Exercise stress echocardiography: Where are we now?

Exercise stress echocardiography (ESE) is a widely used diagnostic test in cardiology departments. ESE is mainly used to study patients with coronary artery disease; however, it has increasingly been used in other clinical scenarios including valve pathology, congenital heart disease, hypertrophic and dilated cardiomyopathies, athlete evaluations, diastolic function evaluation, and pulmonary circulation study. In our laboratories, we use an established methodology in which cardiac function is evaluated while exercising on a treadmill. After completing the exercise regimen, patients remain in a standing position or lie down on the left lateral decubitus, depending on the clinical questions to be answered for further evaluation. This method increases the quality and quantity of information obtained. Here, we present the various methods of exercise stress echocardiography and our experience in many clinical arenas in detail. We also present alternatives to ESE that may be used and their advantages and disadvantages. We review recent advances in ESE and future directions for this established method in the study of cardiac patients and underline the advantage of using a diagnostic tool that is radiation-free.info:eu-repo/semantics/publishedVersio

The perception of nurses regarding their degree of competence to provide nursing care to reconstituted families, with adolescent children, in the area of attention ‘conjugal satisfaction’

The Perception of Nurses Regarding their Degree of Competence to Provide Nursing Care to Reconstituted Families, with Adolescent Children, in the Area of Attention “Conjugal Satisfaction”. Abstract: The family has undergone numerous modifications and adaptations, with the formation of new family identities, which require nurses to identify possible problems. The aim of this study was to analyse nurses’ perceptions regarding the degree of competence to provide nursing care to reconstituted families, with adolescent children, in the area of attention marital satisfaction. Descriptive and exploratory study, of a quantitative nature. 25 primary care nurses participated. An online questionnaire was used, Lickert type, where the participan-ts were asked to indicate their perception about the level of competence to provide nursing care in these families, in the domain of conjugal satisfaction. Of the 25 nurses, 15 considered themselves competent to carry out the identification of needs, formulate diagnoses and plan nursing interventions, 8 are between incompetent and poorly qualified; in the implementation of interventions, 14 considered competent and 9 incompetent or have little competence; regarding to the evaluation of the interventions, 13 consider themselves competent and 10, incompetent or not competent. Thus, 35% of the sample considered not to have the necessary skills to provide care in the context of marital satisfaction, which indicates the need for greater investment in the development of formative processes in the context of marital satisfaction, leading to the improvement of the quality of care and the development of research to identify health gains arising from nurses’ interventions.info:eu-repo/semantics/publishedVersio

Da escola para o exercício : atitudes éticas dos estudantes de enfermagem e dos enfermeiros no cuidar do doente em fase paliativa

