O PROCESSO DE (DES)EMPODERAMENTO DAS MULHERES NA ASSOCIAÇÃO DOS ARTESÃOS DE PORTO NACIONAL

O presente artigo apresenta um estudo acerca das mulheres da Associação dos Artesãos de Porto Nacional, o qual tem como objetivo analisar o processo de (des) empoderamento dessas mulheres no espaço do empreendimento. Essa associação acolhe parte dos artesãos/as da região, e tem uma maioria composta por mulheres que buscam nas atividades do empreendimento uma possibilidade para melhorar sua situação social e econômica. Nesse sentido, discute-se o empoderamento dentro de uma perspectiva de gênero, o que permite adentrar a realidade das mulheres envolvidas desde à produção até a gestão do empreendimento, de forma a observar a contribuição desse empreendimento em suas vidas. Foi a partir de suas narrativas que se conseguiu identificar na trajetória dessas mulheres, fatores capazes de impulsionar e/ou inibir o empoderamento destas. Por meio de suas falas, percebeu-se que as mulheres que compõem a Associação dos Artesãos de Porto Nacional, apesar de todas as dificuldades enfrentadas para manterem-se atuantes, vêm experienciando as idas e vindas de um processo de empoderamento, proporcionado por altos e baixos

Postoperative Pain Management in DIEP Flap Breast Reconstruction: Identification of Patients With Poor Pain Control

Objective: Adequate control of postoperative pain directly improves patient satisfaction and outcomes, and timely identification of patients with poorly controlled pain is essential. Pain management protocols are best studied in patients recovering from the same operation. In our institution, the postoperative pain regimen for patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction is standardized using patient-controlled analgesia (PCA) followed by conversion to oral narcotics. From this uniform population, we were able to identify a subgroup of patients with poor pain control. Methods: Over a 44-month period, 179 consecutive patients underwent DIEP flap breast reconstruction with 242 flaps performed. A retrospective chart review recorded PCA usage, visual analog scale pain scores, and length of stay. Results: Pain management with PCA after DIEP flap breast reconstruction was uniformly controlled. Most patients (74.9%) required PCA usage in the first 2 days with conversion to oral analgesics. A subgroup of patients (25.1%) continued to require PCA usage on the third postoperative day. These “nonresponder” patients had a higher visual analog scale score on the first postoperative day, higher total intravenous morphine use, and a longer length of stay (all, P < .05). A multivariate analysis revealed more nonresponders among patients undergoing immediate breast reconstruction (P < .05); however, all other factors analyzed had no correlation. Conclusion: We report a subgroup of patients with poor pain control after DIEP flap breast reconstruction. This group of patients required a longer course of pain management and subsequently a longer hospital stay. Pain management protocols that identify these patients promptly can allow for appropriate modifications

FIM DA VIDA – DISCIPLINA JURÍDICA DA DISNATÁSIA NO BRASIL E OS LIMITES AO PROLONGAMENTO ARTIFICIAL DA VIDA.

As reflexões deste artigo concentram-se na análise da distanásia no Brasil que consiste, basicamente, no prolongamento artificial da vida através de tratamentos fúteis e inúteis. O presente artigo disporá acerca dos limites, princípios e regras do ordenamento jurídico pátrio que circundam esta matéria, da possibilidade do paciente manifestar a sua vontade no que tange aos tratamentos que lhe serão aplicados no estágio terminal através do que chamamos de “testamento vital” e, principalmente, vamos discorrer acerca da responsabilização do médico nos diferentes âmbitos do Direito brasileiro

Predictive Factors for Preoperative Percutaneous Endoscopic Gastrostomy Placement: Novel Screening Tools for Head and Neck Reconstruction.

OBJECTIVE: The treatment of head and neck cancer has varying impact on postoperative recovery and return of swallowing function. The authors aim to establish screening tools to assist in preoperatively determining the need for gastrostomy tube placement. METHODS: The authors prospectively assessed all patients undergoing complex head and neck reconstructive surgery during a 1-year study period. Only patients tolerating an oral diet, without preoperative gastrostomies, were enrolled for study. Eight parameters were assessed including: body mass index (BMI), prealbumin, albumin, smoking history, comorbidities [including coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM)], age, use of microvascular reconstruction, and type of defect. Two specific screening tools were assessed. In the first, a multivariate logistic regression model was employed to determine factor(s) that predict postoperative gastrostomy tube. In a second screening tool, the 8 parameters were scored between 0 to 1 points. The total score obtained for each patient was correlated with postoperative gastrostomy placement. RESULTS: Out of the 60 study patients enrolled in the study, 24 patients (40%) received a postoperative gastrostomy. In the logistic regression model, albumin level was the only factor that was significantly associated with need for postoperative gastrostomy (P \u3c 0.0023). A score of 4 or greater was determined to have a sensitivity of 83% and specificity of 61% for postoperative gastrostomy. CONCLUSIONS: Patients with a score of 4 or more with this screening scoring system or those patients with an albumin leve