EXPERIÊNCIA RELATADA PELOS DOENTES COM CANCRO COLORRETAL SOBRE OS CUIDADOS RECEBIDOS AO LONGO DO TEMPO. COMO TRADUZI-LOS NUM PROGRAMA DE APOIO A DOENTES E FAMILIARES?

Background: Patient-focused interventions recognize the role of patients as active participants in the process of delivering effective, safe and responsible healthcare. When equipped with appropriate knowledge, patients can play an important role in their own care by early diagnosing self-limiting conditions and establishing a beneficial relationship with the healthcare team. The purpose of this study was to identify the main changes in bodily processes and their impact on dependency and self-care during colorectal cancer multimodal treatment to further develop a consistent patient-focused intervention protocol. Methods: A prospective longitudinal design was chosen to describe the evolution of the health condition of colorectal cancer patients during multimodal treatment. Patients were assessed (N = 129) in three separate moments, namely: T1 – after multi-disciplinary-team treatment decision; T2 – three months after T1; and T3 – six months after T1. Results: The results of this study show that, during treatment, patients with colon or rectal cancer experience significant changes in their health condition. They present a negative evolution on health status related with impairment in the gastrointestinal, circulatory and nervous systems and in psychological, neurovascular and resting processes. Chemotherapy adverse effects significantly reduce the ability to self-care. These patients reveal a higher dependency level in self-care areas, such as: instrumental activities of daily life (IADL) “bathing”, “to dress and undress”, “rising”, “taking medication” and “colostomy”. Conclusion: The results of this study pose a challenge to health care providers in the sense that these professionals are in a privileged position to help with an appropriate program, patients with colorectal cancer and their family in transition from dependence to supported self-care.Introdução: Os doentes quando munidos do conhecimento necessário podem desempenhar um papel importante no seu percurso terapêutico, quer pelo reconhecimento precoce das alterações na sua condição de saúde, quer pela relação que podem estabelecer com os profissionais de saúde. Assim, a prescrição de intervenções focadas no doente e nas suas necessidades individuais torna-os mais participativos no processo de prestação de cuidados, tornando-os mais eficazes e seguros. O objetivo deste estudo foi identificar as principais alterações nos processos corporais e o seu impacto na dependência para o autocuidado durante o tratamento do cancro coloretal para desenvolver um protocolo de intervenção consistente com foco no doente. Métodos: Estudo prospetivo longitudinal. Os doentes foram avaliados (N = 129) em três momentos distintos, a saber: T1 – após decisão do tratamento da equipe multidisciplinar; T2 – três meses após T1; e T3 – seis meses após T1. Resultados: Os resultados deste estudo mostram que, durante o tratamento, os doentes com cancro do cólon ou reto experienciam mudanças significativas no seu estado de saúde. Apresentam uma evolução negativa da condição de saúde de saúde relacionada com compromissos nos sistemas gastrointestinal, circulatório, nervosa, nos processos psicológicos, neurovasculares e regulador. Os efeitos adversos da quimioterapia reduzem significativamente a capacidade para o autocuidado. Esses doentes revelam maior grau de dependência nas áreas de autocuidado, tais como: atividades instrumentais de vida diária (AIVD) “tomar banho”, “vestir-se e despir-se”, “levantar-se”, “tomar medicamentos” e “colostomia”. Conclusão: Os resultados deste estudo representam um desafio para os profissionais de saúde no sentido de que esses profissionais estão numa posição privilegiada para ajudar com um programa de intervenção, adequado aos doentes com cancro coloretal e sua família na transição da dependência para o autocuidado com suporte

O DEBATE HART-DWORKIN E O DILEMAN DE COLEMAN: O QUE A LITERATURA TEM A DIZER SOBRE A RELAÇÃO DIREITO E MORAL?

