Microbiological swabs have no role in the management of acute pilonidal abscesses

Aims: Microbiological swabs are often taken at the time of surgery for the treatment of acute pilonidal abscesses. This audit assessed whether swabs play a role in the management of these patients. Methods: A retrospective audit of electronic records was undertaken over a 2-year period between 1st January 2012 and December 31st 2013. Variables measured included patient sex, episode index, swab results, antibiotic use and recurrences. Results: Over the 2-year period there were 182 operations for acute pilonidal abscesses. Microbiological swabs were taken in 151 cases (83%). The most common culture was anaerobe (36%) followed by no growth (19%) and skin flora (8%). In total, 114 reports (94%) were issued after the patient had been discharged. Post-operative antibiotics were prescribed in 15 cases (8%) and within this group 9 patients (60%) had no growth on swab results. There were 11 recurrences (6%) with no correlation between the initial swab results and recurrent swab results being observed. Conclusions: In this audit, swab results did not alter any patient's treatment and nearly all reports were issued after the patient had been discharged. Recurrent abscesses do not appear to be linked to initial swab results

Optimal management of malignant left-sided large bowel obstruction: do international guidelines agree?

Background Approximately 20% of patients diagnosed with colorectal cancer will present with left-sided large bowel obstruction. The optimal management of this cohort of patients remains unclear. We aimed to review international guidelines to see if there was a consensus on the treatment of this surgical emergency. Methods The PubMed and Medline databases were searched for guidelines on the management of left-sided, malignant large bowel obstruction (MBO) between 2010 and 2018. Results Nineteen guidelines were identified spanning a range of continents. There was no clear consensus on the management of potentially resectable disease. Eight guidelines (42%) suggested primary surgery, two guidelines (11%) suggested stenting as a bridge to surgery and nine guidelines (47%) suggested surgery or stenting could be performed. Primary resection with or without anastomosis was the most frequently recommended procedure (n = 6 35%), but over a third of guidelines gave no operative recommendations. There was very limited detail on the stenting procedure and how long elective surgery should be deferred. In the palliative situation, there was general agreement that stents should be offered in preference to surgery. Conclusion International guidelines offer limited and contrasting recommendations on the management of left-sided MBO. There is a lack of high-quality evidence to support whether emergency surgery or stenting as a bridge to surgery is the optimal procedure in terms of morbidity, mortality and long-term oncological outcome

Meanings about smoking for women participant in a group for smokers

O objetivo deste estudo foi conhecer sentidos produzidos sobre o tabagismo por mulheres participantes de um grupo para tabagistas em Florianópolis, SC, Brasil. O grupo foi composto por sete participantes. Utilizou-se a entrevista estruturada, com cinco questões abertas. O referencial teórico foi construcionismo social. Como conclusão, encontrou-se dois eixos temáticos: 1) cigarro no ciclo vital da mulher 2) expectativas em relação ao tratamento. Os repertórios utilizados para descrever o início do consumo na adolescência incluíram glamour, charme, independência e aceitação pelos pares, enquanto aqueles utilizados para descrever a manutenção do consumo na idade adulta incluíram ansiedade, depressão e recurso para lidar com o estresse diário. Quanto às expectativas em relação ao tratamento, acreditam que o contato com pessoas que vivenciam as mesmas dificuldades, em relação à interrupção do consumo e sonhos de uma vida saudável, seria motivador. O tratamento oferecido para tabagistas deve explorar estratégias para que as mulheres alcancem o que desejam com o consumo de cigarro.El objetivo de este estudio fue conocer el significado, sobre el fumar, declarado por mujeres que participaban en un grupo de fumadores en Florianópolis, estado de Santa Catarina, Brasil. Participaron siete fumadores. Se utilizó entrevistas estructuradas con cinco preguntas abiertas. El marco teórico fue el construccionismo social. Dos temas fueran detectados: 1) Los cigarrillos en el ciclo de vida de la mujer 2) Expectativas en relación al tratamiento. Los repertorios utilizados para describir el inicio del consumo, en la adolescencia, incluyen: glamour, encanto, independencia y el ser aceptado entre iguales; y los utilizados para describir el mantenimiento del consumo en la edad adulta incluyen: ansiedad, depresión y el uso como recurso para lidiar con el estrés diario. En cuanto a las expectativas para el tratamiento, creen que ayudaría el contacto con personas que experimentan las mismas dificultades en relación con la interrupción del consumo; también que los sueños de una vida saludable sería motivador. El tratamiento ofrecido a fumadores debería explorar estrategias para las mujeres que quieren abandonar el consumo de cigarrillos.The aim of this study was to understand the meanings produced about smoking by women participating in a group for smokers in Florianopolis, SC, Brazil. Seven participants took part in structured interviews with five open questions. The theoretical framework was social constructionism with two themes: 1) Cigarettes in the women’s life cycle 2) Expectations regarding treatment. The repertories used to describe the beginning of consumption in adolescence included glamour, charm, independence and peer acceptance and those used to describe the maintenance of consumption in adulthood included anxiety, depression and coping with daily stress. Regarding expectations for treatment they believed that contact with people who experience the same difficulties in relation to the cessation of consumption and the dream of a healthy life would be motivating. The treatment offered to smokers should explore strategies for women to achieve what they want regarding the consumption of cigarettes

