Detecção da hanseniase e a humanização do cuidado: ações do enfermeiro do programa de saúde da familia

The Municipality of São Gonçalo in the Metropolitan Region of Rio de Janeiro - Brazil is considered an endemic area for leprosy according to the Ministry of Health. From this observation, we sought to identify with this work which  actions are performed by nurses from Family Health Program (PSF) to detect leprosy and what care they  provide to people affected by the disease, with the focus on humanization. Thus, we performed descriptive, qualitative and field units in the health of the family of that city, with thirty-one nurses through interviews with open questions. Two categories emerged: the detection actions made by the  nurse, the care given to people affected and the humanization of care needed. It was concluded that the actions taken by the nurses do not follow a single standard and that some lack the necessary training to function with  users of PSF affected by leprosy.El municipio de São Gonçalo, en la Región Metropolitana de Río de Janeiro - Brasil es considerado una zona endémica de la lepra de acuerdo con el Ministerio de Salud. De esta observación, hemos tratado de identificar con este trabajo cuáles son las acciones realizadas por las enfermeras en El Programa de Salud Familiar (PSF) para detectar la lepra y qué tipo de atención prestan a las personas afectadas por la enfermedad, centrándose en la humanización. Así, se realizó investigación descriptiva, cualitativa y de campo en las unidades de salud de la familia de esa ciudad, con treinta y un enfermeros a través de entrevistas con preguntas abiertas. Emergiendo dos categorías: las acciones de detección de la enfermera del PSF, la atención prestada a las personas afectadas y la necesaria humanización de esos cuidados. Se concluyó que las medidas adoptadas por las enfermeras no siguen un estándar único y que algunas no tienen la capacitación necesaria para desenvolverse con los usuarios del PSF afectadas por la lepra.O Município de São Gonçalo na Região Metropolitana do Rio de Janeiro - Brasil é considerado zona endêmica para a Hanseníase segundo dados do Ministério da Saúde. A partir dessa constatação, buscou-se com o presente trabalho identificar quais as ações realizadas pelo enfermeiro do Programa de Saúde da Família (PSF) para detectar a hanseníase e qual o cuidado por ele oferecido às pessoas atingidas pela doença, tendo como foco a humanização. Assim, foi realizada pesquisa descritiva, qualitativa e de campo nas unidades de saúde da família do referido município, com trinta e um enfermeiros através de entrevista com perguntas abertas. Emergindo duas categorias: as ações do enfermeiro do PSF na detecção; os cuidados ministrados às pessoas atingidas e a necessária humanização desses cuidados. Concluiu-se, que as ações realizadas pelos enfermeiros não obedecem a um padrão único e que alguns não possuem a necessária capacitação para atuar com os usuários do PSF atingidos pela hanseníase

Preoperative external beam radiotherapy and reduced dose brachytherapy for carcinoma of the cervix: survival and pathological response

PURPOSE: To evaluate the pathologic response of cervical carcinoma to external beam radiotherapy (EBRT) and high dose rate brachytherapy (HDRB) and outcome. MATERIALS AND METHODS: Between 1992 and 2001, 67 patients with cervical carcinoma were submitted to preoperative radiotherapy. Sixty-five patients were stage IIb. Preoperative treatment included 45 Gy EBRT and 12 Gy HDRB. Patients were submitted to surgery after a mean time of 82 days. Lymphadenectomy was performed in 81% of patients. Eleven patients with residual cervix residual disease on pathological specimen were submitted to 2 additional insertions of HDRB. RESULTS: median follow up was 72 months. Five-year cause specific survival was 75%, overall survival 65%, local control 95%. Complete pelvic pathological response was seen in 40%. Surgery performed later than 80 days was associated with pathological response. Pelvic nodal involvement was found in 12%. Complete pelvic pathological response and negative lymphnodes were associated with better outcome (p = .03 and p = .005). Late grade 3 and 4 urinary and intestinal adverse effects were seen in 12 and 2% of patients. CONCLUSION: Time allowed between RT and surgery correlated with pathological response. Pelvic pathological response was associated with improved outcome. Postoperative additional HDRB did not improve therapeutic results. Treatment was well tolerated