Práticas sustentáveis no âmbito hospitalar: percepção dos enfermeiros

Aim: to know nurses’ perceptions about the environmental sustainability within the hospital environment. Method: this is an exploratory-descriptive study, with a qualitative approach, performed in four hospitals of the 1st, 4th, 17th and 18th Regional Health Coordinations of the State of Rio Grande do Sul. It was developed between September 2013 and February 2014, with the participation of 26 nurses. Data analysis complied with the precepts of Discursive Textual Analysis. Results: the reports originating from the interviewees highlighted that nursing practices in hospital sustainability are exclusively shown under the obedience of hospital organizational structures, dependence on legislation and in the construction of organizational values. Final Considerations: the construction of sustainable practices is linked to the inheritance of the bureaucratic, normative and categorical administrative model in the decision-making process of the formation of sustainable beliefs and values.Objetivo: conocer las percepciones de los enfermeros sobre la sostenibilidad ambiental en el ámbito hospitalario. Método: estudio exploratorio-descriptivo, de perspectiva cualitativa, realizado en cuatro hospitales de la 1ª, 4ª, 17ª y 18ª Coordinaciones Regionales de Salud del Estado de Rio Grande do Sul. Fue desarrollado entre los meses de septiembre de 2013 y febrero de 2014, con 26 enfermeros. El análisis de los datos siguió los preceptos del Análisis Textual Discursivo. Resultados: los informes originarios de los encuestados señalaron que las prácticas de enfermería sobre sostenibilidad hospitalaria se presentan exclusivamente por la obediencia de estructuras organizacionales de los hospitales, el cumplimiento de la legislación y la construcción de valores organizacionales. Consideraciones Finales: la construcción de prácticas sostenibles está relacionada con la herencia del modelo administrativo burocrático, normativo y categórico en el proceso decisorio de la formación de credos y valores sostenibles.Objetivo: conhecer as percepções de enfermeiros acerca da sustentabilidade ambiental no âmbito hospitalar. Método: estudo exploratório-descritivo, com abordagem qualitativa, realizado em quatro hospitais da 1ª; 4ª; 17ª e 18ª Coordenadorias Regionais de Saúde do Estado do Rio Grande do Sul. Foi desenvolvido entre os meses de setembro de 2013 e fevereiro de 2014, tendo como participantes 26 Enfermeiros. Análise dos dados seguiu os preceitos da Análise Textual Discursiva. Resultados: os relatos emergentes dos entrevistados indicaram que as práticas de enfermagem na sustentabilidade hospitalar apresentam-se exclusivamente sob obediência de estruturas organizacionais dos hospitais, dependência da legislação e na construção de valores organizacionais. Considerações Finais: a construção de práticas sustentáveis está atrelada à herança do modelo administrativo burocrático, normativo e categórico no processo decisório da formação de crenças e valores sustentáveis

JUDICIALIZAÇÃO: FORMA NÃO PACTUADA DO ACESSO À REDE DE ATENÇÃO À SAÚDE

O objetivo do estudo foi o de identificar outras formas de acesso, além da pactuada, ao ambulatório do hospital universitário de referência da microrregião litoral lagunar do estado do Rio Grande do Sul, Brasil. O método utilizado foi o estudo de casos múltiplos integrados realizado em 2016, em que a coleta dos dados foi por entrevistas com gestores; profissionais de saúde; serviço de regulação em saúde; e representantes do controle social, utilizando um roteiro inspirado na proposta da Organização Pan-Americana de Saúde para avaliação das redes de atenção à saúde e em uma adaptação baseada no questionário proposto por Eugênio Vilaça Mendes, para avaliação do seu grau de integração; e acesso a documentos emitidos por órgãos do Poder Judiciário. As unidades integradas de análise foram as secretarias municipais de saúde (Unidade 1) da microrregião estudada e o hospital universitário de referência (Unidade 2). Foi utilizada a análise textual discursiva e o corpus analisado a partir dos textos produzidos por entrevistas (Evidência 1) e documentos (Evidência 2). Nos resultados: constatou-se a existência de casos de judicialização como forma de acesso ao ambulatório do hospital de referência da microrregião. Conclui-se que a inversão do fluxo de acesso não atende os princípios e diretrizes do Sistema Único de Saúde quanto à equidade, criando outro fluxo não baseado na necessidade imediata do usuário, mas sim em deliberações não pactuadas

Formação do enfermeiro em relação ao processo de morte-morrer: percepções à luz do pensamento complexo

