su conjunto.Relato de experiência de extensão universitária, desenvolvida com grupos de gestantes e familiares. O objetivo do relato é compartilhar a experiência e discutir, à luz da teoria Pichoniana, acerca dos motivos que justificam o uso de disparadores temáticos em grupos de gestantes e familiares. A atividade é interdisciplinar, reunindo docentes e acadêmicos de Enfermagem, Nutrição, Fisioterapia e Psicologia, por meio do emprego da metodologia de grupos operativos. O uso dos disparadores temáticos junto aos grupos de gestantes e familiares tem contribuído para dar suporte terapêutico a essas pessoas quando vivenciam acontecimento que contribui para mudar-lhes a vida – a gestação de um filho. Em virtude do caráter interdisciplinar, a atividade tem estimulado o trabalho em grupo e contribuído para a formação de um novo Esquema Conceitual Referencial Operativo para cada professor e estudante e para o grupo como um todo

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research