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1.
Perspectivas de estudantes e egressos sobre a aprendizagem baseada em problemas na formação de enfermeiros
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Rodrigues, Paula Sales
; Marin, Maria José Sanches
; Souza, Aline Pereira
; Vernasque, Juliana Ribeiro da Silva
; Grandin, Gabriela Martins
; Almeida, Karina Roberta Vieira de
; Oliveira, Carolina Saab Rocha de
.
Resumo Objetivou-se analisar a percepção de estudantes e egressos sobre a utilização da Aprendizagem Baseada em Problemas (ABP) na formação do enfermeiro. Trata-se de um estudo qualitativo que utiliza a modalidade compreensiva e interpretativa proposta pela Hermenêutica-Dialética. Realizaram-se quatro grupos focais com a participação de 17 estudantes e 16 egressos de uma instituição de ensino superior que aplica a ABP na formação de enfermeiros. A análise dos resultados permitiu a definição de cinco categorias temáticas: dificuldade de adaptação em relação ao método; conquista de autonomia sobre o próprio aprendizado; incentivo ao desenvolvimento do raciocínio clínico; aprimoramento da comunicação e das relações interpessoais e integração entre teoria e prática. Evidencia-se que a utilização da ABP favorece a aproximação com as proposições das diretrizes curriculares para a formação do enfermeiro por meio do desenvolvimento de habilidades e competências como autonomia, comunicação, relações interpessoais e raciocínio clínico mediante práticas integrais e contextualizadas. Entretanto, os estudantes enfrentam dificuldades com as mudanças observadas ao serem inseridos nela ABP, as quais são superadas no decorrer do processo de implementação. Objetivouse Objetivou se (ABP Tratase Trata HermenêuticaDialética. HermenêuticaDialética Hermenêutica Dialética. Dialética Hermenêutica-Dialética Realizaramse Realizaram 1 enfermeiros temáticas método aprendizado prática Evidenciase Evidencia contextualizadas Entretanto implementação
Abstract This study aimed to analyze students’ and graduates’ perceptions regarding the use of Problem-Based Learning (PBL) in nurse education. This is a qualitative study that employs the comprehensive and interpretative approach proposed by Dialectical Hermeneutics. Four focus groups were conducted with the participation of 17 students and 16 graduates from a higher education institution that implements PBL in nurse education. The analysis of results allowed for the identification of five thematic categories: difficulty in adapting to the method; attainment of autonomy in one’s own learning; encouragement of clinical reasoning development; enhancement of communication and interpersonal relationships; and integration between theory and practice. It is evident that the use of PBL promotes alignment with the propositions of curriculum guidelines for nurse education by fostering the development of skills and competencies such as autonomy, communication, interpersonal relationships, and clinical reasoning through comprehensive and contextualized practices. However, students encounter challenges with the changes observed when introduced to PBL, which are overcome during the implementation process. ProblemBased Problem Based (PBL Hermeneutics 1 categories method ones one s learning relationships practice practices However process
2.
Perspectivas de estudantes e egressos sobre a aprendizagem baseada em problemas na formação de enfermeiros
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Rodrigues, Paula Sales
; Marin, Maria José Sanches
; Souza, Aline Pereira
; Vernasque, Juliana Ribeiro da Silva
; Grandin, Gabriela Martins
; Almeida, Karina Roberta Vieira de
; Oliveira, Carolina Saab Rocha de
.
Resumo Objetivou-se analisar a percepção de estudantes e egressos sobre a utilização da Aprendizagem Baseada em Problemas (ABP) na formação do enfermeiro. Trata-se de um estudo qualitativo que utiliza a modalidade compreensiva e interpretativa proposta pela Hermenêutica-Dialética. Realizaram-se quatro grupos focais com a participação de 17 estudantes e 16 egressos de uma instituição de ensino superior que aplica a ABP na formação de enfermeiros. A análise dos resultados permitiu a definição de cinco categorias temáticas: dificuldade de adaptação em relação ao método; conquista de autonomia sobre o próprio aprendizado; incentivo ao desenvolvimento do raciocínio clínico; aprimoramento da comunicação e das relações interpessoais e integração entre teoria e prática. Evidencia-se que a utilização da ABP favorece a aproximação com as proposições das diretrizes curriculares para a formação do enfermeiro por meio do desenvolvimento de habilidades e competências como autonomia, comunicação, relações interpessoais e raciocínio clínico mediante práticas integrais e contextualizadas. Entretanto, os estudantes enfrentam dificuldades com as mudanças observadas ao serem inseridos nela ABP, as quais são superadas no decorrer do processo de implementação.
