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ORIGINAL ARTICLE07-19-2024
Validation of an instrument for patient classification to support obstetric nursing care
Revista Brasileira de Enfermagem. 2024;77(2):e20230401
Abstract
ORIGINAL ARTICLEValidation of an instrument for patient classification to support obstetric nursing care
Revista Brasileira de Enfermagem. 2024;77(2):e20230401
DOI 10.1590/0034-7167-2023-0401
Views0See moreABSTRACT
Objectives:
to develop and validate an instrument for the classification of pregnant and postpartum women according to the demand for nursing care.
Methods:
a methodological study conducted in three stages: 1) construction of the instrument based on literature review; 2) content validation using the Delphi technique with 12 experts; and 3) Evaluation of the convergent construct validity through the correlation between the scores of the constructed instrument and the Fugulin instrument.
Results:
an instrument with ten indicators of specific care for pregnant and postpartum women was developed. A content validity index higher than 0.9 was obtained, requiring only one round of the Delphi technique. The Spearman coefficient was 0.64 between the instruments, indicating a strong correlation.
Conclusions:
the classification instrument specifically constructed for pregnant and postpartum women showed evidence of content validity and convergent construct validity with a widely used instrument in the national territory.
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ORIGINAL ARTICLE07-19-2024
Validation of an instrument for assessing leprosy care in children and adolescents
- Gutembergue Santos de Sousa
, - Isael Marcos Silva Mendonça ,
- Lia Hanna Martins Morita ,
- Denise da Costa Boamorte Cortela ,
- Pãmela Rodrigues de Souza Silva , [ … ],
- Silvana Margarida Benevides Ferreira
Abstract
ORIGINAL ARTICLEValidation of an instrument for assessing leprosy care in children and adolescents
Revista Brasileira de Enfermagem. 2024;77(2):e20230344
DOI 10.1590/0034-7167-2023-0344
- Gutembergue Santos de Sousa ,
- Isael Marcos Silva Mendonça ,
- Lia Hanna Martins Morita ,
- Denise da Costa Boamorte Cortela ,
- Pãmela Rodrigues de Souza Silva ,
- Silvana Margarida Benevides Ferreira
Views1See moreABSTRACT
Objectives:
to validate the content of an instrument for assessing leprosy care in individuals under 15 years old in the context of Primary Health Care.
Methods:
methodological study of content validation, based on the evaluation of essential and derived attributes in primary care, in the professional version. For data analysis, the Content Validation Index (CVI ≥ 0.8) and Cronbach’s Alpha were calculated.
Results:
a higher percentage of judges among nurses (61.5%) was observed; with a doctorate (46.2%), and engaged in teaching and research (77%). The overall Content Validation Index of the instrument was 0.98. In the analysis of Cronbach’s Alpha of the instrument, the assigned value was 0.717.
Conclusions:
the instrument represents an advancement in the measurement of health evaluation policies and can significantly contribute to improving the quality of care provided to children and adolescents with leprosy.
- Gutembergue Santos de Sousa
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ORIGINAL ARTICLE07-19-2024
Validation of the Brazilian Version of the Modified Scale for Delineating Advanced Practice Nursing Roles
Revista Brasileira de Enfermagem. 2024;77(2):e20230211
Abstract
ORIGINAL ARTICLEValidation of the Brazilian Version of the Modified Scale for Delineating Advanced Practice Nursing Roles
Revista Brasileira de Enfermagem. 2024;77(2):e20230211
DOI 10.1590/0034-7167-2023-0211
Views0See moreABSTRACT
Objectives:
to validate the Brazilian version of the Modified Scale for Delineating Advanced Practice Nursing Roles.
Methods:
this was a methodological study for the clinical validation of an instrument, conducted with 207 nurses working in primary care. Exploratory and confirmatory factor analysis, Cronbach’s alpha test, and z-test for proportion comparison were used.
Results:
the internal reliability of the scale was 0.944, with alpha greater than 0.80 in most domains, except for Education (0.786). In the exploratory factor analysis, considering the criterion of eigenvalue greater than one, eight factors were identified, explaining 79.38% of the variance. In the comparison of proportions, the adequate responses (≥ 2) in the domain of Comprehensive Direct Care, in both analyzed groups, were statistically equal. This domain had the highest score of adequate responses, followed by Education and Systems Support. Insufficient scoring was observed in the domains of Publication and Professional Leadership.
