Relatório de estágio

Este relatório resulta de um processo de aprendizagem desenvolvido ao longo do Estágio no âmbito do Curso de Mestrado em Enfermagem, na área de Especialização Médico Cirúrgica. O Estágio decorreu ao longo de dois módulos distintos: o primeiro, Módulo III do curso, na área de opção Bloco Operatório que teve lugar no Bloco Operatório Central do CHLC-HSJ; e um segundo, Módulo I- Urgência que se desenvolveu em Israel - Haifa, no Rambam Health Care Campus, hospital de referência na área de Trauma e Eventos Multi-vítimas. O relatório descreve e fundamenta, analítica e reflexivamente as actividades desenvolvidas em estágio, com a finalidade de aquisição de competências inerentes à categoria de Enfermeiro Especialista em Enfermagem Médico-Cirúrgica, na assistência de enfermagem avançada ao doente adulto e idoso com doença grave, e em particular ao doente em estado crítico. Transversal a ambos os módulos de estágio, surgem duas áreas de interesse que são a Formação e a Comunicação. No módulo referente ao Bloco Operatório o objectivo elaborado dirigiu-se à melhoria da segurança e qualidade de cuidados prestados ao doente proposto para cirurgia major, através da sistematização e uniformização de procedimentos e actividades desenvolvidas pela equipa de enfermagem na área de cirurgia laparoscópica. No módulo referente à Urgência o objectivo elaborado foi o de desenvolver competências científicas, técnicas e relacionais especializadas na abordagem à vítima de trauma em situação de urgência/ emergência num ambiente cultural diferente. Os estágios em contextos específicos, Bloco Operatório e Urgência, experienciados em realidades socioculturais diferentes, Portugal e Israel respectivamente, permitiram uma análise e reflexão da prática, evidenciando a forma evolutiva da aquisição de competências na área de Especialidade Médico-Cirúrgica.This report results from a learning process carried out throughout the Practice developed under a Masters Course in Nursing, Medical Surgical Specialization area. The Practice took place over two separate modules: the first, Module III on Operative Room option that took place in the operating room of the CHLC-HSJ; and a second, Module I- Emergency that as developed in Israel-Haifa, Rambam Health Care Campus, an referral hospital in the area of Trauma and Multi-victims events. The report describes and justifies, analytical and reflexively activities on Practice, with the purpose of acquiring skills inherent in the category of Specialist Nurse in Nursing Medical Surgical Nursing Care, advanced patient adult and elderly with serious illness, and in particular to the patient in critical condition. Transversal to both modules of practice, there were two areas of interest - Training and Communication. In the module for the Operating Room the objective elaborated addressed the improvement of safety and quality of care provided to the patient for major surgery through the systematization and standardization of procedures and activities undertaken by the nursing staff in the area of Laparoscopic surgery. In the module for the Urgency order drafted was to develop scientific expertise, specialized in technical and relational approach to trauma victim in emergency/relief in a different cultural environment. The stages in specific contexts, Operating Room and Urgency, experienced in different sociocultural realities, Portugal and Israel respectively, has an analysis and reflection of practice demonstrating the evolutionary way of acquiring skills in Medical Surgical Specialty area

Ensino experimental das ciências e literacia científica dos alunos: um estudo no 1º ciclo do ensino básico

