scholarly journals Dificuldades da intubação submentoniana em pacientes com traumas faciais: Scoping Review

2020 ◽  
Vol 9 (9) ◽  
pp. e974998171
Author(s):  
Isabel Dutra da Cruz ◽  
Daliane Soares Dantas Monteiro ◽  
Mikael de Araújo Silva ◽  
Hécio Henrique Araújo de Morais
Keyword(s):  
Scoping Review ◽  
Web Of Science ◽  
Cochrane Library ◽  
The Cochrane Library ◽  
Academic Search

A intubação submentoniana consiste em uma técnica de manutenção da via aérea que tem seu acesso cirúrgico situado na região submentual medial/paramedial, paralelamente à base da mandíbula. O seu principal objetivo é substituir a intubação nasotraqueal quando esta é contraindicada, surgindo como uma opção à traqueostomia, que seria o próximo passo nesses casos. Esse artigo é uma scoping review com o objetivo de descrever as evidências de forma a elucidar as dificuldades encontradas na intubação submentoniana no trauma facial. A estratégia de busca se deu nos bancos de dados SciELO, LILACS, PubMed, The Cochrane Library, Web of Science, SCOPUS, CINAHL e Academic Search Premier (via plataforma EBSCO), Biblioteca Digital de Teses e Dissertações USP, Busca Integrada USP e banco de teses CAPES, considerando elegíveis estudos primários, revisões, metanálises e/ou metassínteses, livros e guidelines, teses e dissertações, publicados em fontes indexadas ou na literatura cinzenta e nos idiomas português, inglês e espanhol. Na literatura revisada, foram encontrados 23 diferentes grupos de dificuldades relacionadas ao procedimento. Entre elas, destacam-se como as mais descritas os danos ao tubo endotraqueal e a dificuldade na passagem do tubo pela incisão submentoniana. Portanto, os estudos analisados demonstraram uma grande variedade de dificuldades relacionadas a vários aspectos intrinsecamente relacionados a realização do procedimento da intubação submentoniana.

scholarly journals Benefícios do uso do mel no tratamento do pé diabético: Scoping Review

2020 ◽  
Vol 9 (7) ◽  
pp. e956974663
Author(s):  
Isabel Dutra da Cruz ◽  
Daliane Soares Dantas Monteiro ◽  
Mikael de Araújo Silva ◽  
Bruno Oliveira Carreiro ◽  
Érico Gurgel Amorim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Scoping Review ◽  
Web Of Science ◽  
Cochrane Library ◽  
The Cochrane Library ◽  
Academic Search

O pé diabético pode ser compreendido como destruição de tecidos moles, infecção ou ulceração associada a alterações neurológicas e vasculares nos membros inferiores de portadores de diabetes mellitus (DM). É também uma das mais graves, dispendiosas e devastadoras complicações da DM, sendo as úlceras nos pés precursoras, em 85% dos casos, da amputação do membro inferior. Assim, o mel surge como uma alternativa de tratamento, sendo barato, com pouco risco de resistência bacteriana e amplamente disponível, fatores imprescindíveis para a continuidade do tratamento pelos pacientes. Este artigo é uma Scoping Rewiew que pretende descrever as evidências de forma a elucidar os benefícios do mel no tratamento do pé diabético. A pesquisa engloba estudos primários, revisões, metanálises e/ou metassínteses, livros e guidelines, teses e dissertações, publicados em fontes indexadas ou na literatura cinzenta publicados nas bases de dados: Scielo, LILACS, Pubmed, The Cochrane Library, Web of Science, SCOPUS, CINAHL e Academic Search Premier, CAPS, Biblioteca Digital de Teses e Dissertações USP, Busca Integrada USP. Na literatura revisada, foram encontrados 33 diferentes benefícios descritos para o uso do mel.  Dentre eles, destacam-se a maior taxa de cicatrização, propriedades antimicrobianas, anti-inflamatórias e desbridantes, entre outras. Portanto, os estudos analisados demonstraram uma grande variedade de benefícios, refletindo a complexidade de ação e a utilidade deste produto.