Abstract This study aimed to analyze students’ and graduates’ perceptions regarding the use of Problem-Based Learning (PBL) in nurse education. This is a qualitative study that employs the comprehensive and interpretative approach proposed by Dialectical Hermeneutics. Four focus groups were conducted with the participation of 17 students and 16 graduates from a higher education institution that implements PBL in nurse education. The analysis of results allowed for the identification of five thematic categories: difficulty in adapting to the method; attainment of autonomy in one’s own learning; encouragement of clinical reasoning development; enhancement of communication and interpersonal relationships; and integration between theory and practice. It is evident that the use of PBL promotes alignment with the propositions of curriculum guidelines for nurse education by fostering the development of skills and competencies such as autonomy, communication, interpersonal relationships, and clinical reasoning through comprehensive and contextualized practices. However, students encounter challenges with the changes observed when introduced to PBL, which are overcome during the implementation process.
3.
Recommendations on cutaneous and hematological manifestations of Sjögren’s disease by the Brazilian Society of Rheumatology Sjögrens Sjögren s
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Pugliesi, Alisson
; Egypto, Danielle Christinne Soares do
; Duffles, Guilherme
; Cantali, Diego Ustárroz
; Pasoto, Sandra Gofinet
; Oliveira, Fabiola Reis
; Valim, Valeria
; Lopes, Maria Lucia Lemos
; Miyamoto, Samira Tatiyama
; Fernandes, Marilena Leal Mesquita Silvestre
; Fialho, Sonia Cristina de Magalhães Souza
; Pinheiro, Aysa César
; Santos, Laura Caldas dos
; Appenzeller, Simone
; Ribeiro, Sandra Lucia Euzébio
; Libório-Kimura, Tatiana Nayara
; Santos, Maria Carmen Lopes Ferreira Silva
; Gennari, Juliana D´Agostino
; Pernanbuco, Roberta
; Capobiano, Karina Gatz
; Civile, Vinicius Tassoni
; Pinto, Ana Carolina Pereira Nunes
; Rocha-Filho, César Ramos
; Rocha, Aline Pereira da
; Trevisani, Virginia Fernandes Moça
.
Abstract Sjogren’s disease (SjD) is an autoimmune disease that is characterized not only by the sicca symptoms it causes but also by its systemic nature, which is capable of several and not yet fully understood extraglandular manifestations. To gain a clearer understanding of these manifestations as well as a better practical approach, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of the extraglandular manifestations present in ESSDAI (EULAR Sjogren´s syndrome disease activity index), followed by a voting panel with recommendations for clinical practice. This publication is complementary to others already published and covers cutaneous and hematological manifestations, with prevalence data generated by a meta-analysis of 13 clinical or laboratory manifestations and 6 clinical management recommendations. Sjogrens Sjogren s SjD (SjD nature approach metaanalysis meta analysis EULAR index, index , index) practice 1
4.
To be or not to B27 positive: implications for the phenotypes of axial spondyloarthritis outcomes. Data from a large multiracial cohort from the Brazilian Registry of Spondyloarthritis B B2 positive outcomes
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Resende, Gustavo Gomes
; Saad, Carla Goncalves Schahin
; Marques, Claudia Diniz Lopes
; Ribeiro, Sandra Lúcia Euzébio
; Gavi, Maria Bernadete Renoldi de Oliveira
; Yazbek, Michel Alexandre
; Marinho, Adriana de Oliveira
; Menin, Rita de Cássia
; Ochtrop, Manuella Lima Gomes
; Soares, Andressa Miozzo
; Cavalcanti, Nara Gualberto
; Carneiro, Jamille Nascimento
; Werner de Castro, Glaucio Ricardo
; Fernandes, José Mauro Carneiro
; Souza, Elziane da Cruz Ribeiro E
; Alvarenga, Corina Quental de Menezes
; Vieira, Rejane Maria Rodrigues de Abreu
; Machado, Natalia Pereira
; Ximenes, Antônio Carlos
; Gazzeta, Morgana Ohira
; Albuquerque, Cleandro Pires de
; Skare, Thelma Larocca
; Keiserman, Mauro Waldemar
; Kohem, Charles Lubianca
; Benacon, Gabriel Sarkis
; Rocha, Vítor Florêncio Santos
; Lage, Ricardo da Cruz
; Malheiro, Olivio Brito
; Golebiovski, Rywka Tenenbaum Medeiros
; Oliveira, Thauana Luiza
; Duque, Ruben Horst
; Londe, Ana Carolina
; Pinheiro, Marcelo de Medeiros
; Sampaio-Barros, Percival Degrava
.
