Diagnósticos de enfermagem identificados em pacientes internados em Unidade de Terapia Intensiva Adulto

Estudo descritivo para identificar nos registros de prontuários de pacientes internados em uma Unidade de Terapia Intensiva de Adultos os diagnósticos de enfermagem e mapear os diagnósticos mais frequentes às Necessidades Humanas Básicas. Obteve-se uma amostra de 44 prontuários. Identificaram-se 1.087 diagnósticos de enfermagem. Após exclusão de repetições, encontraram-se 28 diferentes títulos de diagnósticos. Vinte e cinco diagnósticos estavam relacionados às necessidades psicobiológicas, e três, às necessidades psicossociais. Sugere-se a realização de estudos que identifiquem, entre os diagnósticos de enfermagem formulados e as necessidades humanas afetadas, quais foram solucionados e para quais necessidades são predominantemente elaborados os cuidados. Os resultados deste estudo são importantes para a organização de conteúdos de ensino para alunos e enfermeiros, preparando-os para que, ao prestar o cuidado, considerem o ser humano, tanto nos aspectos biológicos, como emocionais e espirituais.This descriptive study was performed to identify the nursing diagnoses in the records of the inpatients of an adult intensive care unit, and map the most frequent diagnosis according to the Fundamental Human Needs. The sample consisted of 44 patient records. A total of 1,087 nursing diagnoses were identified. After excluding the repetitions, 28 different diagnoses were identified. Twenty-five diagnoses were related to psychobiological needs, and three to psychosocial needs. Further studies should identify, among the formulated nursing diagnoses and the affected human needs, which problems were solved and for what needs the care is predominantly developed. The present study results are important for the organization of teaching content for students and nurses, preparing them to consider human beings as a whole when providing care, considering their biological, emotional, and spiritual aspects.Estudio descriptivo apuntando identificar en historias clínicas de pacientes internados en una Unidad de Terapia Intensiva de Adultos los diagnósticos de enfermería y mapear los diagnósticos más frecuentes relativos a las Necesidades Humanas Básicas. Se obtuvo una muestra de 44 historias clínicas. Se identificaron 1087 diagnósticos de enfermería. Luego de exclusión de repeticiones, se encontraron 28 diferentes títulos de diagnósticos. Veinticinco diagnósticos se relacionaban con necesidades psicobiológicas y tres a necesidades psicosociales. Se sugiere realizar estudios que identifiquen, entre los diagnósticos de enfermería formulados y las necesidades humanas afectadas, cuáles de ellos fueron solucionados y para cuáles necesidades son elaborados mayoritariamente los cuidados. Los resultados de este estudio son importantes para la organización de contenidos de enseñanza para alumnos y enfermeros, preparándolos para que al prestar el cuidado consideren al ser humano, tanto en aspectos biológicos como emocionales y espirituales

O Uso da Taxionomia de Bloom no Contexto da Avaliação por Competência

O presente artigo tem como objetivo pensar o uso da Taxionomia de Bloom no contexto da avaliação por competência a fim de propor esse recurso na compreensão da classificação de metas e objetivos educacionais. A partir de um trabalho de revisão bibliográfica, que teve como aportes teóricos Bloom et al (1979), Araújo e Rabelo (2015), Antunes (2011), Demo (1999, 2008), Luckesi (2011), destacamos as necessidades de um aperfeiçoamento ou mesmo uma reestruturação nos objetivos e estraté-gias educacionais para acompanharem as inovações e utilizá-las em favor do processo de ensino-aprendizagem pautado no desenvolvimento de habilidades e competências para a formação integral dos alunos. Pensar o ensino-aprendizagem por competências é entender que o estudante precisa constituir-se como competente nas resoluções de problemas, sejam eles simples ou complexos e em todos os campos sociais. Assim, pode-se afirmar que o uso da taxionomia nos objetivos educacionais e em avaliações, representa um ótimo recurso para o desenvolvimento de avaliações com foco em competências. Com ela, além da possibilidade de elaborar situações problemas para os alunos, o professor também pode se auto avaliar, de modo que possa acompanhar, traçar objetivos e estratégias para o ensino-aprendizagem

Evaluation of sarcopenia in long-lived elderly patients: comparison between the Muscle Mass Index and the Calf Circumference