scholarly journals Evidências científicas das práticas de diagnóstico da retenção urinária: scoping review [Scientific evidence of urinary retention diagnostic practices: scoping review] [Evidencias científicas de las prácticas de diagnóstico de la retención urinaria: scoping review]

2018 ◽  
Vol 26 ◽  
pp. e25840
Author(s):  
Beatriz Maria Jorge ◽  
Alessandra Mazzo ◽  
Anamaria Alves Napoleão ◽  
Anaísa Bianchini
Keyword(s):  
Urinary Retention ◽  
Scoping Review ◽  
Allied Health ◽  
Web Of Science ◽  
Cochrane Library ◽  
National Library ◽  
Cumulative Index ◽  
Diagnostic Practices ◽  
Health Literature ◽  
The Cochrane Library

Objetivo: identificar evidências científicas sobre as práticas para o diagnóstico da retenção urinária. Método: trata-se de uma Scoping Review. A busca foi realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Web of Science, National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library e SCOPUS. Das 2482 referências encontradas, 23 foram selecionadas. Resultados: os 23 artigos que foram agrupados de acordo com a clínica do paciente: clínica cirúrgica, clínica de reabilitação e clínica obstétrica. E as práticas utilizadas para o diagnóstico da retenção urinária: cateterismo urinário de alívio, por meio do ultrassom portátil de bexiga, com a associação do ultrassom portátil de bexiga e do cateterismo urinário e/ou com medidas não invasivas. Conclusão: o diagnóstico da retenção urinária é um assunto que vem sendo discutido há algum tempo, no entanto, ainda não há um consenso, e a sua prática é realizada muitas vezes sem eficácia.ABSTRACTObjective: to identify scientific evidence on urinary retention diagnostic practices. Method: this scoping review searched the Latin American & Caribbean Health Sciences Literature, Web of Science, National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library and SCOPUS databases. Of the 2482 references found, 23 were selected. Results: the 23 articles were grouped by patient clinic (surgery, rehabilitation or obstetrics) and by urinary retention diagnostic practices (intermittent urinary catheterization, by portable bladder ultrasound, combination of portable bladder ultrasound and urinary catheterization and/or non-invasive measures). Conclusion: diagnosis of urinary retention is an issue that has been discussed for some time. However, there is still no consensus, and in practice it is often performed ineffectively.RESUMENObjetivo: identificar evidencias científicas sobre las prácticas para el diagnóstico de la retención urinaria. Método: se trata de una Scoping Review. Se realizó la búsqueda en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Web of Science, National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library y SCOPUS. De las 2482 referencias encontradas, se seleccionaron 23. Resultados: los 23 artículos se agruparon según la clínica del paciente: clínica quirúrgica, clínica de rehabilitación y clínica de obstetricia. Y las prácticas utilizadas para el diagnóstico de retención urinaria: cateterismo urinario de alivio, a través de ecografía (portátil) de vejiga, con la combinación de ecografía de vejiga y del cateterismo urinario y/o con medidas no invasivas. Conclusión: el diagnóstico de la retención urinaria es un tema que está siendo discutido desde hace algún tiempo, sin embargo, todavía no existe un consenso y su práctica se realiza a menudo ineficazmente.