Tese de mestrado, Bioética, Faculdade de Medicina, Universidade de Lisboa, 2011Prestar cuidados aos doentes em fase terminal acarreta ao enfermeiro a mobilização de um conjunto de habilidades e conhecimentos, necessários para uma efectiva ajuda ao doente em fim de vida e seus familiares. No entanto, este necessita ainda de desenvolver e aplicar determinadas atitudes, que, do ponto de vista ético, irão contribuir para uma morte mais humana e, por conseguinte, mais digna. Neste sentido, efectuámos este estudo, através do qual se pretendeu avaliar as competências éticas dos estudantes de enfermagem e dos enfermeiros, que prestam cuidados a doentes em fase paliativa. Tivemos também como objectivo avaliar as atitudes éticas dos estudantes, como forma de verificar se a formação ministrada em sala de aula era adequada. De acordo com estes objectivos, a amostra do estudo foi constituida pelos estudantes de enfermagem, do 4º ano da Licenciatura em Enfermagem, da Escola Superior de Saúde Egas Moniz, no ano lectivo 2009/2010, num total de 54 estudantes; e pelos enfermeiros dos Hospitais Garcia de Orta, serviço de Medicina I e II e Nossa Senhora do Rosário, serviço de Medicina e Unidade de Cuidados Intensivos, que se disponibilizaram a responder ao questionário, num total de 50 enfermeiros. Como resultados do estudo, salientamos que a média do total das atitudes éticas dos estudantes de enfermagem é positiva e semelhante à média do total das atitudes éticas apresentadas pelos enfermeiros, o que pressupõe que o ensino ministrado é adequado. Verificámos, ainda, que não existem diferenças estatisticamente significativas entre os dois grupos da amostra, para cada uma das sub-escalas, com excepção da sub-escala atitude de evitamento, sendo que os estudantes apresentam valores mais baixos que os enfermeiros e a sub-escala atitude de culpabilização, sendo que nesta os estudantes apresentam valores mais elevados que os enfermeiros. Constatámos também que a idade não influencia as atitudes éticas dos estudantes de enfermagem. Quanto aos enfermeiros verificámos que a idade influencia a atitude de evitamento, sendo que quanto maior a idade maiores valores apresentam, nesta sub-escala. Os enfermeiros apresentam também diferenças entre as classes etárias, nas sub-escalas atitude beneficente e atitude de solicitude, sendo que quanto maior a idade mais atitudes éticas favoráveis apresentam. Quanto à influência do tempo de exercício profissional nas atitudes éticas dos enfermeiros, observámos que quanto maior o tempo de exercício profissional mais atitudes de evitamento os enfermeiros apresentam.Taking care of terminal patients entails the caring nurse with the mobilization of a set of skills and knowledge needed for an effective help to the patient and his relatives. However, the nurse still needs to develop and apply certain attitudes that, from an ethical stand point, will contribute to a more humane death and, therefore, more dignifying. In this sense, we have done this study through which it was intended to evaluate the ethical abilities of nursing students and nurses, who take care of palliative patients. We also had as a goal to evaluate the ethical attitudes of the students, as a way to confirm if the class training method used was adequate. According to these objectives, the study sample was composed of nursing students, 4th year of Bachelor in Nursing, School of Health Sciences Egas Moniz, in 2009/2010, in a total of 54 students, and nurses of Garcia de Orta Hospital, Medical Service I and II and Our Lady of the Rosary Hospital, Medical service and Intensive Care Unit, who agreed to answer the questionnaire, in a total of 50 nurses. As a result of this study, we emphasize that the average of the ethical attitudes of the nursing students is positive and similar to the average of the ethical attitudes shown by the nurses, which implies that the training method applied is adequate. We noted also that there are no statistically significant differences between the two sample groups for each of the subscales, with exception of the avoidance attitude subscale where the students showed lower values than the nurses and the attitude of blame subscale, where the students show higher values than the nurses. We also noted that age does not seem to influence the ethical attitudes of the nursing students. As for the nurses we discovered that age does influence the avoidance attitude, where an older age means higher values for this subscale. Nurses also show differences between age groups, specifically in the subscales charitable attitude and attitude of solicitude, where the older they are the more favorable attitudes they show. As for the influence of time of professional exercise in the nurses' ethical attitudes, we observed that the longer the time of exercise training the higher avoidance attitude nurses show

Practice-driven restructuring of the pharmacy curricula: focus on advanced services

Poster presented at the 5th PCNE Working Symposium 2016: “Work in Progress – Progress in Work”, 19-20 February 2016, Hillerød, Denmark

The perception of nurses to identify the need for nursing care in reconstituted families with adolescent children

The Perception of Nurses to Identify the Need for Nursing Care in Reconstituted Families with Adolescent Children. Abstract: Family health nursing aims to promote the empowerment of families in the development of competencies, fostering a healthy living of their processes of change, throughout the life cycle. With respect to these families, dysfunctions can occur due to family coexistence and overlapping of parental roles over the adolescent. In this context the MDAIF arises, aiming to guide the action of nurses, proposing diagnoses and interventions, from the needs identified. The aim was to analyze nurses’ perception of the need for nursing care in reconstituted families with adolescent children. Descriptive and exploratory study, of a qualitative nature, whose participants were nurses who perform functions in primary health care. A questionnaire was used, applied in 2018, with an open question in which the participants were asked to describe strategies for identifying nursing care needs in rebuilt families with adolescent children. For data analysis, content analysis was used, and three categories emerged: “Family Assessment”, focused essentially on observation, interviewing and data collection; the “Context of the evaluation”, predominating the functional unit, within the scope of the nursing consultation; and “Referential”, the MDAIF being the theoretical and operative support for clinical decision making. In the identification of nursing care needs, the family assessment stands out as a methodology valued by nurses. These results may contribute to the development of formative processes, within the framework of family assessment, leading to the improvement of the quality of care.info:eu-repo/semantics/publishedVersio

