Efectividad de la heparina y el suero fisiológico para mantener la permeabilidad de los catéteres venosos centrales: revisión sistemática

OBJETIVO Determinar qual é a solução (flush heparina comparado com oflushde soro fisiológico 0.9%) mais eficaz na redução do risco de oclusões de cateteres venosos centrais (CVC) em adultos. MÉTODO A revisão sistemática seguiu os princípios propostos pelo Cochrane Handbook; a análise crítica, a extração e a síntese dos dados foram realizadas por dois investigadores, isoladamente; e a análise estatística efetuada com recurso ao programa RevMan 5.2.8. RESULTADOS Foram incluídos oito estudos randomizados controlados e um estudo de coorte e os resultados da meta-análise mostram não existir diferenças (RR=0.68, IC 95%=0.41-1.10; p=0.12). A análise por subgrupos mostra que nos CVC totalmente implantados não se verificaram diferenças (RR=1.09, IC 95%=0.53-2.22; p=0.82); nos CVC com vários lúmens existiu um efeito benéfico no grupo da heparina (RR=0.53, IC 95%=0.29-0.95;p=0.03); nos CVC de duplo lúmen para hemodiálise (RR=1.18, IC 95%=0.08-17.82; p=0.90) e nos CVC de inserção periférica (RR=0.14, IC 95%=0.01-2.60; p=0.19) também não se verificaram diferenças. CONCLUSÃO O soro fisiológico é suficiente para manter a permeabilidade dos cateteres venosos centrais, prevenindo os riscos associados à administração da heparina.OBJETIVO Determinar cuál es la solución (flush con heparina comparado con el de suero fisiológico al 0,9%) más eficaz en la reducción del riesgo de oclusiones de catéteres venosos centrales (CVC) en adultos. MÉTODO La revisión sistemática siguió los principios propuestos por elCochrane Handbook; el análisis crítico, la extracción y la síntesis de los datos fueron realizados por dos investigadores, aisladamente; y el análisis estadístico fue llevado a cabo con recurso al programa RevMan 5.2.8. RESULTADOS Se incluyeron ocho estudios randomizados controlados y un estudio de cohorte, y los resultados del metaanálisis muestran no existir diferencias (RR=0.68, IC 95%=0.41-1.10; p=0.12). El análisis por subgrupos muestra que en los CVC totalmente implantados no se verificaron diferencias (RR=1.09, IC 95%=0.53-2.22; p=0.82); en los CVC con varios lúmenes existió un efecto benéfico en el grupo de la heparina (RR=0.53, IC 95%=0.29-0.95; p=0.03); en los CVC de doble lumen para hemodiálisis (RR=1.18, IC 95%=0.08-17.82; p=0.90) y en los CVC de inserción periférica (RR=0.14, IC 95%=0.01-2.60;p=0.19) tampoco se verificaron diferencias. CONCLUSIÓN El suero fisiológico es suficiente para mantener la permeabilidad de los catéteres venosos centrales, previniendo los riesgos asociados con la administración de la heparina.OBJECTIVE Determining which is the most effective solution (heparin flush compared to 0.9% saline flush) for reducing the risk of occlusions in central venous catheters (CVC) in adults. METHOD The systematic review followed the principles proposed by the Cochrane Handbook; critical analysis, extraction and synthesis of data were performed by two independent researchers; statistical analysis was performed using the RevMan program 5.2.8. RESULTS Eight randomized controlled trials and one cohort study were included and the results of the meta-analysis showed no difference (RR=0.68, 95% CI=0.41-1.10; p=0.12). Analysis by subgroups showed that there was no difference in fully deployed CVC (RR=1.09, CI 95%=0.53-2.22;p=0.82); Multi-Lumen CVC showed beneficial effects in the heparin group (RR=0.53, CI 95%=0.29-0.95; p=0.03); in Double-Lumen CVC for hemodialysis (RR=1.18, CI 95%=0.08-17.82;p=0.90) and Peripherally inserted CVC (RR=0.14, CI 95%=0.01-2.60; p=0.19) also showed no difference. CONCLUSION Saline solution is sufficient for maintaining patency of the central venous catheter, preventing the risks associated with heparin administration

