CONTINUING/PERMANENT EDUCATION AS A STRATEGY FOR MANAGING OF NURSING IN THE UNIQUE HEALTH SYSTEM: AN INTEGRATIVE REVIEW

Objetivo: analisar as publicações que enfocam o processo de Educação continuada no âmbito da enfermagem, no período de 2008 a 2011. Método: revisão integrativa realizada nas Bases de Dados da Biblioteca Virtual da Saúde (Lilacs e Scielo), com os seguintes critérios de inclusão: possuir relação ao objetivo proposto; ano de publicação de 2008 a 2011; abordar a temática de educação continuada no âmbito da Enfermagem; possuir o texto na íntegra disponível on line; idioma em português, inglês ou espanhol. Resultados: Após a busca, foram analisados e categorizados nove artigos. Conclusão: percebeu-se que os desafios e ações por parte da equipe multiprofissional na atualidade estão relacionados à carência de incentivo às ações de Educação continuada. No âmbito da Enfermagem são ainda mais imprescindíveis essas ações, pois observa-se no cotidiano, problemas decorrentes de falta de atualização e treinamento, implicando diretamente em uma diminuição no rendimento da qualidade da assistência em saúde

CONTINUING/PERMANENT EDUCATION AS A STRATEGY FOR MANAGING OF NURSING IN THE UNIQUE HEALTH SYSTEM: AN INTEGRATIVE REVIEW

Objetivo: analisar as publicações que enfocam o processo de Educação continuada no âmbito da enfermagem, no período de 2008 a 2011. Método: revisão integrativa realizada nas Bases de Dados da Biblioteca Virtual da Saúde (Lilacs e Scielo), com os seguintes critérios de inclusão: possuir relação ao objetivo proposto; ano de publicação de 2008 a 2011; abordar a temática de educação continuada no âmbito da Enfermagem; possuir o texto na íntegra disponível on line; idioma em português, inglês ou espanhol. Resultados: Após a busca, foram analisados e categorizados nove artigos. Conclusão: percebeu-se que os desafios e ações por parte da equipe multiprofissional na atualidade estão relacionados à carência de incentivo às ações de Educação continuada. No âmbito da Enfermagem são ainda mais imprescindíveis essas ações, pois observa-se no cotidiano, problemas decorrentes de falta de atualização e treinamento, implicando diretamente em uma diminuição no rendimento da qualidade da assistência em saúde

an international survey before and during the COVID-19 pandemic

Funding Information: The Société Française d’Anesthésie et de Réanimation (SFAR), Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), Sociedad Argentina de Terapia Intensiva (SATI), Sociedad Chilena de Medicina Intensiva (SOCHIMI), Associação de Medicina Intensiva Brasileira (AMIB-Net) and the Brazilian Research in Intensive Care Network (BricNet) supported this survey. We would also like to thank our friend Tiago Rocha for making the amazing logo for this study. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001. Publisher Copyright: © 2022, The Author(s).Background: Since the publication of the 2018 Clinical Guidelines about sedation, analgesia, delirium, mobilization, and sleep deprivation in critically ill patients, no evaluation and adequacy assessment of these recommendations were studied in an international context. This survey aimed to investigate these current practices and if the COVID-19 pandemic has changed them. Methods: This study was an open multinational electronic survey directed to physicians working in adult intensive care units (ICUs), which was performed in two steps: before and during the COVID-19 pandemic. Results: We analyzed 1768 questionnaires and 1539 (87%) were complete. Before the COVID-19 pandemic, we received 1476 questionnaires and 292 were submitted later. The following practices were observed before the pandemic: the Visual Analog Scale (VAS) (61.5%), the Behavioral Pain Scale (BPS) (48.2%), the Richmond Agitation Sedation Scale (RASS) (76.6%), and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) (66.6%) were the most frequently tools used to assess pain, sedation level, and delirium, respectively; midazolam and fentanyl were the most frequently used drugs for inducing sedation and analgesia (84.8% and 78.3%, respectively), whereas haloperidol (68.8%) and atypical antipsychotics (69.4%) were the most prescribed drugs for delirium treatment; some physicians regularly prescribed drugs to induce sleep (19.1%) or ordered mechanical restraints as part of their routine (6.2%) for patients on mechanical ventilation; non-pharmacological strategies were frequently applied for pain, delirium, and sleep deprivation management. During the COVID-19 pandemic, the intensive care specialty was independently associated with best practices. Moreover, the mechanical ventilation rate was higher, patients received sedation more often (94% versus 86.1%, p < 0.001) and sedation goals were discussed more frequently in daily rounds. Morphine was the main drug used for analgesia (77.2%), and some sedative drugs, such as midazolam, propofol, ketamine and quetiapine, were used more frequently. Conclusions: Most sedation, analgesia and delirium practices were comparable before and during the COVID-19 pandemic. During the pandemic, the intensive care specialty was a variable that was independently associated with the best practices. Although many findings are in accordance with evidence-based recommendations, some practices still need improvement.publishersversionpublishe

Sigh in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: the PROTECTION pilot randomized clinical trial

