Cuidados de higiene - baño: significados y perspectivas de los enfermeros

Enquadramento: Como cuidado direto à pessoa, o banho, na sua execução ou supervisão, exalta-se como espaço/tempo de interação e conhecimento entre enfermeiro/pessoa. Porém, por vezes, é entendido como a tarefa de manter apenas a pessoa limpa. Objetivos: Compreender o significado que os enfermeiros atribuem aos cuidados de higiene - banho; identificar os focos, relativos à pessoa no seu todo, que os enfermeiros consideram aquando da prestação do banho; e descrever o cuidado desenvolvido durante o banho. Metodologia: Qualitativa. Estudo descritivo-exploratório, transversal, com recurso à entrevista e observação, com 18 participantes. Resultados: Orientam-nos para a prestação dos cuidados de higiene - banho, como um cuidado de Enfermagem essencial à limpeza e conforto do corpo, sendo uma oportunidade para comunicação, presença e relação com a pessoa, onde se pode ter em conta focos que orientem a prestação de cuidados face às suas necessidades. Conclusão: Um cuidado que potencia um espaço direcionado à pessoa, que deve ser efetuado pelo enfermeiro, incentivando-a na participação ativa do seu plano de cuidados.Background: As direct care to the person, the bath, in its performance or supervision, is emphasised as a space/time of interaction and knowledge between the nurse and the person. However, it is sometimes regarded as merely the task of keeping a person clean. Objectives: To understand the meaning assigned by nurses to hygiene care - bath; identify Nursing foci, related to the provision of Nursing care to the person as a whole, considered during hygiene care - bath; and describe the care provided during the bath. Methodology: Qualitative. A descriptive-exploratory, crosssectional study was conducted with 18 participants using interviews and observation. Results: The results indicate that the provision of health care - bath is a type of nursing care essential to body cleanliness and comfort, and offers an opportunity for communication, presence and relationship with the person. Different foci may be taken into account to guide the provision of care with a view to meeting the person’s needs. Conclusion: A type of care that promotes a space directed to the person and that must be provided by the nurse, who should encourage the person to have an active role in the care plan.Antecedentes: Como atención directa a la persona, el baño, es decir, su ejecución o supervisión, se muestra como el espacio/tiempo de interacción y conocimiento entre el enfermero y la persona. Sin embargo, a veces, solo se considera como la tarea de mantener a la persona limpia. Objetivos: Comprender el significado que los enfermeros atribuyen a los cuidados de higiene - baño; identificar los focos de la persona como un todo que los enfermeros consideran al dar el baño, y describir el cuidado llevado a cabo durante el baño. Metodología: Cualitativa; estudio descriptivo-exploratorio y transversal en el que se recurrió a la entrevista y la observación con 18 participantes. Resultados: Nos orientan a considerar que la prestación de los cuidados de higiene - baño es una atención de enfermería esencial para la limpieza y la comodidad del cuerpo y es una oportunidad para la comunicación, la presencia y la relación con la persona, en la que se pueden tener en cuenta focos que orienten la prestación de cuidados frente a las necesidades. Conclusión: Una atención que potencia un espacio dirigido a la persona, que el enfermero debe realizar, fomentando que esta participe activamente en su plan de atención.info:eu-repo/semantics/publishedVersio

Effect of denture-related stomatitis fluconazole treatment on oral Candida albicans susceptibility profile and genotypic variability

Denture-related stomatitis (DRS) is the most common condition affecting removable-denture wearers, and Candida albicans the most frequent pathogenic agent. Systemic antifungal treatment is indicated but recurrences are frequent. The aim of this study was to characterize the oral load, fluconazole susceptibility profile and genotypic variability of oral C. albicans isolates from patients with DRS before (T0), immediately after fluconazole treatment (Tat) and after 6-months follow-up (T6m). Eighteen patients presenting DRS and treated with fluconazole were followed at the Faculty of Dentistry of Oporto University. Seventy C. albicans isolates were obtained and identified using standard cultural and biochemical multi-testing. Fluconazole susceptibility was tested by E-test®. Microsatellite-primed PCR was performed to assess the genotypic variability of C. albicans isolates. The patientsâ mean age was 58.0±3.2 years, and 55.6%/44.4% had total/partial dentures. Before treatment, 22.2%, 44.4% and 33.3% of the patients presented DRS type I, II or III, respectively. Fluconazole treatment healed or improved DRS in 77.8% of the patients, accompanied by an 83.5% reduction in oral C. albicans load. However, after 6-months, oral C. albicans load increased significantly and DRS severity was similar to the one observed before treatment. Moreover, the prevalence of patients presenting fluconazole resistant isolates of C. albicans increased significantly throughout the study: T0-5.6%, Tat-10.0% and T6m-42.9%. A change in the genotypic variability of C. albicans isolates was also verified, being mostly associated to fluconazole susceptibility profile change. In conclusion, fluconazole presents a good short-term DRS treatment efficiency, but may be associated to a long-term emergence of C. albicans fluconazole resistance. © Figueiral et al.; Licensee Bentham Open