Neuroimaging Outcomes in Studies of Cognitive Training in Mild Cognitive Impairment and Early Alzheimer’s Disease: A Systematic Review

2020 ◽  
Vol 17 (5) ◽  
pp. 472-486
Author(s):  
Lucy Beishon ◽  
Kannakorn Intharakham ◽  
David Swienton ◽  
Ronney B. Panerai ◽  
Thompson G. Robinson ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cognitive Impairment ◽  
Search Strategy ◽  
Web Of Science ◽  
Cochrane Library ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Early Alzheimer’S Disease ◽  
Magnetic Resonance Imaging Mri ◽  
The Cochrane Library

Background: Cognitive Training (CT) has demonstrated some benefits to cognitive and psychosocial function in Mild Cognitive Impairment (MCI) and early dementia, but the certainty related to those findings remains unclear. Therefore, understanding the mechanisms by which CT improves cognitive functioning may help to understand the relationships between CT and cognitive function. The purpose of this review was to identify the evidence for neuroimaging outcomes in studies of CT in MCI and early Alzheimer’s Disease (AD). Methods: Medline, Embase, Web of Science, PsycINFO, CINAHL, and The Cochrane Library were searched with a predefined search strategy, which yielded 1778 articles. Studies were suitable for inclusion where a CT program was used in patients with MCI or AD, with a structural or functional Magnetic Resonance Imaging (MRI) outcome. Studies were assessed for quality using the Downs and Black criteria. Results: Medline, Embase, Web of Science, PsycINFO, CINAHL, and The Cochrane Library were searched with a predefined search strategy, which yielded 1778 articles. Studies were suitable for inclusion where a CT program was used in patients with MCI or AD, with a structural or functional Magnetic Resonance Imaging (MRI) outcome. Studies were assessed for quality using the Downs and Black criteria. Conclusions: CT resulted in variable functional and structural changes in dementia, and conclusions are limited by heterogeneity and study quality. Larger, more robust studies are required to correlate these findings with clinical benefits from CT.

scholarly journals The value of lncRNAs as prognostic biomarkers on clinical outcomes in osteosarcoma: a meta-analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenchao Zhang ◽  
Xiaolei Ren ◽  
Lin Qi ◽  
Chenghao Zhang ◽  
Chao Tu ◽  
...  
Keyword(s):  
Web Of Science ◽  
Meta Analysis ◽  
Positive Outcome ◽  
Clinical Applications ◽  
Clinicopathological Features ◽  
Cochrane Library ◽  
Human Osteosarcoma ◽  
Non Coding Rna ◽  
The Cochrane Library ◽  
Long Non Coding Rna

Abstract Background In recent years, emerging studies have demonstrated critical functions and potential clinical applications of long non-coding RNA (lncRNA) in osteosarcoma. To further validate the prognostic value of multiple lncRNAs, we have conducted this updated meta-analysis. Methods Literature retrieval was conducted by searching PubMed, Web of Science and the Cochrane Library (last update by October 2, 2019). A meta-analysis was performed to explore association between lncRNAs expression and overall survival (OS) of osteosarcoma patients. Relationships between lncRNAs expression and other clinicopathological features were also analyzed respectively. Results Overall, 4351 patients from 62 studies were included in this meta-analysis and 25 lncRNAs were identified. Pooled analyses showed that high expression of 14 lncRNAs connoted worse OS, while two lncRNAs were associated with positive outcome. Further, analysis toward osteosarcoma clinicopathologic features demonstrated that overexpression of TUG1 and XIST indicated poor clinical parameters of patients. Conclusions This meta-analysis has elucidated the prognostic potential of 16 lncRNAs in human osteosarcoma. Evidently, desperate expression and functional targets of these lncRNAs offer new approaches for prognosis and therapy of osteosarcoma.

scholarly journals Addressing barriers to the conduct and application of research in complementary and alternative medicine: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yasamin Veziari ◽  
Saravana Kumar ◽  
Matthew Leach
Keyword(s):  
Alternative Medicine ◽  
Complementary And Alternative Medicine ◽  
Scoping Review ◽  
Data Extraction ◽  
Grey Literature ◽  
Evidence Base ◽  
Cochrane Library ◽  
Educational Strategies ◽  
The Cochrane Library ◽  
Complementary And Alternative

Abstract Background Over the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM. Methods The scoping review was undertaken using the Arksey and O’Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data. Results Of the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers. Conclusions While the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.

