Avaliação de enfermagem da ansiedade pré-operatória pediátrica: um estudo qualitativo

Objetivo: explorar e descrever como as enfermeiras perioperatórias avaliam e interpretam o comportamento da criança antes de entrar na sala de cirurgia, identificando as estratégias que utilizam para minimizar a ansiedade e as propostas de melhoria. Método: estudo qualitativo descritivo utilizando entrevistas semiestruturadas e observação participante das rotinas diárias. Análise temática dos dados. O estudo segue os critérios recomendados para publicação de artigos da metodologia qualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: quatro temas emergiram dos dados: a) avaliação da ansiedade ou comunicação próxima com a criança e sua família; b) analisando o que foi observado; c) controlando a ansiedade e d) melhorando a avaliação ou propostas de melhoria na prática diária. Conclusão: as enfermeiras avaliam a ansiedade em sua prática diária por meio da observação e usando julgamento clínico. A experiência da enfermeira é decisiva na avaliação adequada da ansiedade pré-operatória da criança. A falta de tempo entre a espera e o momento de entrar na sala de cirurgia, a escassez de informação que a criança e os pais têm sobre o processo cirúrgico e a ansiedade dos pais, dificultam a avaliação e o controle adequado da ansiedade.Objetivo: explorar y describir cómo las enfermeras perioperatorias evalúan e interpretan el comportamiento del niño antes de entrar a quirófano, identificando las estrategias que utilizan para minimizar la ansiedad y las propuestas de mejora. Método: estudio cualitativo descriptivo mediante entrevistas semiestructuradas y observación participante de las rutinas diarias. Análisis temático de los datos. El estudio sigue las recomendaciones de criterios para la publicación de artículos de metodología cualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: cuatro temas surgieron de los datos: a) evaluación de la ansiedad o comunicación estrecha con el niño y su familia; b) valorando lo observado; c) manejando la ansiedad y d) mejorando la evaluación o propuestas de mejora para la práctica diaria. Conclusión: enfermeras evalúan la ansiedad en su práctica diaria de forma observacional utilizando el juicio clínico. La experiencia de la enfermera es determinante en la adecuada evaluación de la ansiedad prequirúrgica del niño. La falta de tiempo entre la espera y el momento de entrar a quirófano, la mala información que tiene el niño y los padres sobre el proceso quirúrgico y la ansiedad de los padres dificultan la evaluación y el manejo correcto de la ansiedad.Objective: to explore and describe how perioperative nurses assess and interpret the child’s behavior before entering the operating room, identifying the strategies they use to reduce anxiety and the proposals for improvements. Method: descriptive qualitative study using semi-structured interviews and participant observation of daily routines. Thematic analysis of data. This study follows the recommended criteria for publication of articles of the qualitative methodology Consolidated Criteria for Reporting Qualitative Research. Results: four topics emerged from the data: a) assessment of anxiety or close communication with the child and their family; b) evaluating what was observed; c) managing anxiety and d) improving the assessment or proposals for improvements in daily practice. Conclusion: nurses assess anxiety in their daily practice through observation using their clinical judgment. The nurse’s experience is decisive for the appropriate assessment of the preoperative anxiety in child. Insufficient time between waiting and entering the operating room, lack of information from child and their parents about the surgical procedure, and parental anxiety make it difficult to assess and properly manage anxiety

Visión del profesional de enfermería sobre el entorno como parte integrante del metaparadigma

