Utilização do ultrassom terapêutico para a aceleração do processo de cicatrização de feridas agudas em atletas

Orientador : Raciele Ivandra Guarda KoreloMonografia (especialização) - Universidade Federal do Paraná, Setor de Ciências Biológicas, Curso de Especialização em Fisiologia do ExercícioInclui referência

Incorporação da tecnologia da informação na atenção básica do SUS no nordeste do Brasil : expectativas e experiências

A incorporação de tecnologia da informação por meio do registro eletrônico de dados em saúde na atenção básica transforma a organização do trabalho e as práticas profissionais. O objetivo deste estudo é conhecer as expectativas e a experiência da informatização nos serviços de atenção básica do SUS na implantação do Sistema Cartão Nacional de Saúde (SCNS), Cartão SUS. Pesquisa qualitativa, que compara, por meio de 50 entrevistas e 96 questionários, a opinião dos profissionais de saúde sobre a inovação tecnológica, em locais “Sem” e “Com” o SCNS, nos municípios de João Pessoa (Paraíba) e de Aracaju (Sergipe), respectivamente. Há expectativa de que a informatização reduz o tempo para execução do trabalho, o que não foi confirmado pelo local informatizado. A informatização traz melhorias na organização do trabalho, para os usos da informação e possibilita a inserção digital do profissional. A tecnologia “leve” da atividade de cuidado da saúde não é reproduzida pela informatização, a qual aumenta a necessidade de incorporação de saberes aos profissionais, melhora as condições de trabalho, organiza a coleta de dados, aproxima os usos da informação por quem os registrou, e amplia a capacidade de gestão das políticas de saúde.The incorporation of information technology (IT) via an electronic record of health data in primary care is transforming the organization of labor and professional practices in Brazil. The scope of this study is to establish the expectations and experiences of incorporating IT in the primary health care of the Unified Health System (SUS) with the implementation of the National Health Card System (SCNS). It involved qualitative research with 50 interviews and 96 questionnaires comparing the opinion of health professionals about technological innovation in locations with the SCNS and where it has not yet been incorporated in the cities of João Pessoa and Aracaju, respectively. The expectation was that IT would speed up the work schedule, which was not confirmed at the location where the SCNS had been incorporated. IT can improve labor organization, the flow of data and information and enable the digital insertion of the professional. The “light” technology of health care cannot be expedited by IT, as it is necessary to impart knowledge to the professionals. However, it can improve working conditions by data gathering and organization, giving immediate feedback to the professional recording the data and enhance the ability to manage health policies

Impact Of Pharmacist Interventions On Drug-related Problems And Laboratory Markers In Outpatients With Human Immunodeficiency Virus Infection.

Substantial complexity has been introduced into treatment regimens for patients with human immunodeficiency virus (HIV) infection. Many drug-related problems (DRPs) are detected in these patients, such as low adherence, therapeutic inefficacy, and safety issues. We evaluated the impact of pharmacist interventions on CD4+ T-lymphocyte count, HIV viral load, and DRPs in patients with HIV infection. In this 18-month prospective controlled study, 90 outpatients were selected by convenience sampling from the Hospital Dia-University of Campinas Teaching Hospital (Brazil). Forty-five patients comprised the pharmacist intervention group and 45 the control group; all patients had HIV infection with or without acquired immunodeficiency syndrome. Pharmaceutical appointments were conducted based on the Pharmacotherapy Workup method, although DRPs and pharmacist intervention classifications were modified for applicability to institutional service limitations and research requirements. Pharmacist interventions were performed immediately after detection of DRPs. The main outcome measures were DRPs, CD4+ T-lymphocyte count, and HIV viral load. After pharmacist intervention, DRPs decreased from 5.2 (95% confidence interval [CI] =4.1-6.2) to 4.2 (95% CI =3.3-5.1) per patient (P=0.043). A total of 122 pharmacist interventions were proposed, with an average of 2.7 interventions per patient. All the pharmacist interventions were accepted by physicians, and among patients, the interventions were well accepted during the appointments, but compliance with the interventions was not measured. A statistically significant increase in CD4+ T-lymphocyte count in the intervention group was found (260.7 cells/mm(3) [95% CI =175.8-345.6] to 312.0 cells/mm(3) [95% CI =23.5-40.6], P=0.015), which was not observed in the control group. There was no statistical difference between the groups regarding HIV viral load. This study suggests that pharmacist interventions in patients with HIV infection can cause an increase in CD4+ T-lymphocyte counts and a decrease in DRPs, demonstrating the importance of an optimal pharmaceutical care plan.10631-

Epilepsy and social security : the medical decision making on disability compensation

