2,499 research outputs found
Limited Antineutrophil Cytoplasmic Antibodies (ANCA)-Negative Granulomatosis With Polyangiitis: Successful Response to Rituximab
Granulomatosis with polyangiitis (GPA), a systemic vasculitis, is commonly characterized by the presence of antineutrophil cytoplasmic antibodies (ANCA). However, a subset of patients with limited disease may exhibit ANCA negativity. In this article, we report the case of a 40-year-old female diagnosed with GPA with intolerance to methotrexate titration and glucocorticoid therapy, leading to the initiation of rituximab treatment. Subsequently, the patient exhibited sustained clinical, laboratory, and radiological improvement. The identification of limited GPA has important therapeutic implications as the effectiveness of the medical treatment in ANCA-negative GPA may differ. Rituximab has emerged as an optimal treatment, irrespective of ANCA status, offering prolonged responses and a favorable tolerance profile in these patients.info:eu-repo/semantics/publishedVersio
Validation of Blood Gas Analysis in Arteriovenous Fistula for Hemodialysis
Introduction: Arterial blood gas analysis is a minimally invasive technique used in our daily practice but is not a complication free technique. The aim of this study was to validate results from blood gas analysis obtained from the arteriovenous fistula (AVF)/graft as a surrogate marker of the arterial blood gas analysis.
Methods: A prospective observational study was made in 45 patients. We performed arterial and AVF/graft blood gas analysis and results were compared by a paired sample t Student test.
Results: Most of our subjects was male (68.9%) and the mean age was 67 years (±14). Hemodialysis vintage was 63 months (±66), and vascular access age was 62 months (±56). The more prevalent vascular access was left radiocephalic AVF (n = 16; 35.6%) and the main puncture artery was right radial artery (n = 27; 60.0%). There were no statistically significant differences between the samples collected.
Conclusions: Our results suggest a possible alternative of arterial blood gas analysis in AVF/graft for hemodialysis patients. This could result in making an uncomfortable procedure almost painless and reducing complications. Future research should take place to include anatomical characteristics of the AVF or the circulation of recirculation.info:eu-repo/semantics/publishedVersio
MR imaging for diagnostic evaluation of encephalopathy in the newborn.
Magnetic resonance (MR) imaging is used with increasing frequency to evaluate the neonatal brain because it can provide important diagnostic and prognostic information that is needed for optimal treatment and appropriate counseling. Special care must be taken in preparing encephalopathic neonates for an MR study, transporting them from the intensive care unit, monitoring their vital signs, and optimizing MR sequences and protocols. Moreover, to accurately interpret the findings, specific knowledge is needed about the normal MR imaging appearances of the physiologic processes of myelination, cell migration, and sulcation, as well as patterns of injury, in the neonatal brain at various stages of gestational development. Hypoxic-ischemic injury, the most common cause of neonatal encephalopathy, has characteristic appearances that depend on the severity and duration of the insult as well as the stage of brain development. Diffusion-weighted MR imaging and MR spectroscopy depict abnormalities earlier than do conventional MR imaging sequences. However, diffusion-weighted imaging, if performed in the first 24 hours after the insult, might lead to underestimation of the extent of injury. When the MR findings are atypical, the differential diagnosis of neonatal encephalopathy also should include congenital and metabolic disorders and infectious diseases. Despite recent advances in the MR imaging-based characterization of these conditions, the clinical history must be borne in mind to achieve an accurate diagnosis
Liderança, administração e gestão nos cuidados de saúde: um protocolo de revisão de escopo no âmbito do ensino da enfermagem
Introduction: Strategic leadership in nursing, represents one of the global goals at the current time. Although integrated into university programs, the teaching of administration and management, did not seem to promote the expected results. This finding may be a consequence of the teaching methods, competencies targeted, or students' perceptions of the usefulness and interest of the subject. A new theoretical framework is needed, with the identification of underpinning skills, key contents and teaching methodologies adapted to the current reality.
Objectives: Map the models and conceptions of teaching-learning nursing administration and management.
Methods: This review will follow the JBI methodology, and will include all types of studies, published in English, French, Spanish, and Portuguese, on the last decade, without any geographical limitations. The databases included MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection by EBSCO, Scopus (Elsevier), Canadian Science Publishing, grey literature (Google Scholar) and Repositório Científico de Acesso Aberto de Portugal (RCAAP). Data will be analysed and extracted by two independent researchers and will be presented in a specific table.
Results: Previous bibliographic research allowed the identification of some concepts, theories and pedagogical strategies implemented in the teaching-learning process of the subject.
Conclusion: The results will contribute to help instructors to improve their educational approach, adapting the theory of the subject through the use and development of teaching-learning strategies that can support and empower upcoming nurses, face to future challenges in healthcare.info:eu-repo/semantics/publishedVersio
Endobronchial Ultrasound under Moderate Sedation versus General Anesthesia
BACKGROUND:
Different anesthetic protocols may influence endobronchial ultrasound-guided needle aspiration (EBUS-TBNA) outcomes, patient comfort, and even safety. In this study, two anesthesia techniques were assessed and compared for EBUS-TBNA.