Estrogen receptor, progesterone receptor, and bcl-2 are markers with prognostic significance in CIN III

There are no known biological markers or technologies to predict the natural history of an individual CIN III. The probability of progression is considered greater with the persistence of high-risk human papillomavirus (HPV) infection and age. p53 polymorphism has been associated with cervical carcinogenesis. Hormone-induced cervical cancer is mediated by estrogen receptor (ER) and progesterone receptor (PR). In cervical cancer, increased bcl-2 and Bax immunoreactivity is generally associated with a better prognosis. The purpose of this study was to evaluate the value of HPV 16 and HPV 18 typing and p53 codon polymorphism genotyping by polymerase chain reaction and ER, PR, bcl-2, and Bax expression by immunohistochemistry in predicting the CIN III clinical behavior of CIN III lesions. We studied the expression of these prognostic factors in the CIN III adjacent to squamous cell microinvasive carcinomas of the cervix (MIC) from 29 patients with FIGO stage IA1 cervical cancer and in 25 patients with CIN III and no documented focus of invasion. In the MIC group, only the CIN III was considered at least 2 mm away from the microinvasive complex. The ER, PR, bcl-2, and Bax immunoreactivity was scored as positive (>10% staining cells) and negative (<10% staining cells). No significant difference was observed between MIC and CIN III group concerning HPV infection and p53 polymorphism. The ER, PR, bcl-2, and Bax immunohistochemical expression was stronger and more frequent in the CIN III group. After multivariable analysis, coexpression of ER, PR, and bcl-2 was the only independent factor in defining low risk of progression for CIN III. Our study suggests that coexpression of ER, PR, and bcl-2 may be a useful tool in identifying the CIN III lesions with low risk of progression to cervical cance

Safety and Family-Centered Care during Restriction of Hospital Visits due to COVID-19: The Experience of Family Members

Background: Person and Family Centered Care (PFCC) has demonstrated important contributions to health care outcomes. However, in response to the need for safety due to the pandemic COVID-19, measures were taken to restrict hospital visits. So, the aim of this study was to understand the healthcare experience of family members of patients hospitalized during the pandemic period regarding safety and person- and family-centered care. Methods: Qualitative interpretative study, conducted through semi-structured interviews with six family members of people hospitalized during the pandemic period. Content analysis was performed using Atlas.ti software version 22 (Berlin, Germany) and Bardin’s methodology. Results and Conclusions: Restrictions on hospital visits due to the pandemic of COVID-19 have led to a distancing of families from the hospital setting and influenced healthcare practice, making it difficult to involve families in the care process. In some cases, healthcare professionals made efforts to provide PFCC, attempting to minimize the impact of the visitation restriction. However, there were reported experiences of care delivery that did not consider social and psychological factors and did not place the person and family at the center of the care process, relying instead on the biomedical model. These practices left out important factors for the provision of safe care. It is crucial, even in pandemic settings, that healthcare professionals provide person- and family-centered care to the extent possible, promoting the safety of care. The family should be involved in the care of the person in the inpatient setting.info:eu-repo/semantics/publishedVersio

Lipid profile with eslicarbazepine acetate and carbamazepine monotherapy in adult patients with newly diagnosed focal seizures: post hoc analysis of a phase III trial and open-label extension study

