O desenvolvimento de software requer conhecimentos técnicos para projetar, estruturar e implementar sistemas. Todo este processo envolve custos e demanda suporte das tecnologias. Atualmente, com a popularização de smartphones, profissionais da saúde podem contar com aplicativos de auxílio ao atendimento clínico. No entanto, as características de cunho técnico impedem que tais profissionais desenvolvam suas próprias aplicações, principalmente quando há maior complexidade lógica. Os documentos médicos usados como referência no atendimento específico de enfermidades são chamados de protocolos clínicos. Esses documentos possuem estrutura lógica geralmente padronizada, podendo ser expressa em fluxogramas. Baseado nisso, este trabalho propõe através de uma ferramenta web, uma maneira facilitadora para a construção aplicativos móveis. A ferramenta desenvolvida nesse trabalho tem como propósito a geração automática de aplicativos móveis para o dia-a-dia dos profissionais da saúde através da descrição em fluxogramas. Dessa forma, leigos no desenvolvimento de aplicativo podem tomar iniciativa de criar aplicativos que sejam úteis no cotidiano. Desta maneira, em um primeiro momento verificou-se na literatura trabalhos relacionados com geração de aplicativos automáticos e a área de saúde. Após, foi estudado os protocolos clínicos e então foi desenvolvido a arquitetura e lógica de uma ferramenta de geração automática de aplicativos móveis Android a partir da descrição gráfica de protocolos clínicos. Como resultados e validação do trabalho, foram reproduzidos aplicativos publicados em lojas digitais. Através das reproduções pode-se verificar que a proposta conseguiu descrever o conteúdo das aplicações em fluxogramas, mesmo não sendo originalmente utilizado protocolos clínicos como fonte de referência.

INTRODUCTION: Speech discrimination in noise as well as musical interpretation are among the greatest challenges of a patient with an auditory implant.The objective was to present speech discrimination in noisy environments tests and to evaluate their use in daily clinical practice.METHODS: The authors proposed a protocol for assessing speech discrimination in noisy environments for patients who are candidates for auditory implantation, in order to evaluate the integration of binaural information. Four loud-speakers were used, arranged in azimuth 0°, 90°, 180° and 270°. It was presented the conjugation of words/ sentences with speech noise or cafe sound in four possible conditions, being in the overall evaluated 16 parameters. RESULTS: The result is the percentage of words and sentences repeated correctly. Pre and postoperative comparison was performed.CONCLUSION: In parallel with the study of the spatial location of sound, it is considered that this evaluation will allow the understanding of the integration of hearing information in patients with auditory implants and their real binaural integration.

In this paper we propose a mathematical model to describe the evolution of glioma cells taking into account the viscoelastic properties of brain tissue. The mathematical model is established considering that the glioma cells are of two phenotypes: migratory and proliferative. The evolution of the migratory cells is described by a diffusion-reaction equation of non Fickian type deduced considering a mass conservation law with a non Fickian migratory mass flux. The evolution of the proliferative cells is described by a reaction equation. A stability analysis that leads to the design of efficient protocols is presented. Numerical simulations that illustrate the behavior of the mathematical model are included.

Introduction: Denosumab (DMB) is an antiresorptive monoclonal antibody. Even though it is highly effective in treating osteometabolic and oncological conditions, it carries a risk of Medication-Related Osteonecrosis of the Jaw (MRONJ). Tooth extraction and pre-existing local infections are two of the leading triggers for this complication. The presente narrative review aims to analyze and synthesize the available scientific evidence regarding the prevention of MRONJ in patients taking denosumab who undergo oral surgery, thus improving the systematization and updating current clinical protocols.Methodology: A comprehensive search was conducted across four databases (PubMed/MEDLINE, Web of Science, Embase, and Cochrane) using tailored search strategies. We selected studies evaluating the risk and prevention of MRONJ in adult patients undergoing tooth extraction or other oral surgeries, excluding dental implant placement.Discussion: Preventive strategies can be divided into three main phases: preoperative, intraoperative, and postoperative. Preoperatively, primary prevention is the most effective prophylactic approach. When surgery is unavoidable, risk stratification is crucial, with the underlying disease being the primary determinant. Once the baseline risk is established, additional variables must be assessed, including local (particularly, prior local infection), systemic, and factos related to the patient habits. The prophylactic suspension of denosumab is not recommended as standard practice due to the risk of systemic complications, bone fractures, and potential exacerbation of the underlying disease. For osteoporotic patients, it is advisable to perform surgical interventions during a "window of opportunity," typically between the 5th and 6th month following the last dose.Intraoperatively, there is consensus on the need for atraumatic extractions, combined with smoothing of sharp bone margins and the removal of any necrotic boné, if detected. Although primary closure using a mucoperiosteal flap is traditionally recommended, less invasive techniques with secondary intention healing maybe sufficient, particularly for low-risk patients. The use of Leukocyte- and Platelet-Rich Fibrin (L-PRF) has shown promising results as a biological adjunct, promoting tissue healing and potentially helping to reduce the risk of osteonecrosis.Postoperatively, reducing the local bacterial load is achieved through the application of antiseptics and prophylactic antibiotics, mainly amoxicillin. However, this prescribing practice remains largely empirical, as its efficacy is not yet fully proven in the literature. This period must be accompanied by strict postoperative instructions to minimize local trauma, alongside close clinical monitoring. Special attention should be given to the 8-week threshold (the diagnostic criterion for MRONJ), followed by regular long-term follow-ups.Conclusion: Although the described strategies help decrease the risk of MRONJ, significant gaps in the available scientific evidence persist. The existence of contradictory international guidelines reflects a lack of robust primary studies specifically targeting patients on denosumab therapy, showing the clear need for further clinical research in this population.