METHODS:
A prospective, multicenter study was carried out. Patients were allocated to Group 1 (general anesthesia with neuromuscular blockade and controlled ventilation) and Group 2 (intravenous sedation). EBUS-TBNA accuracy was the primary outcome. Safety, patient comfort and satisfaction, and operators' difficulties were defined as secondary outcomes.
RESULTS:
Of the 115 patients enrolled (Group 1 = 59, Group 2 = 56), EBUS-TBNA was performed for hilar or mediastinal lesion diagnosis and lung cancer staging in, respectively, 77 (67%) and 38 (33%) patients. The numbers of lymph nodes stations (1.8 ± 1.0 vs. 1.7 ± 1.0, p = 0.472) and punctures per station (6.9 ± 3.1 vs. 6.0 ± 2.5, p = 0.084) were similar between groups. Adequate samples were obtained from 109 patients (97.3%) with similar diagnostic accuracy. Procedure duration was not significantly different (p = 0.348). Hemodynamic parameters and systolic and diastolic blood pressures were higher in Group 1 at the beginning and at the end of the procedure. Adverse events were equally distributed, and no significant differences were found regarding patient satisfaction and bronchoscopist/anesthesiologist difficulties.
CONCLUSIONS:
The type of anesthesia used did not influence EBUS-TBNA outcomes. EBUS-TBNA performed under sedation or general anesthesia did not affect the diagnostic yield, complication rate, and patients' comfort and satisfaction.info:eu-repo/semantics/publishedVersio
Game2FamilyNursing: Study of a digital game to promote knowledge about family nursing
Background & Aim: The practice of family-centered nursing care brings
positive benefits to health care. This article aims to describe the perception and
usability of a game to promote knowledge about family assessment and
intervention.
Methods & Materials: A descriptive, cross-sectional study was conducted
involving 102 nurses and nursing degree students in the second half of 2021.
The evaluation was performed using the game usability instrument (System
Usability Scale, SUS), the Intrinsic Motivation Inventory, and open questions
about the game's advantages and disadvantages.
Results: The average score obtained by applying the SUS was high, with a
mean of 81.37. In addition, high mean values were observed in all dimensions
of the Intrinsic Motivation Inventory. Concerning the game’s advantages and
disadvantages, 198 codes were grouped into seven categories and 30
subcategories, highlighting more advantages than disadvantages.
Conclusion: Overall, participants evaluated the game positively. Our findings
suggest that using "Game2FamilyNursing" could be helpful and contribute as
an educational tool in family nursing training.info:eu-repo/semantics/publishedVersio
Nursing care needs of clients having hip arthroplasty
Na procura da qualidade dos cuidados, a intervenção
do enfermeiro deve ser centrada no cliente e nas suas
necessidades. Ao explanar o processo de cuidados do
cliente submetido a artroplastia da anca, questionámos
se as necessidades identificadas pelos clientes serão
as mesmas que foram identificadas pelos enfermeiros
que lhes prestaram cuidados e partimos para um
estudo de caso do tipo descritivo, relacional de
medidas repetidas. A amostra foi constituída por 30
clientes, questionados em três fases distintas (préinternamento,
3ºdia de pós-operatório e na alta). Os
resultados revelaram existir discrepâncias entre as
necessidades dos clientes e os cuidados prestados.
A discrepância obtida é mais acentuada ao 3º dia de
pós-operatório do que no momento da alta. Sobre a
continuidade de cuidados observam-se intervenções
pontuais e não uniformizadas.info:eu-repo/semantics/publishedVersio
Validação do conteúdo de um jogo para crianças para promover a profissão de enfemagem
Objetivo: Validar conteúdo para um jogo experimental, designado por Quantos Queres, utilizando um origami, sobre a profissão de
Enfermagem, para crianças dos 7 aos 12 anos.
Método: Estudo metodológico, incluiu dois grupos de peritos: A (n=7), B (n=40). Amostragem não probabilística. Utilizado
formulário de autopreenchimento, disponibilizado por e-mail e redes sociais, em Portugal, entre fevereiro e abril de 2020. Decisão de
aceitação estabelecida para 75% de concordância.
Resultados: Os grupos foram majoritariamente constituídos por enfermeiras. Grupo A identificou as temáticas: perfil profissional,
formação, princípios éticos, elementos históricos e simbólicos e concebeu o conteúdo dos enunciados em forma de perguntas e
respostas. No grupo B obteve-se a concordância superior a 75% nas áreas e nos conteúdos dos enunciados.