A maior dificuldade encontrada no manejo de pacientes com epilepsia frente aos seguros saúde é que, apesar de todo o aparato tecnológico de que se dispõe atualmente, o diagnóstico continua sendo predominantemente clínico, não havendo critérios objetivos na definição da incapacidade laborativa. Este ensaio tem como propósito discutir necessidades e parâmetros e apresentar uma proposta de aperfeiçoamento de relatório a ser preenchido pelo médico assistente a fim de traçar estratégias para que o perito médico defina, com maior segurança, a incapacidade laborativa em segurados portadores de epilepsia. A proposta discute aspectos relacionados a diagnóstico, tratamento e prognóstico, assim como fatores que interferem na capacidade de trabalho, visando auxiliar a decisão médico-pericial acerca da concessão ou não de benefícios. _______________________________________________________________________________ ABSTRACTRegarding health insurances, the major difficulty in handling patients with epilepsy is that the diagnosis is basically clinical, and there is not a totally objective criteria to define work incapacity, even with all the existing modern technology. In this essay we discuss needs and parameters, propose guidelines for the report filled up by assistant physicians, and formulate strategies to help medical experts defining work incapacity for workers with epilepsy, with a greater margin of accuracy. We discuss aspects related to diagnosis, treatment, prognosis, and list facts that can eventually interfere in the ability to work, contributing for medical experts to decide whether they should or not grant disability benefits

Pharmacovigilance in oncology: pattern of spontaneous notifications, incidence of adverse drug reactions and under-reporting

Estudos de farmacovigilância são imprescindíveis em oncologia, pois os antineoplásicos possuem alta toxicidade e estreita janela terapêutica. Os objetivos deste estudo foram analisar o perfil das notificações espontâneas de reações adversas a medicamentos (RAM) em pacientes oncológicos e a incidência de RAM ao tratamento antineoplásico em um hospital terciário e universitário. Para compor o perfil de RAM, revisaram-se os formulários de notificação de reações em pacientes oncológicos do ano de 2010 e classificaram-se as reações conforme o medicamento envolvido, mecanismo, causalidade e gravidade. Para avaliar a incidência de reações, aplicou-se um questionário no momento da quimioterapia e a gravidade foi classificada pelos Critérios Comuns de Toxicidade. Apenas 10 reações foram notificadas ao Setor de Farmacovigilância, cujo perfil encontrado foi tipo B, grave, possível, e foram principalmente relacionadas aos compostos de platina e taxanos. Na análise da incidência das reações, observou-se que náusea, alopecia, fadiga, diarreia e distúrbio do paladar foram as reações mais frequentes relatadas por pacientes oncológicos, e as reações grau 3 e 4 não foram notificadas. De acordo com essas análises, propõe-se que os profissionais da saúde sejam treinados quanto às notificações e que farmacêuticos clínicos sejam cada vez mais inseridos neste contexto para redução da subnotificação de RAM.The high toxicity and narrow therapeutic window of antineoplastic agents makes pharmacovigilance studies essential in oncology. The objectives of the current study were to analyze the pattern of spontaneous notifications of adverse drug reactions (ADRs) in oncology patients and to analyze the incidence of ADRs reported by outpatients on antineoplastic treatment in a tertiary care teaching hospital. To compose the pattern of ADR, the notification forms of reactions in oncology patients in 2010 were reviewed, and the reactions were classified based on the drug involved, mechanism, causality, and severity. To evaluate the incidence of reactions, a questionnaire at the time of chemotherapy was included, and the severity was classified based on the Common Terminology Criteria. The profiles of the 10 responses reported to the Pharmacovigilance Sector were type B, severe, possible, and they were primarily related to platinum compounds and taxanes. When the incidence of reactions was analyzed, it was observed that nausea, alopecia, fatigue, diarrhea, and taste disturbance were the most frequently reported reactions by oncology patients, and the grade 3 and 4 reactions were not reported. Based on this analysis, it is proposed that health professionals should be trained regarding notifications and clinical pharmacists should increasingly be brought on board to reduce under-reporting of ADRs

High 15-f2t-isoprostane Levels In Patients With A Previous History Of Nonmelanoma Skin Cancer: The Effects Of Supplementary Antioxidant Therapy.

Phase I of this study was aimed at comparing the profiles of oxidative stress biomarkers in patients with history of nonmelanoma skin cancer (NMSC), previously treated with surgery, to the healthy subjects. Phase II aimed to evaluate the effects of supplementary antioxidant therapy on the levels of biomarkers in the case group. In Phase I, oxidative stress biomarkers were measured in blood samples obtained from 24 healthy subjects and 60 patients with history of NMSC previously treated with surgery. In Phase II, the 60 patients with history of NMSC were randomized into two subgroups, one receiving placebo (n = 34) and the other (n = 26) receiving vitamin C, vitamin E, and zinc supplementation for 8 weeks, followed by reevaluation of biomarkers. In Phase I, patients with history of NMSC showed increased plasma concentrations of all biomarkers, but only 15-F2t-isoprostane was significantly higher than in the healthy subjects. Risk of NMSC increased by 4% for each additional 1 pg/mL increase in 15-F2t-isoprostane. In Phase II, supplementation did not significantly reduce levels of oxidative stress biomarkers. Patients with history of NMSC had significantly high 15-F2t-isoprostane plasma levels; supplementation did not result in significant reduction of oxidative stress biomarkers. This trial was registered with ClinicalTrials.gov (ID NCT02248584).201596356