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ORIGINAL ARTICLE09-20-2024
Content validity of guidance on self-care in the post-operative period for breast cancer
- Cristina Poliana Rolim Saraiva dos Santos
, - Natália Frota Goyanna ,
- Erilaine de Freitas Corpes ,
- Romel Jonathan Velasco Yanez ,
- José Jeová Mourão Netto , [ … ],
- Ana Fátima Carvalho Fernandes
Abstract
ORIGINAL ARTICLEContent validity of guidance on self-care in the post-operative period for breast cancer
Revista Brasileira de Enfermagem. 2024;77(4):e20240188
DOI 10.1590/0034-7167-2024-0188
- Cristina Poliana Rolim Saraiva dos Santos ,
- Natália Frota Goyanna ,
- Erilaine de Freitas Corpes ,
- Romel Jonathan Velasco Yanez ,
- José Jeová Mourão Netto ,
- Régia Christina Moura Barbosa ,
- Ana Fátima Carvalho Fernandes
Views0See moreABSTRACT
Objectives:
to validate the content of a guidance guide on self-care in the postoperative period of breast surgery for breast cancer.
Methods:
a methodological study with content validity, carried out with 15 expert nurses and physiotherapists, between May and July 2022. Recruitment took place from the Lattes Platform, using snowball sampling. The level of relevance and representativeness for each item was verified using the Content Validity Index (CVI). It was considered valid when CVI was equal to or greater than 78% (0.78).
Results:
from the initial total of 37 items, two were excluded, as they had insufficient practical relevance and theoretical relevance, and another five items which, although presenting a CVI lower than the established cut-off, were suggested to be rewritten and grouped with other similar items.
Conclusions:
thirty items were considered valid and demonstrated important and significant characteristics, constituting suitable material for application in clinical practice.
- Cristina Poliana Rolim Saraiva dos Santos
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ORIGINAL ARTICLE09-20-2024
Sociocognitive factors determining compliance with standard precautions by nursing professionals during the COVID-19 pandemic
- Andressa Silva Torres dos Santos ,
- Ana Cristina de Oliveira e Silva ,
- Fernanda Maria Vieira Pereira-Ávila ,
- Hemílio Fernandes Campos Coêlho ,
- Laelson Rochelle Milanês Sousa , [ … ],
- Elucir Gir
Abstract
ORIGINAL ARTICLESociocognitive factors determining compliance with standard precautions by nursing professionals during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77(4):e20230301
DOI 10.1590/0034-7167-2023-0301
- Andressa Silva Torres dos Santos ,
- Ana Cristina de Oliveira e Silva ,
- Fernanda Maria Vieira Pereira-Ávila ,
- Hemílio Fernandes Campos Coêlho ,
- Laelson Rochelle Milanês Sousa ,
- Renata Karina Reis ,
- Elucir Gir
Views0See moreABSTRACT
Objectives:
to assess the socio-cognitive factors determining adherence to standard precautions by nursing professionals in care practice during the COVID-19 pandemic in Brazil.
Methods:
an analytical cross-sectional study, carried out with 9,039 nursing professionals in Brazil, using an electronic form containing participant sociodemographic, training and work variables, and the Brazilian version of the Standard Precautions Questionnaire. Descriptive and inferential statistics were used using the statistical software R.
Results:
participants recognize standard precautions as effective measures to reduce infections and report intention to perform them. Training regarding standard precautions was evidenced as a facilitator of adherence (4.72; SD: 0.73), and problems related to materials (3.78; SD: 1.45) were a hindrance.
Conclusions:
among the determining factors, facilitating organization presented the highest score, followed by intention to perform. Facilitating and hindering factor identification makes it possible to develop intervention strategies to strengthen patient safety and reduce occupational risks among professionals.
