Relevância dos indicadores de estratégias de supervisão clínica em enfermagem

Objective: to identifying the indicators of strategies of clinical supervision in nursing that nurses consider more relevant. Methods: it is a descriptive and exploratory research with a quantitative approach. A questionnaire was constructed to collect data, applied to a sample of 316 nurses who performed functions in a hospital context and primary health care. Results: the relevance attributed by the nurses to the indicators of clinical supervision strategies, especially the reflexive processes, as well as to methods directed to action and demonstration, are highlighted. Conclusion: the indicators identified in the study constitute an important step in the structuring and evaluation of supervision processes, contributing to the improvement of quality and safety of care.Objetivo: identificar os indicadores de estratégias de supervisão clínica em enfermagem que os enfermeiros consideram mais relevantes. Métodos: investigação quantitativa, de caráter descritivo e exploratório. Para a coleta de dados foi construído um questionário, que foi aplicado a uma amostra de 316 enfermeiros que exerciam funções em contexto hospitalar e em cuidados de saúde primários. Resultados: destaca-se a relevância atribuída pelos enfermeiros aos indicadores das estratégias de supervisão clínica, em particular no que concerne aos processos reflexivos, bem como aos métodos direcionados para a ação e demonstração. Conclusão: os indicadores identificados no estudo constituem um importante passo para a estruturação e avaliação dos processos de supervisão, concorrendo para a melhoria da qualidade e segurança dos cuidados.info:eu-repo/semantics/publishedVersio

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Guaraná (Paullinia cupana) improves the proliferation and oxidative metabolism of senescent adipocyte stem cells derived from human lipoaspirates

AbstractCellular senescence is a limiting factor in the proliferative expansion and quality of adult mesenchymal stem cells, often making them unviable in regenerative clinical practice. In vitro supplementation by antioxidant food extract of senescent mesenchymal stem cells could reverse these undesirable characteristics. To evaluate this hypothesis, senescent adipocyte-mesenchymal cells (ASCs) obtained from human lipoaspirates were exposed at different concentrations of hydro-alcoholic guaraná (Paullinia cupana) extract for 72h. After the incubation, we performed a proliferative assay. Oxidative stress indicators and antioxidant enzymes (biochemical activity and gene expression by qRT-PCR analysis) in these senescent cells were also evaluated. In senescent cells exposed to guaraná at 5mg/g concentration increased cellular proliferation occurred compared to untreated senescent cells (79.1±15.7%). Concomitantly, a decrease in several oxidative stress indicators was observed in senescent cells treated with guaraná. A genomic effect of guaraná exposure was observed when the modulation of antioxidant enzymes genes was analyzed. The results described here suggest that the food extract supplementation could reverse the initial senescence processes in ASCs. These results have potential application in regenerative medicine

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved