Relato de experiência como facilitadora do curso Técnico em Prótese Dentária pelo Centro Formador de Recursos Humanos – CEFOR/RH / Experience report as facilitator of the Dental Prosthesis Technician course by the Human Resources Training Center - CEFOR / RH

Um relato de experiência vivenciado na área do ensino-aprendizagem promove uma releitura de como a educação aprimorada e cautelosamente entrelaçada numa didática explicativa, emite reflexos positivos e reais para os receptores do assunto exposto, através não só de textos verbais mas também de práticas inovadoras. Reuniões pedagógicas e planejamentos, durante essa trajetória, nos permitiram aprimorar mais ainda a forma atenuante do exercício da docência em questão. Promover alunos sedentos de conhecimento a oportunidade de ter um crescimento tecnológico, foi simplesmente gratificante e recompensador para os propagadores desse projeto. As atividades foram desenvolvidas com a primeira turma do curso técnico em prótese dentária, no turno da manhã e tarde, no período de novembro de 2016 a novembro de 2018, no município de João Pessoa. O objetivo deste trabalho é relatar a experiência das autoras na condução de um grupo de alunos em sua formação pelo Centro de Formador de Recursos Humanos da Paraíba (CEFOR), desse modo, criando propostas para o ensino e, principalmente auxiliando aos iniciantes da jornada. 

Manejo Terapêutico do Paciente Queimado: Revisão de Literatura

Burns are traumatic wounds resulting from thermal, chemical, electrical or radioactive agents that compromise vital skin functions. In Brazil, they constitute one of the main external causes of death, alongside transport accidents and homicides. An integrative review was carried out, using the Google Scholar database with the following descriptors “Burn”, “Pain Management”, “Therapeutic Indication”. In which 8 articles were selected from 1,710, published in English and Portuguese from 2019 to 2024. The main author conducted the analysis, with disagreements resolved between the authors. WHO estimates indicate 300,000 annual deaths from burns globally. In Brazil, one million people suffer burns annually, with young adults being the most vulnerable, mainly in domestic or work environments. The classification of burns, extent of the affected area and treatment are fundamental for the best therapeutic management, given that pain is a prevalent complaint that is difficult to control in these patients. Protocols vary, and wound care, hydration, and pain management are challenges. Different therapies, including agents such as silver sulfadiazine and essential fatty acids, show promising results. Surgical treatment aims to remove compromised tissues, contributing to effective healing. The study reinforces the importance of medical knowledge in the management of burns and its relevance to public health.As queimaduras são feridas traumáticas resultantes de agentes térmicos, químicos, elétricos ou radioativos que comprometem funções vitais tanto da pele, como dos demais órgãos internos. No Brasil, constituem uma das principais causas externas de morte, disputando com acidentes de transporte e homicídios. Realizou-se uma revisão integrativa, utilizando a base de dados Google Acadêmico com os seguintes descritores “Queimadura”, “Manejo da Dor”, “Indicação Terapêutica”. Nos quais foram selecionados 8 artigos entre 1.710, publicados em inglês e português de 2019 a 2024. O autor principal conduziu a análise, com discordâncias resolvidas entre os autores. Estimativas da OMS indicam 300 mil mortes anuais por queimaduras globalmente. No Brasil, um milhão de pessoas anualmente sofrem queimaduras, sendo adultos jovens mais vulneráveis, principalmente em ambientes domésticos ou laborais. A classificação das queimaduras, extensão da área afetada e o tratamento são fundamentais para o melhor manejo terapêutico, haja vista que a dor é uma queixa prevalente e de difícil controle nesses pacientes. Protocolos variam, e o cuidado da ferida, hidratação e manejo da dor são desafios. Diferentes terapias, incluindo agentes como sulfadiazina de prata e ácidos graxos essenciais, apresentam resultados promissores. O tratamento cirúrgico visa a remoção de tecidos comprometidos, contribuindo para a cicatrização eficaz. O estudo reforça a importância do conhecimento médico na abordagem de queimaduras e sua relevância para a saúde pública

Guidance on mucositis assessment from the MASCC Mucositis Study Group and ISOO: an international Delphi studyResearch in context

Summary: Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022–July 2023). The first phase involved a survey to MASCC-MSG members (January 2022–May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023–May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received