- Andressa Silva Torres dos Santos
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ORIGINAL ARTICLE09-20-2024
Predictor variables effect on the development of Burnout Syndrome in higher education professor
- Italo Everton Bezerra Barbosa ,
- Aristéia Nunes Sampaio ,
- Cristiane Pereira de Souza ,
- Breno de Souza Mota ,
- Carla Roberta Monteiro Miura , [ … ],
- Angélica Gonçalves Silva Belasco
Abstract
ORIGINAL ARTICLEPredictor variables effect on the development of Burnout Syndrome in higher education professor
Revista Brasileira de Enfermagem. 2024;77(4):e20240132
DOI 10.1590/0034-7167-2024-0132
- Italo Everton Bezerra Barbosa ,
- Aristéia Nunes Sampaio ,
- Cristiane Pereira de Souza ,
- Breno de Souza Mota ,
- Carla Roberta Monteiro Miura ,
- Cassiane Dezoti da Fonseca ,
- Angélica Gonçalves Silva Belasco
Views0See moreABSTRACT
Objectives:
to correlate the development of Burnout Syndrome in higher education professors with the following variables: sociodemographic, economic, work, sleep pattern, level of anxiety and quality of life.
Methods:
observational, analytical, cross-sectional study with a quantitative approach. Data collection took place from August to November 2022, with 140 professors from a private higher education institution in the Western Brazilian Amazon.
Results:
professors who carried out activities outside institutional hours and who had sleep duration < 5 hours, presented lower scores in the personal fulfillment dimension of burnout, with (p=0.002) and (p=0.001), respectively. The higher the scores for the physical (p=0.001), psychological (p=0.000) and social relationships (p=0.002) domains of quality of life, the lower the personal fulfillment scores for the syndrome.
Conclusions:
through linear regression, it was evidenced that several variables explain the development of burnout. Institutional and governmental actions can minimize the negative influence of these variables.
- Italo Everton Bezerra Barbosa
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ORIGINAL ARTICLE09-20-2024
Transgender people’s knowledge about the adverse effects of cross-hormonization: challenges for nursing
- Andréa Felizardo Ahmad ,
- Adriana Lemos ,
- Cláudia Regina Ribeiro ,
- Luciane Marques de Araujo ,
- Vanessa de Almeida Ferreira Corrêa , [ … ],
- Beatriz Rodrigues Silva Selles Dantas
Abstract
ORIGINAL ARTICLETransgender people’s knowledge about the adverse effects of cross-hormonization: challenges for nursing
Revista Brasileira de Enfermagem. 2024;77(4):e20230346
DOI 10.1590/0034-7167-2023-0346
- Andréa Felizardo Ahmad ,
- Adriana Lemos ,
- Cláudia Regina Ribeiro ,
- Luciane Marques de Araujo ,
- Vanessa de Almeida Ferreira Corrêa ,
- Janaína Pinto Janini ,
- Rosâne Mello ,
- Beatriz Rodrigues Silva Selles Dantas
Views0See moreABSTRACT
Objectives:
to identify trans women’s and men’s knowledge about the adverse effects of cross-hormonization and understand the repercussions of hormonization practices on trans women’s and men’s health.
Methods:
exploratory, descriptive, qualitative research, developed with 41 participants, from July 2019 to February 2020, in a trans health outpatient clinic. Thematic-categorical content analysis was used.
Results:
from the analysis, the categories emerged: Knowledge about the adverse effects of cross-hormonization; and Cross-hormonization practices and their meaning.
Final Considerations:
nursing practices, based on the identification of knowledge about adverse effects and the understanding of cross-hormonization practices in trans women’s and men’s health, can result in more inclusive care.
- Andréa Felizardo Ahmad
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ORIGINAL ARTICLE09-20-2024
Construction and validation of a checklist for the management of totally implanted catheters in children
- Giselle Vieira de Souza ,
- Isabella Pavarine de Souza ,
- Maria Paula Custodio Silva ,
- Silmara Elaine Malaguti Toffano ,
- Divanice Contim
Abstract
ORIGINAL ARTICLEConstruction and validation of a checklist for the management of totally implanted catheters in children
Revista Brasileira de Enfermagem. 2024;77(4):e20230447
DOI 10.1590/0034-7167-2023-0447
- Giselle Vieira de Souza ,
- Isabella Pavarine de Souza ,
- Maria Paula Custodio Silva ,
- Silmara Elaine Malaguti Toffano ,
- Divanice Contim
Views0See moreABSTRACT
Objectives:
to construct and validate the content of a checklist for the management of totally implanted catheters in hospitalized children and adolescents.
Methods:
methodological research conducted from October 2021 to December 2022 in two stages: development of the instrument with care guidelines and content validation of the checklist. The instrument, containing 23 items presented in Likert format, was evaluated online by specialists in two rounds. The Content Validity Index was applied, considering indices above 0.8 as valid.