scholarly journals Relative infectiousness of asymptomatic SARS-CoV-2 infected persons compared with symptomatic individuals: a rapid scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042354
Author(s):  
David McEvoy ◽  
Conor McAloon ◽  
Aine Collins ◽  
Kevin Hunt ◽  
Francis Butler ◽  
...  
Keyword(s):  
Scoping Review ◽  
Quantitative Measure ◽  
Contact Tracing ◽  
Cochrane Library ◽  
International Studies ◽  
Screening Process ◽  
Modelling Studies ◽  
Asymptomatic Individuals ◽  
Definition Of ◽  
The Cochrane Library

ObjectivesThe aim of this study was to determine the relative infectiousness of asymptomatic SARS-CoV-2 infected persons compared with symptomatic individuals based on a scoping review of available literature.DesignRapid scoping review of peer-reviewed literature from 1 January to 5 December 2020 using the LitCovid database and the Cochrane library.SettingInternational studies on the infectiousness of individuals infected with SARS-CoV-2.ParticipantsStudies were selected for inclusion if they defined asymptomatics as a separate cohort distinct from presymptomatics and if they provided a quantitative measure of the infectiousness of asymptomatics relative to symptomatics.Primary outcome measuresPCR result (PCR studies), the rate of infection (mathematical modelling studies) and secondary attack rate (contact tracing studies) - in each case from asymptomatic in comparison with symptomatic individuals.ResultsThere are only a limited number of published studies that report estimates of relative infectiousness of asymptomatic compared with symptomatic individuals. 12 studies were included after the screening process. Significant differences exist in the definition of infectiousness. PCR studies in general show no difference in shedding levels between symptomatic and asymptomatic individuals; however, the number of study subjects is generally limited. Two modelling studies estimate relative infectiousness to be 0.43 and 0.57, but both of these were more reflective of the infectiousness of undocumented rather than asymptomatic cases. The results from contact tracing studies include estimates of relative infectiousness of 0, but with insufficient evidence to conclude that it is significantly different from 1.ConclusionsThere is considerable heterogeneity in estimates of relative infectiousness highlighting the need for further investigation of this important parameter. It is not possible to provide any conclusive estimate of relative infectiousness, as the estimates from the reviewed studies varied between 0 and 1.

scholarly journals Scoping review protocol: the use of telemedicine in providing opioid agonist treatment and related psychosocial supports

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040556
Author(s):  
Des Crowley ◽  
Robyn Homeniuk ◽  
Ide Delargy
Keyword(s):  
Scoping Review ◽  
Psychosocial Support ◽  
Descriptive Analysis ◽  
Cochrane Library ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Search Terms ◽  
Medical Librarian ◽  
The Cochrane Library

IntroductionThe global opioid-related disease burden is significant. Opioid agonist treatment (OAT) can be effective in reducing illicit opioid use and fatal overdose, and improving multiple health and social outcomes. Despite evidence for its effectiveness, there are significant deficits in OAT globally. COVID-19 has required rapid adaptation of remote models of healthcare. Telemedicine is not used routinely in OAT, and little is known about the current levels of use and effectiveness. The objective of this review is to describe models of telemedicine and their efficacy.Methods and analysisThis scoping review uses the review methodology described by Arksey and O’Malley and adapted by Levac et al. The search strategy developed by the medical librarian at the Irish College of General Practitioners in conjunction with the research team will involve five databases (PubMed, EMBASE, the Cochrane Library, PsycInfo and OpenGrey) and the hand searching of reference lists. A limited initial search of two databases will be completed to refine search terms, followed by a second comprehensive search using newly refined search terms of all databases and finally hand searching references of included studies. To be included, studies must report on remote ways of providing OAT (including assessment, induction and monitoring) or related psychosocial support; be published in English after 2010. Two researchers will independently screen titles, abstracts and full-text articles considered for inclusion. Data will be extracted onto an agreed template and will undergo a descriptive analysis of the contextual or process-oriented data and simple quantitative analysis using descriptive statistics.Ethics and disseminationResearch ethics approval is not required for this scoping review. The results of this scoping review will inform the development of a national remote model of OAT. The results will be published in peer-reviewed journals and presented at relevant conferences.