Conclusions:
the instrument demonstrated stability and reliability to be used in the evaluation of advanced nursing practice.
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REVIEW07-15-2024
Factors associated with Burnout Syndrome in police officers: a scoping review
- Beatriz Maria dos Santos Santiago Ribeiro ,
- Fabio Scorsolini-Comin ,
- Maria Lucia do Carmo Cruz Robazzi ,
- Sérgio Valverde Marques dos Santos ,
- Fábio de Souza Terra , [ … ],
- Rita de Cassia de Marchi Barcellos Dalri
Abstract
REVIEWFactors associated with Burnout Syndrome in police officers: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230444
DOI 10.1590/0034-7167-2023-0444
- Beatriz Maria dos Santos Santiago Ribeiro ,
- Fabio Scorsolini-Comin ,
- Maria Lucia do Carmo Cruz Robazzi ,
- Sérgio Valverde Marques dos Santos ,
- Fábio de Souza Terra ,
- Rita de Cassia de Marchi Barcellos Dalri
Views0See moreABSTRACT
Objectives:
to synthesize research on factors associated with Burnout Syndrome (BS) in police officers.
Methods:
a scoping review was conducted without temporal or language restrictions. Data were exported to EndNote to remove duplicates and then imported into the Rayyan app for organization, article selection, and data extraction.
Results:
a total of 4559 publications were identified, with 50 studies included in the review. Research conducted in Brazil and the United States predominated. Certain occupational factors were found to be more closely linked to police officers compared to other professions, including law enforcement, frequency of interaction with suspects and criminals, rank, dissatisfaction with the organization, and civilian confrontations.
Conclusions:
certain aspects of the police profession contribute to BS, even in countries with better working conditions in public security. It is recommended to prioritize health promotion initiatives for these professionals.
- Beatriz Maria dos Santos Santiago Ribeiro
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07-15-2024
Invisibilidade do trabalho da enfermagem: tecnologia como via de combate
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
Abstract
Invisibilidade do trabalho da enfermagem: tecnologia como via de combate
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
DOI 10.1590/0034-7167.202477suppl0301pt
Views0Na concepção comum, o trabalho é comumente associado a uma atividade remunerada em uma sociedade mercantil e de direito, refletindo a visão moderna que o limita ao tempo trocado por salário. Essa perspectiva, influenciada pelos princípios da Revolução Industrial, estabelece uma dicotomia entre o trabalho e o tempo fora dele, segmentando a vida em esferas […]See more -
ORIGINAL ARTICLE07-15-2024
Root cause analysis of safety incidents in antineoplastic use in children
- Elizangela Domiciano Garcia Barreto ,
- Valcieny Souza Sandes ,
- Gustavo Cattelan Nobre ,
- Monica Martins ,
- Sima Esther Ferman , [ … ],
- Elisangela Costa Lima
Abstract
ORIGINAL ARTICLERoot cause analysis of safety incidents in antineoplastic use in children
Revista Brasileira de Enfermagem. 2024;77:e20230139
DOI 10.1590/0034-7167-2021-0139
- Elizangela Domiciano Garcia Barreto ,
- Valcieny Souza Sandes ,
- Gustavo Cattelan Nobre ,
- Monica Martins ,
- Sima Esther Ferman ,
- Elisangela Costa Lima
Views1See moreABSTRACT
Objectives:
to identify and analyze the factors that contribute to safety incident occurrence in the processes of prescribing, preparing and dispensing antineoplastic medications in pediatric oncology patients.
Methods:
a quality improvement study focused on oncopediatric pharmaceutical care processes that identified and analyzed incidents between 2019-2020. A multidisciplinary group performed root cause analysis (RCA), identifying main contributing factors.
Results:
in 2019, seven incidents were recorded, 57% of which were prescription-related. In 2020, through active search, 34 incidents were identified, 65% relating to prescription, 29% to preparation and 6% to dispensing. The main contributing factors were interruptions, lack of electronic alert, work overload, training and staff shortages.
Conclusions:
the results showed that adequate recording and application of RCA to identified incidents can provide improvements in the quality of pediatric oncology care, mapping contributing factors and enabling managers to develop an effective action plan to mitigate risks associated with the process.