Results:
the final checklist included four domains and 22 checklist items, validated with a Content Validity Index of 0.98. The overall evaluation of the instrument presented a global score of 9.9.
Conclusions:
the validation and application of instruments that standardize procedures, in addition to supporting professionals, promote autonomy and quality of care for children and adolescents using this device.
- Giselle Vieira de Souza
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ORIGINAL ARTICLE09-20-2024
Cross-cultural adaptation and validation of the Healthy Work Environment Assessment Tool in Brazilian culture
- Renata Cristina Gasparino ,
- Sharlla Milênia Nogueira da Silva ,
- Letícia Bianchini de Barros Minatogawa ,
- Olga Maria Pimenta Lopes Ribeiro ,
- Andrea Bernardes
Abstract
ORIGINAL ARTICLECross-cultural adaptation and validation of the Healthy Work Environment Assessment Tool in Brazilian culture
Revista Brasileira de Enfermagem. 2024;77(4):e20230505
DOI 10.1590/0034-7167-2023-0505
- Renata Cristina Gasparino ,
- Sharlla Milênia Nogueira da Silva ,
- Letícia Bianchini de Barros Minatogawa ,
- Olga Maria Pimenta Lopes Ribeiro ,
- Andrea Bernardes
Views0See moreABSTRACT
Objectives:
to adapt and validate the content of the Healthy Work Environment Assessment Tool for Brazilian culture, and evaluate the practical aspects of its application.
Methods:
methodological study that followed six stages: translation; synthesis; back translation; content validation by a group of experts, pre-testing and approval of the process by the author of the original instrument.
Results:
the first three stages were carried out by contracted companies. In the committee, two items and the title of a subscale were evaluated in a second round, when consensus was reached among experts. In the pre-test, more than 93% of professionals agreed that the tool was easy to understand. The average completion time was 8.53 minutes. The American Association of Critical-Care Nurses authorized publication of the results.
Conclusions:
the adaptation of the tool to Brazilian culture was completed following the adopted framework. In addition to the evidence of content validity, the tool appears promising for managerial use.
- Renata Cristina Gasparino
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REVIEW09-20-2024
Brazilian nursing specific situation, middle and micro-range theories: a bibliometric study
- Rosane Barreto Cardoso ,
- Marcos Antônio Gomes Brandão ,
- Jéssica Cristina Sobrinho da Silva Cavalcante ,
- Rafael Oliveira Pitta Lopes ,
- Kênia Rocha Leite Zaccaro , [ … ],
- Cândida Caniçali Primo
Abstract
REVIEWBrazilian nursing specific situation, middle and micro-range theories: a bibliometric study
Revista Brasileira de Enfermagem. 2024;77(4):e20230520
DOI 10.1590/0034-7167-2023-0520
- Rosane Barreto Cardoso ,
- Marcos Antônio Gomes Brandão ,
- Jéssica Cristina Sobrinho da Silva Cavalcante ,
- Rafael Oliveira Pitta Lopes ,
- Kênia Rocha Leite Zaccaro ,
- Cândida Caniçali Primo
Views0See moreABSTRACT
Objectives:
to map the nursing theories developed in stricto sensu graduate programs in nursing in Brazil.
Methods:
a bibliometric study, carried out on the Coordination for the Improvement of Higher Education Personnel Theses and Dissertations Portal in October 2023. The controlled descriptors “Nursing Theory” and “Nursing Models” and the uncontrolled descriptors “Theories” and “Middle-Range Theory” were used. Selected studies were cataloged for analysis, which was conducted by the study authors, who have a doctoral degree and expertise in research on nursing theories.
Results:
thirty-nine nursing theories were mapped, with a predominance of middle-range theories (79.5%), focusing on nursing diagnostic concepts and use of the theoretical-methodology strategy of theoretical-causal validity.
Conclusions:
the study identified nursing theories developed in Brazil, recognizing trends, development strategies, theorized objects of disciplinary interest and investments necessary for practical application in Brazilian contexts.