The increase in life expectancy, observed in several countries, including Brazil, is due to improvements in living and health conditions and the epidemiological transition from the causes of morbidity and mortality, from infectious and parasitic diseases to chronic diseases. Furthermore, an increase in longevity, in addition to advances in science, with the improvement of diagnoses and the search for new treatments contributed to the increase in years lived1,2. However, the aging process is associated with a decrease in organic functions over the years. Sarcopenia is considered a complex geriatric syndrome and is defined as an age-related decline in skeletal muscle mass and function2. It is a major public health concern because it can result in functional decline, disability, falls, increased hospitalization costs, poor quality of life, and even deaths3. Although Dual-energy X-ray Absorptiometry (DXA) is the most used method to estimate the loss of muscle mass4 the high cost and low viability hinder its use in Primary Health Care (PHC). Methods such as Muscle Mass Index (MMI) and Calf Circumference (CC) can be used replacing DXA due to ease of access and application as well as low cost5. The Academic League of Geriatrics and Gerontology, Três Lagoas Campus, Federal Univeristy of Mato Grosso do Sul designed and executed a research intending to evaluate several aspects in elderly people with extreme longevity. One of the variables analyzed was sarcopenia, which was evaluated and compared using MMI and CC. For this purpose, a cross-sectional and quantitative study was performed in 2019/2020, with n = 69 individuals aged ≥ 90 years, of both genders, users of the Unified Health System in the town of Três Lagoas – MS. A sociodemographic questionnaire containing gender, age, and years of schooling was applied. Anthropometric data (CC and MMI) were collected in triplicate. The skeletal muscle mass was determined using the formula of Lee and collaborators which considers age, body mass, gender, ethnicity and height5. The values of MMI ​​of Janssen and collaborators were used as a reference to classify whether the nonagenarian or centenarians were sarcopenic or not6. For CC, a cutoff score ≤ 31 centimeters was adopted as a sign of sarcopenia7. The interviewed elderly had an average age of 93.5 years old, 1.3 years of schooling and 52.2% of the participants were women. The average CC was 31.2 centimeters, with 46.1% being considered sarcopenic patients according to this parameter. The average MMI was 5.1 kg/m2, with 100% of the elderly patients being considered sarcopenic through this method. There was no relationship between CC and MMI (p = 0.213). The high rates of sarcopenia found, especially using MMI and the absence of a relationship between the CC and MMI highlights the need to use more reliable methods to evaluate sarcopenia in long-lived elderly people, since the identification from CC, despite being easy and fast, may not be sensitive in this age group. These findings also lead to considering the use of more specific methods or those associated with other variables, such as Timed up and Go (TUG), for the evaluation of sarcopenia in the elderly aged 90 years or over. Future investigations should  consider the importance of validating specific instruments for elderly people in extreme longevity, as they constitute a group that has unique characteristics. The screening, monitoring, and health promotion carried out by PHC teams can promote the improvement in the quality of life of elderly people in extreme longevity

ABUSE AND DISRESPECT IN CHILDBIRTH CARE AS A PUBLIC HEALTH ISSUE IN BRAZIL: ORIGINS, DEFINITIONS, IMPACTS ON MATERNAL HEALTH, AND PROPOSALS FOR ITS PREVENTION

Disrespect and abuse (in Brazil called obstetric violence), described by different terms, is increasingly used in social activism, in academic research and public policy formulation, and was recently recognized as a public health issue by the World Health Organization. As an innovative theme, it requires a mapping its origins, definitions, typology, impacts on maternal health and proposals for its preventing and remedy. We presente a critical-narrative review about this issue, including academic literature, productions of social movements and institutional documents, in Brazil and internationally. After a short historical overview, we map the definitions and types of violence. The complex causation of these forms of violence is discussed, including the role of professional training, the organization of health services, and the implications for maternal morbidity and mortality. Finally we present interventions in public health that have been used or proposed to prevent and mitigate obstetric violence, and an agenda for innovation and research in this area

Recurrent respiratory papillomatosis: clinical characteristics and viral genotyping in a Brazilian population

This study presents 25 cases of recurrent respiratory papillomatosis (RRP) that occurred in Sao Luis, Maranhao State, Northeast region, Brazil, between January 2007 and December 2018. Sociodemographic and clinical profile of patients as well as human papillomavirus (HPV) infection status were evaluated. Clinical and histopathological data were collected from the patients’ medical records. For the HPV infection analysis, DNA was extracted and subjected to amplification by a nested polymerase chain reaction. Viral genotyping was performed by automated sequencing. The median age of patients was 12.40 ± 12.6. years, and the juvenile form of the disease (68%) was the predominant form of disease. Female participants were predominant (60%), and they were from cities located in the interior of the State (60%). The most common clinical manifestation was dysphonia; recurrence was observed in most cases (56%), and tracheostomy was necessary in seven patients (26.9%). When comparing the RRP forms, patients in the juvenile-RRP group had higher recurrence rates and need of tracheostomy than those in the adult-RRP group. The viral genotyping analysis revealed that 47.8% of patients had low-risk HPVs, whereas 13.1% had high-risk HPVs, and in 39.1% of patients the viral genotype was not obtained. HPV-6 was the most prevalent type and Juvenile-RRP was more prevalent in our population. HPV was present at a high rate, and HPV-6 was the predominant genotype. This study serves as the basis for further studies to be conducted in the Brazilian population. Our findings aid the better understanding of RRP, possibly suggesting some prognostic factors associated with the disease aggressiveness