Background: Sigh is a cyclic brief recruitment manoeuvre: previous physiological studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity and increase release of surfactant. Research question: Is the clinical application of sigh during pressure support ventilation (PSV) feasible? Study design and methods: We conducted a multi-center non-inferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or acute respiratory distress syndrome undergoing PSV. Patients were randomized to the No Sigh group and treated by PSV alone, or to the Sigh group, treated by PSV plus sigh (increase of airway pressure to 30 cmH2Ofor 3 seconds once per minute) until day 28 or death or successful spontaneous breathing trial. The primary endpoint of the study was feasibility, assessed as non-inferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiological parameters in the first week from randomization, 28-day mortality and ventilator-free days. Results: Two-hundred fifty-eight patients (31% women; median age 65 [54-75] years) were enrolled. In the Sigh group, 23% of patients failed to remain on assisted ventilation vs. 30% in the No Sigh group (absolute difference -7%, 95%CI -18% to 4%; p=0.015 for non-inferiority). Adverse events occurred in 12% vs. 13% in Sigh vs. No Sigh (p=0.852). Oxygenation was improved while tidal volume, respiratory rate and corrected minute ventilation were lower over the first 7 days from randomization in Sigh vs. No Sigh. There was no significant difference in terms of mortality (16% vs. 21%, p=0.342) and ventilator-free days (22 [7-26] vs. 22 [3-25] days, p=0.300) for Sigh vs. No Sigh. Interpretation: Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk

Revista iberoamericana de educación

Resumen basado en el de la publicaciónTítulo, resumen y palabras clave en portugués e inglésNúmero especial que acompaña al monográfico "Educación Infantil (I)"Se busca discutir y verificar la utilización de las tecnologías de la información y comunicación (TIC), más específicamente del ordenador y demás tecnologías digitales, en las clases y analizar su uso fuera del aula, por profesores y alumnos. Los resultados apuntaron que tanto profesores como alumnos están bien familiarizados con las tecnologías digitales y las utilizan en su día a día en diversas actividades, la mayoría de ellas orientadas hacia el ocio, el entretenimiento y la comunicación. Los datos mostraron que sólo el 40% de los profesores que participaron en la investigación utilizan las tecnologías digitales con sus alumnos, mostrando que la presencia de las TIC en las escuelas y la familiaridad de los profesores con ellas no se traduce, fácilmente, en su utilización en el proceso de enseñanza- el aprendizaje.ES

Produção de goma xantana obtida a partir do caldo de cana Production of xanthan gum obtained from sugarcane

Goma xantana é um heteroexopolissacarídeo sintetizado por Xanthomonas utilizando glicose ou sacarose como fontes de carbono, além de outros micronutrientes. É de grande aplicação industrial, devido às suas propriedades reológicas. O caldo de cana é rico em nutrientes, podendo ser utilizado como substrato para obtenção de xantana, viabilizando a produção no País pela redução dos custos. O objetivo deste estudo foi testar a produção da xantana obtida com diferentes cepas nativas de Xanthomonas em meio de cultivo composto de caldo de cana (XCC) e compará-la com os valores obtidos com a sacarose (XS). Foram preparados meios com o mínimo dos requerimentos nutricionais, contendo sacarose ou caldo de cana, suplementados apenas com uréia (0,01%) e fosfato (0,1%), fermentados em shaker (28 °C, 250 rpm, 120 horas). A maior produção de xantana foi obtida com a Xanthomonas campestris manihotis e caldo de cana (33,54 g.L-1), valor aproximadamente dez vezes maior que o obtido com a sacarose (3,45 g.L-1). A viscosidade aparente a 25 s-1, 2,0% de goma e 25 °C foi de 99,36 mPa.s para XCC e de 500,43 mPa.s para XS. A biossíntese da xantana a partir do caldo de cana merece peculiar atenção, constituindo-se numa possibilidade promissora para sua produção em larga escala.The xanthan gum is a heteroexopolysaccharide synthesized by Xanthomonas campestris in a culture medium using glucose or sucrose as carbon sources and other nutrients. Due to its rheological properties, it has been contributing for the range of applications in the food industry, pharmaceutical, and tertiary recovery of oil. Sugarcane is rich in nutrients (sugars and minerals) and can be used as a substratum for the xanthan production, which can be produced in Brazil due to its cost reduction. The objective of this study was to test the production of the xantana obtained with different culture native of Xanthomonas in medium composed of sugarcane broth (XSC) and to compare with the values obtained with sucrose (XS). Two medium cultures were used with the minimum of the nutrients, contained sucrose or sugar cane complemented with urea (0.01%) and K2HPO4 (0.1%), fermented in shaker (28 °C, 250 rpm, 120 hours). The best production was obtained using Xanthomonas campetris manihotis and sugarcane (33.54 g.L-1), approximately ten times bigger then obtained with the sucrose (3.45 g.L-1). The apparent viscosity for an aqueous solution of 2.0% of gum to 25 °C and 25 s-1 was 99.36 mPa.s for XSC and 500.43 mPa.s to XS. The biosynthesis of xanthan starting from sugarcane deserves peculiar attention, constituting like this, a promising possibility for gum production in wide climbs