- Rosane Barreto Cardoso
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09-09-2024
Potential of Artificial Intelligence in Evidence-Based Practice in Nursing
Revista Brasileira de Enfermagem. 2024;77(5):e770501
Abstract
Potential of Artificial Intelligence in Evidence-Based Practice in Nursing
Revista Brasileira de Enfermagem. 2024;77(5):e770501
DOI 10.1590/0034-7167.2024770501
Views0Evidence-based practice (EBP) has established itself as a fundamental pillar in nursing, driving effective clinical decision-making based on high-quality scientific research. The primary goal of EBP is to ensure that patients receive the most appropriate and safe care, based on the best available evidence. In this context, knowledge synthesis methods are essential tools for EBP, […]See more
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ORIGINAL ARTICLE06-24-2020
Serious Game e-Baby Família: an educational technology for premature infant care
- Marcela Mobiglia D’Agostini ,
- Natália Del Angelo Aredes ,
- Suzanne Hetzel Campbell ,
- Luciana Mara Monti Fonseca
Abstract
ORIGINAL ARTICLESerious Game e-Baby Família: an educational technology for premature infant care
Revista Brasileira de Enfermagem. 2020;73(4):e20190116
DOI 10.1590/0034-7167-2019-0116
- Marcela Mobiglia D’Agostini ,
- Natália Del Angelo Aredes ,
- Suzanne Hetzel Campbell ,
- Luciana Mara Monti Fonseca
Views0See moreABSTRACT
Objectives:
to develop and assess the serious game e-Baby Família with parents of premature infants.
Methods:
a methodological study regarding the development of the serious game, with participatory design in scope definition, starting from parents’ learning needs about premature infant care. A qualitative approach was performed in the assessment stage with parents, with content analysis of the speech of the eight participants.
Results:
the following categories emerged: Realistic appearance of the virtual setting and game content and Gameplay implications for the use of e-Baby Família. The game was satisfactorily assessed regarding content, appearance and dynamics use, motivating participants to learn.
Final Considerations:
in the context of prematurity as a public health problem in Brazil and the need to strengthen family health education for care, the serious game was assessed as motivating and appropriate for health learning.
- Marcela Mobiglia D’Agostini
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ORIGINAL ARTICLE12-05-2019
Aging, sexuality and nursing care: the elderly woman’s look
- Cinoélia Leal de Souza ,
- Vanda Santana Gomes ,
- Roberta Lopes da Silva ,
- Elaine Santos da Silva ,
- Jaqueline Pereira Alves , [ … ],
- Simone Aline Ferreira
Abstract
ORIGINAL ARTICLEAging, sexuality and nursing care: the elderly woman’s look
Revista Brasileira de Enfermagem. 2019;72:71-78
DOI 10.1590/0034-7167-2018-0015
- Cinoélia Leal de Souza ,
- Vanda Santana Gomes ,
- Roberta Lopes da Silva ,
- Elaine Santos da Silva ,
- Jaqueline Pereira Alves ,
- Núbia Rêgo Santos ,
- Victor Neves Reis ,
- Simone Aline Ferreira
Views0See moreABSTRACT
Objective:
to analyze the perception of elderly women about sexuality and practice of nursing care in this context.
Method:
a descriptive qualitative study. Fifty elderly women from Guanambi City – Bahia State were interviewed in 2016. Data collection technique was direct interview by using an unstructured script. Analysis of the semantic content described was carried out, and two empirical categories: the elderly woman’s view of nursing care in the promotion of sexual health and experience of sexuality in the elderly; and nursing care in the context of women’s aging.
Results:
it has been noted that the elderly women are afraid to talk about sexuality, especially with health professionals. By influences of society, they often exclude this issue of health care for elderly women.
Final considerations:
changes must be thought about assistance provided in relation to sexuality.
- Cinoélia Leal de Souza
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01-22-2021
HIV infection in pregnant women and its challenges for the prenatal care
- Lidiane de Nazaré Mota Trindade ,
- Laura Maria Vidal Nogueira ,
- Ivaneide Leal Ataide Rodrigues ,
- Angela Maria Rodrigues Ferreira ,
- Gracileide Maia Corrêa , [ … ],
- Natasha Cristina Oliveira Andrade
Abstract
HIV infection in pregnant women and its challenges for the prenatal care
Revista Brasileira de Enfermagem. 2021;74:e20190784
DOI 10.1590/0034-7167-2019-0784
- Lidiane de Nazaré Mota Trindade ,
- Laura Maria Vidal Nogueira ,
- Ivaneide Leal Ataide Rodrigues ,
- Angela Maria Rodrigues Ferreira ,
- Gracileide Maia Corrêa ,
- Natasha Cristina Oliveira Andrade
Views0See moreABSTRACT
Objective:
To analyze the epidemiological profile of HIV infections in pregnant women.