Abstract Background There is a remarkable variability in the frequency of HLA-B27 positivity in patients with spondyloarthritis (SpA), which may be associated with different clinical presentations worldwide. However, there is a lack of data considering ethnicity and sex on the evaluation of the main clinical and prognostic outcomes in mixed-race populations. The aim of this study was to evaluate the frequency of HLA-B27 and its correlation with disease parameters in a large population of patients from the Brazilian Registry of Spondyloarthritis (RBE). Methods The RBE is a multicenter, observational, prospective cohort that enrolled patients with SpA from 46 centers representing all five geographic regions of Brazil. The inclusion criteria were as follow: (1) diagnosis of axSpA by an expert rheumatologist; (2) age ≥18 years; (3) classification according to ASAS axial. The following data were collected via a standardized protocol: demographic data, disease parameters and treatment historical. Results A total of 1096 patients were included, with 73.4% HLA-B27 positivity and a mean age of 44.4 (±13.2) years. Positive HLA-B27 was significantly associated with male sex, earlier age at disease onset and diagnosis, uveitis, and family history of SpA. Conversely, negative HLA-B27 was associated with psoriasis, higher peripheral involvement and disease activity, worse quality of life and mobility. Conclusions Our data showed that HLA-B27 positivity was associated with a classic axSpA pattern quite similar to that of Caucasian axSpA patients around the world. Furthermore, its absence was associated with peripheral manifestations and worse outcomes, suggesting a relevant phenotypic difference in a highly miscegenated population. HLAB27 HLAB HLA B27 B HLA-B2 SpA, , (SpA) worldwide However mixedrace mixed race populations RBE. . (RBE) multicenter observational 4 Brazil follow 1 (1 rheumatologist 2 (2 18 ≥1 years 3 (3 axial protocol historical 109 included 734 73 73.4 444 44 44. ±13.2 132 13 (±13.2 uveitis Conversely psoriasis activity mobility world Furthermore HLAB2 B2 HLA-B (SpA (RBE ( ≥ 10 7 73. ±13. (±13. ±13 (±13 ±1 (±1 ± (±
5.
Effectiveness and safety of tocilizumab for COVID-19: a systematic review and meta-analysis of randomized clinical trials COVID19 COVID 19 COVID-19 metaanalysis meta analysis COVID1 1 COVID-1 COVID-
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Almeida, Paula Ribeiro Lopes
; Person, Osmar Clayton
; Puga, Maria Eduarda dos Santos
; Giusti, Maria Fernanda
; Pinto, Ana Carolina Pereira Nunes
; Rocha, Aline Pereira
; Atallah, Álvaro Nagib
.
ABSTRACT BACKGROUND: Tocilizumab is an anti-human interleukin 6 receptor monoclonal antibody that has been used to treat coronavirus disease 2019 (COVID-19). However, there is no consensus on its efficacy for the treatment of COVID-19. OBJECTIVE: To evaluate the effectiveness and safety of tocilizumab for treating COVID-19. DESIGN AND SETTING: Systematic Review of randomized controlled trials (RCTs), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. METHODS: We searched MEDLINE via PubMed, EMBASE, CENTRAL, and IBECS for RCTs published up to March 2021. Two authors selected studies and assessed the risk of bias and the certainty of the evidence following Cochrane Recommendations. RESULTS: Eight RCTs with 6,139 participants were included. We were not able to find differences between using tocilizumab compared to standard care on mortality in hospitalized patients with COVID-19 (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.84 to 1.13; 8 trials; 5,950 participants; low-certainty evidence). However, hospitalized patients under tocilizumab plus standard care treatment seemed to present a significantly lower risk of needing mechanical ventilation (risk ratio = 0.78; 95% CI 0.64−0.94 moderate-certainty of evidence). CONCLUSIONS: To date, the best evidence available shows no difference between using tocilizumab plus standard care compared to standard care alone for reducing mortality in patients with COVID-19. However, as a finding with a practical implication, the use of tocilizumab in association to standard care probably reduces the risk of progressing to mechanical ventilation in those patients. REGISTRATION: osf.io/qe4fs. BACKGROUND antihuman anti human 201 COVID19. COVID19 COVID 19 . (COVID-19) However 19. OBJECTIVE SETTING RCTs, , (RCTs) UNIFESP, UNIFESP (UNIFESP) SP, SP (SP) Brazil METHODS PubMed EMBASE CENTRAL 2021 Recommendations RESULTS 6139 139 6,13 included COVID-1 RR (RR 097 0 97 0.97 95 (CI 084 84 0.8 1.13 113 1 13 5950 5 950 5,95 lowcertainty low evidence. evidence) 0.78 078 78 064094 64 94 0.64−0.9 moderatecertainty moderate CONCLUSIONS date implication REGISTRATION osfioqe4fs osfioqefs osf io qe4fs qe fs osf.io/qe4fs 20 COVID1 (COVID-19 (RCTs (UNIFESP (SP 202 613 6,1 COVID- 09 9 0.9 08 0. 1.1 11 595 5,9 0.7 07 7 06409 0.64−0. osfioqe qefs 2 (COVID-1 61 6, 1. 59 5, 0640 0.64−0 (COVID- 064 0.64− (COVID 06 0.64 0.6
6.
Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023 202 20 2
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Marin-Neto, José Antonio
; Rassi Jr, Anis
; Oliveira, Gláucia Maria Moraes
; Correia, Luís Claudio Lemos
; Ramos Júnior, Alberto Novaes
; Luquetti, Alejandro Ostermayer
; Hasslocher-Moreno, Alejandro Marcel
; Sousa, Andréa Silvestre de
; Paola, Angelo Amato Vincenzo de
; Sousa, Antônio Carlos Sobral
; Ribeiro, Antonio Luiz Pinho
; Correia Filho, Dalmo
; Souza, Dilma do Socorro Moraes de
; Cunha-Neto, Edecio
; Ramires, Felix Jose Alvarez
; Bacal, Fernando
; Nunes, Maria do Carmo Pereira
; Martinelli Filho, Martino
; Scanavacca, Maurício Ibrahim
; Saraiva, Roberto Magalhães
; Oliveira Júnior, Wilson Alves de
; Lorga-Filho, Adalberto Menezes
; Guimarães, Adriana de Jesus Benevides de Almeida
; Braga, Adriana Lopes Latado
; Oliveira, Adriana Sarmento de
; Sarabanda, Alvaro Valentim Lima
; Pinto, Ana Yecê das Neves
; Carmo, Andre Assis Lopes do
; Schmidt, Andre
; Costa, Andréa Rodrigues da
; Ianni, Barbara Maria
; Markman Filho, Brivaldo
; Rochitte, Carlos Eduardo
; Macêdo, Carolina Thé
; Mady, Charles
; Chevillard, Christophe
; Virgens, Cláudio Marcelo Bittencourt das
; Castro, Cleudson Nery de
; Britto, Constança Felicia De Paoli de Carvalho
; Pisani, Cristiano
; Rassi, Daniela do Carmo
; Sobral Filho, Dário Celestino
; Almeida, Dirceu Rodrigues de
; Bocchi, Edimar Alcides
; Mesquita, Evandro Tinoco
; Mendes, Fernanda de Souza Nogueira Sardinha
; Gondim, Francisca Tatiana Pereira
; Silva, Gilberto Marcelo Sperandio da
; Peixoto, Giselle de Lima
; Lima, Gustavo Glotz de
; Veloso, Henrique Horta
; Moreira, Henrique Turin
; Lopes, Hugo Bellotti
; Pinto, Ibraim Masciarelli Francisco
; Ferreira, João Marcos Bemfica Barbosa
; Nunes, João Paulo Silva
; Barreto-Filho, José Augusto Soares
; Saraiva, José Francisco Kerr
; Lannes-Vieira, Joseli
; Oliveira, Joselina Luzia Menezes
; Armaganijan, Luciana Vidal
; Martins, Luiz Cláudio
; Sangenis, Luiz Henrique Conde
; Barbosa, Marco Paulo Tomaz
; Almeida-Santos, Marcos Antonio
; Simões, Marcos Vinicius
; Yasuda, Maria Aparecida Shikanai
; Moreira, Maria da Consolação Vieira
; Higuchi, Maria de Lourdes
; Monteiro, Maria Rita de Cassia Costa
; Mediano, Mauro Felippe Felix
; Lima, Mayara Maia
; Oliveira, Maykon Tavares de
; Romano, Minna Moreira Dias
; Araujo, Nadjar Nitz Silva Lociks de
; Medeiros, Paulo de Tarso Jorge
; Alves, Renato Vieira
; Teixeira, Ricardo Alkmim
; Pedrosa, Roberto Coury
; Aras Junior, Roque
; Torres, Rosalia Morais
; Povoa, Rui Manoel dos Santos
; Rassi, Sergio Gabriel
; Alves, Silvia Marinho Martins
; Tavares, Suelene Brito do Nascimento
; Palmeira, Swamy Lima
; Silva Júnior, Telêmaco Luiz da
; Rodrigues, Thiago da Rocha
; Madrini Junior, Vagner
; Brant, Veruska Maia da Costa
; Dutra, Walderez Ornelas
; Dias, João Carlos Pinto
.
