A gestão de sintomas do doente em tratamento por Quimioterapia e os métodos de informação utilizados pelos enfermeiros

Introdução: O diagnóstico de cancro está frequentemente associado a tratamentos prolongados, dolorosos, em que a gestão dos sintomas dos efeitos secundários é difícil e por vezes devastadora. Os enfermeiros que prestam cuidados em hospital de dia de quimioterapia caracterizam-se pela avaliação e intervenção rápida de forma a dar resposta, num curto espaço de tempo, às necessidades reais/potenciais do doente (Glennon, 2005). Importa, por isso, saber e procurar optimizar a forma como o fazem. Objetivo: Conhecer e comparar estudos de qualidade que permitam, identificar métodos de informação utilizados pelos enfermeiros que contribuem para a gestão de sintomas dos doentes em tratamento por quimioterapia. Metodologia: Foram incluídos 7 estudos seleccionados a partir da pesquisa em bases de dados electrónicas (EBSCO), com diferentes desenhos de investigação, em que os participantes eram todos doentes com cancro em tratamento por quimioterapia. Resultados: Os vários métodos de informação utilizados pelos enfermeiros na gestão dos sintomas dos doentes em quimioterapia revistos nesta revisão mostraram alguma eficácia no controlo dos sintomas, e são uma mais-valia no processo de comunicação/educação entre o enfermeiro/doente. Devem ser, no entanto, um complemento e não um substituto no processo de cuidados. Conclusões: A eficácia da gestão dos sintomas do doente em tratamento por quimioterapia depende das intervenções de enfermagem nomeadamente na utilização de vários métodos de colheita de informação. A utilização de dispositivos de multimédia pode contribuir positivamente para melhorar o impacto de efeitos secundários relacionados com o tratamento. Isto sugere, que as necessidades educacionais e de informação dos doentes são imensas, com impacto na capacidade do indivíduo para compreender como e quando iniciar estratégias recomendadas para o auto cuidado. Os enfermeiros devem, desenvolver estratégias para optimizar os cuidados ao doente convertendo-se num elemento fundamental na garantia da qualidade de vida

Capacitar o cuidador do doente oncológico com doença avançada, para a gestão da dor no domicílio, através de um Programa educacional

Introdução: Um programa educacional de intervenções de enfermagem direccionado ao cuidador, relativamente à gestão da dor poderá ter resultados no controlo da dor do doente oncológico em domicílio. Objetivo: Conhecer e analisar estudos sobre a temática “Programa educacional ao cuidador do doente oncológico com dor no domicílio”. Metodologia: No planeamento e condução desta Revisão Sistemática foi utilizada a metodologia PICO(D). Foram seleccionados a partir da pesquisa em bases de dados electrónicas (EBSCO), cinco estudos, um de natureza qualitativa, outro de natureza quantitativa e um secundário RSL, posteriormente e após analisar o estudo de revisão sistemática da literatura incluíram-se dois estudos experimentais, cuja população não era o cuidador, mas sim o doente oncológico Resultados: Existem alguns trabalhos que apresentam dados sobre o desenvolvimento de programas educativos como intervenção de enfermagem, nomeadamente como deverá ser desenvolvido este programa e como poderão ser avaliados os resultados. Não foram encontrados estudos primários relativamente à eficácia dum programa educativo ao cuidador do doente oncológico com dor no domicílio. Foram encontrados dois estudos que comprovam a eficácia dum programa educacional, mas aplicado ao doente oncológico no domicílio, este programa educativo, poderá vir a ser desenvolvido com o cuidador. Os estudos primários e secundários, comprovam as necessidades de informação e apoio por parte do cuidador na gestão e controlo da dor. Conclusões: Foram identificadas no cuidador do doente oncológico com dor no domicílio, necessidades de informação, treino e apoio de enfermagem. O familiar cuidador do doente oncológico com doença avançada e dor no domicílio é um elemento muito importante na equipa de saúde. Um programa educacional de gestão da dor, estruturado e formalizado, que vá de encontro às necessidades apresentadas pelo cuidador e que seja aplicado de forma gradual, contribui para o envolvimento do cuidador na gestão da dor e capacita o mesmo para o auto cuidado. Palavras chave: Dor, Cuidador, programas educativos, doente oncológico Referências bibliográficas: Jung-Eun, K., Dodd, M., West, C., Paul, S., Facione, N., Schumacher, K., & ... Miaskowski, C. (2004). The PRO-SELF© Pain Control Program Improves Patients' Knowledge of Cancer Pain Management. Oncology Nursing Forum, 31(6), 1137-1143. doi:10.1188/04.ONF.1137-1143 Kim,J.,Dodd,M.,West,C.,Paul,S.,Facione,N.,Schumacher,K.,&...Miaskowski,C.(2004).ThePRO-SELF pain control program improves patients' knowledge of cancer pain management. Oncology Nursing Forum, 31(6), 1137-1143. Retrieved from EBSCOhost. Tsigaroppoulos, T., Mazaris, E., Chatzidarellis, E., Skolarikos, A., Varkarakis, I., & Deliveliotis, C. (2009). Problems faced by relatives caring for cancer patients at home. International Journal Of Nursing Practice, 15(1), 1-6. Retrieved from EBSCOhost. Vallerand, A., Riley-Doucet, C., Hasenau, S., & Templin, T. (2004). Improving cancer pain management by homecare nurses. Oncology Nursing Forum, 31(4), 809-816. Retrieved fro

Analgesic interpatient variability of remifentanil assessed through pupillary dilation reflex

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Pupillary pain index correlates with postoperative pain scores in neurosurgical patients