Pregnant women with thromboembolic diseases, previous thrombotic episodes or thrombophilia family history were supervised in a multidisciplinary Obstetrics/ Hematology consultation in Centro Hospitalar São João EPE, Porto, Portugal. For the evaluation and medication of these women, a risk stratification scale was used.

ABSTRACT Purpose: The aim of this work is to review and synthesize the existing evidence and recommendations regarding to the therapeutic and surgical indications as well as monitoring of patients with Penile Cancer in COVID-19 era and to propose an action protocol to facilitate decision-making. Material and Methods: A non-systematic review of the literature regarding the management of penile cancer during the COVID-19 pandemic was performed until April 30, 2020. We propose our recommendations based on this evidence. Results: Penile cancer is an uncommon but aggressive disease. Prognosis is determined by several characteristics, being the most important the presence of lymph nodes, in which case, treatment should not be delayed. For these reasons, an initial evaluation is mandatory. Priority classifications, based on the oncological outcomes when treatment is delayed, have been made in order to separate deferrable disease from the one that needs high priority treatment. In penile cancer with low risk of progression, surgical treatment can be delayed, but other options must be considered, like topical treatment or laser therapy. In cases with intermediate risk of progression, surgical treatment may be delayed up to three months, but we must consider radiation therapy and brachytherapy as effective options. When feasible, follow-up should by telemonitoring. Conclusions: In the COVID 19 era, initial evaluation of the patient is mandatory. Histological diagnosis with local staging is necessary before offering any therapeutic option. In case of superficial non-invasive disease, topical treatment is effective in absence of lymph node involvement. In selected patients, radiotherapy is an organpreserving approach with good results. Non-deferrable surgical treatment must be performed by an experienced surgeon and as an outpatient procedure when possible. When indicated, iLND should not be delayed since it is decisive for patient survival. Follow-up should be by telemonitoring.

ABSTRACT Purpose: to provide an update on the management of a Urology Department during the COVID-19 outbreak, suggesting strategies to optimize assistance to the patients, to implement telemedicine and triage protocols, to define pathways for hospital access, to reduce risk of contagious inside the hospital and to determine the role of residents during the pandemic. Materials and Methods: In May the 6th 2020 we performed a review of the literature through online search engines (PubMed, Web of Science and Science Direct). We looked at recommendations provided by the EAU and ERUS regarding the management of urological patients during the COVID-19 pandemic. The main aspects of interest were: the definition of deferrable and non-deferrable procedures, Personal Protective Equipment (PPE) and hospital protocols for health care providers, triage, hospitalization and surgery, post-operative care training and residents' activity. A narrative summary of guidelines and current literature for each point of interest was performed. Conclusion: In the actual Covid-19 scenario, while the number of positive patients globally keep on rising, it is fundamental to embrace a new way to deliver healthcare and to overcome challenges of physical distancing and self-isolation. The use of appropriate PPE, definite pathways to access the hospital, the implementation of telemedicine protocols can represent effective strategies to carry on delivering healthcare.

This study aimed to report the experience in the elaboration of standard operating procedures at a hospital from north zone of the state of Ceará. It is a descriptive experience report that discusses the importance of developing protocols to promote patient safety. The professionals involved developed 35 protocols which adressednursering, pharmacy, nutrition, phisioterapy and public attendance procedures. The main difficulty was to gather the group of professionals and managers from the hospital for the discussion and validation.Among the new protocols are protocols of blood collection, enteral nutrition administration and adult patient transport.

ABSTRACT Purpose: evaluate the influence of frenotomy on the breastfeeding of newborns diagnosed with ankyloglossia. Methods: this is an intervention study performed with 50 newborns diagnosed with ankyloglossia. It was conducted in three stages: diagnosis, intervention and reassessment. In the diagnostic phase, the Protocol for the Assessment of Speech Language with Scores for Babies was applied to diagnose ankyloglossia and a questionnaire assessing the symptoms and coordination of sucking, swallowing and breathing during breastfeeding. In the intervention, frenotomy was performed, and at reassessment, the diagnostic protocol and questionnaire in order to compare the post-surgical effects. Results: of the 50 babies participating in the study, 35 (70%) were boys and 15 (30%) girls. A total of 68% of ankyloglossia cases were reported in the family, a majority (38%) involving cousins. There was a statistically significant reduction in the average protocol score in the reassessment stage, from 8.38 (7-12 points) to 0.86 (0-5 points), as well as a statistically significant improvement in all variables related to the symptoms of breastfeeding. Conclusion: surgical intervention, known as frenotomy, made it possible to improve the negative symptoms of breastfeeding in newborns diagnosed with ankyloglossia.

ABSTRACT Objectives: to describe the use of the International Classification for Nursing Practice (ICNP®) in the construction of a nursing care protocol for children undergoing hematopoietic stem cell transplantation. Methods: experience report. Results: nursing problems were defined based on complications identified in a previous study; later, the ICNP® enabled the organization and systematization of childcare. The care protocol consists of 40 nursing problems, with their human needs affected, diagnoses and nursing interventions. The axes Focus, Judgment, Location, Action, Means, Time, and Client were used in the elaboration of diagnoses and interventions proposed in the protocol. Final Considerations: the use of the classification allowed the establishment of nursing interventions compatible with the needs of the child undergoing transplantation, providing support for the care protocol. It made it possible to encourage the use of classification in this context, contribute to patient safety and strengthen professional practice.