At-admission prediction of mortality and pulmonary embolism in an international cohort of hospitalised patients with COVID-19 using statistical and machine learning methods

By September 2022, more than 600 million cases of SARS-CoV-2 infection have been reported globally, resulting in over 6.5 million deaths. COVID-19 mortality risk estimators are often, however, developed with small unrepresentative samples and with methodological limitations. It is highly important to develop predictive tools for pulmonary embolism (PE) in COVID-19 patients as one of the most severe preventable complications of COVID-19. Early recognition can help provide life-saving targeted anti-coagulation therapy right at admission. Using a dataset of more than 800,000 COVID-19 patients from an international cohort, we propose a cost-sensitive gradient-boosted machine learning model that predicts occurrence of PE and death at admission. Logistic regression, Cox proportional hazards models, and Shapley values were used to identify key predictors for PE and death. Our prediction model had a test AUROC of 75.9% and 74.2%, and sensitivities of 67.5% and 72.7% for PE and all-cause mortality respectively on a highly diverse and held-out test set. The PE prediction model was also evaluated on patients in UK and Spain separately with test results of 74.5% AUROC, 63.5% sensitivity and 78.9% AUROC, 95.7% sensitivity. Age, sex, region of admission, comorbidities (chronic cardiac and pulmonary disease, dementia, diabetes, hypertension, cancer, obesity, smoking), and symptoms (any, confusion, chest pain, fatigue, headache, fever, muscle or joint pain, shortness of breath) were the most important clinical predictors at admission. Age, overall presence of symptoms, shortness of breath, and hypertension were found to be key predictors for PE using our extreme gradient boosted model. This analysis based on the, until now, largest global dataset for this set of problems can inform hospital prioritisation policy and guide long term clinical research and decision-making for COVID-19 patients globally. Our machine learning model developed from an international cohort can serve to better regulate hospital risk prioritisation of at-risk patients

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19

Importance: Research diversity and representativeness are paramount in building trust, generating valid biomedical knowledge, and possibly in implementing clinical guidelines. Objectives: To compare variations over time and across World Health Organization (WHO) geographic regions of corticosteroid use for treatment of severe COVID-19; secondary objectives were to evaluate the association between the timing of publication of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial (June 2020) and the WHO guidelines for corticosteroids (September 2020) and the temporal trends observed in corticosteroid use by region and to describe the geographic distribution of the recruitment in clinical trials that informed the WHO recommendation. Design, setting, and participants: This prospective cohort study of 434 851 patients was conducted between January 31, 2020, and September 2, 2022, in 63 countries worldwide. The data were collected under the auspices of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC)-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Analyses were restricted to patients hospitalized for severe COVID-19 (a subset of the ISARIC data set). Exposure: Corticosteroid use as reported to the ISARIC-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Main outcomes and measures: Number and percentage of patients hospitalized with severe COVID-19 who received corticosteroids by time period and by WHO geographic region. Results: Among 434 851 patients with confirmed severe or critical COVID-19 for whom receipt of corticosteroids could be ascertained (median [IQR] age, 61.0 [48.0-74.0] years; 53.0% male), 174 307 (40.1%) received corticosteroids during the study period. Of the participants in clinical trials that informed the guideline, 91.6% were recruited from the United Kingdom. In all regions, corticosteroid use for severe COVID-19 increased, but this increase corresponded to the timing of the RECOVERY trial (time-interruption coefficient 1.0 [95% CI, 0.9-1.2]) and WHO guideline (time-interruption coefficient 1.9 [95% CI, 1.7-2.0]) publications only in Europe. At the end of the study period, corticosteroid use for treatment of severe COVID-19 was highest in the Americas (5421 of 6095 [88.9%]; 95% CI, 87.7-90.2) and lowest in Africa (31 588 of 185 191 [17.1%]; 95% CI, 16.8-17.3). Conclusions and relevance: The results of this cohort study showed that implementation of the guidelines for use of corticosteroids in the treatment of severe COVID-19 varied geographically. Uptake of corticosteroid treatment was lower in regions with limited clinical trial involvement. Improving research diversity and representativeness may facilitate timely knowledge uptake and guideline implementation