7.
Ciência da disseminação e implementação em países de língua portuguesa: por que considerar? portuguesa considerar
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Sala, Danila Cristina Paquier
; Okuno, Meiry Fernanda Pinto
; Buccini, Gabriela
; Hankins, Jane Silva
; Câmara, Alice Barros
; Vieira, Ana Claudia
; Horta, Ana Lucia de Moraes
; Varela, Andrea Liliana Vesga
; Trapé, Carla Andrea
; Treichel, Carlos Alberto dos Santos
; Luizaga, Carolina Terra de Moraes
; Oliveira, Cintia de Freitas
; Luquine Jr, Cézar D
; Bonfim, Daiana
; Melo, Daiane Sousa
; Fatori, Daniel
; Bernardo, Debora
; Silva, Flávio Dias
; Paiva Neto, Francisco Timbó de
; Sousa, Girliani Silva de
; Relvas, Gláubia Rocha Barbosa
; Eshriqui, Ilana
; Chavez, Leidy Janeth Erazo
; Almeida, Leticia Yamawaka de
; Godoi, Lídia Pereira da Silva
; Belotti, Lorrayne
; Corrêa, Lucas Hernandes
; Cordeiro, Luciana
; Hespanhol, Luiz
; Juskevicius, Luize Fábrega
; Padoveze, Maria Clara
; Bueno, Mariana
; Siqueira, Marina Martins
; Bortoli, Maritsa Carla de
; Louvison, Marília Cristina Prado
; Cardoso, Marília Mastrocolla de Almeida
; Becker, Natália
; Tanaka, Oswaldo Yoshimi
; Costa, Paula Cristina Pereira da
; Bomfim, Rafael Aiello
; Luz, Reginaldo Adalberto
; Gimbel, Sarah
; Dias, Sónia
; Castral, Thaíla Corrêa
; Domingos, Thiago da Silva
; Baumann, Ana A.
.
8.
[SciELO Preprints] - Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy
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Marin-Neto, José Antonio
Rassi Jr., Anis
Moraes Oliveira, Gláucia M.
Lemos Correia, Luís Claudio
Novaes Ramos Jr., Alberto
Hasslocher-Moreno, Alejandro Marcel
Luquetti Ostermayer, Alejandro
Sousa, Andréa Silvestre de
Amato Vincenzo de Paola, Angelo
Sobral de Sousa, Antonio Carlos
Pinho Ribeiro, Antonio Luiz
Correia Filho, Dalmo
Moraes de Souza, Dilma do Socorro
Cunha-Neto, Edecio
J. A. Ramires, Felix
Bacal, Fernando
Pereira Nunes, Maria do Carmo
Martinelli Filho, Martino
Ibrahim Scanavacca, Maurício
Magalhães Saraiva, Roberto
Alves de Oliveira Júnior, Wilson
M. Lorga-Filho, Adalberto
de Jesus Benevides de Almeida Guimarães, Adriana
Lopes Latado Braga, Adriana
Sarmento de Oliveira, Adriana
V. L. Sarabanda, Alvaro
Yecê das Neves Pinto, Ana
Assis Lopes do Carmo, André
Schmidt, André
Costa, Andréa Rodrigues da
Ianni, Barbara Maria
Markman Filho, Brivaldo
Eduardo Rochitte, Carlos
Thé Macedo, Carolina
Mady, Charles
Chevillard, Christophe
Bittencourt das Virgens, Cláudio Marcelo
Nery de Castro, Cleudson
De Paoli de Carvalho Britto, Constança Felícia
Pisani, Cristiano
do Carmo Rassi, Daniela
C. Sobral Filho, Dario
Rodrigues Almeida, Dirceu
A. Bocchi, Edimar
T. Mesquita, Evandro
de Souza Nogueira Sardinha Mendes, Fernanda
Pereira, Francisca Tatiana
Sperandio da Silva, Gilberto Marcelo
de Lima Peixoto, Giselle
Glotz de Lima, Gustavo
H. Veloso, Henrique
Turin Moreira, Henrique
Bellotti Lopes, Hugo
Masciarelli Francisco Pinto, Ibraim
Pinto Dias, João Carlos
Bemfica, João Marcos
Silva-Nunes, João Paulo
Soares Barreto-Filho, José Augusto
Kerr Saraiva, José Francisco
Lannes-Vieira, Joseli
Menezes Oliveira, Joselina Luzia
V. Armaganijan, Luciana
Martins, Luiz Cláudio
C. Sangenis, Luiz Henrique
Barbosa, Marco Paulo
Almeida-Santos, Marcos Antônio
Simões, Marcos Vinicius
Shikanai-Yasuda, Maria Aparecida
Vieira Moreira, Maria da Consolação
Higuchi, Maria de Lourdes
Costa Monteiro, Maria Rita de Cássia
Felix Mediano, Mauro Felippe
Maia Lima, Mayara
T. Oliveira, Maykon
Moreira Dias Romano , Minna
Nitz, Nadjar
de Tarso Jorge Medeiros, Paulo
Vieira Alves, Renato
Alkmim Teixeira, Ricardo
Coury Pedrosa, Roberto
Aras, Roque
Morais Torres, Rosália
dos Santos Povoa, Rui Manoel
Rassi, Sérgio Gabriel
Salles Xavier, Sérgio
Marinho Martins Alves , Silvia
B. N. Tavares, Suelene
Lima Palmeira, Swamy
da Silva Junior, Telêmaco Luiz
da Rocha Rodrigues, Thiago
Madrini Junior, Vagner
Maia da Costa , Veruska
Dutra, Walderez
This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.nbsp;
Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.
