Programa de melhoria da qualidade nos cuidados em serviços de saúde: estudo de reflexão

The aim was to reflect on the potential of applying the continuous quality improvement model, disseminated by the Institute for Healthcare Improvement (IHI) in health services. This is a reflective study on the application of the continuous quality improvement model in national and international research. The purpose of the model is to improve healthcare outcomes and the patient experience through changes in the behavior of healthcare professionals and institutions and by systematically applying changes to complex processes and systems. Furthermore, the model consists of three fundamental questions that are combined with the PDSA cycle (Plan-Do-Study-Act). The impacts of these cycles on care processes and patient safety were also presented. Studies that used this methodology showed a reduction in adverse events and improvement in care processes in health services. Thus, the continuous quality improvement model should be widely used in clinical practice and research to improve care provided to all patients and at all levels of health care with limited resources and without great costs.Objetivou-se  refletir sobre a potencialidade da aplicação do modelo de melhoria contínua da qualidade, difundido pelo Institute for Healthcare Improvement (IHI) em serviços de saúde. Trata-se de um estudo reflexivo sobre a aplicação do modelo de melhoria contínua da qualidade nas pesquisas nacionais e internacionais. A finalidade do modelo é melhorar os resultados em saúde e a experiência do paciente, por meio de mudanças no comportamento dos profissionais e instituições de saúde e pela aplicação sistemática de mudanças em processos e sistemas complexos. Ademais o modelo é constituído por três perguntas fundamentais que são combinadas com o ciclo PDSA (Plan-Do-Study-Act). Também foram apresentados os impactos desses ciclos nos processos assistenciais e na segurança do paciente. Os estudos que utilizaram tal metodologia demonstraram redução de eventos adversos e melhoria nos processos assistenciais em serviços de saúde. Com isso, o modelo de melhoria contínua da qualidade deve ser utilizado amplamente na prática clínica e nas pesquisas para melhorar a assistência prestada a todos os pacientes e em todos os níveis de atenção à saúde com recursos limitados e sem grandes custos

Avaliação de neuropatia sensitiva motora do pé de pacientes portadores de Diabetes Mellitus tipo 2 atendidos em unidades de saúde de Vila Velha e Centro de Especialidades Médicas e Atenção à Saúde (CEMAS) / Evaluation of motor sensory neuropathy of the foot of patients with type 2 Diabetes Mellitus treated at health units in Vila Velha and a Center for Medical Specialties and Health Care

Introdução: O pé diabético é conceituado no glossário do Consenso Internacional como infecção, ulceração e/ou destruição de tecidos moles associados a alterações neurológicas e vários graus de doença arterial periférica (DAP) nos membros inferiores. Objetivo: Avaliar a neuropatia sensitiva motora do pé de 52 pacientes portadores do diabetes mellitus tipo 2 participantes do HIPERDIA das Unidades de Saúde de Vila Nova, Ibes e do CEMAS. Método: Foi aplicado um questionário avaliando fatores de risco para ulceração dos pés como: polineuropatia periférica (PND), deformidades (PND motora, biodinâmica, limitação da mobilidade articular), trauma, doença arterial periférica (DAP), histórico de úlcera e/ou histórico de amputação, nefropatia, retinopatia, morar sozinho, inacessibilidade ao sistema de saúde. Além disso, foi realizado exame físico para avaliar a sensibilidade protetora plantar utilizando monofilamento de náilon de 10 g, diapasão 128Hz para estímulo de vibração em saliência óssea, palito para avaliação de dor em qualquer ponto plantar e martelo para avaliação dos reflexos tendíneos (Aquileu). Resultados e Discussão: Foram avaliados 52 pacientes, dos quais 63,46% eram mulheres e 36,54% homens com a faixa etária entre 44 a 89 anos, tendo como idade média 64,65 ± 8,79 anos. Todos tinham acesso ao Sistema Único de Saúde (SUS), 38,46% já tinham neuropatia instalada e dentre os 61,54% restantes, que não possuíam neuropatia, apenas 6,25% foram classificados com perda da sensibilidade protetora plantar. Conclusão: Diante do exposto, destaca-se a importância do atendimento primário no setor de saúde, por meio da ampliação das ações básicas direcionadas aos cuidados com o diabetes, levando em consideração a alta porcentagem de diabéticos com neuropatia já instalada, afim de prevenir possíveis complicações em membros inferiores de pacientes que ainda não possuem neuropatias e a implementação de medidas de tratamento com a finalidade de diminuir o avanço das complicações em pacientes que já as possuem