S-1 and Capecitabine for the Treatment of Colorectal Cancer: A Meta-Analysis

2021 ◽  
Vol 11 (6) ◽  
pp. 1144-1152
Author(s):  
Ping Huang ◽  
Zhenfen Wang ◽  
Qian Liu ◽  
Guohao Cai
Keyword(s):  
Colorectal Cancer ◽  
Web Of Science ◽  
Advanced Colorectal Cancer ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Therapeutic Effects ◽  
Chemotherapeutic Drugs ◽  
The Third ◽  
Hand Foot Syndrome ◽  
The Cochrane Library

Colorectal cancers common tumors that develop in the large intestines. The incidence of colorectal cancer is second only to gastric and esophageal cancers. Both S-1 and capecitabine are the third-generation fluorouracil-based chemotherapeutic drugs. We hope to summarize the therapeutic effects of tecotae and capecitabine in patients with colorectal cancer through this Meta-analysis. We performed a meta-analysis of the findings in the current literature. We performed a systematic review of outcomes associated with S-1 and capecitabine used to treat advanced colorectal cancer based on findings from both English and Chinese publications listed in PubMed, Embase, CNKI, Wanfang, EBSCO, Web of Science and the Cochrane Library. End-points included ORR, DCR, OS, and PFS; adverse events (grades 1–2 and 3–4) were also evaluated. Statistical analysis was performed using RevMan 5.3. A total of 12 studies were eventually included, involving a total of 3,375 patients. Of this group, 1,683 and 1,692 patients underwent treatment with S-1 or capecitabine, respectively. There were no greatly differences with respect to ORR, DCR, or OS; however, PFS was bettered in the group of S-1 compared to those treated with capecitabine. The incidence of leukopenia, diarrhea and anorexia were all higher among those in S-1 group compared to the capecitabine group, but a higher incidence of hand-foot syndrome was linked with use of capecitabine. Use of S-1 for the treatment of colorectal cancer may result in superior outcomes when compared to use of capecitabine.

scholarly journals Complicações renais decorrentes da infecção por SARS-CoV-2 em pessoas com COVID-19 hospitalizadas: scoping review

2022 ◽  
Vol 11 (1) ◽  
pp. e40811125217
Author(s):  
Anyele Albuquerque Lima ◽  
Alda Graciele Claudio dos Santo Almeida ◽  
Izabelly Carollynny Maciel Nunes ◽  
Patrícia de Albuquerque Sarmento ◽  
Wanda Tenório Barros Passos Alves
Keyword(s):  
Acute Kidney Injury ◽  
Scoping Review ◽  
Web Of Science ◽  
Kidney Diseases ◽  
Grey Literature ◽  
Kidney Injury ◽  
Glomerular Disease ◽  
Google Scholar ◽  
Cochrane Library