nbsp;
Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.nbsp;
The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.nbsp;
The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.nbsp; nbsp;nbsp;
Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.
Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou.
A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica.
Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas.
A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica.
A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.nbsp;nbsp;nbsp;
Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.nbsp;
9.
Aprendizagem baseada em problema na graduação de enfermagem: Percepção dos estudantes e egressos
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Rodrigues, Paula Sales
; Marin, Maria José Sanches
; Souza, Aline Pereira
; Grandin, Gabriela Martins
; Almeida, Karina Roberta Vieira de
; Oliveira, Carolina Saab Rocha de
.
Resumo: A ABP vem sendo utilizada como método de aprendizagem no mundo todo, porém, no ensino da graduação em enfermagem ainda é pouco utilizada. Considera-se relevante a realização de estudos a partir das experiências de estudantes e egressos de um curso que se utiliza da mesma. Objetivo: Compreender a percepção de estudantes e egressos sobre a utilização da ABP no curso de graduação em enfermagem. Método: Trata-se de um estudo qualitativo pautado na modalidade compreensiva e interpretativa, fundamentada nos pressupostos da Hermenêutica-Dialética. Foi realizado a partir de quatro grupos focais com 17 estudantes e 16 egressos de uma instituição de ensino superior do interior do estado de São Paulo, que se utiliza da ABP na formação dos enfermeiros de forma remota. O convite para participar do estudo foi feito via e-mail, Whatsapp e Facebook, ocasião em que foram explicados os objetivos do estudo, verificando-se o interesse em participar. Resultados: A análise dos dados levou à elaboração de cinco categorias temáticas, sendo elas: sofrimento para se apropriar da lógica da aprendizagem ativa; aquisição de autonomia para busca contínua do conhecimento; estímulo ao raciocínio clínico; melhora das relações interpessoais e comunicação; e, por fim, articulação teórico-prática. Conclusões: Ao utilizar a APB, há uma aproximação com as orientações dadas pelas diretrizes curriculares para a formação do enfermeiro, promovendo a aquisição de autonomia para a busca contínua do conhecimento, a capacidade de comunicação e de relações interpessoais e o desenvolvimento do raciocínio clínico e do pensamento crítico, levando a uma prática contextualizada e ampliada. Ressalta-se, ainda, a potencialidade do estudo para a pesquisa qualitativa por utilizar-se de grupos focais online, superando, assim, os desafios da pesquisa qualitativa em ambientes virtuais.
Abstract: ABP has been used as a learning method all over the world, however, in undergraduate nursing education it is still little used. It is considered relevant to carry out studies based on students and graduates’ experiences of a degree course that use this method. Main Goal: To understand the perception of students and graduates about the use of PBL in the undergraduate nursing course. Method: This is a qualitative study guided by the comprehensive and interpretive modality, based on dialectical hermeneutics assumptions. The research was conducted from four focus groups with 17 students and 16 graduates from a higher education institution in the interior of the state of São Paulo that uses PBL remotely in nurses’ training. The invitation to participate in the study was made via email, WhatsApp and Facebook, when the analysis’ goals were explained and the interest in participating was verified. Results: Data analysis led to the elaboration of five thematic categories, namely: suffering to appropriate the logic of active learning; acquisition of autonomy for the continuous search for knowledge; stimulation of clinical reasoning; improved interpersonal relationships and communication; and finally, theoretical-practical articulation. Conclusions: When using the PBL, there is an approximation with the curricular guidelines for the nurses’ training, promoting the acquisition of autonomy for the continuous search for knowledge, the ability to communicate and interpersonal relationships, the development of clinical reasoning and critical thinking, leading to a contextualized and expanded practice. Furthermore, we emphasize the potential of the study for qualitative research, using online focus groups, thus overcoming the challenges of qualitative research in virtual environments.