Assessment of the suitability of chitosan/polybutylene succinate scaffolds seeded with mouse mesenchymal progenitor cells for a cartilage tissue engineering approach

In this work, scaffolds derived from a new biomaterial originated from the combination of a natural material and a synthetic material were tested for assessing their suitability for cartilage tissue engineering applications. In order to obtain a better outcome result in terms of scaffolds’ overall properties, different blends of natural and synthetic materials were created. Chitosan and polybutylene succinate (CPBS) 50/50 (wt%) were melt blended using a twin-screw extruder and processed into 5 5 5mm scaffolds by compression moulding with salt leaching. Micro-computed tomography analysis calculated an average of 66.29% porosity and 92.78% interconnectivity degree for the presented scaffolds. The salt particles used ranged in size between 63 and 125 lm, retrieving an average pore size of 251.28 lm. Regarding the mechanical properties, the compressive modulus was of 1.73 ± 0.4MPa (Esec 1%). Cytotoxicity evaluation revealed that the leachables released by the developed porous structures were not harmful to the cells and hence were noncytotoxic. Direct contact assays were carried out using a mouse bone marrow–derived mesenchymal progenitor cell line (BMC9). Cells were seeded at a density of 5 105 cells/scaffold and allowed to grow for periods up to 3 weeks under chondrogenic differentiating conditions. Scanning electron microscopy analysis revealed that the cells were able to proliferate and colonize the scaffold structure, and MTS test demonstrated cell viability during the time of the experiment. Finally, Western blot performed for collagen type II, a natural cartilage extracellular matrix component, showed that this protein was being expressed by the end of 3 weeks, which seems to indicate that the BMC9 cells were being differentiated toward the chondrogenic pathway. These results indicate the adequacy of these newly developed C-PBS scaffolds for supporting cell growth and differentiation toward the chondrogenic pathway, suggesting that they should be considered for further studies in the cartilage tissue engineering field.J. T. Oliveira would like to acknowledge the grant (SFRH/ BD17135/2004) from Portuguese Foundation for Science and Technology (FCT). The authors would like to thank Fernanda Marques, at the Institute for Health and Life Sciences (ICVS), University of Minho, Braga, Portugal, for her help with the Western blot analysis, as well as the staff at ICVS for allowing to use their facilities. The monoclonal antibody for collagen type II was obtained from the Developmental Studies Hybridoma Bank developed under the auspices of the NICHD and maintained by the Department of Biological Sciences, University of Iowa (Iowa City, IA). This work was carried out under the scope of the European NoE EXPERTISSUES (NMP3-CT-2004-500283), and partially supported by the European Project GENOSTEM (LSHB-CT-2003-503161) and the FCT Project CartiScaff (POCTI/SAU-BMA/58991/2004)

VOLVO DE CÓLON DIREITO: RELATO DE CASO

Introdução: O volvo de cólon é uma das principais causas de obstrução intestinal, porém o volvo do cólon direito é responsável por apenas 1-2% dos casos. A clínica é caracterizada por dor aguda e distensão abdominal, associada a náuseas, vômitos e hipertimpanismo, com ou sem massa abdominal palpável. Objetivo: Relatar um caso de volvo extenso envolvendo todo o cólon direito em paciente com alterações motoras e intelectuais. Relato de caso: Mulher, 39 anos, portadora de Síndrome de Rett com obstrução intestinal e tentativa de tratamento conservador que acabou evoluindo para laparotomia exploradora que evidenciou torção no sentido anti-horário do mesocólon envolvendo todo o cólon direito até ângulo esplênico. Conclusão: Embora a paciente tenha realizado tomografia computadorizada só obteve o diagnóstico definitivo durante o tratamento operatório

Efeito do nitrogênio em feijão cultivado em terras altas no sul do estado de TocantinsNitrogen effect on bean grown in southern uplands in Tocantins state

