Navegando por Palavras-chave "Case Reports"
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- ItemAcesso aberto (Open Access)Citologia de impressão no diagnóstico de infecção corneana por Acanthamoeba: relato de caso(Conselho Brasileiro de Oftalmologia, 2007-03-01) Barros, Jeison de Nadai [UNIFESP]; Mascaro, Vera Lucia Degaspare [UNIFESP]; Lowen, Marcia Serva [UNIFESP]; Martins, Maria Cristina [UNIFESP]; Foronda, Annette [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)To describe three cases of corneal infection due to Acanthamoeba sp in which was possible to detect Acanthamoeba sp cysts by the corneal impression cytology technique. Three patients referred to the External Eye Disease Laboratory in 2004 with superficial corneal alterations were submitted to corneal specimen collection by impression cytology filter paper to investigate the presence of Acanthamoeba sp cysts. Two impression cytology samples were obtained from each patient and were stained by PAS, hematoxylin and Papanicolaou. Routine microbiological investigation and culture were also performed using corneal scraping. Positive culture and impression cytology for Acanthamoeba sp was observed in all patients while smears with Giemsa stain were positive in two. Impression cytology Acanthamoeba sp cysts were observed among sheets of corneal epithelial cells and as isolated cells. Cysts were also found in the superficial epithelium in one of these patients after treatment while corneal scraping did not reveal any cyst. Histopathology revealed cysts in the epithelium and stroma in a transplanted cornea in one of these patients. The first description of impression cytology as a diagnostic method for Acanthamoeba keratitis occurred recently. In this study corneal impression cytology detected Acanthamoeba sp cysts successfully in these patients with only superficial involvement. Impression cytology as a non invasive technique can be used to facilitate early recognition of Acanthamoeba infection playing a useful role in the follow-up of the disease.
- ItemSomente MetadadadosElaboração e validação de um estudo de caso para o desenvolvimento do raciocínio diagnóstico de estudantes e enfermeiros(Universidade Federal de São Paulo (UNIFESP), 2020-09-24) Leandro, Daniela Luana Fernandes [UNIFESP]; Lopes, Juliana De Lima [UNIFESP]; Universidade Federal de São PauloIntroduction: Case studies are teaching tools that can be used for the development and improvement of diagnostic reasoning, contributing to an evidence-based nursing practice and with better health indicators for the patient. Therefore, they must be prepared based on the literature and their content must be validated. In the literature, there are few validated case studies and, to the best of our knowledge, none addressing peripheral arterial disease (PAD). Due to the high prevalence of this disease in the world population, it is relevant that nurses are able to identify the human responses common to patients with PAD. Objective: Develop and validate a case study to assist in the development of the diagnostic reasoning of students and nurses. Method: Methodological study, carried out in three stages: 1) preparation of the case study; 2) content validation of the case study and identification of the nursing diagnoses present; 3) assessment of diagnostic accuracy and establishment of priority diagnosis. This study was approved by the Unifesp Research Ethics Committee, Protocol 1550/2017. Participants: Twelve nurses specialized in Nursing Process selected according to pre-defined criteria. Results: The case study was based on a narrative review of the literature, which allowed the identification of clues related to the most frequent nursing diagnoses (ND) in patients with PAD, selected as the central health problem of the case. For the construction of the case, Lunney's eight assumptions were followed for the elaboration of case studies. The content of the case study was validated in the second evaluation round and the experts identified 18 ND with different degrees of accuracy. The most frequent diagnoses were: ineffective peripheral tissue perfusion (100%), impaired ambulation (83%), impaired comfort (50%) and chronic pain (50%). The diagnosis considered a priority by all specialists was "Ineffective peripheral tissue perfusion". Conclusion: The validated case study can be used by students and nurses to facilitate the development of diagnostic reasoning and critical thinking in the context of care practice, teaching and research.
- ItemAcesso aberto (Open Access)Judicialização da saúde na voz do usuário: a procura do cuidado através da justiça(Universidade Federal de São Paulo (UNIFESP), 2019-02-05) Capiberibe, Cláudia Camargo [UNIFESP]; Rios, Ademar Arthur Chioro dos [UNIFESP]; http://lattes.cnpq.br/9454572596499303; http://lattes.cnpq.br/2555792761200636; Universidade Federal de São Paulo (UNIFESP)Introduction: In Brazil, health has been a constitutional right since 1988, but the lack of full service to the population by SUS [Sistema Única de Saúde – Brazil’s public healthcare system] or the private sector has led to the judicialization of health, a legal recourse that allows for the enforceability of rights when these are denied by the parties responsible, and which has transformed into an alternative means for accessing medicines, services and products not covered by the policies and protocols of SUS or on the lists of the ANS [Brazil’s National Health Agency]. It is a phenomenon that involves multiple parties, with distinct and often conflicting objectives and interests. Studies have shown that the judicialization of health is a legitimate form of pressuring the State, but one which has relevant secondary effects, such as significant impact on costs and increasing inequalities in access to and use of healthcare services. Its complexity and effects have been well studied, but the point of view of the user has been mostly ignored. Objective: To analyze the experiences of people who have sought redress in the courts to have access to services and to guarantee their health. Methodology: The investigation, based on a micropolitical approach, was conducted through qualitative research. Seven interviews were carried out with people who reside in Sao Paulo and have initiated court actions, selected at random from the search tool of the Sao Paulo Court of Justice and through indications from de first selected interviewed. Resorting to personal documents and using oral history techniques, the research seeks to identify the users' care maps, the obstacles they face, as well as the strategies and mechanisms used to attain their health objectives. Results and Discussion: The data from the research was organized along cutting-planes: the experience with the infirmity and the experience with the judicialization process. The first permitted the construction of care maps and the second allowed for the description and analysis of the trajectory relative to the legal requests. These experiences played out in different planes of visibility, with relevant meanings, made visible/utterable by repeated examination of the narratives. The users initiate actions in the Court against SUS and/or the private healthcare provider motivated fundamentally by their suffering and the desire to recover autonomy, reduce the financial impact of the infirmity and by the belief that therapies and innovative technologies not yet contemplated by the System might provide better quality of life. They see themselves as guaranteeing unseen and unconsidered health needs, exercising a kind of "social control" and demanding fair return for taxes paid. The Court becomes an important and decisive point on the care maps of these users and their families. Judicialization, however, ends up becoming yet another form of regulating access to use of the healthcare system and a form of privileged access to public funds, creating a “marketplace” for health services and products, a shortcut for technological incorporation and greater iniquity. To the users, however, the parties that act in this complex arena are not motivated by personal interests or economic gain. Instead, they are imagined to be links in the system willing to produce alternatives so that the care map may be complemented or improved, without any moral or ethical judgement, as well as providing an individualized solution. Conclusion: The empirical results of the research demonstrate that there is great diversity in the narrated experiences, which allowed for the identification of various facets to the judicialization of healthcare. The most common and relevant to the users who go through the experience is the desire to survive the infirmity, recover their health and improve their quality of life, whatever the cost and through whatever means at their disposal, including judicialization, and despite regulations or other rules of the system or societal interests, which appear to be insufficient to limit their actions.