Family perspective about home non-invasive ventilation implications

Several studies have demonstrated that non-invasive home mechanical ventilation is a therapy that brings benefits to people with type 2 respiratory failure and their family. The objective of this study is to explore the implications of non-invasive home ventilation for the user’s family. An exploratory desc riptive study with quantitative qualitative nature in 10 families using noninvasive home ventilation. Mainly, they are nuclear families (8) belonging to the middle class (7). The data were collected through a semi-structured interview, with a data collection instrument that integrated sociodemographic issues and two open questions related to the participants’ perspective on the implications of non-invasive home ventilation for the family. They were processed with descriptive statistics and content analysis. From the narratives, three categories emerged: maladjustment, benefits and family process. They are divided into eight subcategories that describe the issues related to the use of non-invasive home ventilation: discomfort, sleep impairment, silence, crisis reduction, role interaction, dynamic relationship, coping and communication. The results demonstrate that non-invasive mechanical ventilation has implications for the users´ families, can be a stress cause, bring benefits and cause changes in the family process.info:eu-repo/semantics/publishedVersio

Efficacy of beta-blocker therapy in symptomatic athletes with exercise-induced intra-ventricular gradients

<p>Abstract</p> <p>Background</p> <p>Upright exercise stress echocardiography (SE) induces significant intraventricular gradient (IVG) and systolic anterior motion (SAM) in a large proportion of symptomatic athletes, who may therefore benefit from a negative inotropic therapy.</p> <p>The purpose of the present study was to assess the effect of chronic oral β blocker therapy on the occurrence of exercise-induced IVG and mitral valve SAM, in symptomatic athletes.</p> <p>Methods</p> <p>We enrolled 35 symptomatic athletes (age = 23 ± 11 years) with IVG (>30 mmHg) during SE off therapy. All repeated SE on chronic oral beta-blocker therapy (atenolol up to 50 mg, bisoprolol up to 10 mg, or metoprolol up to 100 mg daily according to physician-driven choice).</p> <p>Results</p> <p>On therapy, there was during SE a reduction in IVG (35 off vs 17 on beta blocker, p < 0.01), decrease of IVG (102 ± 34 mmHg off vs 69 ± 24 mmHg on beta blocker, p < 0.01), peak heart rate (178 ± 15 bpm off vs 157 ± 9 bpm on beta blocker), SAM (24 off vs 9 on beta blocker, p < 0.001), symptoms during SE (17 off vs 2 on beta blocker p < 0.001), ST segment depression (13 off vs 2 on beta blocker, p < 0.001).</p> <p>Conclusions</p> <p>In athletes with positive screening on medical evaluation for sports practice and IVG on exertion, treatment with oral beta blockers improved symptoms in the large majority of patients. Symptomatic benefit was mirrored by objective evidence of improvement of echocardiographic signs of obstruction (IVG and SAM) and reduction of ischemia-like electrocardiographic changes.</p

Ganhos na qualidade alimentar dos lanches escolares das crianças do ensino primário