Este trabalho tem a ver com a promoção da literacia científica em alunos do 1º Ciclo do Ensino Básico através do ensino experimental das ciências e com o estudo das características sociológicas (Relações entre Sujeitos, Espaços e Discursos) que se estabelecem na sala de aula aquando da realização das actividades experimentais. Assim sendo, os principais objectivos consistiram em caracterizar a prática pedagógica (Pp) de duas professoras (uma que tinha participado no Programa de Formação em Ensino Experimental das Ciências para professores do 1º CEB e outra não) em função de características sociológicas (o Que e o Como da Pp) e relacionar essa prática com a aprendizagem científica dos alunos, nomeadamente, nas competências que exigem elevado nível de abstracção (competências cognitivas complexas), fomentadoras de elevado nível de literacia científica. Para a realização do trabalho tivemos em consideração as teorias de Bernstein, Vygotsky e Brunner e fundamentámo-nos em estudos já realizados pelo Grupo de Estudos Sociológicos da Sala de Aula ao nível do 1º e 2º CEB (Morais et al, 1993, 2000; Pires, 2002; Pires et al, 2004). Do estudo faziam parte duas turmas de 4ºano de escolaridade de duas escolas de uma cidade do interior, uma com 12 e outra com 14 alunos, e respectivas professoras. Os alunos tinham idades entre os 8 e os 10 anos e pertenciam a diferentes níveis socioeconómicos e culturais familiares. Foi implementada uma prática pedagógica com ensino experimental para os temas Realizar experiências com a electricidade; Realizar experiências com o ar e Realizar experiências com o som, observadas as aulas das duas professoras durante os temas e aplicados dois testes para avaliar, nomeadamente, o nível conceptual dos alunos e a sua capacidade de aplicação dos conhecimentos adquiridos em situações novas. Quase todos os alunos do estudo atingiram elevados níveis de literacia científica, ainda que tenham sido mais evidentes a nível do desenvolvimento conceptual (aferido a partir do desempenho nas competências cognitivas simples e complexas) do que a nível do desenvolvimento cognitivo e da capacidade de aplicação dos conhecimentos adquiridos na resolução de situações novas (aferidos a partir das competências cognitivas complexas). Também se verificou que das duas professoras do estudo, aquela que participou no Programa de Formação em Ensino Experimental das Ciências para professores do 1º CEB, realizou uma prática pedagógica com características mais promotoras do sucesso dos alunos, nomeadamente nas competências CC, do que aquela que não participou no Programa de Formação. This essay has to do with the promotion of the scientific literacy in Primary School Children through the experimental teaching of sciences and with the study of the sociological characteristics (relations between subjects, spaces and speeches) which are established in the classroom when doing the experimental activities. So, the main goals were the characterization of the pedagogical practice (Pp) of two teachers (one who had been a participant in the Training Program in the Experimental Teaching of Sciences for Primary School Teachers and the other didn´t) according to the sociological characteristics (the Who and the How of the Pp) and relate that practice with the scientific learning of the students, namely, in the competences which require a high level of abstraction (complex cognitive competences), promoters of a high level of scientific literacy. For the realization of the essay we considered the theories of Bernstein, Vygotsky and Brunner and we supported in already done studies by the Group of Sociological Studies of the Classroom at the level of Primary and Middle School ((Morais et al, 1993, 2000; Pires, 2002; Pires et al, 2004). This study considered two classes of the fourth grade of two schools from a city of the countryside, one with 12 and the other with 14 students, respectively and their teachers. The students’ ages were comprehended between the ages of 8 and 10 belonging to families with different socioeconomic and cultural backgrounds. It was implemented a pedagogical practice with the experimental teaching for the themes Doing experiences with the electricity; Doing experiences with the air and Doing experiences with the sound, the classes of two teachers were observed during the themes and two tests were applied to assess, namely, the conceptual level of the students and their capacity of application of the acquired knowledge in new situations. Almost all students of the study reached high levels of scientific literacy, though they have been more evident at the level of the conceptual development (measured from the development of complex and cognitive competences) than at the level of the cognitive development and of the capacity of application of the acquired knowledge in the resolution of new situations (measured from the complex cognitive competences). It was also checked that from both teachers of the study, that the one who took part in the Training Program in the Experimental Teaching of Sciences for Primary School Teachers, did a pedagogical practice with more promoting characteristics of the students’ success, namely in the CC competences, than that the one who didn’t take part in the training program

“Living Together with Dementia”—A psychoeducational group programme for family caregivers

Purpose: To evaluate the effectiveness of the psychoeducational programme “Living together with dementia” applied to a group of family caregivers of people with dementia. Design and Methods: A quasi‐experimental study with pretest and posttest and a 4‐month follow‐up. Fifteen family caregivers of people with dementia were recruited in a community care unit in northern Portugal. Results: A positive and statistically significant impact on these caregivers' burden was found. Practice Implications: The programme could be an important mechanism to train family caregivers of home‐dwelling people with dementia.info:eu-repo/semantics/publishedVersio

Is the chlorophyll derivative Zn(II)e6Me a good photosensitizer to be used in root canal disinfection?

The aim of this study was to assess antimicrobial efficacy and cytotoxic outcomes of a chlorophyll based photosensitizer (PS) Zn(II)chlorin e6 methyl ester (Zn(II)e6Me), when applied to human dentin discs and root blocks infected with 48 h biofilms. The results were compared with the ones obtained with FotoSan® (commercial Toluidine Blue O formulation) and 3% sodium hypochlorite (NaOCl).publishe