Objective: To know the theoretical standpoint on the concept of environment of nurses belonging to the Healthcare Corporation Parc Taulí (CSPT) and evaluate the relationship with demographic variables and nurses proposed model in their day-to-day practice. Methodology: Descriptive, observational, cross-sectional study. 546 professionals interviewed using a questionnaire of our own elaboration between April - May, 2006. Results: 205 questionnaires were collected. Age 37 ± 9, 89.7 % women. Years work experience: 14±9. Training: 23.5 % in models. Henderson training model 74 %. They were mainly identified with definitions of environment based in Roy and Henderson. We found statistically significant relationships in the choice of environment concept with age, nursing school, year of completion, the qualification, type of service (direct or non-direct assistance), and years of experience. Conclusions: The professionals are identified with the concept of environment from the paradigm of integration, although they see the vision of transforming possibly due to the organizational vision of biomedical assistance.Objetivo: Conocer el posicionamiento sobre el concepto de entorno de los profesionales de enfermería del Parc Taulí (CSPT) y evaluar relación con variables demográficas y modelo enfermero propuesto para la práctica diaria. Método: descriptivo, observacional, transversal. 546 profesionales encuestados a través de cuestionario de elaboración propia entre abril-mayo 2006. Resultados: 205 cuestionarios recogidos. Edad 37±9, 89,7% mujeres. Años experiencia laboral: 14±9. Formación: 23,5% en modelos. Modelo de formación Henderson 74%. Se identificaron con definiciones de entorno basadas en Roy y Henderson mayoritariamente. Se encontraron relaciones estadísticamente significativas en la elección del enunciado entorno con algunas de las variables estudiadas edad, escuela de Enfermería, año de finalización, la titulación, el tipo de servicio (atención directa o no), y los años de experiencia. Conclusiones: Los profesionales se identifican con el concepto de entorno del paradigma de la integración, aunque se vislumbra la visión de la transformación debido posiblemente a la visión organizativa biomédica de la asistencia

Objectively Measured Physical Activity and Body Mass Index in Preschool Children

Aim. To examine the association between objectively measured physical activity (PA) and body mass index (BMI) in preschool children. Methods. The study comprised 281 children (55.9% boys) aged from 4 to 6 years. PA was measured by accelerometer. Children were categorized as non-overweight (NOW) and overweight/obese (OW) according to the sex-adjusted BMI z-score (<1 and ≥1, resp.). Results. Total and moderate intensity PA were not associated with BMI. We observed that a higher proportion of OW children were classified as low-vigorous PA compared to their NOW peers (43.9 versus 32.1%, resp., P > .05). Logistic regression analysis showed that children with low-vigorous PA had higher odds ratio (OR) to be classified as OW compared to those with high-vigorous PA (OR = 4.4; 95% CI: 1.4–13.4; P = .008) after adjusting for BMI at first and second years of life and other potential confounders. Conclusion. The data suggests that vigorous PA may play a key role in the obesity development already at pre-school age

Storm Gloria: sea state evolution based on in situ measurements and modeled data and its impact on extreme values

Storm Gloria, generated on January 17th, 2020 in the Eastern North Atlantic, crossed the Iberian Peninsula and impacted the Western Mediterranean during the following days. The event produced relevant damages on the coast and the infrastructures at the Catalan-Balearic Sea, due to extraordinary wind and wave fields, concomitant with anomalously intense rain and ocean currents. Puertos del Estado (the Spanish holding of harbors) has developed and operates a complex monitoring and forecasting system (PORTUS System), in collaboration with the Spanish Met Office (AEMET). The present work shows how Gloria was correctly forecasted by this system, alerts were properly issued (with special focus to the ports), and the buoys were able to monitor the sea state conditions during the event, measuring several new records of significant wave height and exceptional high mean wave periods. The paper describes, in detail, the dynamic evolution of the atmospheric conditions, and the sea state during the storm. It is by means of the study of both in situ and modeled PORTUS data, in combination with the AEMET weather forecast system results. The analysis also serves to place this storm in a historical context, showing the exceptional nature of the event, and to identify the specific reasons why its impact was particularly severe. The work also demonstrates the relevance of the PORTUS System to warn, in advance, the main Spanish Ports. It prevents accidents that could result in fatal casualties. To do so, the wave forecast warning performance is analyzed, making special focus on the skill score for the different horizons. Furthermore, it is demonstrated how a storm of this nature results in the need of changes on the extreme wave analysis for the area. It impacts all sorts of design activities at the coastline. The paper studies both how this storm fits into existing extreme analysis and how these should be modified in the light of this particular single event. This work is the first of a series of papers to be published on this issue. They analyze, in detail, other aspects of the event, including evolution of sea level and description of coastal damages

