Longitudinality in primary health care: an integrative literature review / Longitudinalidade na atenção primária à saúde: revisão integrativa da literatura

Objetivo: analisar a produção científica que descreve a longitudinalidade na Atenção Primária à Saúde e verificar como ocorre nos serviços. Método: revisão integrativa da literatura de estudos que tratam sobre a longitudinalidade do cuidado nos serviços. Foram utilizadas as bases de dados Literatura Latino-America e Caribe em Ciências da Saúde, Public MEDLINE, SciVerseScopus e no Portal Regional da Biblioteca Virtual em Saúde utilizando os termos: “Primary Health Care”, “Longitudinality” e “Public Health”. Resultados: 18 artigos, os quais foram categorizados pela sua similaridade nos temas: estudos sobre os atributos da APS, participação dos usuários na efetivação da longitudinalidade e longitudinalidade no cuidado à criança. Conclusão: a confiança mútua entre profissionais e usuários, a continuidade da atenção, a escuta, a credibilidade e a vinculação do usuário com os profissionais configuram a longitudinalidade nos serviços de saúde

Evaluation of Waste Related to the Admission Process of Low-Complexity Patients in Emergency Services, in Light of the Lean Healthcare Philosophy

The adequacy of work processes in healthcare services contributes to the quality of care provided to the patient. However, in emergency units, overcrowding is a constant reality, resulting in the lack of materials and long waiting lines. Taking this into consideration, this study aimed to map and analyze the value stream of patients classified as blue, green, or yellow in a Referral Emergency Unit. The evaluation research with analysis of processes was carried out in a teaching hospital on 30 patients seen at the emergency service. Value Stream Maps were drawn and the times involved in the process were calculated. Wastes and their possible causes were identified. A total of 13 maps were created and the mean process time between the activities involved in the process ranged between 7.3′ and 114.0′; the interruption time, between 0′ and 27.6′; the waiting time, between 43.2′ and 507.5′; and the lead time between 56.6′ and 638.0′ min. Some causes of waste were: high demand from patients; a shortage of personnel and offices. Following the Ishikawa Diagram, most of the waste is found regarding methods, human resources, and physical structure

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

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field