AZD1775 Induces Toxicity Through Double-Stranded DNA Breaks Independently of Chemotherapeutic Agents in p53-Mutated Colorectal Cancer Cells

AZD1775 is a small molecule WEE1 inhibitor used in combination with DNA-damaging agents to cause premature mitosis and cell death in p53-mutated cancer cells. Here we sought to determine the mechanism of action of AZD1775 in combination with chemotherapeutic agents in light of recent findings that AZD1775 can cause double-stranded DNA (DS-DNA) breaks. AZD1775 significantly improved the cytotoxicity of 5-FU in a p53-mutated colorectal cancer cell line (HT29 cells), decreasing the IC50 from 9.3 μM to 3.5 μM. Flow cytometry showed a significant increase in the mitotic marker pHH3 (3.4% vs. 56.2%) and DS-DNA break marker γH2AX (5.1% vs. 50.7%) for combination therapy compared to 5-FU alone. Combination therapy also increased the amount of caspase-3 dependent apoptosis compared to 5-FU alone (4% vs. 13%). The addition of exogenous nucleosides to combination therapy significantly rescued the increased DS-DNA breaks and caspase-3 dependent apoptosis almost to the levels of 5-FU monotherapy. In conclusion, AZD1775 enhances 5-FU cytotoxicity through increased DS-DNA breaks, not premature mitosis, in p53-mutated colorectal cancer cells. This finding is important for designers of future clinical trials when considering the optimal timing and duration of AZD1775 treatment

Evaluación de seis años de interconsultas odontológicas provenientes del área de internación pediátrica del Hospital Criança Conceição de Porto Alegre, Brasil

Introduction: this study aimed to describe the profile of the referrals sent to the hospital dentistry team from patients in Hospital Criança Conceição in Porto Alegre, Rio Grande do Sul, Brazil, from January 2012 to July 2018. Methods: a descriptive, retrospective study was conducted, evaluating 193 electronic dental records to extract the following data: patient’s sex and age, description of the referral made by other health professionals and the dentist’s behavior in solving the presented problem. Results: 61.6% of patients were male and the mean age of all patients was 10.5 years. Most dental referrals came from the oncohematology area (75.12%) and the predominant reason was pre- and post-chemotherapy patients’ dental care (40.4%). The diagnosis most commonly found by dentists was mucositis (17.6%) and caries (16%). There was absence of oral diseases in 23.8% of cases. The interventions most commonly performed by the hospital dentistry team were laser therapy (57.5%) and oral hygiene instructions (49.1%) in the hospital setting, while procedures in dental offices and surgical rooms included exodontias (27.7%) and restorations (11.7%). Conclusions: the profile of referrals sent to the hospital dentistry team from patients hospitalized in the Hospital Criança Conceição in Porto Alegre, Rio Grande do Sul, Brazil, is inadequate, since there was a lack of transdisciplinary management including dental care, in addition to poor use of information technology resources and lack of more objective medical records for easy retrieval of patient health information.Introducción: este estudio pretende describir el perfil de las interconsultas enviadas al equipo de odontología hospitalaria provenientes de pacientes internados en el Hospital Criança Conceição de Porto Alegre, Rio Grande do Sul, Brasil, en el período de enero de 2012 a julio de 2018. Métodos: estudio descriptivo retrospectivo en el que se evaluaron 193 historias clínicas odontológicas electrónicas para extraer los siguientes datos: sexo y edad del paciente, descripción de la interconsulta realizada por otros profesionales de salud y conducta del cirujano dentista frente al problema presentado. Resultados: el 61,6% de los pacientes fue de sexo masculino y la edad promedio general fue 10,5 años. Las interconsultas más solicitadas para los cirujanos dentistas fueron provenientes del área de oncohematología (75,12%) y el motivo predominante fue sobre el cuidado bucal a pacientes pre y posquimioterapia (40,4%). El diagnóstico que más encontraron los dentistas fue mucositis (17,6%) y lesiones de caries (16%). Hubo ausencia de enfermedades bucales en 23,8% de los casos. Las intervenciones más realizadas por el equipo de odontología fueron aplicaciones de laserterapia (57,5%) y orientaciones de higiene bucal (49,1%) en ámbito hospitalario; en sillón dental y sala quirúrgica, fueron exodoncias (27,7%) y restauraciones (11,7%). Conclusiones: el perfil de las interconsultas enviadas al equipo de odontología hospitalaria provenientes de pacientes internados en el Hospital Criança Conceição de Porto Alegre, Rio Grande do Sul, Brasil, es inadecuado, pues se demostró falta de manejo transdisciplinar que incluya odontología, además de la necesidad de un mejor aprovechamiento de los recursos de tecnología de información e historias clínicas más objetivas y que permitan obtener más fácilmente la información de salud de los pacientes