BACKGROUND: Antiseizure medications can have negative effects on plasma lipid levels. OBJECTIVES: To evaluate plasma lipid changes in patients with newly diagnosed focal epilepsy treated with eslicarbazepine acetate (ESL) or controlled-release carbamazepine (CBZ-CR) monotherapy during a phase III, randomized, double-blind (DB) trial and 2 years of ESL treatment in an open-label extension (OLE). DESIGN: Post hoc analysis of a phase III trial and OLE study. METHODS": Proportions of patients with elevated levels of total cholesterol and low-density lipoprotein (LDL) cholesterol were assessed at DB baseline, OLE baseline (last visit of DB trial), and end of OLE. RESULTS: A total of 184 patients received ESL monotherapy during the OLE: 96 received ESL monotherapy in the DB trial and 88 patients received CBZ-CR monotherapy. The proportions of patients with elevated total cholesterol and LDL cholesterol increased significantly during the DB trial in those treated with CBZ-CR monotherapy [total cholesterol, +14.9% (p < 0.001); LDL cholesterol, +11.5% (p = 0.012)] but decreased significantly after switching to ESL monotherapy in the OLE [total cholesterol, −15.3% (p = 0.008); LDL cholesterol, −11.1% (p = 0.021)]. No significant changes were observed in those treated with ESL monotherapy during the DB trial and OLE. At the end of the DB trial, between-group differences (ESL–CBZ-CR) in the proportions of patients with elevated total and LDL cholesterol were −13.6% (p = 0.037) and −12.3% (p = 0.061), respectively; at the end of the OLE, these between-group differences were −6.0% (p = 0.360) and −0.6% (p = 1.000), respectively. CONCLUSION:A lower proportion of patients with newly diagnosed focal epilepsy had increased levels of total and LDL cholesterol, compared to baseline, following monotherapy with ESL versus CBZ-CR; after switching from CBZ-CR to ESL, the proportions of patients with increased levels decreased significantly. REGISTRATION: ClinicalTrials.gov NCT01162460/NCT02484001; EudraCT 2009-011135-13/2015-001243-36

Factores relacionados con la fragilidad multidimensional en personas mayores

Objective: to analyze the sociodemographic and health factors related to multidimensional frailty in elderly people living at home. Method: descriptive, exploratory and cross-sectional study, which evaluated 300 elderly enrolled in a Health Unit in the Northern Region of Portugal. The sociodemographic and health conditions of the old people were analyzed, with application of the Tilburg Frailty Index, Falls Efficacy Scale International – 7 items, Barthel Index and Lawton and Brody Scale. Results: in the elderly in the study, with a mean age of 81.34±6.75 years, frailty was identified in 60.33%. The related factors were: gender, marital status, self-perceived health, pathological history, severe disease in the last year, polymedication, falls, fear of falling and higher level of dependence. Conclusion: multidimensional frailty of the elderly living at home is a prevalent condition. When predictor factors in primary health care are analyzed early, it is possible to intervene in order to delay this syndrome.Objetivo: analisar os fatores sociodemográficos e de saúde relacionados com a fragilidade multidimensional em idosos que vivem no domicílio. Método: estudo descritivo, exploratório e transversal, que avaliou 300 idosos inscritos numa Unidade de Saúde da Região Norte de Portugal. Foram analisadas as condições sociodemográficas e de saúde das pessoas idosas, com aplicação do Índice de Fragilidade de Tilburg, Falls Efficacy Scale International – 7 itens, Índice de Barthel e Escala Lawton & Brody. Resultados: nos idosos do estudo, com idade média de 81,34±6,75 anos, a fragilidade foi identificada em 60,33%. Os fatores relacionados foram: género, estado civil, autopercepção de saúde, antecedentes patológicos, doença grave no último ano, polimedicação, quedas, medo de cair e maior nível de dependência. Conclusão: a fragilidade multidimensional dos idosos que vivem no domicílio é uma condição prevalente. Quando analisados precocemente os fatores preditores na atenção primária à saúde, é possível intervir de forma a retardar essa síndrome.Objetivo: analizar los factores sociodemográficos y de salud relacionados con la fragilidad multidimensional en personas mayores que viven en el hogar. Método: estudio descriptivo, exploratorio y transversal, que evaluó a 300 ancianos matriculados en una Unidad de Salud de la Región Norte de Portugal. Se analizaron las condiciones sociodemográficas y de salud de los ancianos, con aplicación del Tilburg Frailty Index, Falls Efficacy Scale International – 7 items, Barthel Index y Lawton and Brody Scale. Resultados: en los ancianos del estudio, con una edad media de 81,34±6,75 años, se identificó fragilidad en el 60,33%. Los factores relacionados fueron: género, estado civil, salud autopercibida, antecedentes patológicos, enfermedad grave en el último año, polimedicación, caídas, miedo a caerse y mayor nivel de dependencia. Conclusión: la fragilidad multidimensional de los ancianos que viven en el hogar es una condición prevalente. Cuando los factores predictores en la atención primaria de salud se analizan temprano, es posible intervenir para retrasar este síndrome.info:eu-repo/semantics/publishedVersio

Attitudes of specialist nurses towards death: particularities of specialist nurses in rehabilitation nursing