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Exploring How Mindfulness May Enhance Perceived Value of Travel Experience

This study aims to explore the effect of tourists’ mindfulness on the perceived value of travel experience (PVTE) through destination images (cognitive, affective, and conative) and tourist experiences. Data (n = 370) were gathered using a self-administered structured questionnaire distributed to travellers departing from Lisbon International airport towards Spain in July 2017. The results show the important role of mindfulness in shaping all dimensions of destination image. Tourist experience acts as a mediator between destination images and PVTE. However, perceived authenticity does not have a moderating, but rather a controlling effect on the relationship between tourist experience and PVTE. From a theoretical point of view, the study makes important contribution in conceptualising the influence of a tourist’s mindfulness on PVTE through destination image components and tourist experience. From a practical perspective, it offers practitioners and DMOs valuable insights into the effective design and implementation of suitable destination marketing activities.info:eu-repo/semantics/acceptedVersio

Sometimes it is better to just make it simple. De-escalation of oncoplastic and reconstructive procedures

© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Simple breast conservation surgery (sBCS) has technically advanced onto oncoplastic breast procedures (OBP) to avoid mastectomy and improve breast cancer patients' psychosocial well-being and cosmetic outcome. Although OBP are time-consuming and expensive, we are witnessing an increase in their use, even for cases that could be managed with sBCS. The choice between keeping it simple or opting for more complex oncoplastic procedures is difficult. This review proposes a pragmatic approach in assisting this decision. Medical literature suggests that OBP and sBCS might be similar regarding local recurrence and overall survival, and patients seem to have higher satisfaction levels with the aesthetic outcome of OBP when compared to sBCS. However, the lack of comprehensive high-quality research assessing their safety, efficacy, and patient-reported outcomes hinders these supposed conclusions. Postoperative complications after OBP may delay the initiation of adjuvant RT. In addition, precise displacement of the breast volume is not effectively recorded despite surgical clips placement, making accurate dose delivery tricky for radiation oncologists, and WBRT preferable to APBI in complex OBP cases. With a critical eye on financial toxicity, patient satisfaction, and oncological outcomes, OBP must be carefully integrated into clinical practice. The thoughtful provision of informed consent is essential for decision-making between sBCS and OBP. As we look into the future, machine learning and artificial intelligence can potentially help patients and doctors avoid postoperative regrets by setting realistic aesthetic expectations.Eduard-Alexandru Bonci’s work has been supported by a UICC Technical Fellowship [grant number UICC-TF/2022-1429].info:eu-repo/semantics/publishedVersio

Assessment of the geological heritage of Cape Mondego Natural Monument (Central Portugal)

In the western coast of Portugal, Cape Mondego is a well-known set of outcrops due to its international stratigraphic relevance given by the establishment of two stratotypes: the Global Boundary Stratotype Section and Point (GSSP) for the base of the Bajocian Stage and the Auxiliary Stratotype Section and Point (ASSP) for the base of the Bathonian Stage. The remarkable geodiversity of these Jurassic outcrops justifies the implementation of strategies in order to conserve and promote the geosites, which include a rich palaeontological record of macrofossils, microfossils and dinosaur footprints. Based on the exceptional quality of the geological record, on its international importance and on its high scientific and educational values, this area was classified in 2007 as Natural Monument. However, no geosite systematic inventory was ever done. In this work, a systematic identification, characterization and assessment of geosites was done in the Natural Monument. Based on fieldwork and published data, a first set of 32 potential geosites was identified taking into account their scientific, educational and touristic values. After the application of three criteria (representativeness, singularity and proximity) this group of 32 potential geosites was reduced to 12. These 12 geosites were assessed resulting on the establishment of a medium to high ranks for both educational and geotouristic potential uses. Based on this assessment, some valuing strategies were proposed, aiming at the sustainable use and the promotion of the Natural Monument geosites, within the scope of both educational and geotouristic activities addressed to secondary school students and the general public

Roman situlae from Conimbriga (Portugal): Compositional and microstructural characterization of anthropomorphic handle attachments

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Bulletproof Temporal Bone: A Case of Self-Inflicted Ballistic Injury

Temporal bone injuries due to gunshot wounds are uncommon but devastating, with a high risk of damage to critical neurovascular structures. The high resistance of the temporal bone, the densest bone in the human body, can sometimes avoid a fatal outcome. However, the complications are in many cases devastating and include hearing loss, facial paralysis, cerebrospinal fluid leakage, intracranial damage, and vascular injuries. Our goal was to report a case of ballistic injury to the temporal bone and describe the surgical approach taken for treatment. A 74-year-old man was transferred to the emergency room of our tertiary hospital, intubated and sedated, after an attempted suicide with a firearm. The CT scan showed the metal projectile lodged within the temporal bone on the right side, with the destruction of the ossicular chain and bony labyrinth. After stabilization, sedation was reversed, and the otolaryngology team was called. On examination, the entry wound was located in the cavum concha, with no active bleeding but presenting active otorrhea of cerebrospinal fluid. The patient had complete peripheral facial paralysis on the right side and spontaneous horizontal nystagmus toward the left side. Empirical antibiotic therapy was initiated. A subtotal petrosectomy was performed, with the removal of the foreign body, repair of the cerebrospinal fluid fistula, obliteration of the cavity with abdominal fat, and closure of the external auditory canal. He was discharged on the 11th-day post-surgery, maintaining complete facial paralysis and right-side anacusis, but was able to walk with assistance. In conclusion, penetrating trauma of the temporal bone is a potentially life-threatening situation, and patients that survive have a guarded prognosis, as it often leads to permanent sequelae even when managed promptly.info:eu-repo/semantics/publishedVersio