10.
Differentials in death count records by databases in Brazil in 2010
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Diógenes, Victor Hugo Dias
; Pinto Júnior, Elzo Pereira
; Gonzaga, Marcos Roberto
; Queiroz, Bernardo Lanza
; Lima, Everton E. C.
; Costa, Lilia Carolina C. da
; Rocha, Aline S.
; Ferreira, Andrêa J. F.
; Teixeira, Camila S. S.
; Alves, Flávia Jôse O.
; Rameh, Leila
; Flores-Ortiz, Renzo
; Leyland, Alastair
; Dundas, Ruth
; Barreto, Maurício L.
; Ichihara, Maria Yury Travassos
.
ABSTRACT OBJECTIVE To compare the death counts from three sources of information on mortality available in Brazil in 2010, the Mortality Information System (SIM - Sistema de Informações sobre Mortalidade ), Civil Registration Statistic System (RC - Sistema de Estatísticas de Resgistro Civil ), and the 2010 Demographic Census at various geographical levels, and to confirm the association between municipal socioeconomic characteristics and the source which showed the highest death count. METHODS This is a descriptive and comparative study of raw data on deaths in the SIM, RC and 2010 Census databases, the latter held in Brazilian states and municipalities between August 2009 and July 2010. The percentage of municipalities was confirmed by the database showing the highest death count. The association between the source of the highest death count and socioeconomic indicators - the Índice de Privação Brasileiro (IBP – Brazilian Deprivation Index) and Índice de Desenvolvimento Humano Municipal (IHDM – Municipal Human Development Index) - was performed by bivariate choropleth and Moran Local Index of Spatial Association (LISA) cluster maps. RESULTS Confirmed that the SIM is the database with the highest number of deaths counted for all Brazilian macroregions, except the North, in which the highest coverage was from the 2010 Census. Based on the indicators proposed, in general, the Census showed a higher coverage of deaths than the SIM and the RC in the most deprived (highest IBP values) and less developed municipalities (lowest IDHM values) in the country. CONCLUSION The results highlight regional inequalities in how the databases chosen for this study cover death records, and the importance of maintaining the issue of mortality on the basic census questionnaire.
11.
Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary Sjögren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian society of rheumatology (hepatic, gastrointestinal and pancreatic)
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Trevisani, Virginia Fernandes Moça
; Pinheiro, Aysa César
; Fialho, Sonia Cristina de Magalhães Souza
; Fernandes, Marilena Leal Mesquita Silvestre
; Pugliesi, Alisson
; Pasoto, Sandra Gofinet
; Lopes, Maria Lucia Lemos
; Guedes, Lissiane Karine Noronha
; Miyamoto, Samira Tatiyama
; Santos, Laura Caldas dos
; Appenzeller, Simone
; Fidelix, Tania
; Ribeiro, Sandra Lúcia Euzébio
; Brito, Danielle Christinne Soares Egypto de
; Libório-Kimura, Tatiana Nayara
; Santos, Maria Carmen Lopes Ferreira Silva
; Cantali, Diego Ustárroz
; Gennari, Juliana D.’Agostino
; Capobianco, Karina Gatz
; Civile, Vinicius Tassoni
; Pinto, Ana Carolina Pereira Nunes
; Rocha, Aline Pereira da
; Rocha Filho, César Ramos
; Oliveira, Fabiola Reis
; Valim, Valeria
.
Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients.
12.
Mortality inequalities measured by socioeconomic indicators in Brazil: a scoping review
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Ichihara, Maria Yury
; Ferreira, Andrêa J.F.
; Teixeira, Camila S. S.
; Alves, Flávia Jôse O.
; Rocha, Aline Santos
; Diógenes, Victor Hugo Dias
; Ramos, Dandara Oliveira
; Pinto Júnior, Elzo Pereira
; Flores-Ortiz, Renzo
; Rameh, Leila
; Costa, Lilia Carolina C. da
; Gonzaga, Marcos Roberto
; Lima, Everton E. C.
; Dundas, Ruth
; Leyland, Alastair
; Barreto, Maurício L.
.