Objetivou-se avaliar o efeito da adubação nitrogenada em genótipos de feijão comum em solos de cerrado, no período da entressafra, na região sul do Estado do Tocantins sob irrigação suplementar. Foram conduzidos dois experimentos: no primeiro experimento, foram aplicados 20 kg ha-1 e no segundo 120 kg ha-1 de nitrogênio. Foram utilizados 12 genótipos no delineamento de blocos casualisados, com quatro repetições. Foram avaliados diâmetro de caule, altura da planta, altura de inserção da primeira vagem, número de vagens por planta, número de grãos por vagem, massa de cem grãos e produtividade de grãos. Existe diferença entre os genótipos quanto à utilização do nitrogênio. Para as condições em estudo, o ambiente com maior dose de nitrogênio resultou em maior diâmetro de caule, altura de planta e número de vagens por planta. Os genótipos BRS-Grafite, IAC-Centauro, IPR-Colibri, IAC-Diplomata, IAC-Una, Princesa e a linhagem CNFC-10406 responderam de forma diferenciada ao acréscimo de nitrogênio. O cultivar Princesa (no ambiente sem estresse de N – 120 kg ha-1) e o cultivar IAC-Eté (no ambiente com estresse de N – 20 kg ha-1) obtiveram produtividades de grãos acima de 3000 kg ha-1 e 2200 kg ha-1, respectivamente. Abstract The objective in this research was to evaluate the effect of nitrogen fertilization on bean genotypes in soil of Savannah, during the off season, in the south region of Tocantins State under supplementary irrigation. Two experiments were conducted. The first received 20 kg ha-1 of nitrogen and the second received 120 kg ha-1, respectively. Twelve genotypes were used in an experimental design and were randomized blocks with four repetitions. The stem diameter, plant height, height of insertion of first pod, number of pods per plant, number of grains per pod, weight of one hundred grains and grain yield were measured. There is a difference among the genotypes concerning the use of nitrogen. For the conditions studied, the environment with higher nitrogen levels resulted in higher stem diameter, plant height and number of pods per plant. The genotypes BRS- Grafite, IAC-Centauro, IPR-Colibri, IAC-Diplomata, IAC-Una, Princesa and the line CNFC- 10406 responded differently to the addition of nitrogen. The genotype Princesa (in the environment without N stress – 120 kg ha-1) and the IAC-Eté (in the environment with N stress – 20 kg ha-1) had grain yields above 3000 kg ha-1 and 2200 kg ha-1, respectively

O USO DA SIMULAÇÃO NO ENSINO DA TÉCNICA DE ASPIRAÇÃO DE VIAS AÉREAS: ENSAIO CLÍNICO RANDOMIZADO CONTROLADO

RESUMO Estudo com o objetivo de avaliar o efeito do uso da simulação no ensino da habilidade de aspiração de vias aéreas inferiores. Trata-se de ensaio clínico controlado randomizado realizado em uma universidade pública federal em outubro de 2016. Amostra de 33 estudantes alocados mediante sorteio aleatório nos grupos intervenção (n=17) e controle (n=16). A intervenção avaliada foi o ensino da técnica de aspiração de vias aéreas inferiores utilizando a simulação (oficinas individuais e debriefing), e o controle foi o ensino da técnica pelo método tradicional (aula expositiva e treinamento em grupo). Os desfechos avaliados foram o conhecimento teórico e prático sobre a habilidade ensinada, cujas pontuações máximas eram, respectivamente, 19 e 29 pontos. Os dados foram analisados utilizando-se estatística descritiva e inferencial. No conhecimento teórico, a média de acertos do grupo intervenção foi de 15,1 pontos e no grupo-controle foi de 15,5 pontos. Na avaliação prática, a pontuação média no grupo intervenção foi de 22,9 pontos e no grupo-controle foi de 20,8 pontos. Não houve diferença na média de acertos no conhecimento teórico e prático sobre a habilidade ensinada entre os grupos intervenção e controle. Entretanto, alunos que participaram das atividades simuladas relataram mais confiança e segurança no desenvolvimento da técnica em laboratório. Sugere-se a replicação do estudo com amostra maior para comparação dos achados. Registro Brasileiro de Ensaios Clínicos: RBR-8bsmyz

Concepções e práticas de gestão relacionadas à política do envelhecimento ativo em um município C

Este artigo teve como objetivo identificar as concepções e práticas de gestão relacionadas à política do envelhecimento ativo em um município C.  É uma pesquisa qualitativa, estudo de caso, realizada por meio de entrevista semiestruturada com oito sujeitos. Para análise dos dados, foi utilizado como suporte teórico-metodológico o documento da Organização Mundial da Saúde, Envelhecimento Ativo e a Análise do Discurso sob a perspectiva da Teoria Semiolinguística de Patrick Charaudeau. Os gestores envolvidos apontam o envelhecimento como processo natural, multifatorial e contínuo, que requer políticas públicas voltadas às demandas geradas pelo fenômeno, além de uma vitória, que necessita de investimentos ao longo da vida para que o momento seja vivido com autonomia, independência, saúde e qualidade de vida. Outra associação do envelhecimento foi conferida à incapacidade, necessidade de provisão de cuidados, aumento dos gastos com saúde e previdência, e preconceito com a pessoa idosa. Quanto às práticas, os gestores reconhecem a importância da atuação do órgão ou instituição da qual eles fazem parte, oportunizando a construção de uma velhice ativa e saudável, porém parece apresentar um distanciamento de uma intervenção que se aproprie dos pilares do Envelhecimento Ativo, como estratégia de gestão