As questões relativas à relação entre o direito e a moral inspiram diversos debates teóricos, os quais influenciam sobremaneira os paradigmas dominantes na teoria do direito. Dentre esses diálogos, merece especial destaque o promovido entre Hart e Dworkin, justamente porque evidencia a concepção do positivismo jurídico de Hart e, consequentemente, a oposição feita por Dworkin, principalmente no que diz respeito à discricionariedade. Cumpre, portanto, realizar o enfrentamento desta temática a partir da narrativa literária da obra “A mancha humana”, de Philip Roth, a fim de perquirir quais as possíveis contribuições que a literatura pode ofertar a partir desse enredo para revisitar o debate entre Hart e Dworkin, especialmente no que diz respeito às relações entre direito e moral e discricionariedade

ESTADO NUTRICIONAL PRÉ-OPERATÓRIO E COMPLICAÇÕES CIRÚRGICAS EM DOENTES COM CANCRO DIGESTIVO E DA CABEÇA E PESCOÇO

Introduction: Malnutrition is present in 40-50% of surgical patients upon hospital admission and is one of the most important factors influencing post-surgical morbidity and mortality. It is important to establish routines to identify and monitor patients at nutritional risk nutritional, to start early nutritional therapy, ideally in the pre-surgical phase. The aim of this study was to evaluate the association between pre-surgical nutritional status and postoperative complications and assess the nutritional assessment tool with the best prognostic value for post-surgical complications, in patients referred to surveillance in intermediate and intensive care units during surgical planning. Methods: We recruited patients at the Digestive Pathology and Head and Neck Units, referred for surgery and signaled at the anesthesia consultation for post-surgical surveillance in Intermediate or Intensive Care, from August to December 2016, at the Portuguese Institute of Oncology of Porto, Francisco Gentil, EPE. Clinical and demographic data were collected from the clinical process of the patients. Risk and nutritional status assessment was performed in the first 24 hours of patient’s admission to hospital using the PG-SGA and NRI. Data analysis was performed using the SPSS 23.0 statistical program. Results: We included 97 patients, 62 with digestive malignancies and 35 with head and neck malignant tumors. The prevalence of pre-surgical malnutrition was 51.2% and 33%, as assessed by NRI and PG-SGA, respectively. Nutritional status, as assessed by NRI was associated with postoperative complications and length of hospital stay. Nutritional status and lack of nutritional support were also associated with greater odds of prolonged hospitalizations (>10 days). Conclusion: The odds of developing post-surgical complications was about 3 times higher if the patient is malnourished or at risk of malnutrition, as assessed by NRI.Introdução: A desnutrição está presente em 40-50% dos doentes cirúrgicos no momento da admissão hospitalar, sendo considerada um dos fatores que mais influencia a morbimortalidade pós-cirúrgica. É importante estabelecer rotinas para identificar e monitorizar os doentes em risco nutricional, para iniciar a terapia nutricional precocemente, idealmente na fase pré-cirúrgica. O objetivo do presente trabalho foi avaliar a associação entre estado nutricional pré-cirúrgico e as complicações pós-cirúrgicas e verificar qual o instrumento de avaliação nutricional com melhor valor prognóstico para complicações pós-cirúrgicas, em doentes encaminhados para vigilância para as unidades de cuidados intermédios e intensivos durante o planeamento cirúrgico. Métodos: Foram recrutados doentes nas Unidades de Patologia Digestiva e de Cabeça e Pescoço, que tinham sido encaminhados para cirurgia e sinalizados na consulta de anestesia para vigilância pós-cirúrgica em Terapia Intermediária ou Intensiva, de agosto a dezembro de 2016, no Instituto Português de Oncologia do Porto, Francisco Gentil, EPE. Dados clínicos e demográficos foram recolhidos através de consulta ao processo clínico. A avaliação do risco e do estado nutricional foi realizada através do PG-SGA e do NRI, nas primeiras 24 horas da admissão do doente para internamento hospitalar. A análise dos dados foi realizada através do programa estatístico SPSS 23.0. Resultados: Foram incluídos 97 doentes, 62 com neoplasias digestivas e 35 com neoplasias malignas de cabeça e pescoço. A prevalência de desnutrição pré-cirúrgica avaliada foi de 51,2% e 33%, avaliada pelo NRI e PG-SGA, respetivamente. O estado nutricional, avaliado pelo NRI, foi associado a complicações pós-operatórias e maior tempo de hospitalização. O estado nutricional e a falta de suporte nutricional também foram associados a maior risco de hospitalização prolongada (> 10 dias). Conclusão: O risco de desenvolver complicações pós-cirúrgicas foi cerca de 3 vezes maior em doentes desnutridos ou em risco de desnutrição avaliados pelo NRI

Experiência relatada pelos doentes com cancro colorretal sobre os cuidados recebidos ao longo do tempo. Como traduzi-los num programa de apoio a doentes e familiares?