ABSTRACT OBJECTIVE Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil. METHODS This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations. RESULTS Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation. CONCLUSIONS Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.
13.
Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force
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Tavares, Anna Carolina Faria Moreira Gomes
; Melo, Ana Karla Guedes de
; Cruz, Vítor Alves
; Souza, Viviane Angelina de
; Carvalho, Joana Starling de
; Machado, Ketty Lysie Libardi Lira
; Valadares, Lilian David de Azevedo
; Reis Neto, Edgard Torres dos
; Rezende, Rodrigo Poubel Vieira de
; Guimarães, Maria Fernanda Brandão de Resende
; Ferreira, Gilda Aparecida
; Braz, Alessandra de Sousa
; Vieira, Rejane Maria Rodrigues de Abreu
; Pinheiro, Marcelo de Medeiros
; Ribeiro, Sandra Lúcia Euzébio
; Bica, Blanca Elena Gomes Rios
; Baptista, Kátia Lino
; Costa, Izaias Pereira da
; Marques, Claudia Diniz Lopes
; Lopes, Maria Lúcia Lemos
; Martinez, José Eduardo
; Giorgi, Rina Dalva Neubarth
; Mota, Lícia Maria Henrique da
; Loures, Marcos Antônio Araújo da Rocha
; Paiva, Eduardo dos Santos
; Monticielo, Odirlei André
; Xavier, Ricardo Machado
; Kakehasi, Adriana Maria
; Pileggi, Gecilmara Cristina Salviato
.
Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle–Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.
14.
Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary sjogren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian Society of Rheumatology (articular, pulmonary and renal)
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Trevisani, Virginia Fernandes Moça
; Pugliesi, Alisson
; Pasoto, Sandra Gofinet
; Lopes, Maria Lucia Lemos
; Guedes, Lissiane Karine Noronha
; Miyamoto, Samira Tatiyama
; Fernandes, Marilena Leal Mesquita Silvestre
; Fialho, Sonia Cristina de Magalhães Souza
; Pinheiro, Aysa César
; Santos, Laura Caldas dos
; Appenzeller, Simone
; Fidelix, Tania
; Ribeiro, Sandra Lúcia Euzébio
; Brito, Danielle Christinne Soares Egypto de
; Libório-Kimura, Tatiana Nayara
; Santos, Maria Carmen Lopes Ferreira Silva
; Cantali, Diego Ustárroz
; Gennari, Juliana D’Agostino
; Civile, Vinicius Tassoni
; Pinto, Ana Carolina Pereira Nunes
; Rocha-Filho, César Ramos
; Oliveira, Fabiola Reis
; Rocha, Aline Pereira da
; Valim, Valeria
.
Abstract Sjogren’s Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients.
15.
Effectiveness and safety of tocilizumab for COVID-19: a systematic review and meta-analysis of randomized clinical trials
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Almeida, Paula Ribeiro Lopes
; Person, Osmar Clayton
; Puga, Maria Eduarda dos Santos
; Giusti, Maria Fernanda
; Pinto, Ana Carolina Pereira Nunes
; Rocha, Aline Pereira
; Atallah, Álvaro Nagib
.
ABSTRACT BACKGROUND: Tocilizumab is an anti-human interleukin 6 receptor monoclonal antibody that has been used to treat coronavirus disease 2019 (COVID-19). However, there is no consensus on its efficacy for the treatment of COVID-19. OBJECTIVE: To evaluate the effectiveness and safety of tocilizumab for treating COVID-19. DESIGN AND SETTING: Systematic Review of randomized controlled trials (RCTs), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. METHODS: We searched MEDLINE via PubMed, EMBASE, CENTRAL, and IBECS for RCTs published up to March 2021. Two authors selected studies and assessed the risk of bias and the certainty of the evidence following Cochrane Recommendations. RESULTS: Eight RCTs with 6,139 participants were included. We were not able to find differences between using tocilizumab compared to standard care on mortality in hospitalized patients with COVID-19 (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.84 to 1.13; 8 trials; 5,950 participants; low-certainty evidence). However, hospitalized patients under tocilizumab plus standard care treatment seemed to present a significantly lower risk of needing mechanical ventilation (risk ratio = 0.78; 95% CI 0.64−0.94 moderate-certainty of evidence). CONCLUSIONS: To date, the best evidence available shows no difference between using tocilizumab plus standard care compared to standard care alone for reducing mortality in patients with COVID-19. However, as a finding with a practical implication, the use of tocilizumab in association to standard care probably reduces the risk of progressing to mechanical ventilation in those patients. REGISTRATION: osf.io/qe4fs.
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