Quality of life in caregivers of patients with multiple myeloma

Objectives: This study aimed to assess the relationship between sociodemographic, clinical, and psychological variables with quality of life (QoL) and the moderating role of caregivers' age and caregiving duration in caregivers of patients with Multiple Myeloma.Method: The sample included 118 caregivers who completed questionnaires that assessed psychological morbidity, satisfaction with social support, coping, burden, unmet needs, and QoL.Results: High psychological morbidity, burden and information, financial and emotional unmet needs were associated with lower QoL, while higher satisfaction with social support and more effective use of coping strategies were associated with better QoL. Women caregivers reported more satisfaction with social support and those who did not choose to care reported greater financial unmet needs and more use of coping strategies. The relationship between caregivers' psychological morbidity/social support and QoL was mediated by emotional needs and double mediated by coping and burden. The caregivers' age moderated the relationship between psychological morbidity/social support and emotional needs.Conclusion: Interventions to support the caregiver's emotional needs to promote their QoL are needed. These should be particularly tailored for older caregivers reporting greater psychological morbidity and younger caregivers less satisfied with their social support, as they have a negative indirect impact on their QoL.Portuguese Associations of Portuguese Association against Leukemia and the PortugueseAssociation of Leukemias and Lymphoma

Comparison with adult-onset rheumatic diseases

Objective To compare physical disability, mental health, fatigue and health-related quality of life (HRQoL) across juvenile idiopathic arthritis (JIA) categories in adulthood and between JIA and adult-onset rheumatic diseases. Methods Cross-sectional analysis nested in a cohort of adult patients with JIA registered in the Rheumatic Diseases Portuguese Register (Reuma.pt). Physical disability (Health Assessment Questionnaire - Disability Index), mental health symptoms (Hospital Anxiety and Depression Scale), fatigue (Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-F)) and HRQoL (EuroQol-5D (EQ5D) and Short Form (SF-36)) were compared across JIA categories. Patients with polyarticular JIA and enthesis-related arthritis (ERA) JIA were compared respectively to patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA), matched for gender and age, adjusted for disease duration and activity. Results 585 adult patients with JIA were included. Comparison across JIA categories showed that persistent oligoarthritis and patients with ERA reported a higher score in EQ5D and SF-36 physical component when compared with other JIA categories. Polyarticular JIA reported less disability and fatigue than patients with RA (median Health Assessment Questionnaire of 0.25 vs 0.63; p<0.001 and median FACIT-F score 42 vs 40; p=0.041). Polyarticular JIA had also better scores on EQ5D and all domains of SF-36, than patients with RA. Patients with ERA reported less depression and anxiety symptoms (0% vs 14.8%; p=0.003% and 9% vs 21.3%; p=0.002) and less fatigue symptoms (45 vs 41; p=0.01) than patients with SpA. Conclusion Persistent oligoarticular JIA and ERA are the JIA categories in adulthood with better HRQoL. Overall, adult polyarticular and patients with ERA JIA have lower functional impairment and better quality-of-life than patients with RA and SpA.publishersversionpublishe

Burden, coping, physical symptoms and psychological morbidity in caregivers of functionally dependent family members

Objectives: this study assessed burden, coping, physical symptoms and psychological morbidity in caregivers of functionally dependent family members. Methods: fifty family caregivers completed self-reported measures of burden, physical symptoms, psychological morbidity and coping strategies. Results: there was a significant negative correlation between coping strategies and the different clinical variables, as well as a significant positive correlation between coping strategies and duration of care. It appears that the stronger bond between caregiver and family member leads to a poorer use of adaptive coping strategies. It also appears that the deterioration of the relationship between them and the lower perceived self-efficacy are more prominente in caregivers of family members with cognitive impairment, indicating that caregivers with family members without cognitive impairment face fewer difficulties. Conclusion: these results emphasize the need for interventions to include coping strategies, since they are important in reducing caregivers’ burden, psychological morbidity and physical symptoms

The GO-DACT protocol : a multicentre, randomized, double-blind, parallel-group study to compare the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy

© 2001-2020 Sociedade Portuguesa de ReumatologiaThe GO-DACT is an investigator-initiated, national, multicentric randomized placebo-controlled double-blinded trial, that assesses dactylitis as primary endpoint. Psoriatic arthritis patients naïve to methotrexate and biologic disease modifying anti-rheumatic drugs, with at least one active dactylitis, were assigned to golimumab in combination with methotrexate or placebo in combination with methotrexate, for 24 weeks. Both clinical (dactylitis severity score and the Leeds dactylitis index) and imaging (high resolution magnetic resonance imaging), among others, were assessed as outcomes. The main objective of GO-DACT is to provide evidence to improve the treatment algorithm and care of psoriatic arthritis patients with active dactylitis. In this manuscript we describe the GO-DACT protocol and general concepts of the methodology of this trial.info:eu-repo/semantics/publishedVersio

Risk factors for infection, predictors of severe disease, and antibody response to COVID-19 in patients with inflammatory rheumatic diseases in Portugal: a multicenter, nationwide study