- Elizangela Domiciano Garcia Barreto
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07-15-2024
Invisibility of nursing work: technology as a means of combat
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
Abstract
Invisibility of nursing work: technology as a means of combat
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
DOI 10.1590/0034-7167.202477suppl0301
Views0In the common conception, work is commonly associated with a paid activity in a commercial and legal society, reflecting the modern view that limits it to time exchanged for wage. This perspective, influenced by Industrial Revolution principles, establishes a dichotomy between work and time outside of work, segmenting life into professional and private spheres. However, […]See more -
REVIEW07-15-2024
Risk for imbalanced blood pressure pattern among incarcerated women: Middle-Range Theory
- Gabrielle Pessôa da Silva ,
- Camila Takáo Lopes ,
- Marcos Venícios de Oliveira Lopes ,
- Ryanne Carolynne Marques Gomes Mendes ,
- Jaqueline Galdino Albuquerque Perrelli , [ … ],
- Francisca Márcia Pereira Linhares
Abstract
REVIEWRisk for imbalanced blood pressure pattern among incarcerated women: Middle-Range Theory
Revista Brasileira de Enfermagem. 2024;77:e20230288
DOI 10.1590/0034-7167-2023-0288
- Gabrielle Pessôa da Silva ,
- Camila Takáo Lopes ,
- Marcos Venícios de Oliveira Lopes ,
- Ryanne Carolynne Marques Gomes Mendes ,
- Jaqueline Galdino Albuquerque Perrelli ,
- Lívia Maia Pascoal ,
- Suzana de Oliveira Mangueira ,
- Francisca Márcia Pereira Linhares
Views0See moreABSTRACT
Objectives:
to develop a Middle-Range Theory for the Risk for imbalanced blood pressure pattern among incarcerated women.
Methods:
theoretical development study to obtain the theoretical-causal validity of the Nursing Diagnosis Risk for unstable blood pressure. The Middle-Range Theory was developed according to six stages: establishment of the approach to developing the theory; definition of the conceptual models to be later analyzed; definition of the main conceptions; a pictorial diagram; propositions; causal relationships and evidence for practice.
Results:
two attributes and 20 antecedents related to imbalanced blood pressure were identified, a pictorial diagram was developed, and nine theoretical propositions were presented.
Conclusions:
the theory developed here favors the diagnostic reasoning of nurses and contributes to planning actions to promote the cardiovascular health of incarcerated women. A new proposition for the diagnosis of Risk for unstable blood pressure was also structured with a new title, definition, and etiological factors.
- Gabrielle Pessôa da Silva
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ORIGINAL ARTICLE12-13-2019
Quality of life in the climacteric of nurses working in primary care
- Geyslane Pereira Melo de Albuquerque ,
- Fátima Maria da Silva Abrão ,
- Ana Maria de Almeida ,
- Débora Larissa Rufino Alves ,
- Priscyla de Oliveira Nascimento Andrade , [ … ],
- Aurélio Molina da Costa
Abstract
ORIGINAL ARTICLEQuality of life in the climacteric of nurses working in primary care
Revista Brasileira de Enfermagem. 2019;72:154-161
DOI 10.1590/0034-7167-2018-0306
- Geyslane Pereira Melo de Albuquerque ,
- Fátima Maria da Silva Abrão ,
- Ana Maria de Almeida ,
- Débora Larissa Rufino Alves ,
- Priscyla de Oliveira Nascimento Andrade ,
- Aurélio Molina da Costa
Views0See moreABSTRACT
Objective:
to evaluate the quality of life of primary care nurses in the climacteric.
Method:
A cross-sectional descriptive-analytic study, performed with 98 female nurses, aged 40-65 years, using the WHOQOL-Bref questionnaire.
Results:
the worst level of quality of life was observed for professionals aged 50-59 years, non-white, specialists, divorced or widowed, with children, a lower income, with another employment relationship, a weekly workload of more than 40 hours, who consumed alcoholic beverages weekly, with chronic disease, in continuous use of medications, sedentary, who did not menstruate and did not receive hormonal treatment, and who went through menopause between the ages of 43-47 years.