Níveis de ativação eletromiográfica em dois tipos de exercícios de hiperextensão reversa de quadril: um estudo piloto

O objetivo deste trabalho foi avaliar por eletromiografia os níveis de atividade dos músculos glúteo máximo, semimembranoso e adutor magno nos exercícios de extensão do quadril em uma maca com os joelhos estendidos ou flexionados. Foram recrutados 10 voluntários, ativos, para realizar os exercícios em ordem aleatória, em única série de 3 repetições sem carga externa para avaliar a atividade eletromiográfica dos extensores do quadril. Os resultados foram processados com o auxílio do software GraphPad Prism 5, utilizando o teste ANOVA one-way e pós-teste de comparação de Tukey. Os dados revelaram que o semimembranoso apresentou maior Pico de ativação comparado ao adutor magno em ambos os exercícios, porém, sem diferença de atividade para os outros grupamentos. Além disso, no exercício com os joelhos flexionados o semimembranoso apresentou média de níveis de atividade significativamente superiores aos do adutor magno e das fibras inferiores do glúteo máximo, sem diferença para as fibras superiores do glúteo máximo. No exercício com os joelhos estendidos o semimembranoso e as fibras superiores do glúteo máximo apresentaram maior média de atividade comparado ao adutor magno, mas sem diferença para as fibras inferiores do glúteo máximo. Os resultados mostraram que a realização da extensão do quadril com joelho flexionado não resultou em diminuição da atividade do semimembranoso comparado ao exercício com joelho estendido e nem resultou em aumento da ativação das fibras superiores ou inferiores do glúteo máximo

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Regulatory miRNA–mRNA Networks in Parkinson’s Disease

Parkinson’s disease (PD) is the second-most common neurodegenerative disease, and its pathophysiology is associated with alpha-synuclein accumulation, oxidative stress, mitochondrial dysfunction, and neuroinflammation. MicroRNAs are small non-coding RNAs that regulate gene expression, and many previous studies have described their dysregulation in plasma, CSF, and in the brain of patients with PD. In this study, we aimed to provide a regulatory network analysis on differentially expressed miRNAs in the brain of patients with PD. Based on our systematic review with a focus on the substantia nigra and the putamen, we found 99 differentially expressed miRNAs in brain samples from patients with PD, which regulate 135 target genes. Five genes associated with neuronal survival (BCL2, CCND1, FOXO3, MYC, and SIRT1) were modulated by dysregulated miRNAs found in the substantia nigra and the putamen of patients with PD. The functional enrichment analysis found FoxO and PI3K-AKT signaling as pathways related to PD. In conclusion, our comprehensive analysis of brain-related miRNA–mRNA regulatory networks in PD showed that mechanisms involving neuronal survival signaling, such as cell cycle control and regulation of autophagy/apoptosis, may be crucial for the neurodegeneration of PD, being a promising way for novel disease-modifying therapies

Fecal shedding of Salmonella spp., Clostridium perfringens, and Clostridioides difficile in dogs fed raw meat-based diets in Brazil and their owners' motivation.

The present study aimed to explore the motivations of Brazilian dog owners and their knowledge about the risks related to raw meat-based diets (RMBD) as well as to evaluate important enteropathogens such as Salmonella spp., C. perfringens, and C. difficile, in feces of dogs fed different diets. The majority of the pet owners (69.3%) reported to have chosen this diet for their dogs, considering it to be more "natural". A large number of owners declared that RMBD do not pose health risks for their animals (87.9%) or humans (98.8%), even though almost one third of the respondents (34.8%) declared having at least one individual at high risk of infection in contact with RMBD-fed dogs. Stool samples from 46 RMBD-fed dogs and 192 dogs fed commercial dry feed were collected. The present study revealed that dogs fed raw meat diets were almost 30 times more likely to be positive for Salmonella spp. than dogs on a conventional diet. Some of the serovars detected were commonly associated with human salmonellosis, such as S. Typhimurium and S. Saintpaul, and were multidrug resistant. RMBD-fed dogs were more likely to be positive for C. perfringens type A (p = 0.008) and one C. perfringens type F was isolated from these animals. Two toxigenic strains (4.3%) of C. difficile were isolated only from raw meat-fed dogs, all of which were under antibiotic therapy. These toxigenic C. difficile isolates were classified as RT106/ST54 and RT600/ST149, previously associated with infection in dogs and humans. The present work revealed that the owners have a tendency to ignore or are unaware of the risks associated with raw meat diets for dogs. Also, the higher fecal shedding of important enteropathogens in dogs fed RMBD suggests that this diet poses a risk for the animals and the people in contact with them