A idade escolar representa uma janela de oportunidade para se adquirirem hábitos alimentares saudáveis. A escola é uma instituição fundamental na formação destes hábitos, nomeadamente os lanches escolares, na medida em que proporciona uma aprendizagem formal colaborativa com a família. Pretendeu-se caracterizar a qualidade alimentar dos lanches escolares das crianças do 1º Ciclo do Ensino Básico e os seus determinantes individuais e sociais de saúde; avaliar os ganhos na qualidade alimentar dos lanches escolares das crianças do 1º Ciclo do Ensino Básico, sensíveis ao projeto “Lanches saudáveis”. Estudo quantitativo, quase-experimental sem grupo de controlo. Participaram no estudo 753 crianças do 1º CEB de um Concelho da Região Centro de Portugal no ano letivo 2018/2019 (amostra de base populacional). A intervenção consistiu na realização de sessões de educação para a saúde e ensinos adaptados a cada criança, no início do projeto e aquando da avaliação cega dos lanches escolares. Os registos da qualidade alimentar dos lanches foram feitos, através de grelha criada para o efeito, pelos professores após treinamento dos critérios de classificação dos lanches. A avaliação foi cega realizada durante 5 semanas do 2º e 3º período. Ao longo do desenvolvimento do projeto verificou-se uma melhoria continua e gradual da qualidade alimentar dos lanches escolares por parte dos participantes. As meninas apresentaram melhor qualidade alimentar dos lanches escolares que os meninos. A intervenção realizada foi eficaz na melhoria da qualidade alimentar dos lanches escolares das crianças com resultados estatísticos 42Pensar Enfermagem | Vol. 25 | N.º 1 | 1º Semestre de 2021 ABSTRACT: School age represents a window of opportunity to acquire healthy eating habits. The school is a fundamental institution in the formation of these habits, namely school snacks, insofar as it provides formal collaborative learning with the family. It was intended to characterize the food quality of school meals for children in the 1st Cycle Basic Education and their individual and social health determinants; to evaluate the gains in food quality of school meals for children in the 1st Cycle Basic Education, sensitive to the “Healthy snacks” project. Quantitative study, quasi-experimental study without a control group. 753 children from the 1st CEB of a municipality in the Central Region of Portugal participated in the study year 2018/2019 (population-based sample). The intervention consisted of health education sessions and lessons adapted to each child, at the beginning of the project and when blindly evaluating school snacks. The records of the food quality of the snacks were made, through a grid created for the purpose, by the teachers after training the classification criteria of the snacks. The evaluation was performed blindly during 5 weeks of the 2nd and 3rd periods. During the development of the project, there was a continuous and gradual improvement in the food quality of school snacks by the participants. Girls showed better food quality in school snacks than boys. The intervention performed was effective in improving the food quality of children's school snacks with highly significant statistical results. The project to promote healthy eating resulted in improving the food quality of children's school snacks. The results suggest the need to expand the project's implementation to other children from a health perspective in all policies and collaborative work to promote the exercise of parenting and children's health.altamente significativos. O projeto de promoção da alimentação saudável traduziu-se na melhoria da qualidade alimentar dos lanches escolares das crianças. Os resultados sugerem a necessidade ampliar a implementação do projeto a outras crianças numa perspetiva de saúde em todas as políticas e de um trabalho colaborativo para promover o exercício da parentalidade e a saúde das crianças.School age represents a window of opportunity to acquire healthy eating habits. The school is a fundamental institution in the formation of these habits, namely school snacks, insofar as it provides formal collaborative learning with the family. It was intended to characterize the food quality of school meals for children in the 1st Cycle Basic Education and their individual and social health determinants; to evaluate the gains in food quality of school meals for children in the 1st Cycle Basic Education, sensitive to the “Healthy snacks” project. Quantitative study, quasi-experimental study without a control group. 753 children from the 1st CEB of a municipality in the Central Region of Portugal participated in the study year 2018/2019 (population-based sample). The intervention consisted of health education sessions and lessons adapted to each child, at the beginning of the project and when blindly evaluating school snacks. The records of the food quality of the snacks were made, through a grid created for the purpose, by the teachers after training the classification criteria of the snacks. The evaluation was performed blindly during 5 weeks of the 2nd and 3rd periods. During the development of the project, there was a continuous and gradual improvement in the food quality of school snacks by the participants. Girls showed better food quality in school snacks than boys. The intervention performed was effective in improving the food quality of children's school snacks with highly significant statistical results. The project to promote healthy eating resulted in improving the food quality of children's school snacks. The results suggest the need to expand the project's implementation to other children from a health perspective in all policies and collaborative work to promote the exercise of parenting and children's health.info:eu-repo/semantics/publishedVersio

Children’s Understanding of Informed Assents in Research Studies

The assent procedure reflects an effort to enable the minor to understand, to the degree they are capable of, what their participation in the decision making process would involve. Aims: To evaluate the minors’ ability to understand the information provided to them when obtaining assent and to evaluate the opinion of the parents regarding the importance of asking the child’s assent. Methods: The sample included a total of 52 minors aged between 10 and 17 years who underwent exercise echocardiogram. The Quality of Informed Consent is divided into two parts: Part A was used to measure objective understanding and part B to measure subjective understanding. Results: The results show that the minors have a high capacity to understand the information given to them when asking for assent. A positive relationship was found between the two parts of the questionnaire. No statistically significant relationship was found between age and sex and part A and part B or between both age groups (&lt;14 years old and ≥14 years old) and the measure. In the case of the parents, 96.6% of parents consider assent as an advantage for the child’s acceptance of health care. The opinion of the parents is not related to the age, sex or level of schooling. Conclusion: Minors showed a substantial level of understanding regarding the information provided to them. The parents considered the implementation of assent fundamental to the child’s acceptance of health care