Methods:
Analytical study with a quantitative approach.
Results:
The HIV rate in pregnant women increased from 1.5/1000 babies born alive, in 2010, to 3.3/1000 in 2017. There was a significant association between the prenatal and the variables educational level (p<0.0001), occupation (p=0.0105), gestational age (p < 0.0001), and type of delivery (p < 0.0001). The mean rate of adherence to the antiretroviral treatment in the prenatal was 68.8% (DP = ± 3.7).
Conclusion:
The high rates of HIV detection in pregnant women suggest the need to intensify the health care to women during the prenatal, guaranteeing an integral care, early diagnoses, and enhancing the strategies to improve the adherence to the antiretroviral treatment, aiming to achieve the viral suppression of the mother by the time of childbirth, thus diminishing the risk of a vertical transmission.
- Lidiane de Nazaré Mota Trindade
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06-11-2021
Investigação qualitativa em tempos de pandemia
Revista Brasileira de Enfermagem. 2021;74:e74Suppl101
Abstract
Investigação qualitativa em tempos de pandemia
Revista Brasileira de Enfermagem. 2021;74:e74Suppl101
DOI 10.1590/0034-7167.202174Suppl101
Views0INTRODUÇÃOA investigação qualitativa permite a compreensão de realidades singulares que, dificilmente, são apreendidas a partir de um único prisma, assumindo-se cada vez mais como um campo inter e transdisciplinar–, com métodos e técnicas especificas que implicam a relação entre o investigador e os participantes para a colheita, análise e validação das transcrições e análise efetuada […]See more -
ORIGINAL ARTICLE09-21-2020
Clinical judgment and diagnostic reasoning of nursing students in clinical simulation
- Janaina Gomes Perbone Nunes ,
- José Joaquim Penedos Amendoeira ,
- Diná de Almeida Lopes Monteiro da Cruz ,
- Kathie Lasater ,
- Sheila Coelho Ramalho Vasconcelos Morais , [ … ],
- Emilia Campos de Carvalho
Abstract
ORIGINAL ARTICLEClinical judgment and diagnostic reasoning of nursing students in clinical simulation
Revista Brasileira de Enfermagem. 2020;73(6):e20180878
DOI 10.1590/0034-7167-2018-0878
- Janaina Gomes Perbone Nunes ,
- José Joaquim Penedos Amendoeira ,
- Diná de Almeida Lopes Monteiro da Cruz ,
- Kathie Lasater ,
- Sheila Coelho Ramalho Vasconcelos Morais ,
- Emilia Campos de Carvalho
Views0See moreABSTRACT
Objectives:
to determine the degree of association between clinical judgment and diagnostic reasoning of nursing students in clinical simulation.
Methods:
this is a correlational research design using a quantitative approach. The sample consisted of 41 nursing students who assisted a patient with vaso-occlusive crisis in a high-fidelity clinical simulation setting. The instruments used included the Lasater Clinical Judgment Rubric – Brazilian Version and the Diagnostic Thinking Inventory.
Results:
clinical judgment was associated with diagnostic reasoning (r=0.313; p=0.046), as well as the “noticing” aspect of clinical judgment with diagnostic reasoning (r=0.312; p=0.047).
Conclusions:
the results show that skills to interpret patient data are associated with diagnostic reasoning skills. Teaching clinical judgment skills is necessary to develop the diagnostic reasoning of nursing students.
- Janaina Gomes Perbone Nunes
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ORIGINAL ARTICLE10-18-2022
Quality of life of nurse practitioners during the COVID-19 pandemic
- Juliano de Souza Caliari ,
- Mariana Alvina dos Santos ,
- Carla Renata Silva Andrechuk ,
- Kétrya Raiany Costa Campos ,
- Maria Filomena Ceolim , [ … ],
- Flávia Helena Pereira
Abstract
ORIGINAL ARTICLEQuality of life of nurse practitioners during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2022;75:e20201382
DOI 10.1590/0034-7167-2020-1382
- Juliano de Souza Caliari ,
- Mariana Alvina dos Santos ,
- Carla Renata Silva Andrechuk ,
- Kétrya Raiany Costa Campos ,
- Maria Filomena Ceolim ,
- Flávia Helena Pereira
Views0See moreABSTRACT
Objective:
to assess the quality of life of nurse practitioners during the COVID-19 pandemic and analyze related factors.