Background: Patient-focused interventions recognize the role of patients as active participants in the process of delivering effective, safe and responsible healthcare. When equipped with appropriate knowledge, patients can play an important role in their own care by early diagnosing self-limiting conditions and establishing a beneficial relationship with the healthcare team. The purpose of this study was to identify the main changes in bodily processes and their impact on dependency and self-care during colorectal cancer multimodal treatment to further develop a consistent patient-focused intervention protocol. Methods: A prospective longitudinal design was chosen to describe the evolution of the health condition of colorectal cancer patients during multimodal treatment. Patients were assessed (N = 129) in three separate moments, namely: T1 – after multi-disciplinary-team treatment decision; T2 – three months after T1; and T3 – six months after T1. Results: The results of this study show that, during treatment, patients with colon or rectal cancer experience significant changes in their health condition. They present a negative evolution on health status related with impairment in the gastrointestinal, circulatory and nervous systems and in psychological, neurovascular and resting processes. Chemotherapy adverse effects significantly reduce the ability to self-care. These patients reveal a higher dependency level in self-care areas, such as: instrumental activities of daily life (IADL) “bathing”, “to dress and undress”, “rising”, “taking medication” and “colostomy”. Conclusion: The results of this study pose a challenge to health care providers in the sense that these professionals are in a privileged position to help with an appropriate program, patients with colorectal cancer and their family in transition from dependence to supported self-care.info:eu-repo/semantics/publishedVersio

Desastre socioambiental: condições de saúde dos atingidos na perspectiva dos profissionais de saúde e gestores

Objective: to analyze the health conditions of the population affected by the mining dam collapse from the perspective of healthcare professionals and managers. Method: this is a qualitative case study, conducted using public domain documents and interviews with healthcare professionals and managers, from March to May 2022, totaling 14 participants. The data were analyzed according to the theoretical propositions strategy based on the Social Determinants of Health. Results: the health conditions of this population have worsened in terms of respiratory problems, gastroenteritis, obesity, arboviruses, increased use of alcohol and drugs, and mental illnesses. The loss of employment, home, and community belonging of those affected is highlighted. Conclusion: the socio-environmental disaster was a conditioning factor for changes in the health conditions of those affected, exposing them to new scenarios and overlapping risks capable of modifying their quality of life and aggravating their biopsychosocial health conditions.Objetivo: analizar las condiciones de salud de la población afectada por el colapso de la presa minera desde la perspectiva de los profesionales y gestores sanitarios. Método: estudio de caso cualitativo, realizado por medio de documentos de dominio público y entrevistas a profesionales y gestores de salud, entre marzo y mayo de 2022, con un total de 14 participantes. Los datos fueron analizados según la estrategia de proposiciones teóricas a la luz de la Determinación Social de la Salud. Resultados: se considera el empeoramiento de las condiciones de salud en relación con los problemas respiratorios, la gastroenteritis, la obesidad, los arbovirus, la intensificación del consumo de alcohol y drogas, y las enfermedades mentales. Se destacan la pérdida del trabajo, del hogar, y de la pertenencia a la comunidad de los afectados. Conclusión: el desastre socioambiental fue un factor condicionante de alteraciones en las condiciones de salud de los afectados, exponiéndolos a nuevos escenarios y riesgos superpuestos capaces de modificar la calidad de vida y empeorar las condiciones de salud biopsicosocial.Objective: to analyze the health conditions of the population affected by the mining dam collapse from the perspective of healthcare professionals and managers. Method: this is a qualitative case study, conducted using public domain documents and interviews with healthcare professionals and managers, from March to May 2022, totaling 14 participants. The data were analyzed according to the theoretical propositions strategy based on the Social Determinants of Health. Results: the health conditions of this population have worsened in terms of respiratory problems, gastroenteritis, obesity, arboviruses, increased use of alcohol and drugs, and mental illnesses. The loss of employment, home, and community belonging of those affected is highlighted. Conclusion: the socio-environmental disaster was a conditioning factor for changes in the health conditions of those affected, exposing them to new scenarios and overlapping risks capable of modifying their quality of life and aggravating their biopsychosocial health conditions

Programa de Assistência de Enfermagem a clientes portadores de danos cardiovasculares, no ambulatório de um hospiatl de ensino de Porto Alegre, RS

Descreve a programação proposta pelas enfermeiras que atuam no Serviço de Enfermagem de Saúde Pública, de um hospital de ensino de Porto Alegre, RS, a clientes portadores de danos cardiovasculares, destacando as atividades finais (consulta de enfermagem, chamamento de faltosos e Cursos de Educação para Saúde). Procura-se caracterizar a clientela assistida, através da Consulta de Enfermagem, quanto a sexo, idade, classe social, procedência e problemas apresentados

