Palliative care production for health professionals in the context of home care

ABSTRACT Objectives: to analyze palliative care production developed by health professionals to home care patients. Methods: this is an exploratory study, with a qualitative approach, using the transpersonal care theoretical framework. Thirteen interviews were conducted with health professionals and 18 observations were conducted on different cases. Content analysis was performed using MAXQDA©. Results: actions performed: maintenance and follow-up measures to people eligible for palliative care, in acts of dialogue and "listening" to caregivers and users, conducting guidelines for the care and self-care process, performing technical procedures, delivery of materials, referrals and medical prescriptions to users. Final Considerations: it is perceived the need for advances in the implementation of government policies in Brazil that insert palliative care into the Health Care Network through educational, managerial and care actions that ensure human dignity, thus allowing the development of these and other palliative care interventions.

Separación Madre - Recién Nacido hospitalizado en pandemia: Un acontecimiento para reflexionar

RESUMENLa pandemia por el virus SARS-CoV-2, ha provocado cambios en los protocolos de atención en todos los servicios del país, incluidas las unidades de neonatología, dificultando la cercanía entre las madres y sus recién nacidos, y poniendo en riesgo la generación del vínculo y posterior apego seguro entre el niño y la madre. La hospitalización neonatal, gatilla en las madres afecciones psicoemocionales, debidas principalmente por la consecuente separación. Existe evidencia del impacto que genera en las madres la hospitalización neonatal durante el período de pandemia. Se visualiza la insuficiencia de protocolos establecidos para permitir la cercanía materna con el neonato en contexto de pandemia, por lo que se plantea la necesidad de replantear los protocolos de visita y definir estrategias de detección precoz de alteraciones de salud mental en las madres que han sido separadas de sus neonatos. Se efectúa una reflexión respecto de las acciones, prioridades y desafíos que las matronas y matrones debemos considerar para velar por el bienestar del binomio. Así como la detección a nivel primario de salud, mediante acciones de matronería, que parece ser una intervención ética.Palabras Claves: SARS-CoV-2; Salud Materna, Cuidado Perinatal, Matronería.ABSTRACTThe pandemic caused by the SARS-CoV-2 virus has caused changes in the care protocols in all the neonatology units, making it difficult for mothers and their newborns to be close. And, is a risk of generating a healthy bond and subsequent sure attachment between the child and the mother. Neonatal hospitalization triggers psycho-emotional conditions in mothers, mainly due to the consequent separation.Was identified publications related to the experience of mothers of hospitalized newborns during the pandemic period. In addition, fundamental aspects of the mothers' mental health are pointed out during this parenting period. A reflection is proposed regarding the actions, priorities, and challenges that midwives must consider to ensure the well-being of the couple, especially in the context of a pandemic. The insufficiency of established protocols to care for the mental health of mothers of hospitalized newborns is visualized, for which reason early detection strategies and timely referral to the health care network are proposed for mothers who have been separated from their neonates. Detection at the primary health care level, through midwifery actions, seems to be an ethical intervention.Key Words: SARS-CoV-2; Maternal Health; Perinatal Care; Midwifery.

Home peritoneal dialysis: interlocations between users and health care network services / Diálise peritoneal domiciliar: interlocuções entre usuários e serviços da rede de atenção à saúde

Objetivo: compreender as interlocuções entre os usuários que realizam a diálise peritoneal domiciliar e os serviços da Rede de Atenção à Saúde. Método: pesquisa desenvolvida em um serviço de diálise e domicílios com 19 pessoas em tratamento dialítico distribuídas em três grupos amostrais conforme o método da Grounded Theory realizando-se observação participante e 23 entrevistas abertas. Análise através da codificação aberta, axial e seletiva. Resultado: o contexto assistencial estudado expõe a descontinuidade do cuidado dialítico nas esferas da atenção primária e hospitalar, analisada pela categoria “Realizando a Diálise Peritoneal no domicílio, estando inserido na Rede de Atenção à Saúde”. Conclusão: na ótica dos entrevistados a principal interlocução é com o serviço de terapia renal substitutiva, principal referência para o cuidado e intercorrências com a dialise domiciliar. As interlocuções com os outros pontos assistenciais da Rede visam obter serviços de apoio, não implicados com o procedimento de dialise peritoneal domiciliar.

Cardiovascular Disease Risk–Based Statin Utilization and Associated Outcomes in a Primary Prevention Cohort: Insights From a Large Health Care Network

Background: Current American College of Cardiology/American Heart Association guidelines recommend using the 10-year atherosclerotic cardiovascular disease (ASCVD) risk to guide statin therapy for primary prevention. Real-world data on adherence and consequences of nonadherence to the guidelines in primary are limited. We investigated the guideline-directed statin intensity (GDSI) and associated outcomes in a large health care system, stratified by ASCVD risk. Methods: Statin prescription in patients without coronary artery disease, peripheral vascular disease, or ischemic stroke were evaluated within a large health care network (2013–2017) using electronic medical health records. Patient categories constructed by the 10-year ASCVD risk were borderline (5%–7.4%), intermediate (7.5%–19.9%), or high (≥20%). The GDSI (before time of first event) was defined as none or any intensity for borderline, and at least moderate for intermediate and high-risk groups. Mean (±SD) time to start/change to GDSI from first interaction in health care and incident rates (per 1000 person-years) for each outcome were calculated. Cox regression models were used to calculate hazard ratios for incident ASCVD and mortality across risk categories stratified by statin utilization. Results: Among 282 298 patients (mean age ≈50 years), 29 134 (10.3%), 63 299 (22.4%), and 26 687 (9.5%) were categorized as borderline, intermediate, and high risk, respectively. Among intermediate and high-risk categories, 27 358 (43%) and 8300 (31%) patients did not receive any statin, respectively. Only 17 519 (65.6%) high-risk patients who were prescribed a statin received GDSI. The mean time to GDSI was ≈2 years among the intermediate and high-risk groups. At a median follow-up of 6 years, there was a graded increase in risk of ASCVD events in intermediate risk (hazard ratio=1.15 [1.07–1.24]) and high risk (hazard ratio=1.27 [1.17–1.37]) when comparing no statin use with GDSI therapy. Similarly, mortality risk among intermediate and high-risk groups was higher in no statin use versus GDSI. Conclusions: In a real-world primary prevention cohort, over one-third of statin-eligible patients were not prescribed statin therapy. Among those receiving a statin, mean time to GDSI was ≈2 years. The consequences of nonadherence to guidelines are illustrated by greater incident ASCVD and mortality events. Further research can develop and optimize health care system strategies for primary prevention.