Methods:
cross-sectional and analytical study carried out with nurse practitioners. A questionnaire on sociodemographic characterization, work activities and changes perceived with the pandemic and WHOQOL-bref were used. To compare the groups of interest, analysis of covariance was used.
Results:
572 professionals participated, who had a mean total quality of life score of 56.79 (SD=13.56). In the relationship of variables with WHOQOL-bref, having two or more jobs and being a nurse were associated with better quality of life, but being a woman and working more than 50 hours a week was associated with a worse perception of the construct.
Conclusions:
the factors analyzed indicate a lower perception of quality of life associated with the social domain, requiring interventions that reduce the damage to professionals’ health and contribute to quality of care provided.
- Juliano de Souza Caliari
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ORIGINAL ARTICLE10-21-2019
Nurses defending the autonomy of the elderly at the end of life
- Rafael Barroso Gaspar ,
- Marcelle Miranda da Silva ,
- Karen Gisela Moraes Zepeda ,
- Ítalo Rodolfo Silva
Abstract
ORIGINAL ARTICLENurses defending the autonomy of the elderly at the end of life
Revista Brasileira de Enfermagem. 2019;72(6):1639-1645
DOI 10.1590/0034-7167-2018-0768
- Rafael Barroso Gaspar ,
- Marcelle Miranda da Silva ,
- Karen Gisela Moraes Zepeda ,
- Ítalo Rodolfo Silva
Views1See moreABSTRACT
Objective:
to understand how nurses deal with the elderly’s autonomy at the end of life.
Method:
qualitative, exploratory study, guided by the Grounded Theory. Ten nurses, eight doctors and 15 nursing technicians were interviewed between November 2016 and May 2017 at a university hospital in Rio de Janeiro/Brazil.
Results:
nurses deal with the elderly’s autonomy in compliance with the code of ethics and exercise leadership in actions and interactions to defend this right, evaluating, guiding and listening to the preferences of the elderly; interacting with the family; and sharing information with the health team.
Final considerations:
the elderly’s autonomy must be ensured in care planning, based on patient-centered communication and developed in the interaction among agents involved in care. The discussion on “Living Wills” Health Care Directives and principles of palliative care must be encouraged.
- Rafael Barroso Gaspar
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ORIGINAL ARTICLE01-27-2020
Factors associated with depressive symptoms in elderly caregivers with chronic pain
- Marielli Terassi ,
- Estefani Serafim Rossetti ,
- Bruna Moretti Luchesi ,
- Karina Gramani-Say ,
- Priscilla Hortense , [ … ],
- Sofia Cristina Iost Pavarini
Abstract
ORIGINAL ARTICLEFactors associated with depressive symptoms in elderly caregivers with chronic pain
Revista Brasileira de Enfermagem. 2020;73(1):e20170782
DOI 10.1590/0034-7167-2017-0782
- Marielli Terassi ,
- Estefani Serafim Rossetti ,
- Bruna Moretti Luchesi ,
- Karina Gramani-Say ,
- Priscilla Hortense ,
- Sofia Cristina Iost Pavarini
Views0See moreABSTRACT
Objective:
to identify factors associated with depressive symptoms in elderly caregivers with chronic pain.
Method:
the study included people 60 years of age or older who reported chronic pain and cared for another elderly person living in the same household (n=186). Statistical analyzes were performed using the Mann-Whitney test, univariate and multiple logistic regression.
Results:
most participants had no depressive symptoms (70.4%), 24.2% had mild depressive symptoms and 5.4% had severe symptoms. Univariate analysis showed that the variables family income, number of diseases, number of medications in use, pain intensity, overload and perceived stress were associated with depressive symptoms. Multivariate analysis found an association with perceived stress (95% CI 1.101-1207) and number of medications (95% CI 1.139-1.540) in use.
Conclusion:
factors associated with depressive symptoms in elderly caregivers with chronic pain were stress and the number of medications in use.
- Marielli Terassi
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