Caution when using images during science lessons

O uso de imagens no ensino de Ciências é absolutamente rotineiro. Pesquisas têm mostrado que a leitura de imagens precisa ser ensinada, pois elas não são transparentes. Como qualquer outro recurso, o professor tem um papel, intencional ou não, direto ou indireto, no modo como as imagens funcionam em sala de aula. Além desses pressupostos, considerou-se que a leitura de imagens depende de condições sócio-historicamente construídas. O sujeito faz parte dessas condições. Essas idéias nos mostram a necessidade de se estudar com mais profundidade o papel da formação de professores na constituição dos modos de mediação do uso de imagens no ensino de Ciências. Com base nesses pressupostos, analisamos em que aspectos um curso de formação continuada de curta duração influenciou a relação dos professores com as imagens, suas representações e possíveis ações em sala de aula. Mostramos que houve deslocamentos nos modos como os professores se relacionam com as imagens e como significam sua relação com o ensino. _________________________________________________________________________________ ABSTRACTThe use of images in the teaching of sciences is quite a routine. Research has been showing the necessity of teaching the reading of images since their reading is not straightforward. As with any other resource, the teacher has an indispensable role, direct or indirect, in the way images work in the classroom context. Beyond of those presuppositions, it was considered that the reading of images depends on the historically-built conditions. The subject is part of those conditions. So, it is fundamental that we think about the role of teacher education courses in the understanding of the manner of mediation of the use of images when teaching science. In this work we analyzed in what aspects a short duration course of in-service teacher education influenced teachers' relationship with the images, their representations and possible actions in classroom. At the end of the course it was realised that there were changes in the ways teachers thought about images and in their relationship with images within science teaching and learning processes

Eventos agudos em saúde mental

Na unidade Agressão e autoagressão você terá a oportunidade de estudar se que a violência, a agressão e a autoagressão são fenômenos refletidos na perspectiva de condições humanas. A patologização desses fenômenos fica evidente quando são promovidas rupturas sociais e quando determinados critérios técnicos são estabelecidos para interpretá-los. O acolhimento, o vínculo, a responsabilidade e a atuação em Rede Intersetorial são premissas para o cuidado nesta especificidade. Na unidade Alterações de comportamento é apresentado as principais alterações destacando-se os estados psicóticos agudos, a ansiedade e a depressão. Esses conceitos se originam de diferentes abordagens teóricas que determinam sua classificação. A organização Mundial da Saúde através do CID 10 é o que prevalece no campo dos diagnósticos descritivos em psiquiatria e saúde mental. O cuidado a pessoa em sofrimento psíquico grave segue a lógica da oferta das ações e serviços através da Rede de Atenção Psicossocial, onde o acolhimento e o Projeto Terapêutico Singular são elementos organizadores desse cuidado. Na unidade que trata de Problemas relacionados ao uso de substâncias psicoativas é abordado os saberes e as práticas relacionados ao uso abusivo de álcool, crack e outras drogas. Assim, foram indicadas as diferentes formas e os modelos de cuidado dos pacientes usuários de substâncias psicoativas, observando-se que apesar de cada uma dessas apresentar sua especificidade, as decisões terapêuticas devem considerar a pessoa que sofre e oportunizar sua participação efetiva na construção de seu projeto terapêutico.1.0UNA-SUSMinistério da Saúd

