GESTÃO DO CUIDADO INTEGRAL EM ENFERMAGEM: REFLEXÕES SOB A PERSPECTIVA DO PENSAMENTO COMPLEXO

RESUMO Este artigo trata-se de promover reflexões acerca da gestão do cuidado integral de enfermagem sob a perspectiva do pensamento complexo. A partir da reflexão sobre o conceito da gerência do cuidado de enfermagem sob a perspectiva do pensamento complexo observou-se que a gerência do cuidado em enfermagem possui dois objetos principais: o cuidar e o administrar e seis dimensões. Os objetos relacionam-se de forma dialética, ou seja, influenciam-se mutuamente, mas não são a mesma coisa ou se excluem. Eles acontecem de forma integral e nos diferentes contextos de atuação da enfermagem. A partir de um novo pensamento sobre quais são as atribuições da enfermagem é possível aprimorar a prática e assim evidenciar a singularidade da atuação da enfermagem como profissão do cuidado

Nutrient inputs in soil cultivated with coffee crop fertigated with domestic sewage

Fertigation with wastewaters is a great option for reuse of effluents in agriculture. Domestic effluent can be reused after primary treatment, reducing treatment costs and pollution, also providing water and nutrients to crops. This work aimed to quantify the nutrients income in coffee crop fertigated with domestic sewage. Five treatments were used. T1 received only clean water, and treatments T2, T3, T4 e T5 received 180, 350, 480 and 638 mm of sewage, respectively, during four months. Monthly soil analyses allowed to quantify nutrient inputs of 67.45 kg ha-1 of N, 81.89 kg ha-1 of P, 33.34 kg ha-1 of K+, 173.24 kg ha-1 of Ca2+, 49.18 kg ha-1 of Mg2+, 161.56 kg ha-1 of Na+ and 116.19 kg ha-1 of S. Even though the treatments promoted reductions in fertilization and liming, it was still necessary to complement fertilization of coffee crop fertigated with domestic sewage

Câncer de Próstata: Retrato de uma realidade dos pacientes, a importância e o preconceito com o toque retal / Prostate Cancer: Portrait of a patients' reality, the importance and the prejudice with the rectal touch

O câncer é um desequilíbrio entre a proliferação celular e a diferenciação celular. O câncer de próstata é a neoplasia maligna mais frequente no homem, altamente prevalente e é considerado um problema de saúde pública. No Brasil, o rastreamento do câncer de próstata é preconizado para homens acima de 45 anos através do exame de toque retal e dosagem do PSA (antígeno prostático específico). O objetivo do trabalho constitui em mostrar, através de revisão de literatura, os principais métodos de diagnóstico referente ao preconceito, prevenção e tratamento para o câncer de próstata, a atribuição do enfermeiro frente a esse processo e aspectos epidemiológicos. Concluiu-se que o câncer de próstata é evidenciado pelo crescimento anormal da próstata, glândula integrante do sistema reprodutor masculino, e os principais fatores de risco estão correlacionados ao avanço da idade, influências genéticas, metabolismo hormonal, estilo de vida. Embora ainda haja preconceito com relação ao toque retal, ele é o método mais importante no rastreamento do tumor prostático. O enfermeiro, como membro da equipe multidisciplinar de saúde, tem condições de atuar não só nas atividades de controle da doença, mas também na implementação de medidas preventivas contra o câncer

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Structure and absolute configuration of a secolignan from Peperomia blanda

A secolignan, (-)-2-methyl-3-[bis(3 ',4 '-methylenedioxy-5 '-methoxyphenyl) methyl] butyrolactone (1), with a rare cis configuration was isolated from the aerial parts of Peperomia blanda (Piperaceae). The structure of this compound was elucidated by a combination of spectroscopic methods, including ultraviolet, infrared, 1D- and 2D- nuclear magnetic resonance as well as high resolution mass spectrometry data. The absolute configuration of (-)-1 was determined as (2R,3S) by the comparison of experimental electronic circular dichroism (ECD) spectroscopy and time-dependent density functional theory (TDDFT) calculations. (C) 2011 Phytochemical Society of Europe. Published by Elsevier B.V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Autoexame da cavidade bucal

O câncer bucal está classificado entre os dez cânceres maisfrequentes. É uma neoplasia maligna localizada na gengiva, no soalho da boca ou palato, e em outras partes não específicas da boca. Este trabalho busca selecionar os oito passos do autoexame para que o cirurgião-dentista possa orientar, dialogar e educar o paciente quanto ao câncer de boca, além de o identificar e reconhecer precocemente, atuando diretamente na prevenção docâncer bucal

Acute intake of a high-fructose diet alters the balance of adipokine concentrations and induces neutrophil influx in the liver

The postprandial state is a period of metabolic fluxes, biosynthesis and oxidative metabolism. A considerable amount is known about the inflammatory response to the chronic consumption of fructose, but little is known about its effects in the postprandial state. The aim of the present study was to investigate the inflammatory effects of a single meal containing fructose on healthy mice. Male BALB/c and LysM-eGFP mice at 12-14 weeks were divided into three groups: fasted, control (mice fed with a sucrose-containing diet) and fructose (mice fed with a fructose-containing diet). One, 2 or 4 h postprandial, the BALB/c mice were killed, and samples were collected. LysM-eGFP mice were submitted to intravital microscopy. The fed mice showed a low-grade inflammatory response apart from dietary composition, which was characterized by increased numbers of leukocytes and high serum concentrations of pentraxin 3, leptin and resistin. TNF-α and CCL2 concentrations rose in the liver after the meal. IL-6 concentration increased and IL-10 decreased in the adipose tissue of the fed mice. Mice fed with the fructose-containing diet showed an intensification of the inflammatory response. Furthermore, the adiponectin concentration dropped, and the liver influx of neutrophils increased after fructose intake. Overall, this study showed a rapid increase in the systemic and tissue-specific immune response after a balanced meal. The study also showed an increased neutrophil influx in liver associated with an imbalance of adipokine concentrations and an increase of cytokine in the liver and adipose tissue following a fructose-containing meal.status: publishe