Neoadjuvant gastric cancer treatment and associated nutritional critical domains for the optimization of care pathways: a systematic review

(1) Background: Gastric cancer patients are known to be at a high risk of malnutrition, sarcopenia, and cachexia, and the latter impairs the patient’s nutritional status during their clinical course and also treatment response. A clearer identification of nutrition-related critical points during neoadjuvant treatment for gastric cancer is relevant to managing patient care and predicting clinical outcomes. The aim of this systematic review was to identify and describe nutrition-related critical domains associated with clinical outcomes. (2) Methods: We performed a systematic review (PROSPERO ID:CRD42021266760); (3) Results: This review included 14 studies compiled into three critical domains: patient-related, clinical-related (disease and treatment), and healthcare-related. Body composition changes during neoadjuvant chemotherapy (NAC) accounted for the early termination of chemotherapy and reduced overall survival. Sarcopenia was confirmed to have an independent prognostic value. The role of nutritional interventions during NAC has not been fully explored. (4) Conclusions: Understanding critical domain exposures affecting nutritional status will enable better clinical approaches to optimize care plans. It may also provide an opportunity for the mitigation of poor nutritional status and sarcopenia and their deleterious clinical consequences.info:eu-repo/semantics/publishedVersio

Fragmentação, pluralismo e eficácia dos direitos fundamentais na ordem jurídica transnacional: uma análise crítica das contribuições de Gunther Teubner

: Este artigo analisa o diagnóstico e as contribuições de Gunther Teubner para a compreensão dos direitos fundamentais na ordem transnacional. Considerando o conceito de sociedade mundial, cunhado por Luhmann e apontando para uma possível transição das sociedades organizadas estatalmente para uma sociedade global, o problema que move este trabalho é: como é possível observar sistemicamente as relações jurídicas e conflitos emergentes entre os novos atores internacionais em contraste com as soluções clássicas do Direito interno e internacional no que toca à realização dos direitos fundamentais? Adota-se o método hipotético dedutivo, em pesquisa exploratória realizada por meio de revisão bibliográfica

Development of a preoperative risk score on admission in surgical intermediate care unit in gastrointestinal cancer surgery

DSAIPA/DS/0042/2018 UID/DTP/00617/2019Background: Gastrointestinal cancer surgery continues to be a significant cause of postoperative complications and mortality in high-risk patients. It is crucial to identify these patients. Our study aimed to evaluate the accuracy of specific perioperative risk assessment tools to predict postoperative complications, identifying the most informative variables and combining them to test their prediction ability as a new score. Methods: A prospective cohort study of digestive cancer surgical patients admitted to the surgical intermediate care unit of the Portuguese Oncology Institute of Porto, Portugal was conducted during the period January 2016 to April 2018. Demographic and medical information including sex, age, date from hospital admission, diagnosis, emergency or elective admission, and type of surgery, were collected. We analyzed and compared a set of measurements of surgical risk using the risk assessment instruments P-POSSUM Scoring, ACS NSQIP Surgical Risk Calculator, and ARISCAT Risk Score according to the outcomes classified by the Clavien-Dindo score. According to each risk score system, we studied the expected and observed post-operative complications. We performed a multivariable regression model retaining only the significant variables of these tools (age, gender, physiological P-Possum, and ACS NSQIP serious complication rate) and created a new score (MyIPOrisk-score). The predictive ability of each continuous score and the final panel obtained was evaluated using ROC curves and estimating the area under the curve (AUC). Results: We studied 341 patients. Our results showed that the predictive accuracy and agreement of P-POSSUM Scoring, ACS NSQIP Surgical Risk Calculator, and ARISCAT Risk Score were limited. The MyIPOrisk-score, shows to have greater discrimination ability than the one obtained with the other risk tools when evaluated individually (AUC = 0.808; 95% CI: 0.755-0.862). The expected and observed complication rates were similar to the new risk tool as opposed to the other risk calculators. Conclusions: The feasibility and usefulness of the MyIPOrisk-score have been demonstrated for the evaluation of patients undergoing digestive oncologic surgery. However, it requires further testing through a multicenter prospective study to validate the predictive accuracy of the proposed risk score.publishersversionpublishe