Copyright © 2022 Cruz-Machado, Barreira, Bandeira, Veldhoen, Gomes, Serrano, Duarte, Rato, Miguel Fernandes, Garcia, Pinheiro, Bernardes, Madeira, Miguel, Torres, Bento Silva, Pestana, Almeida, Mazeda, Cunha Santos, Pinto, Sousa, Parente, Sequeira, Santos, Fonseca and Romão. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Objective: To identify risk factors for SARS-CoV-2 infection and for severe/critical COVID-19, and to assess the humoral response after COVID-19 in these patients. Methods: Nationwide study of adult patients with inflammatory RMDs prospectively followed in the Rheumatic Diseases Portuguese Register-Reuma.pt-during the first 6 months of the pandemic. We compared patients with COVID-19 with those who did not develop the disease and patients with mild/moderate disease with those exhibiting severe/critical COVID-19. IgG antibodies against SARS-CoV-2 were measured ≥3 months after infection and results were compared with matched controls. Results: 162 cases of COVID-19 were registered in a total of 6,363 appointments. Patients treated with TNF inhibitors (TNFi; OR = 0.160, 95% CI 0.099-0.260, P < 0.001) and tocilizumab (OR 0.147, 95% CI 0.053-0.408, P < 0.001) had reduced odds of infection. Further, TNFi tended to be protective of severe and critical disease. Older age, major comorbidities, and rituximab were associated with an increased risk of infection and worse prognosis. Most patients with inflammatory RMDs (86.2%) developed a robust antibody response. Seroconversion was associated with symptomatic disease (OR 13.46, 95% CI 2.21-81.85, P = 0.005) and tended to be blunted by TNFi (OR 0.17, 95% CI 0.03-1.05; P = 0.057). Conclusions: TNFi and tocilizumab reduced the risk of infection by SARS-CoV-2. Treatment with TNFi also tended to reduce rates of severe disease and seroconversion. Older age, general comorbidities and rituximab were associated with increased risk for infection and worse prognosis, in line with previous reports. Most patients with RMDs developed a proper antibody response after COVID-19, particularly if they had symptomatic disease.We acknowledge the generous sharing of the expression constructs by Dr. Florian Krammer, Icahn School of Medicine at Mount Sinai, New York, USA [Development of SARS-CoV-2 reagents was partially supported by the NIAID Centers of Excellence for Influenza Research and Surveillance (CEIRS) contract HHSN272201400008C] and the protein production by Drs. Paula Alves and Rute Castro at Instituto de Biologia Experimental e Tecnológica (iBET) Oeiras, Portugal as part of the Serology COVID consortium.info:eu-repo/semantics/publishedVersio

GO-DACT : a phase 3b randomised, double-blind, placebo-controlled trial of GOlimumab plus methotrexate (MTX) versus placebo plus MTX in improving DACTylitis in MTX-naive patients with psoriatic arthritis

© author(s) (or their employer(s)) 2020. Re-use permitted under CC BY- nC. no commercial re-use. see rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-­NC 4.0) license.Objectives: To assess the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy in psoriatic arthritis (PsA) dactylitis. Methods: Multicentre, investigator-initiated, randomised, double-blind, placebo-controlled, parallel-design phase 3b trial in 11 Portuguese rheumatology centres. Patients with PsA along with active dactylitis and naive to MTX and biologic disease-modifying antirheumatic drugs (bDMARDs) were randomly assigned to golimumab or placebo, both in combination with MTX. The primary endpoint was Dactylitis Severity Score (DSS) change from baseline to week 24. Key secondary endpoints included DSS and Leeds Dactylitis Index (LDI) response, and changes from baseline in the LDI and MRI dactylitis score. Analysis was by intention-to-treat for the primary endpoint. Results: Twenty-one patients received golimumab plus MTX and 23 MTX monotherapy for 24 weeks. One patient from each arm discontinued. Patient inclusion was halted at 50% planned recruitment due to a favourable interim analysis. Median baseline DSS was 6 in both arms. By week 24, patients treated with golimumab plus MTX exhibited significantly greater improvements in DSS relative to MTX monotherapy (median change of 5 vs 2 points, respectively; p=0.026). In the golimumab plus MTX arm, significantly higher proportions of patients achieved at least 50% or 70% improvement in DSS and 20%, 50% or 70% improvement in LDI in comparison to MTX monotherapy. Conclusions: The combination of golimumab and MTX as first-line bDMARD therapy is superior to MTX monotherapy for the treatment of PsA dactylitis.info:eu-repo/semantics/publishedVersio