Objetivo: analisar as diferenças no perfil de atitudes face à morte entre enfermeiros especialistas em enfermagem de reabilitação e enfermeiros especialistas em outras áreas. Método: estudo comparativo, quantitativo, transversal, com participação de 223 enfermeiros especialistas de um hospital do norte de Portugal. Como instrumento de colheita de dados usou-se o questionário. Para análise dos dados recorreu-se a estatística descritiva e analítica. Resultados: quanto às atitudes face à morte, nos enfermeiros especialistas em enfermagem de reabilitaçãopredominaram as de aproximação, neutralidade, medo, evitamento e escape. Nos enfermeiros com especializaçãoem outras áreas prevaleceram as atitudes de aproximação, medo, neutralidade, evitamento e escape. Conclusão: embora as atitudes positivas dos enfermeiros especialistas em enfermagem de reabilitação face à morte, adquirissem um valor percentual superior, a diferença não foi significativa. Além disso, as atitudes negativas sinalizam para a necessidade de ser repensarem as estratégias de formação no contexto académico, mas também no contexto profissional. Descritores: Atitude Frente à Morte; Morte; Enfermeiras Especialistas; Especialidades de Enfermagem; Enfermagem em Reabilitação; Hospitais.Objective: to analyse the differences in the profile of attitudes towards death between specialist nurses in rehabilitation nursing and specialist nurses in other areas. Method: comparative, quantitative, cross-sectional study, with the participation of 223 specialist nurses from a hospital in northern Portugal. A questionnaire was applied as a data collection instrument. For data analysis, descriptive and analytical statistics were used. Results: as for attitudes towards death, in nurses who specialize in rehabilitation, those of approach, neutrality, fear, avoidance and escape predominated. In nurses with expertise in other areas, attitudes of approach, fear, neutrality, avoidance and escape prevailed. Conclusion: although the positive attitudes towards death, of nurses specializing in rehabilitation, acquired a higher percentage value, the difference was not significant. In addition, negative attitudes signal the need to rethink training strategies in the academic, but also in the professional context.Objetivo: analizar las diferencias en el perfil de actitudes hacia la muerte entre enfermeros especializados en enfermería de rehabilitación y enfermeros especializados en otras áreas. Método: estudio comparativo, cuantitativo, transversal, con la participación de 223 enfermeros especializadas de un hospital del norte de Portugal. Como instrumento de recolección de datos, se utilizó el cuestionario. Para el análisisde datos, se utilizaron estadísticas descriptivas y analíticas. Resultados: en cuanto a las actitudes hacia la muerte, en los enfermeros especializados en enfermería de rehabilitación, predominaron las de enfoque, neutralidad, miedo, evitación y escape. En los enfermeros con experiencia en otras áreas, prevalecieron las actitudes de acercamiento, miedo, neutralidad, evitación y escape. Conclusión: aunque las actitudes positivas de los enfermeros especializados en enfermería de rehabilitación hacia la muerte adquirieron un mayor valor porcentual, la diferencia no fue significativa. Además, las actitudes negativas señalan la necesidad de repensar las estrategias de aprendizaje en el contexto académico, pero tambiénen el contexto profesional.info:eu-repo/semantics/publishedVersio

Effect of the Active Aging-in-Place–Rehabilitation Nursing Program: A Randomized Controlled Trial

Abstract: (1) Background: It is of great importance to promote functional capacity and positive lifestyles, since they contribute to preventing the progression of frailty among the older adults. The aim of this study was to evaluate the effect of active aging-in-place–rehabilitation nursing program (AAP-RNP) on the functional capacity and lifestyles of frail older adults. (2) Methods: This was a single-blinded, two-group, randomized, controlled trial of 30 frail older people enrolled at a Health-care unit in Portugal between 2021 and 2022. The duration of the program was 12 weeks, and the sessions took place at the participants’ homes. We used as instruments the Tilburg Frailty Indicator; Fried frailty phenotype; Senior Fitness Test battery; Barthel Index; Lawton Index; handgrip strength measurement; Tinetti Index; Individual lifestyle profile; and Borg’s perception of effort. (3) Results: Post-program, there was an improvement in multidimensional and physical frailty, functional capacity, balance, and perceived exertion (p < 0.05) in the experimental group. Among the older adults’ lifestyles, we observed significant improvements in physical activity habits, relational behavior, and stress management. (4) Conclusions: Rehabilitation nurses have a relevant role, and the AAP-RNP seems to be effective in improving functional capacity and lifestyles in frail older adults.info:eu-repo/semantics/publishedVersio

Actitudes de los enfermeros frente a la muerte en el contexto hospitalario: diferenciación por unidades de cuidados