Agro-industrial wastes as alternative substrates for the production of prebiotic with Zymomonas mobilis

Fructooligosaccharides (FOS) are promising prebiotics in the relevant and increasing market of functional food. However, to achieve a more sustainable process, the industrial production of FOS should use cheap substrates. Zymomonas mobilis (ZM) has great potential for the production of FOS due to the presence of native enzymes (levansucrase) capable of metabolizing sucrose. In addition, ZM can use different carbon sources, such as molasses and sugarcane juice, which make the FOS production process cost-effective. In this study, sugarcane molasses (a potential replacement of sucrose) and corn step liquor (CSL) (a potential replacement of yeast extract (YE)), were used as nutrients for FOS production using ZM in an in vivo bioprocess approach. FOS production process from sucrose was first optimized and 52 g/L of FOS with a yield of 0.16 g/g was obtained. Afterwards, molasses and CSL were used as alternative nutrients. After studying different combinations of CSL and YE, the highest amount of FOS (54 g/L, with a yield of 0.18 g/g) was obtained with 12 g/L of CSL and 8 g/L of YE. In addition, 45 g/L of FOS were produced from molasses containing 200 g/L of sucrose, with a yield of 0.3 g/g. With this approach, it was possible to reduce around 5.5-times the cost associated with the FOS production medium. Moreover, this study proposed a sustainable process for the valorization of agro-industrial wastes contributing to the future Circular (Bio)Economy and the EU Green Deal.Cláudia Amorim, João Rainha, Beatriz B. Cardoso and Daniela Gomes acknowledge their grants (2020.0029.CEECIND, SFRH/BD/138325/2018, SFRH/BD/132324/2017 and SFRH/BD/04433/2020, respectively) from Portuguese Foundation for Science and Technology (FCT). The study received financial support from Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UIDB/04469/2020 unit and by LABBELS – Associate Laboratory in Biotechnology, Bioengineering and Microelectromechanical Systems, LA/P/0029/2020.info:eu-repo/semantics/publishedVersio

Zymomonas mobilis an emerging microbial cell factory to produce prebiotics

info:eu-repo/semantics/publishedVersio

Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review

Abstract OBJECTIVE Determining which is the most effective solution (heparin flush compared to 0.9% saline flush) for reducing the risk of occlusions in central venous catheters (CVC) in adults. METHOD The systematic review followed the principles proposed by the Cochrane Handbook; critical analysis, extraction and synthesis of data were performed by two independent researchers; statistical analysis was performed using the RevMan program 5.2.8. RESULTS Eight randomized controlled trials and one cohort study were included and the results of the meta-analysis showed no difference (RR=0.68, 95% CI=0.41-1.10; p=0.12). Analysis by subgroups showed that there was no difference in fully deployed CVC (RR=1.09, CI 95%=0.53-2.22;p=0.82); Multi-Lumen CVC showed beneficial effects in the heparin group (RR=0.53, CI 95%=0.29-0.95; p=0.03); in Double-Lumen CVC for hemodialysis (RR=1.18, CI 95%=0.08-17.82;p=0.90) and Peripherally inserted CVC (RR=0.14, CI 95%=0.01-2.60; p=0.19) also showed no difference. CONCLUSION Saline solution is sufficient for maintaining patency of the central venous catheter, preventing the risks associated with heparin administration