Objetivos: Identificar complicações/sequelas renais decorrentes da infecção por SARS-CoV-2 em pessoas com COVID-19; e descrever a característica de idade da população estudada. Metodologia: Scoping Review realizada nas bases de dados Web of Science, BVS, Cochrane Library, MEDLINE/PubMed, CINAHL, SCOPUS, Embase, LILACS. E nos sites online: ProQuest Dissertations and Theses, Grey Literature e Google Scholar. Os descritores utilizados foram (comorbidity OR sequel OR complications), (kidney diseases OR glomerular disease OR acute kidney injury OR nephropathy) AND (coronavirus OR SARS-CoV-2 OR COVID-19). Critérios de inclusão: artigos em português, inglês e espanhol, com abordagens metodológicas diversas, disponíveis na íntegra, online, publicados no período de 01 de janeiro de 2020 a 29 de setembro de 2021. E de exclusão: pessoas com diagnósticos prévios de patologias renais agudas e/ou crônicas; cartas ao editor; artigos de opinião; editoriais; e notas. Resultados: Selecionaram-se 10 artigos, que evidenciaram que o processo infeccioso causado pelo SARS-CoV-2 pode iniciar com uma leve proteinúria e hematúria, e evoluir para uma injúria renal aguda causada pela diminuição da capacidade de filtração glomerular, que favorece a retenção de algumas escórias nitrogenadas, causando o aumento dos níveis de creatinina e de ureia. Ademais, informaram que indivíduos entre 52-69 anos foram os mais acometidos. Considerações finais: As complicações/sequelas renais decorrentes da infecção por SARS-CoV-2 são: deposição de imunocomplexos nas células renais, proteinúria, hematúria, aumento da creatinina sérica, aumento da ureia nitrogenada no sangue, diminuição da TFG, e IRA estágio 1, 2 e 3. Tais complicações ocorreram principalmente em pessoas com idade ≥ 52 anos.

Espiritualidade nos cuidados paliativos pediátricos: protocolo de scoping review

2021 ◽  
Vol 10 (16) ◽  
pp. e444101623459
Author(s):  
Fabiana Helena da Conceição ◽  
Viviani Aparecida Fraga ◽  
Cristiane Aparecida Silveira Monteiro ◽  
Melissa Santos Nassif ◽  
Isabelle Cristinne Pinto Costa
Keyword(s):  
Scoping Review ◽  
Web Of Science ◽  
Google Scholar ◽  
Cochrane Library ◽  
Scoping Reviews

Objetivo: Este estudo tem como objetivo descrever o protocolo e a metodologia usados para realizar uma revisão de escopo que irá mapear as evidências científicas sobre a espiritualidade no contexto dos cuidados paliativos pediátricos. Metodologia: Trata-se de uma revisão de escopo que será desenvolvida conforme as recomendações do Instituto Joanna Briggs (JBI). Para a redação do estudo, será utilizado o PRISMA Extension for Scoping Reviews (PRISMA-ScR). Uma pesquisa abrangente será realizada nas bases de dados Web of Science, Scopus, Cochrane Library, PubMed, CINAHL e EMBASE, além da busca de literatura cinzenta nas bases Google Scholar, ProQuest e OpenGrey, sem limitação quanto ao ano de publicação e idioma. Além disso, será realizada busca adicional de artigos por meio da leitura das referências dos estudos incluídos na revisão. Serão incluídos estudos primários e secundários que abordem a espiritualidade no contexto dos cuidados paliativos pediátricos, independentemente do tipo de delineamento. Serão excluídos documentos do tipo cartas, comentários, editoriais e artigos de opinião. A seleção dos estudos por meio da leitura dos títulos, resumos e texto completo será conduzida por dois revisores independentes. A extração de dados será realizada por meio de formulário construído pelos autores com base nas recomendações do JBI. Os dados serão organizados, resumidos e analisados quanto à extensão, natureza, distribuição e padrões recorrentes e os resultados serão comunicados narrativamente e por meio de mapas de rede. Considerações finais: Espera-se que os resultados provenientes da realização desta revisão de escopo possam contribuir para o fortalecimento da utilização do cuidado espiritual às crianças sob os cuidados paliativos, com o escopo de promover uma melhor qualidade de vida para ela e seus familiares. Adicionalmente, pretende-se por meio dessa pesquisa estimular os profissionais de saúde a atender essa dimensão durante o cuidado à crianças sob os cuidados paliativos, com vistas a proporcionar um cuidado humanizado e uma assistência espiritual de qualidade que possam ajudá-los na busca de um significado para a vida, no alívio de dores e que facilitem a lidar com a angústia e o medo que permeiam esse processo.

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