ACOMPANHAMENTO PRÉ-NATAL PRECOCE E A INFLUÊNCIA NO DESFECHO DA GESTAÇÃO: ANÁLISE DO PERFIL EPIDEMIOLÓGICO DE GESTANTES EM UNIDADES DE SAÚDE DO MUNICÍPIO DE PALMAS-TO

Objetivos: Analisar o acompanhamento pré-natal precoce e sua influência no desfecho da gestação. Observar o perfil epidemiológico das gestantes em Palmas, Tocantins. Métodos: Estudo quantitativo e transversal realizado entre o período de janeiro de 2016 a janeiro de 2019 nos centros de saúde comunitária (CSC) das quadras 406 norte e 210 sul em Palmas- Tocantins. Foram avaliadas 178 gestantes por meio de análise do prontuário eletrônico (E-SUS). As análises obervacionais foram realizadas usando Microsoft Excel-2010. As variáveis descritas relacionadas a um pré-natal, foram: idade da paciente, raça, estado marital, escolaridade, renda, início do pré-natal, consultas ambulatoriais e visitas domiciliares. Resultados: O perfil epidemiológico encontrado no estudo foi de mulheres com idade média de 26 anos, as pacientes pardas totalizaram 54% das gestantes, o nível de escolaridade das gestantes participantes do estudo, cerca de 51% do total possuía nível de escolaridade de ensino básico completo (alfabetização), 77% das gestantes iniciaram o pré-natal no primeiro trimestre, cerca de 65% das pacientes tiveram sete ou mais consultas durante o pré-natal e  foram encaminhadas ao serviço de pré-natal de alto risco 19% das gestantes participantes do estudo. Conclusão: O acompanhamento pré-natal de forma precoce contribui para uma gestação mais segura, além de possibilitar intervenções precoces e um tratamento adequado para mãe e feto

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Entre experimentações e experiências: desafios para o ensino das competências para a promoção da saúde na formação do enfermeiro

The aim of this study was to analyse the teaching of competencies for health promotion in Nursing Education and to identify experimentations and experiences in this process. It was a qualitative whose data were collected in focus groups with teachers and students from 11 undergraduate nursing courses in Brazil. The results showed that health promotion competencies are temporally taught in the contact and interaction with reality through experimentations and experiences. Experimentation is an event determined by a specific place and time in the course, while experiences are related to a meaningful discovery and an opening to the unknown. The challenge to the teaching of competencies for health promotion is that it should overcome the logic of experimentation, which is structured on technical rationality, and favour a perspective that allows and values experiences in Nursing education