Conclusion:
Although the variables “physical activity” and “age” have a statistically significant association with quality of life, other variables seem to interfere in these professionals’ lives, indicating the need for a more critical and deep reflection on these relations.
- Geyslane Pereira Melo de Albuquerque
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ORIGINAL ARTICLE09-21-2020
Incontinence associated dermatitis in elderly people admitted to a university hospital
- Clóris Regina Blanski Grden ,
- Alessandra Rodrigues Martins ,
- Luciane Patrícia Andreani Cabral ,
- Péricles Martim Reche ,
- Guilherme Arcaro , [ … ],
- Danielle Bordin
Abstract
ORIGINAL ARTICLEIncontinence associated dermatitis in elderly people admitted to a university hospital
Revista Brasileira de Enfermagem. 2020;73:e20190374
DOI 10.1590/0034-7167-2019-0374
- Clóris Regina Blanski Grden ,
- Alessandra Rodrigues Martins ,
- Luciane Patrícia Andreani Cabral ,
- Péricles Martim Reche ,
- Guilherme Arcaro ,
- Daniele Brasil ,
- Danielle Bordin
Views0See moreABSTRACT
Objective:
To identify the frequency and factors associated to incontinence associated dermatitis in elderly people.
Methods:
Cross-sectional study with 202 elderly patients admitted to a university hospital between September 2017 and January 2018. Data collection included: cognitive screening, sociodemographic and clinical questionnaire. It was performed exploratory and descriptive analysis, where prevalence and ratios (PR) were calculated.
Results:
Prevalence of injury was 9.4%, age range 70-79 years (13.5%), African American (21.4%), hospitalization period ≥ 21 days (44.4%), in use of nasogastric tube (33.3%), medical device (11.3%), restricted mobility (18.5%). It was associated with hospitalization period, use of nasogastric tube, restricted mobility, medical devices, and cognition.
Conclusion:
It was confirmed an average frequency of incontinence associated dermatitis in elderly patients and association to factors such as hospitalization period, immobility, cognition, use of nasogastric tube and devices. It must be highlighted the importance of prevention measures, early detection, assessment and monitoring of this type of injury.
- Clóris Regina Blanski Grden
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ORIGINAL ARTICLE07-13-2020
Culture of patient safety in hospital units of gynecology and obstetrics: a cross-sectional study
- Juliana Maria Almeida do Carmo ,
- Isabel Yovana Quispe Mendoza ,
- Vania Regina Goveia ,
- Kleyde Ventura de Souza ,
- Bruna Figueiredo Manzo , [ … ],
- Gilberto de Lima Guimarães
Abstract
ORIGINAL ARTICLECulture of patient safety in hospital units of gynecology and obstetrics: a cross-sectional study
Revista Brasileira de Enfermagem. 2020;73(5):e20190576
DOI 10.1590/0034-7167-2019-0576
- Juliana Maria Almeida do Carmo ,
- Isabel Yovana Quispe Mendoza ,
- Vania Regina Goveia ,
- Kleyde Ventura de Souza ,
- Bruna Figueiredo Manzo ,
- Gilberto de Lima Guimarães
Views0See moreABSTRACT
Objectives:
to assess the patient safety culture of the health team working in three maternity hospitals.
Methods:
observational, cross-sectional, comparative study. 301 professionals participated in the study. The Hospital Survey on Patient Safety Culture questionnaire validated in Brazil was used. For data analysis, it was considered a strong area in the patient safety culture when positive responses reached over 75%; and areas that need improvement when positive responses have reached less than 50%. To compare the results, standard deviation and thumb rule were used.
Results:
of the 12 dimensions of patient safety culture, none obtained a score above 75%, with nine dimensions scoring between 19% and 43% and three dimensions between 55% and 57%.
Conclusions:
no strong dimensions for safety culture were identified in the three maternity hospitals. It is believed that these results may contribute to the development of policies that promote a culture of safety in institutions.