Evidence Based Practice in the Nursing Education Process in Portugal

Tese no âmbito do Programa de Doutoramento em Ciências da Saúde – Ramo Enfermagem, apresentada à Faculdade de Medicina da Universidade de Coimbra.Introdução: A prática baseada em evidências (PBE) evita a insegurança/ineficiência e melhora a qualidade dos cuidados de saúde. No entanto, a implementação e a sustentabilidade da PBE são um desafio para as organizações de saúde tendo em conta as lacunas entre investigação e prática. Uma preparação educacional dos futuros profissionais de saúde pode minimizar estas lacunas. Assim, é imperativo que os currículos dos cursos de licenciatura em ciências da saúde, nomeadamente em enfermagem, promovam uma cultura de PBE para que futuros profissionais de saúde a utilizem na sua prática clínica. Objetivo: Sintetizar a realidade atual portuguesa das instituições de ensino de enfermagem sobre: predisposição para a integração da PBE; crenças relativas à PBE de professores de enfermagem e o seu nível de implementação; crenças relativas à PBE dos estudantes de licenciatura em enfermagem e o seu nível de implementação. Desenvolver um programa educacional de PBE e avaliar a sua efetividade nos conhecimentos e competências em PBE dos estudantes do quarto ano de licenciatura em enfermagem. Metodologia: O estudo foi realizado em sete fases: (i) revisão sistemática da literatura sobre instrumentos de medida; (ii) tradução e adaptação transcultural para a população portuguesa dos intrumentos “EBP Beliefs Scale for Educators” (EBPB-E), “EBP Implementation Scale for Educators” (EBPI-E) e “Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey” (OCRSIEP-E) para professores; (iii) tradução e adaptação transcultural para a população portuguesa da “EBP Beliefs Scale” (EBPB), da “EBP Implementation Scale for Students” (EBPI-S) e da “Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey” (OCRSIEP-ES) para estudantes; (iv) tradução e adaptação transcultural para a população portuguesa e para os estudantes de licenciatura em enfermagem do teste Fresno; (v) análise da predisposição para a integração da PBE nas instituições de ensino de enfermagem; das crenças relativamente à PBE de professores de enfermagem e o seu nível de implementação da PBE; das crenças relativamente à PBE dos estudantes de licenciatura em enfermagem e o seu nível de implementação da PBE; (vi) desenvolvimento de um programa educacional estruturado sobre PBE; (vii) avaliação da efetividade do programa educacional de PBE nos conhecimentos e competências em PBE dos estudantes de licenciatura em enfermagem. Resultados: Os professores e os estudantes apresentaram fortes crenças relativamente à PBE, mas baixos níveis de implementação desta, e as escolas mostraram um movimento moderado para uma cultura de PBE. Um programa educacional de PBE foi desenvolvido para 17 semanas, com um total de 18 horas (12 horas de aulas em sala de aula mais 6 horas de orientação) e implementado numa escola de enfermagem portuguesa. Esta implementação contribuiu para a melhoria dos conhecimentos e competências em PBE de estudantes de licenciatura em enfermagem do quarto ano, específicamente ao nível da formulação de questões de revisão. Conclusões: O programa educacional sobre PBE é o primeiro programa estruturado para estudantes de licenciatura em enfermagem desenvolvido de acordo com a “Guideline for Reporting Evidence-based practice Educational interventions and Teaching checklist” para o ensino da PBE em Portugal. Este programa mostrou potencial para ser implementado nos currículos de enfermagem de forma a promover uma cultura de PBE, incluindo o uso crítico das melhores evidências disponíveis em contextos clínicos como estudante e futuro profissional de saúde.Introduction: Evidence-based practice (EBP) prevents unsafety/inefficiency and improves healthcare quality. However, EBP implementation and sustainment are challenging for healthcare organizations and providers considering gaps between research and practice. An educational preparation of the future healthcare professionals can minimise these gaps. Thus, it is mandatory that undergraduate curricula in health sciences, namely in nursing, promote an EBP culture so that future health professionals use it into their clinical practice. Objectives: To synthesize the current Portuguese reality of nursing education institutions about: readiness of EBP integration; nurse educators' EBP beliefs and the extent of their EBP implementation; undergraduate nursing students’ EBP beliefs and the extent of their EBP implementation. To develop an educational EBP program and evaluate its effectiveness in fourth-year undergraduate nursing students’ EBP knowledge and skills. Methodology: The study was performed in seven phases: (i) systematic literature review of outcome measurement instruments; (ii) translation and cross-cultural adaptation to the Portuguese population the EBP Beliefs Scale for Educators” (EBPB-E), the “EBP Implementation Scale for Educators” (EBPI-E) and the “Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey” (OCRSIEP-E) for educators; (iii) translation and cross-cultural adaptation to the Portuguese population the “EBP Beliefs Scale” (EBPB), the “EBP Implementation Scale for Students” (EBPI-S) and the “Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey” (OCRSIEP-ES) for students.; (iv) translation and cross-cultural adaptation to the Portuguese population and to the undergraduate nursing students the Fresno test; (v) analysis of readiness of EBP integration of the nursing education institutions; nurse educators' EBP beliefs and the extent of their EBP implementation; undergraduate nursing students’ EBP beliefs and the extent of their EBP implementation; (vi) development of a structured educational EBP program; (vii) evaluation of the effectiveness of the educational EBP program in undergraduate nursing students’ EBP knowledge and skills. Results: Educators and students had strong EBP beliefs, but low levels of EBP implementation and schools have shown a moderate movement to a culture of EBP. An educational EBP program was designed for 17 weeks with a total of 18 hours (12 hours of classroom lessons plus 6 hours of mentorship) and implemented in a Portuguese nursing school. This implementation contributed to the improvement of EBP knowledge and skills of fourth-year undergraduate nursing students, specifically at the level of review questions formulation. Conclusions: The educational EBP program is the first structured program developed according to the Guideline for Reporting Evidence-based practice Educational interventions and Teaching checklist in Portugal for undergraduate nursing students. This program showed potential to be implemented in nursing curricula to promote an EBP culture, including the critical use of the best available evidence in clinical contexts as student and future health professional