Users' preferences and perceptions of thecomprehensibility and readability of medication labels

Objective: To evaluate the labeling preferences of medication users and characterize their perceptions of the comprehensibility and readability of medication labels. Methods: We conducted a population-based cross-sectional study of medication users aged 18 years or older in 10 Brazilian capital cities. Perceptions of the comprehensibility and readability of medication labels in relation to sociodemographic characteristics were evaluated by Poisson regression models with robust variance. Labeling preferences were assessed through questions addressing possible improvements and through the use of digitally simulated packages. Results Of 6,255 medication users interviewed, more than half found it difficult or very difficult to read (50.8%) and/or understand (52.0%) medication labels. Difficulties were more pronounced for participants aged 40 years or older, with lower levels of education, and nonwhites. Increasing the font size (93.7%), describing the indications for use (95.9%) and contraindications (95.6%) on the label, and highlighting the expiration date (96.3%) were the most widely accepted improvements. In the evaluation of simulated packages, users preferred factors that improved readability, such as increased font size, use of graphic elements and color to highlight the concentration of the active ingredient, and contrast between the font color and background. The new simulated package design, with increased font size, color to highlight the concentration and contrast between the font color and background, was preferred over the standard design by 77.0% of participants. Conclusion: Based on users’ perceptions, increased font size and use of graphic elements and color to emphasize critical information, such as expiration date and concentration, are factors that contribute to making medication labels clearer to users. Pharmaceutical industries and policy makers should consider these items when developing labels and defining policies on this issue

Rótulos de medicamentos na perspectiva dos profissionais de saúde brasileiros dificuldades, nível de satisfação e melhorias propostas

Objective: To evaluate health professionals’ perceptions of medication error situations associated with labeling. Methods: Crosssectional study of 1056 nurse technicians, nurses, and pharmacists interviewed in 10 Brazilian capital cities. We assessed participants’ perceptions of difficulty in differentiating or seeing information on labels, likelihood of a medication error to occur, and frequency of medication errors, including: 1) look-alike vials or labels; 2) two packages of the same medicine but of different doses; 3) ampoule labels; 4) blister pack labels; and 5) labels printed on secondary packages. Results: Most participants reported it difficult or very difficult to differentiate between look-alike vials (82.4%) and between different doses of the same medicine (82.5%). Identifying important information on ampoules, blister packs, and secondary packages was considered difficult or very difficult by 89.9%, 64.4%, and 48.9% of participants, respectively. Approximately half of the participants reported that an error was most likely to occur in situations involving difficulty in seeing the information on an ampoule, look-alike labels, and packages of the same medicine but of different doses. Conclusion: Difficulty in at least one of the situations involving the identification or differentiation of medication labels is common among health professionals, leading to a greater likelihood of medication errors.Objetivo: Avaliar as percepções de profissionais da saúde sobre situações de erros de medicação associado a rotulagem. Métodos: Estudo transversal com 1.056 técnicos de enfermagem, enfermeiros e farmacêuticos entrevistados em 10 capitais brasileiras. Avaliamos a percepção dos participantes sobre a dificuldade em diferenciar ou ver as informações nos rótulos, a probabilidade de ocorrer um erro de medicação e a frequência de erros de medicação, incluindo: 1) frascos ou rótulos semelhantes; 2) duas embalagens do mesmo medicamento, mas com doses diferentes; 3) rótulos de ampolas; 4) rótulos das embalagens blister; e 5) etiquetas impressas nas embalagens secundárias. Resultados: A maioria dos participantes relatou ser difícil ou muito difícil diferenciar entre frascos idênticos (82,4%) e entre diferentes doses do mesmo medicamento (82,5%). A identificação de informações importantes sobre ampolas, blisters e embalagens secundárias foi considerada difícil ou muito difícil por 89,9%, 64,4% e 48,9% dos participantes, respectivamente. Aproximadamente metade dos participantes relatou que um erro era mais provável de ocorrer em situações envolvendo dificuldade em ver as informações em uma ampola, rótulos semelhantes e embalagens do mesmo medicamento, mas com doses diferentes. Conclusão: A dificuldade em pelo menos uma das situações que envolvem a identificação ou diferenciação dos rótulos dos medicamentos é comum entre os profissionais de saúde, levando a uma maior probabilidade de erros de medicação