- Juliana Maria Almeida do Carmo
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ORIGINAL ARTICLE02-25-2022
Diabetes mellitus type 2: factors related to adherence to self-care
- Raquel de Aguiar Portela ,
- José Rodrigo Santos Silva ,
- Flávia Baluz Bezerra de Farias Nunes ,
- Maria Lúcia Holanda Lopes ,
- Rosângela Fernandes Lucena Batista , [ … ],
- Andréa Cristina Oliveira Silva
Abstract
ORIGINAL ARTICLEDiabetes mellitus type 2: factors related to adherence to self-care
Revista Brasileira de Enfermagem. 2022;75(4):e20210260
DOI 10.1590/0034-7167-2021-0260
- Raquel de Aguiar Portela ,
- José Rodrigo Santos Silva ,
- Flávia Baluz Bezerra de Farias Nunes ,
- Maria Lúcia Holanda Lopes ,
- Rosângela Fernandes Lucena Batista ,
- Andréa Cristina Oliveira Silva
Views0See moreABSTRACT
Objectives:
to analyze the sociodemographic and clinical variables related to the adherence to self-care activities in people with diabetes mellitus type 2.
Methods:
quantitative, cross-sectional study, carried out with 270 people with diabetes from December 2019 to October 2020, in São Luís, Maranhão.
Results:
the adherence to self-care was greater when it comes to medications (Md=7.0) and foot care (Md= 6.0), but lower in regard to blood sugar testing (Md=1.0), exercise (Md=2,0), and diet (general) (Md=4.0). The variables age group (p=0.007), educational level (p=0.015), body mass index (p=0.035), complications with diabetes (p=0.009), and nutritional follow-up (p=0.000) had associations with self-care activities.
Conclusions:
identifying the factors related to the adherence to self-care was found to be essential to strengthen the line of care in chronic diseases and to direct educational actions, aiming to improve the quality of life of people with diabetes.
- Raquel de Aguiar Portela
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ORIGINAL ARTICLE09-21-2020
Frailty, depression, and quality of life: a study with elderly caregivers
- Letícia Alves de Melo ,
- Isabela Thaís Machado de Jesus ,
- Fabiana de Souza Orlandi ,
- Grace Angélica de Oliveira Gomes ,
- Marisa Silvana Zazzetta , [ … ],
- Ariene Angelini dos Santos-Orlandi
Abstract
ORIGINAL ARTICLEFrailty, depression, and quality of life: a study with elderly caregivers
Revista Brasileira de Enfermagem. 2020;73:e20180947
DOI 10.1590/0034-7167-2018-0947
- Letícia Alves de Melo ,
- Isabela Thaís Machado de Jesus ,
- Fabiana de Souza Orlandi ,
- Grace Angélica de Oliveira Gomes ,
- Marisa Silvana Zazzetta ,
- Tábatta Renata Pereira de Brito ,
- Ariene Angelini dos Santos-Orlandi
Views0See moreABSTRACT
Objective:
to analyze the relationship between frailty, depressive symptoms, and quality of life of elderly caregivers of other elderly living in high social vulnerability.
Methods:
a descriptive, correlational and cross-sectional study conducted with 40 elderly caregivers. A questionnaire to characterize elderly caregivers, the Fried frailty phenotype, the Geriatric Depression Scale (to screen depressive symptoms) and the Short-Form 6 Dimension (to assess quality of life) were used. For data analysis, Student’s t-test, ANOVA, Pearson’s χ2 and Fisher’s exact test were used.
Results:
most were pre-frail (52.5%) and had no evidence of depressive symptoms (57.5%). They presented, on average, a score of 0.76 (±0.1) in relation to quality of life. Statistical significance was observed between the average scores of quality of life with depressive symptoms (p=0.012) and frailty level (p=0.004).
Conclusion:
frail elderly caregivers with depressive symptoms had a worse perception of quality of life.
- Letícia Alves de Melo
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ORIGINAL ARTICLE09-21-2020
Autonomy in the reproductive health of quilombolas women and associated factors
- Elionara Teixeira Boa Sorte Fernandes ,
- Sílvia Lúcia Ferreira ,
- Cláudia Suely Barreto Ferreira ,
- Eliene Almeida Santos
Abstract
ORIGINAL ARTICLEAutonomy in the reproductive health of quilombolas women and associated factors
Revista Brasileira de Enfermagem. 2020;73:e20190786
DOI 10.1590/0034-7167-2019-0786
- Elionara Teixeira Boa Sorte Fernandes ,
- Sílvia Lúcia Ferreira ,
- Cláudia Suely Barreto Ferreira ,
- Eliene Almeida Santos
Views0See moreABSTRACT
Objective:
Identify the level of reproductive autonomy of quilombola women and associate it with sociodemographic characteristics and aspects of sexual and reproductive health.