Promoción de la práctica basada en la evidencia: formación de profesionales de salud para la síntesis de la evidencia

Objetivo: Relatar a experiência do Portugal Centre For Evidence Based Practice (PCEBP): a JBI Centre of Excellence na formação de profissionais de saúde, pesquisadores e docentes no Comprehensive Systematic Review Training Program, um curso em Síntese da Evidência, especificamente sobre Revisões Sistemáticas da Literatura. Método: Este artigo tem como objetivo relatar a experiência do Portugal Centre For Evidence Based Practice: a JBI Centre of Excellence na implementação do Comprehensive Systematic Review Training Program que capacita profissionais de saúde, pesquisadores e docentes para o desenvolvimento de Revisões Sistemáticas, segundo a abordagem do JBI. Resultados: Até o final do ano 2020, foram desenvolvidas 11 edições do curso com um total de 136 participantes provenientes de diferentes instituições de ensino e de saúde, de diferentes países. Resultante da formação destes participantes, 13 revisões sistemáticas foram publicadas na JBI Evidence Synthesis e 10 revisões foram publicadas noutras revistas. Conclusão: Os referidos resultados e a avaliação de satisfação dos formados nos permitem realçar a pertinência do curso para a formação em síntese de evidência de profissionais de saúde.Objective: To report the experience of the Portugal Centre For Evidence Based Practice (PCEBP): a JBI Centre of Excellence in the training of health professionals, researchers, and professors in the Comprehensive Systematic Review Training Program, a course on Evidence Synthesis, specifically on Systematic Literature Reviews. Method: This article aims to report the experience of the Portugal Centre For Evidence Based Practice: a JBI Centre of Excellence in the implementation of the Comprehensive Systematic Review Training Program that trains health professionals, researchers, and teachers to develop Systematic Reviews, according to the JBI approach. Results: By the end of 2020, 11 editions of the course had been developed with 136 participants from different educational and health institutions, from different countries. As a result of the training of these participants, 13 systematic reviews were published in JBI Evidence Synthesis and 10 reviews were published in other journals. Conclusion: The reported results and the students’ satisfaction evaluation allow us to emphasize the relevance of the course for health professionals training on evidence synthesis.Objetivo: Relatar la experiencia del Portugal Centre For Evidence Based Practice (PCEBP): a JBI Centre of Excellence en la formación de profesionales de salud, investigadores y docentes en el Comprehensive Systematic Review Training Program, un curso en Síntesis de la Evidencia, específicamente sobre Revisiones Sistemáticas de la Literatura. Método: Este artículo tiene como objetivo relatar la experiencia del Portugal Centre For Evidence Based Practice: a JBI Centre of Excellence en la implementación del Comprehensive Systematic Review Training Program que capacita profesionales de salud, investigadores y docentes para el desarrollo de Revisiones Sistemáticas, según la metodología del JBI. Resultados: Hasta el final del año 2020, fueron desarrolladas 11 ediciones del curso sumando en total 136 participantes provenientes de diferentes instituciones de enseñanza y de salud, de distintos países. Resultó tras la formación de estos participantes que, 13 revisiones sistemáticas fueron publicadas en la JBI Evidence Synthesis y 10 revisiones fueron publicadas en otras revistas. Conclusión: Los referidos resultados y la evaluación de satisfacción de los egresos nos permiten resaltar la pertinencia del curso para la formación en síntesis de evidencia de profesionales de salud