Objetivo: identificar a ocorrência da morte nas unidades de cuidados, bem como analisar os registros e as atitudes dos enfermeiros frente à morte no contexto hospitalar. Método: estudo quantitativo, descritivo, transversal, com participação de 900 enfermeiros de um hospital do Norte de Portugal. Com recurso à triangulação de fontes de dados, a coleta realizou-se de fevereiro a março de 2018 através de questionário e observação de registros efetuados pelos enfermeiros. Para análise dos dados, usou-se estatística descritiva e analítica. Resultados: são as unidades de medicina que apresentam maior número de mortes, sendo no turno da noite que se registra um valor mais elevado de ocorrências. Com relação às atitudes dos enfermeiros frente à morte, à exceção do evitamento, todas as outras evidenciam tendência semelhante entre o grupo profissional, independentemente da sua área de atuação. Os registros de enfermagem apresentam maior incidência ao nível da função ao invés de focados no domínio da pessoa. Conclusão e implicações para a prática: além da aquisição de conhecimentos através da participação em formações sobre a morte e o processo de morrer, o acompanhamento e apoio dos profissionais, poderão desempenhar um papel fundamental na preparação dos enfermeiros para cuidar das pessoas em fim de vida.Objective: to identify the occurrence of death in the care units, as well as to analyze the nurses’ records and attitudes towards death in the hospital context. Method: quantitative, descriptive, cross-sectional study, with the participation of 900 nurses from a hospital in northern Portugal. Using data source triangulation, the collection took place from February to March 2018 through a questionnaire and observation of records made by nurses. For data analysis, descriptive and analytical statistics were used. Results: it is the medical units that present the highest number of deaths, with the highest number of occurrences taking place in the night shift. Regarding the nurses’ attitudes towards death, with the exception of avoidance, all the others show a similar trend among the professional group, regardless of their area of activity. Nursing records have a higher incidence at the function level rather than focusing on the person’s domain. Conclusion and implications for the practice: in addition to the acquisition of knowledge, through participation in training on death and the dying process, the monitoring and support of professionals, may play a fundamental role in preparing nurses to care of people at the end of life.Objetivo: identificar la ocurrencia de la muerte en unidades de cuidados y analizar registros y actitudes de los enfermeros frente a la muerte en el contexto hospitalario. Método: estudio cuantitativo, descriptivo, transversal, con participación de 900 enfermeros de un hospital en el Norte de Portugal. Utilizando la triangulación de fuentes de datos, la recopilación se realizó de febrero a marzo de 2018 a través de cuestionario y observación de registros de enfermeros. Para el análisis, se utilizaron estadísticas descriptivas y analíticas. Resultados: las unidades médicas presentan mayor número de muertes, con mayor número de ocurrencias en el turno nocturno. Con respecto a las actitudes de los enfermeros frente a la muerte, con excepción de la evitación, todas las demás muestran una tendencia similar entre el grupo profesional, independientemente de su área de especialización. Los registros de enfermería tienen una mayor incidencia a nivel de función, en lugar de centrarse en el dominio de la persona. Conclusión e implicaciones para la práctica: además de la obtención de conocimiento sobre la muerte y el morir, el seguimiento y el apoyo de profesionales puede desempeñar un papel fundamental en la preparación de los enfermeros para cuidar a los enfermos en final de vida.info:eu-repo/semantics/publishedVersio

Multidimensional Frailty and Lifestyles of Community-Dwelling Older Portuguese Adults

Abstract: (1) Background: Lifestyles are referred to as conditioning factors for the frailty of older adults. However, there are few studies that explore its association. The objective of the present study is to analyze the association between sociodemographic, clinical, and lifestyle factors of older adults people with multidimensional frailty. (2) Methods: Descriptive and correlational study carried out with older adults people registered in a Health Unit in Portugal. Data were collected through a sociodemographic and clinical questionnaire and application of the Individual Lifestyle Profile and Tilburg Frailty Index to assess the lifestyles and multidimensional frailty of older adults, respectively. This last instrument, being of a multidimensional nature, assesses not only physical, but also psychological and social frailty, with a cut-off point of 6. (3) Results: Of the 300 older adults who participated, most were female (60.3%) and had a mean age of 81.34 6.75 years. Moreover, 60.3% of the sample were frail older adults. Gender, marital status, number of household members, number of chronic diseases, number of daily medications, self-perception of health status and lifestyle and use of a walking device were associated with multidimensional frailty (p 0.001). Healthy eating habits, physical activity, relational behaviour, preventive behaviour, and stress management were significantly associated with lower physical, psychological, and social frailty (p 0.001). (4) Conclusions: When community health workers are aware of multidimensional frailty predictors and their components, they can intervene early and, consequently, delay the onset and progression of frailty in older adults.info:eu-repo/semantics/publishedVersio