Objetivou-se conhecer a percepção do processo de morte-morrer na perspectiva de discentes de enfermagem. Pesquisa exploratório-descritiva de caráter qualitativo, cujos dados foram coletados entre junho e julho de 2013, a partir de três encontros focais, com seis discentes de enfermagem de um Centro Universitário Comunitário localizado na região central do Rio Grande do Sul. Os encontros foram organizados/dinamizados de modo que ampliassem as discussões acerca do processo morte-morrer na perspectiva do pensamento complexo. Da Análise Focal Estratégica dos dados, foram delimitadas três categorias: Morte: processo de ruptura ou continuidade?; Reconhecendo fragilidades no processo de formação e Delineando estratégias capazes de ampliar as discussões acadêmicas. Conclui-se que o processo de mortemorrer é minimamente discutido na formação profissional do enfermeiro e quando discutido, os debates ocorrem de forma fragmentada e disjuntiva, não integrando-o ao processo de viver humano

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Chimerism monitoring using biallelic single nucleotide or insertion/deletion polymorphisms : how many markers to screen?

Background/aims: Chimerism monitoring by means of high-throughput sequencing or quantitative PCR of biallelic single nucleotide and insertion/deletion polymorphisms has shown potential for improved patient care when compared to the gold standard capillary electrophoresis assays. When designing chimerism assays the number of markers to screen needs consideration: it determines the informativity rate and accuracy of the assay, but screening too many markers increases the assay's cost and complexity. The minimal number of biallelic markers to screen is currently unstudied.Materials/methods: A simulation framework accounting for marker minor allele frequencies, the number of markers screened, marker allelic constellations and donor-recipient relatedness was constructed. The framework was validated through analysis of 324 clinical samples.Results: Empirical clinical data confirm the validity of the simulation framework. With guidelines suggesting to monitor at least three informative markers, we demonstrate that, for optimized assays, at least 40 biallelic markers need to be screened to achieve enough informative markers in over 99% of cases. We propose and discuss several assay optimization strategies.Conclusion: Currently used chimerism assays often screen too little or too many markers, leaving room for optimization. Through support of the simulation framework here introduced and validated, more informative, cost-effective chimerism assays can be designed

Bias reduction improves accuracy and informativity of high-throughput sequencing chimerism assays

Background and aims: Chimerism monitoring by means of high-throughput sequencing of biallelic polymorphisms has shown promising advantages for patient follow-up after hematopoietic stem cell transplantation. Yet, the presence of method bias precludes achievement of an assay's theoretically attainable informativity rate, as method bias necessitates the exclusion of some markers. This method bias arises because of preferential obser-vation of one allele over the other, and for some allelic constellations because of stochasticity.Results: This paper suggests how preferential allelic observation may lead to method bias, and when and why such bias necessitates the exclusion of markers. It is shown that also markers that remain informative suffer a reduction in trueness and precision due to method bias. A bias reduction approach in the data analysis phase is introduced and shown to improve trueness and precision under all circumstances, meriting its universal adop-tion. This bias reduction furthermore allows to achieve an assay's theoretically achievable informativity rate, though at the cost of reduced sensitivity. Several strategies to consider in the assay design phase that may lower biases are proposed.Conclusion: Improved design and data analysis of chimerism assays increase the accuracy, applicability, and cost-effectiveness of high-throughput sequencing chimerism assays

Mediastinal Myeloid Sarcoma with TP53 Mutation Preceding Acute Myeloid Leukemia with a PICALM-MLLT10 Fusion Gene

INTRODUCTION: Myeloid sarcoma (MS), previously known as granulocytic sarcoma or chloroma, is a rare neoplastic condition defined as a tumor mass consisting of myeloblasts or immature myeloid cells occurring at an extramedullary site. Clinical presentation is diverse and determined by a tumor mass effect or local organ dysfunction. CASE REPORT: We report the case of a 25-year-old previously healthy male with rapidly progressive shortness of breath. A chest CT scan demonstrated a heterogenous anterosuperior mediastinal mass with pleural and pericardial invasion. A diagnosis of MS with both myeloid and lymphoid characteristics was made by pathologic, morphologic, and immunophenotypic investigation. Next generation analysis revealed a pathogenic TP53 mutation (c.1035_1036insCT, p.Glu346Leufs*25). After 4 cycles of chemotherapy only a partial metabolic response and tumor size reduction was obtained. A pretransplant bone marrow biopsy revealed the progression of disease to acute myeloid leukemia. Cytogenetic analysis demonstrated a t(10; 11)(p12;q21). Fluorescence in situ hybridization confirmed the presence of a PICALM-MLLT10 fusion gene. CONCLUSION: MS with a mediastinal localization is rare and often misdiagnosed as malignant lymphoma. Acute leukemia harboring a PICALM-MLLT10 fusion gene is characterized by a mixed T cell and myeloid phenotype. The rearrangement is a rare recurrent translocation associated with specific clinical features, as illustrated in this case report.status: publishe