Respiratory Rehabilitation programs for people with Parkinson disease: a Scoping Review protocol

Background: Parkinson's disease is a common, progressive, and heterogeneous neurodegenerative disease. The decreased in the strength of respiratory muscles, the chest wall stiffness and postural changes, may lead to dysfunctions in speech and swallowing, ineffective coughing, dyspnea, as well as complications like atelectasis and respiratory infections. To mitigate the impact in people lives, Respiratory Rehabilitation programs are considered essential. Many studies have been conducted within the scope, yet the programs present considerable heterogeneity. To date, no previous scoping review has addressed this purpose. This study aims to map the current evidence on Respiratory Rehabilitation programs implemented for people with Parkinson's disease. Methods: A Scoping review will be conducted, following the JBI methodology. Published and unpublished literature will be considered. Two independent reviewers will assess and screen the articles and perform data extraction and synthesis. Results: This review plans to include studies that address the Respiratory Rehabilitation programs. Conclusions: This scoping review will map Respiratory Rehabilitation programs in people with Parkinson's disease, while doing so it may inform the development or adaptation of such interventions, identify gaps requiring further research and support future systematic reviews

Schizophrenia and Progressive Muscle Relaxation – A systematic review of effectiveness

Objective: We perform a systematically search, appraise and synthesize of the best available evidence on the effectiveness of Progressive Muscle Relaxation (PMR) in the adults with schizophrenia, in any setting, regarding anxiety, personal and social functioning, cognition, and well-being. Method: Major databases were searched to find both published and unpublished studies from inception until April 2017, using Schizophren* AND Relax* as keywords, and studies published in Portuguese, English, Spanish, Italian, French were considered for inclusion in this review. Methodological quality was assessed by two independent reviewers using the Critical Appraisal Checklist for Randomized Controlled Trials from the Joanna Briggs Institute. Results: From a total of 1172 studies, five studies, involving 216 adults with schizophrenia, met the inclusion criteria for this systematic review after assessment of their methodological quality. These studies reported benefits in experimental group participants after PMR intervention on anxiety (assessed with State anxiety inventory, Beck Anxiety Inventory and Spielberger Trait Anxiety Inventory), well-being (assessed with Subjective Exercise Experiences Scale) and personal and social functioning (assessed with Sheehan Disability Scale and Therapist Rating Scale). Conclusions: Evidence suggests that PMR was effective in adults diagnosed with schizophrenia, except in one study where was only effective when combined with education. Thus, PMR may be useful to decrease state anxiety, improve well-being and social functioning in adults diagnosed with schizophrenia. However, due to the diversity of clinical intervention designs of PMR (different number and length of sessions) and outcome assessment scales, no strong evidence was found in this systematic review

Efeito da estimulação cognitiva em Idosos Efecto de la estimulación cognitiva en los ancianos The effect of cognitive stimulation in the elderly