Methods:
Cross-sectional census study carried out in quilombola communities in a municipality in Bahia. Data was collected through questionnaires from the National Health Survey and the Reproductive Autonomy Scale, applied to quilombola women who agreed to participate. Descriptive statistics procedures were used and associations were made between reproductive autonomy scores and sociodemographic and reproductive characteristics.
Results:
The average total score for reproductive autonomy was 2.06. An association was found between the “decision-making” score and marital status. The score for “total reproductive autonomy” was associated with the use of contraceptive method.
Conclusion:
The reality of the study participants converges with the literature regarding the interference of sociodemographic and reproductive factors in the reproductive autonomy of black women.
- Elionara Teixeira Boa Sorte Fernandes
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06-28-2021
Trends in fertility rates, proportion of antenatal consultations and caesarean sections among Brazilian adolescents
- Milena Laryssa Costa Bicalho ,
- Fernanda Gontijo Araújo ,
- Gisele Nepomuceno de Andrade ,
- Eunice Francisca Martins ,
- Mariana Santos Felisbino-Mendes
Abstract
Trends in fertility rates, proportion of antenatal consultations and caesarean sections among Brazilian adolescents
Revista Brasileira de Enfermagem. 2021;74:e20200884
DOI 10.1590/0034-7167-2020-0884
- Milena Laryssa Costa Bicalho ,
- Fernanda Gontijo Araújo ,
- Gisele Nepomuceno de Andrade ,
- Eunice Francisca Martins ,
- Mariana Santos Felisbino-Mendes
Views1See moreABSTRACT
Objective:
To analyze the temporal trends in the fertility rate, proportion of antenatal consultations and caesarean sections in Brazilian adolescents aged 15 to 19, between 2000 and 2015. Methods: The fertility rate, proportion of prenatal consultations and proportion of routes of birth were calculated using data from DATASUS. The trend analysis was performed using the Prais-Winsten regression model and the annual percentage change.
Results:
There was a trend of reduction of 3.5% per year in the fertility rate among adolescents (p<0.05), in addition to an increasing trend of 6% per year in the proportion of more than six antenatal consultations (p <0.0001) and an increasing trend of 6.8% per year in the proportion of caesarean sections (p<0.0001).
Conclusion:
Despite the decreasing trend in fertility rates among Brazilian adolescents, they remain high. Also noteworthy is the growing trend for caesarean sections, even with improved access to antenatal care.
- Milena Laryssa Costa Bicalho
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ORIGINAL ARTICLE10-21-2019
Nursing protocol in vascular trauma prevention: peripheral catheterization bundle in urgency
- Paula Krempser ,
- Cristina Arreguy-Sena ,
- Pedro Miguel dos Santos Dinis Parreira ,
- Anabela de Sousa Salgueiro-Oliveira
Abstract
ORIGINAL ARTICLENursing protocol in vascular trauma prevention: peripheral catheterization bundle in urgency
Revista Brasileira de Enfermagem. 2019;72(6):1512-1518
DOI 10.1590/0034-7167-2018-0457
- Paula Krempser ,
- Cristina Arreguy-Sena ,
- Pedro Miguel dos Santos Dinis Parreira ,
- Anabela de Sousa Salgueiro-Oliveira
Views0See moreABSTRACT
Objective:
to create, apply and analyze in clinical practice the effectiveness of a bundle to prevent peripheral vascular trauma to approach the peripheral venous puncture process.
Method:
action research with 435 adult participants in an emergency service from 2011 to 2013. Creation of the bundle for prevention of vascular trauma based on scientific evidence, ease of operation, observation and measurement with implantation through an educational intervention of the team of nursing. Effectiveness analyzed by descriptive and inferential statistics using chi-square. Consecutive sample with 95% confidence interval.
Results:
Five stages of the bundle were related to the catheter fixation, permanence and removal process. The incidence of vascular traumas due to vein punctures reduced by 46.41% after implantation of the bundle to prevent vascular trauma associated with emergency peripheral catheterization.
Conclusion:
The bundle in clinical practice reduced vascular traumas by venipuncture.
- Paula Krempser
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