Hyperspectral imaging and robust statistics in non-melanoma skin cancer analysis

Non-Melanoma skin cancer is one of the most frequent types of cancer. Early detection is encouraged so as to ensure the best treatment, Hyperspectral imaging is a promising technique for non-invasive inspection of skin lesions, however, the optimal wavelengths for these purposes are yet to be conclusively determined. A visible-near infrared hyperspectral camera with an ad-hoc built platform was used for image acquisition in the present study. Robust statistical techniques were used to conclude an optimal range between 573.45 and 779.88 nm to distinguish between healthy and non-healthy skin. Wavelengths between 429.16 and 520.17 nm were additionally found to be optimal for the differentiation between cancer types.Gerencia Regional de Salud de Castilla y León (GRS 2139/A/20); Spanish Ministry of Science, Innovation and Universities (PRE2019-089411); Instituto de Salud Carlos III (PI18/00587); Ibderdrola Spain; Junta de Castilla y León (GRS 1837/A/18). This project was funded by the Junta de Castilla y Leon, under the title project HYPERSKINCARE (Ref. GRS 1837/A/18). Lloyd Austin Courtenay is funded by the Spanish Ministry of Science, Innovation and Universities with an FPI Predoctoral Grant (Ref. PRE2019-089411) associated to project RTI2018-099850-B-I00 and the University of Salamanca. Susana Lagüela and Susana del Pozo are both funded by the Iberdrola Spain through the initiative Cátedra Iberdrola VIII Centenario of the University of Salamanca. Javier Cañueto is partially supported by the PI18/00587(Instituto de Salud Carlos III cofinanciado con fondos FEDER) and GRS 2139/A/20 (Gerencia Regional de Salud de Castilla y León

Planejamento e avaliação: pilares da gestão do modelo pedagógico Syllabus

O artigo relata os resultados verificados em uma pesquisa envolvendo a importância do planejamento e da avaliação tanto para o docente quanto para o discente e discute a implantação do Projeto Piloto para aplicação do Modelo Pedagógico Syllabus, no Ensino Superior. Este modelo de ensino e aprendizagem está amparado na nova política de gestão escolar da Universidade Sagrado Coração e, seu enfoque é voltado para o planejamento e avaliação da disciplina e da aula, ocorrendo concomitantemente com o comprometimento de propostas sistematizadas no plano de ensino e de aula, com objetivos e metodologias definidos previamente. O envolvimento dos estudantes ocorre através da sua capacidade de compreender as orientações prévias à aula presencial, disponibilizadas pelo docente e avaliadas com a sua participação no Quiz. O Modelo Pedagógico Syllabus propõe uma metodologia de interação entre o professor e o estudante, para facilitar a aprendizagem e a construção do conhecimento em sala de aula. O processo vem se consolidando pedagogicamente e embora ocorra a padronização de processos e formação continuada periodicamente, com o subsídio pedagógico no trabalho docente, há evidências de dificuldades de sistematização do planejamento e da avaliação

Deep Convolutional Neural Support Vector Machines for the Classification of Basal Cell Carcinoma Hyperspectral Signatures

[EN] Non-melanoma skin cancer, and basal cell carcinoma in particular, is one of the most common types of cancer. Although this type of malignancy has lower metastatic rates than other types of skin cancer, its locally destructive nature and the advantages of its timely treatment make early detection vital. The combination of multispectral imaging and artificial intelligence has arisen as a powerful tool for the detection and classification of skin cancer in a non-invasive manner. The present study uses hyperspectral images to discern between healthy and basal cell carcinoma hyperspectral signatures. Upon the combined use of convolutional neural networks, with a final support vector machine activation layer, the present study reaches up to 90% accuracy, with an area under the receiver operating characteristic curve being calculated at 0.9 as well. While the results are promising, future research should build upon a dataset with a larger number of patients.SIJunta de Castilla y Leo

Hyperspectral imaging and robust statistics in non-melanoma skin cancer analysis

[EN] Non-Melanoma skin cancer is one of the most frequent types of cancer. Early detection is encouraged so as to ensure the best treatment, Hyperspectral imaging is a promising technique for non-invasive inspection of skin lesions, however, the optimal wavelengths for these purposes are yet to be conclusively determined. A visible-near infrared hyperspectral camera with an ad-hoc built platform was used for image acquisition in the present study. Robust statistical techniques were used to conclude an optimal range between 573.45 and 779.88 nm to distinguish between healthy and non-healthy skin. Wavelengths between 429.16 and 520.17 nm were additionally found to be optimal for the differentiation between cancer typesSIGerencia Regional de Salud de Castilla y LeónSpanish Ministry of Science, Innovation and UniversitiesInstituto de Salud Carlos IIIJunta de Castilla y Leó