Contexto: a evidência sugere que a estimulação cognitiva (EC) tem um efeito positivo na cognição, na sintomatologia depressiva (SD) e na autonomia dos idosos. Objectivo: analisar a eficácia da EC na cognição, na SD, e nas actividades instrumentais de vida diária (AIVD’s) de idosos em contexto comunitário. Metodologia: estudo experimental, com pré e pós-teste, numa amostra de 23 idosos, sendo 30,43% homens e 69,57% mulheres, com idade média 77,66 anos, DP 7,73. Foram utilizadas as versões portuguesas da Montreal Cognitive Assessment, Geriatric Depression Scale-15 e Lawton Brody Instrumental Activities of Daily Living. O grupo experimental foi sujeito a tratamento com 14 sessões de EC. Resultados: os idosos submetidos a EC melhoraram o estado cognitivo, explicando a intervenção de 17,86% da variação. A evidência não permite concluir sobre o efeito da EC na SD e nas AIVD’s embora, respetivamente, 20% e 17% mais idosos tenham melhorado a sua condição clínica comparativamente aos não submetidos ao programa. Conclusões: a estimulação cognitiva melhorou a condição cognitiva dos idosos, pelo que se aconselha a sua implementação como componente do cuidado a idosos em contexto comunitário. Sugerem-se novos estudos, com amostras de maior dimensão, PEC de manutenção e follow-up, que reforcem e clarifiquem estes resultados.Contexto: la evidencia sugiere que la estimulación cognitiva (EC) tiene un efecto positivo sobre la cognición, sobre la sintomatología depresiva (SD) y sobre la autonomía de los adultos mayores. Objetivo: analizar la eficacia de la EC en la cognición, en la SD y en las actividades instrumentales de la vida diaria (AIVD) de los adultos mayores en el contexto comunitario. Metodología: estudio experimental con pre y postest, en una muestra de 23 adultos mayores, con 30,43% hombres y 69,57% mujeres; con una edad media de 77,66 años, DE 7,73 años. Fueron utilizadas versiones portuguesas de las escalas Montreal Cognitive Assessment, Geriatric Depression Scale-15 y Lawton Brody Scale for Instrumental Activities of Daily Living. El grupo experimental fue sometido a 14 sesiones de tratamiento con EC. Resultados: los adultos mayores sometidos a la EC mejoraron su estado cognitivo, lo que explica una intervención de 17.86% de variación. Aunque la evidencia no es concluyente sobre el efecto de la EC en la SD y en las AIVD, más el 20% y 17% respectivamente, de los adultos mayores sometidos al programa mejoraron su condición clínica en comparación con los no sometidos. Conclusiones: la EC mejoró la condición cognitiva de los adultos mayores, por lo que se aconseja su aplicación como componente de la atención a los adultos mayores en el contexto comunitario. Se sugieren nuevos estudios con muestras de mayor dimensión, con programa de mantenimiento y seguimiento para fortalecer y aclarar estos resultados.Context: evidence suggests that cognitive stimulation (CS) has a positive effect on cognition, depressive symptomatology (DS), and autonomy in elderly people. Objectives: to analyze the effectiveness of cognitive stimulation on cognition, DS, and autonomy in instrumental activities of daily living (IADL) of the senior community. Methodology: experimental study with pre- and post-test, with a sample of 23 elders, 30.43% men and 69.57% women, mean age of 77.66, SD 7.73 years. We used the Portuguese versions of the Montreal Cognitive Assessment, the Geriatric Depression Scale-15 and the Lawton Brody Scale for Instrumental Activities of Daily Living. The experimental group received 14 treatment sessions with CS. Results: elders undergoing CS improved their cognitive state and the intervention explained the variation of 17.86%. Although the evidence is not conclusive about the effect of CS in DS and IADL, 20% and 17%, respectively, more of the elders improved their clinical condition compared to those who were not treated. Conclusions: the cognitive stimulation improved senior´s cognitive condition therefore we recommend its implementation as a component of care for the elderly in a community context. Further studies ought to include larger samples as well as maintenance program and follow-up in order to strengthen and clarify these results

Programas formativos mediados por tecnologia dirigidos às equipas de saúde escolar focados nas necessidades de saúde especiais: protocolo scoping review

Protocolo de Revisão de Scopin