Conclusão: A seleção do conteúdo a integrar o jogo é fundamental. A concordância obtida evidencia a importância dos temas eleitos
e a adequação à finalidade que será testada posteriormenteObjective: To validate content for an experimental game named Quantos Queres, using an origami, about the Nursing profession, for
children from 7 to 12 years old.
Method: Methodological study that included two groups of experts: A (n=7), B (n=40). Non-probabilistic sampling approach
was used. We used a self-completion form, available by email and social networks, in Portugal, between February and April 2020.
Acceptance decision established for 75% agreement.
Results: The groups were mostly composed by nurses. Group A identified the themes: professional profile, training, ethical principles,
historical and symbolic elements and conceived the content of the statements in the form of questions and answers. In group B,
agreement was higher than 75% in the areas and contents of the statements.
Conclusion: The selection of content to integrate the game is essential. The agreement obtained shows the importance of the chosen
themes and the adequacy to the purpose that will be tested laterinfo:eu-repo/semantics/publishedVersio
Ancianos residentes en la comunidad: conocer para defender un programa de enfermería de rehabilitación
To analyze the socio-demographic and health conditions of the elderly living in the community and describe the pillars for the design of a rehabilitation nursing program in the community.Objetivo: Analisar as condições sociodemográficas e de saúde dos idosos residentes na
comunidade e descrever os pilares para a concepção de um programa de enfermagem de
reabilitação na comunidade. Métodos: Estudo descritivo, transversal, com participação de
48 idosos selecionados por amostragem de conveniência. A coleta de dados realizou-se entre
setembro de 2018 e julho de 2019, numa unidade de saúde do norte de Portugal, usando
um formulário. Resultados: Todos os idosos têm processos patológicos e excesso de peso.
Majoritariamente são sedentários, apresentam sentimentos de solidão e comportamentos
relacionais inapropriados. Nos últimos seis meses, 25% caíram pelo menos uma vez, tendo sido
notórias alterações no equilíbrio, estilos de vida e percepção do estado de saúde. Conclusão:
Evidenciou-se a necessidade de os enfermeiros de reabilitação conceberem e implementarem
programas de envelhecimento ativo que garantam acompanhamento individual dos idosos
valorizando estilos de vida, treino de equilíbrio e promoção da participação social.Objetivo: Analizar las condiciones sociodemográficas y de salud de ancianos residentes en
la comunidad y describir los pilares para la concepción de un programa de enfermería de
rehabilitación en la comunidad. Métodos: Estudio descriptivo, transversal, con participación
de 48 ancianos seleccionados por muestreo de conveniencia. La recogida de datos se realizó
entre septiembre de 2018 y julio de 2019, en unidad de salud del norte de Portugal, usando
un formulario. Resultados: Todos los ancianos tienen procesos patológicos y sobrepeso.
Mayoritariamente son sedentarios, sienten soledad y comportamientos relacionales
inapropiados. En los últimos seis meses, 25% cayeron por lo menos una vez, siendo notorias
alteraciones en el equilibrio, estilos de vida y percepción en la salud. Conclusión: Se evidenció
la necesidad de los enfermeros de rehabilitación concebir e implementar programas de
envejecimiento activo que garantizan acompañamiento individual de ancianos valorizando
estilos de vida, ejercicios de equilibrio y promoción de la participación social.info:eu-repo/semantics/publishedVersio
Primary Anti-Phospholipid Antibody Syndrome: Real-World Defining Features of Rethrombosis in the Course of Disease
Objective: We aimed to identify features that allow differentiation of primary antiphospholipid syndrome (PAPS) patients that suffer recurrent thrombotic events (RTE) despite anticoagulation, from the other diagnosed PAPS patients.
Methods: This was an exploratory study of anticoagulated PAPS patients attending an Autoimmune Diseases Unit (1998-2018). From 2016, anti-phospholipid antibodies and lupus anticoagulant were determined for each patient at consecutive visits, collected together with retrospective clinical characteristics, laboratory, and therapeutic markers and compared according to the occurrence of thrombotic events during follow-up.
Results: Overall, two thirds of the patients were female, 93% were Caucasian, with a median age of 40 years at diagnosis, for a median time of 11.5 years in follow-up. Out of 54 patients, 10 were identified with RTE. There were no significant differences among the RTE and non-RTE patients as far as classical risk factors for clotting disorders. The RTE group was characterized by a higher proportion of younger patients, male sex and positivity for all laboratory markers, and initially and over follow-up as well as a sustained high-risk profile based on APS laboratory markers. Anticardiolipin IgG at onset was the only statistically significant marker of the RTE group. At the end of follow-up, consistent reversion to negative status was a rare event, observed in 20% of RTE vs. 25% of non-RTE patients.
Conclusions: Despite therapy, we were able to identify features associated to thrombotic events in patients with PAPS. Prospectively regular clinical and laboratory monitoring might be warranted in order to treat APS more assertively.info:eu-repo/semantics/publishedVersio
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