Role of atrial tissue remodeling on rotor dynamics an in vitro study

The objective of this article is to present an in vitro model of atrial cardiac tissue that could serve to study the mechanisms of remodeling related to atrial fibrillation (AF). We analyze the modification on gene expression and modifications on rotor dynamics following tissue remodeling. Atrial murine cells (HL-1 myocytes) were maintained in culture after the spontaneous initiation of AF and analyzed at two time points: 3.1 +/- 1.3 and 9.7 +/- 0.5 days after AF initiation. The degree of electrophysiological remodeling (i.e., relative gene expression of key ion channels) and structural inhomogeneity was compared between early and late cell culture times both in nonfibrillating and fibrillating cell cultures. In addition, the electrophysiological characteristics of in vitro fibrillation [e.g., density of phase singularities (PS/cm2), dominant frequency, and rotor meandering] analyzed by means of optical mapping were compared with the degree of electrophysiological remodeling. Fibrillating cell cultures showed a differential ion channel gene expression associated with atrial tissue remodeling (i.e., decreased SCN5A, CACN1C, KCND3, and GJA1 and increased KCNJ2) not present in nonfibrillating cell cultures. Also, fibrillatory complexity was increased in late- vs. early stage cultures (1.12 +/- 0.14 vs. 0.43 +/- 0.19 PS/cm(2), P < 0.01), which was associated with changes in the electrical reentrant patterns (i.e., decrease in rotor tip meandering and increase in wavefront curvature). HL-1 cells can reproduce AF features such as electrophysiological remodeling and an increased complexity of the electrophysiological behavior associated with the fibrillation time that resembles those occurring in patients with chronic AF.This work was supported in part by grants from the Spanish Ministry of Science and Innovation (PLE2009-0152), the Instituto de Salud Carlos III (Ministry of Economy and Competitiveness, Spain: PI13-01882, PI13-00903, and TEC2013-50391-EXP), and the Red de Investigacion Cardiovacular (RIC) from Instituto de Salud Carlos III (Ministry of Economy and Competitiveness, Spain).Climent, A.; Guillem Sánchez, MS.; Fuentes, L.; Lee, P.; Bollensdorff, C.; Fernandez-Santos, M.; Suarez-Sancho, S.... (2015). Role of atrial tissue remodeling on rotor dynamics an in vitro study. AJP - Heart and Circulatory Physiology. 309(11):H1964-H1973. doi:10.1152/ajpheart.00055.2015SH1964H197330911Allessie, M. (2002). 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H., Cappato, R., Brugada, J., Camm, A. J., Chen, S.-A., … Wilber, D. (2012). 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design. Heart Rhythm, 9(4), 632-696.e21. doi:10.1016/j.hrthm.2011.12.016Claycomb, W. C., Lanson, N. A., Stallworth, B. S., Egeland, D. B., Delcarpio, J. B., Bahinski, A., & Izzo, N. J. (1998). HL-1 cells: A cardiac muscle cell line that contracts and retains phenotypic characteristics of the adult cardiomyocyte. Proceedings of the National Academy of Sciences, 95(6), 2979-2984. doi:10.1073/pnas.95.6.2979Filgueiras-Rama, D., Price, N. F., Martins, R. P., Yamazaki, M., Avula, U. M. R., Kaur, K., … Berenfeld, O. (2012). Long-Term Frequency Gradients During Persistent Atrial Fibrillation in Sheep Are Associated With Stable Sources in the Left Atrium. Circulation: Arrhythmia and Electrophysiology, 5(6), 1160-1167. doi:10.1161/circep.111.969519Haïssaguerre, M., Jaïs, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., … Clémenty, J. (1998). Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins. New England Journal of Medicine, 339(10), 659-666. doi:10.1056/nejm199809033391003Haralick, R. M., Shanmugam, K., & Dinstein, I. (1973). Textural Features for Image Classification. IEEE Transactions on Systems, Man, and Cybernetics, SMC-3(6), 610-621. doi:10.1109/tsmc.1973.4309314Jalife, J. (2010). Deja vu in the theories of atrial fibrillation dynamics. Cardiovascular Research, 89(4), 766-775. doi:10.1093/cvr/cvq364Koivumäki, J. T., Seemann, G., Maleckar, M. M., & Tavi, P. (2014). In Silico Screening of the Key Cellular Remodeling Targets in Chronic Atrial Fibrillation. PLoS Computational Biology, 10(5), e1003620. doi:10.1371/journal.pcbi.1003620Lee, P., Klos, M., Bollensdorff, C., Hou, L., Ewart, P., Kamp, T. J., … Herron, T. J. (2012). Simultaneous Voltage and Calcium Mapping of Genetically Purified Human Induced Pluripotent Stem Cell–Derived Cardiac Myocyte Monolayers. Circulation Research, 110(12), 1556-1563. doi:10.1161/circresaha.111.262535Lieu, D. K., Fu, J.-D., Chiamvimonvat, N., Tung, K. C., McNerney, G. P., Huser, T., … Li, R. A. (2013). Mechanism-Based Facilitated Maturation of Human Pluripotent Stem Cell–Derived Cardiomyocytes. Circulation: Arrhythmia and Electrophysiology, 6(1), 191-201. doi:10.1161/circep.111.973420Liu, X., Shi, H., Tan, H., Wang, X., Zhou, L., & Gu, J. (2009). Decreased Connexin 43 and Increased Fibrosis in Atrial Regions Susceptible to Complex Fractionated Atrial Electrograms. Cardiology, 114(1), 22-29. doi:10.1159/000210398Mansour, M., Mandapati, R., Berenfeld, O., Chen, J., Samie, F. H., & Jalife, J. (2001). 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Electrical Restitution and Spatiotemporal Organization During Ventricular Fibrillation. Circulation Research, 84(8), 955-963. doi:10.1161/01.res.84.8.955Samie, F. H., Mandapati, R., Gray, R. A., Watanabe, Y., Zuur, C., Beaumont, J., & Jalife, J. (2000). A Mechanism of Transition From Ventricular Fibrillation to Tachycardia. Circulation Research, 86(6), 684-691. doi:10.1161/01.res.86.6.684Samie, F. H., Berenfeld, O., Anumonwo, J., Mironov, S. F., Udassi, S., Beaumont, J., … Jalife, J. (2001). Rectification of the Background Potassium Current. Circulation Research, 89(12), 1216-1223. doi:10.1161/hh2401.100818Smith, A. W., Segar, C. E., Nguyen, P. K., MacEwan, M. R., Efimov, I. R., & Elbert, D. L. (2012). Long-term culture of HL-1 cardiomyocytes in modular poly(ethylene glycol) microsphere-based scaffolds crosslinked in the phase-separated state. 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Modelos teóricos y estudiantes de enfermería: aspectos motivacionales para su elección durante las prácticas clínicas

Introducción: el cuerpo teórico y filosófico de enfermería es complejo; existen un gran número de teorías enfermeras, algunas de difícil comprensión, por lo que habitualmente su aplicación práctica se ve restringida. Objetivo: identificar el modelo teórico de enfermería que los estudiantes dicen utilizar durante las prácticas clínicas, la motivación para su elección, y la escuela universitaria donde estaban cursando sus estudios. Sujetos y métodos: estudio descriptivo en el que participaron 105 estudiantes (de una población total de 108) que realizaban prácticas de enfermería en el hospital durante el curso 2006-2007. La variables de estudio fueron los modelos teóricos enfermeros, las razones de la elección y variables sociodemográficas. La recogida de datos se llevo a cabo mediante un cuestionario cumplimentado durante su experiencia clínica. El análisis de los datos se realizó mediante un análisis temático de texto, categorizando para crear finalmente un marco explicativo. Resultados y conclusiones: el modelo elegido es principalmente el de Virginia Henderson. Las motivaciones para la elección, según los estudiantes, son su uso en la enseñanza universitaria y la facilidad de ejecución del modelo. Se evidenció confusión entre los términos 'modelo conceptual y/o teórico' y 'metodología enfermera'