Gestão da dor na pessoa em situação crítica vítima de trauma torácico

A dor é um fenómeno com uma elevada taxa de incidência na pessoa em situação crítica vítima de trauma torácico. Quando controlada de forma ineficaz, tem consequências nefastas. Apesar da importância que lhe é atribuída, as restantes necessidades da pessoa em situação crítica acabam por ser priorizadas face ao controlo da dor, podendo resultar num impacto negativo no outcome da pessoa. Na sua intervenção, o enfermeiro deve priorizar a gestão da dor visando a prevenção de complicações e a obtenção de resultados em saúde. O presente relatório de estágio pretende efetuar uma descrição e análise reflexiva do meu percurso de desenvolvimento de competências, tendo como objetivo geral: Desenvolver competências especializadas de enfermagem na gestão da dor na pessoa em situação crítica vítima de trauma torácico. A análise reflexiva foi suportada no modelo teórico de Dreyfus de aquisição de competências, adaptado por Benner (2001) para a prática de enfermagem, na Teoria do Conforto de Kolcaba (1994) e na Teoria da Vigilância de Meyer e Lavin (2005). Foi produzida uma revisão integrativa da literatura procedida da realização de estágios nos contextos de serviço de urgência e unidade de cuidados intensivos, que permitiram a concretização dos objetivos e das competências definidas para este Curso de Mestrado, bem como das competências do enfermeiro especialista na área da pessoa em situação crítica preconizadas pela Ordem dos Enfermeiros. A produção deste trabalho permitiu articular a evidência científica com a prática clínica durante a realização dos estágios, contribuindo para a melhoria da qualidade dos cuidados prestados e culminando no desenvolvimento de competências especializadas de enfermagem na área da pessoa em situação crítica.Pain is a phenomenon with a high incidence rate in the critically ill person who has suffered thoracic trauma. When ineffectively controlled, it has harmful consequences. Despite the importance assigned to it, the other needs of critically ill patients are prioritized over pain control, which may have a negative impact on the patient's outcome. In their intervention, nurses should prioritize pain management aimed at preventing complications and achieving health outcomes. This internship report aims to describe and analyse my skills development process, with the following general objective: To develop specialized nursing skills in pain management in critically-ill patients with chest trauma. The reflective analysis was based on Dreyfus' theoretical model of skill acquisition, adapted by Benner (2001) for nursing practice, Kolcaba's Comfort Theory (1994) and Meyer and Lavin's Theory of Vigilance (2005). An integrative literature review was conducted, followed by internships in emergency departments and intensive care units, which allowed achieving the objectives and competencies defined for this Master's Degree, as well as the competencies of the specialist nurse in the area of critically ill patients recommended by the Ordem dos Enfermeiros (Portuguese Nurses Association). This study allowed for the articulation between the scientific evidence and the clinical practice during internships, thus contributing to improve the quality of the care provided and culminating in the development of specialized nursing skills in the area of critically ill patients

Gestão da dor na pessoa em situação crítica vítima de trauma torácico:uma revisão integrativa da literatura / Pain management in critically ill thoracic trauma patients: an integrative literature review

Introdução: A dor na pessoa em situação crítica vítima de trauma torácico tem-se revelado como o principal fator de risco para o agravamento e surgimento de comorbilidades, sendo por isso imprescindível que os enfermeiros incorporem uma intervenção multimodal na gestão da dor, com o intuito de obter um melhor outcome. Objetivos: Identificar quais as intervenções de enfermagem para a gestão da dor na pessoa em situação crítica vítima de trauma torácico. Metodologia: Revisão Integrativa da Literatura (RIL) desenvolvida através da pesquisa científica nas bases de dados CINHAL® e MEDLINE®. Os procedimentos metodológicos têm como objetivo responder à seguinte questão de investigação: “Quais as intervenções de enfermagem na gestão da dor na pessoa em situação crítica vítima de trauma torácico?” Resultados: Do processo de identificação, seleção e elegibilidade, resultaram 48 artigos, publicados entre 2016 e 2021, dos quais foram incluídos nove artigos para análise e extração de dados. Conclusão: É emergente a realização de estudos de enfermagem com foco nesta temática, com vista a prestação de cuidados de enfermagem baseados em evidência. A literatura destaca que deve ser realizada uma intervenção multimodal, onde a comunhão entre intervenções farmacológicas e não-farmacológicas se revela estruturante para uma gestão eficaz da dor na pessoa em situação crítica vítima de trauma torácico

Regular crianças com PEA durante a sua participação nas AVD`s

Introdução: Crianças com PEA são caracterizadas por apresentarem respostas atípicas aos estímulos sensoriais, tendo impacto no envolvimento e na participação funcional. Objetivo: O presente estudo descreve o processo de desenvolvimento de uma app com o intuito de ajudar as famílias a regular as crianças com PEA, entre os 3-6 anos, através da aplicação de estratégias sensoriais, para melhorar a participação da criança nas rotinas diárias, em contexto de casa. Material e Métodos: Para o estudo foi selecionado um focus group composto por quatro terapeutas ocupacionais com vários anos de experiência em trabalhar com crianças com PEA e com formação especializada na área da Integração Sensorial, de forma a desenvolver e a analisar o conteúdo da app. Estabeleceu-se uma colaboração com o Departamento de Engenharia Informática, e através de reuniões quinzenais conjuntas, foi possível desenvolver toda a configuração e programação da app de forma articulada. Resultados: “Regul-A” foi o nome atribuído à app, uma vez que apresenta como principal finalidade ajudar na regulação de crianças com PEA. Os resultados abrangem as diversas estratégias sensoriais selecionadas pelo focus group, assim como, a estrutura da app, desenvolvida em colaboração com o Departamento de Engenharia Informática. Conclusões: Acredita-se que a app “Regul-A” venha a constituir-se uma potencial ferramenta para reunir, analisar e gerir dados da criança relativos ao seu desempenho ocupacional, facilitando a implementação de estratégias e a partilha de informação entre os pais e os terapeutas ocupacionais.Introduction: Children with ASD are characterized by atypical responses to sensory stimuli, which have an impact on involvement and functional participation. Goals: This study describes the several steps of an app development that intends to help families to regulate children with ASD aged 3-6 years old through the application of sensory strategies to improve participation in daily routines in home setting. Material and Methods: To develop and analyze the content of the app, a study was performed by a focus group formed by four occupational therapists with several years of experience in working with children with ASD and with specialized training in Sensory Integration Therapy. A collaboration was established with the Department of Computer Engineering of Polytechnic of Leiria, and through biweekly meetings it was possible to develop the entire configuration and programming of the app. Results: “Regul-A” is the name assigned to the app, since it has the main purpose to help parents regulate children with ASD. The results cover the various sensory strategies selected by the focus group, as well as the structure of the app. Conclusions: It is believed that the “Regul-A” app will become a potential tool to gather, analyze and manage children's data related to their occupational performance facilitating the implementation of strategies and the sharing of information between parents and occupational therapists.info:eu-repo/semantics/publishedVersio

Proof-of-Concept Study of Multifunctional Hybrid Nanoparticle System Combined with NIR Laser Irradiation for the Treatment of Melanoma

Abstract: The global impact of cancer emphasizes the importance of developing innovative, effective and minimally invasive therapies. In the context of superficial cancers, the development of a multifunctional nanoparticle-based system and its in vitro and in vivo safety and efficacy characterization are, herein, proposed as a proof-of-concept. This multifunctional system consists of gold nanoparticles coated with hyaluronic and oleic acids, and functionalized with epidermal growth factor for greater specificity towards cutaneous melanoma cells. This nanoparticle system is activated by a near-infrared laser. The characterization of this nanoparticle system included several phases, with in vitro assays being firstly performed to assess the safety of gold nanoparticles without laser irradiation. Then, hairless immunocompromised mice were selected for a xenograft model upon inoculation of A375 human melanoma cells. Treatment with near-infrared laser irradiation for five minutes combined with in situ administration of the nanoparticles showed a tumor volume reduction of approximately 80% and, in some cases, led to the formation of several necrotic foci, observed histologically. No significant skin erythema at the irradiation zone was verified, nor other harmful effects on the excised organs. In conclusion, these assays suggest that this system is safe and shows promising results for the treatment of superficial melanoma

Proof-of-Concept Study of Multifunctional Hybrid Nanoparticle System Combined with NIR Laser Irradiation for the Treatment of Melanoma

Supplementary Materials - available online at https://www.mdpi.com/article/10.3390/biom11040511/s1The global impact of cancer emphasizes the importance of developing innovative, effective and minimally invasive therapies. In the context of superficial cancers, the development of a multifunctional nanoparticle-based system and its in vitro and in vivo safety and efficacy characterization are, herein, proposed as a proof-of-concept. This multifunctional system consists of gold nanoparticles coated with hyaluronic and oleic acids, and functionalized with epidermal growth factor for greater specificity towards cutaneous melanoma cells. This nanoparticle system is activated by a near-infrared laser. The characterization of this nanoparticle system included several phases, with in vitro assays being firstly performed to assess the safety of gold nanoparticles without laser irradiation. Then, hairless immunocompromised mice were selected for a xenograft model upon inoculation of A375 human melanoma cells. Treatment with near-infrared laser irradiation for five minutes combined with in situ administration of the nanoparticles showed a tumor volume reduction of approximately 80% and, in some cases, led to the formation of several necrotic foci, observed histologically. No significant skin erythema at the irradiation zone was verified, nor other harmful effects on the excised organs. In conclusion, these assays suggest that this system is safe and shows promising results for the treatment of superficial melanoma.The authors would like to thank to Fundação para a Ciência e Tecnologia (FCT) for the essential financial support under the project’s references PTDC/BBB-BMC/0611/2012, UIDB/00645/2020, UIDB/04138/2020 and UIDP/04138/2020 as well as for the PhD fellowships SFRH/BD/148044/2019 and SFRH/BD/147306/2019.info:eu-repo/semantics/publishedVersio

Refinement of animal model of colorectal carcinogenesis through the definition of novel humane endpoints

This study aimed to define appropriate humane endpoints (HEs) for an animal model of colorectal carcinogenesis (CRC). Twenty-nine male Wistar rats were divided into two control groups (CTRL1 and CTRL2) injected with ethylenediamine tetraacetic acid (EDTA)–saline solutions and two induced groups (CRC1 and CRC2) injected with 1,2-dimethylhydrazine (DMH) for seven weeks. A score sheet with 14 biological parameters was used to assess animal welfare. Groups CRC1 and CTRL1 and groups CRC2 and CTRL2 were euthanized 11 and 17 weeks after the first DMH administration, respectively. Five animals from the induced groups died unexpectedly during the protocol (survival rates of 75.0% and 66.7% for groups CRC1 and CRC2, respectively). The final mean body weight (BW) was smaller in the CRC groups when compared with that in the CTRL groups. A uniformity of characteristics preceding the premature animals’ death was observed, namely an increase of 10% in mean BW, swollen abdomen, diarrhea, and priapism. The surface abdominal temperature of group CRC2 was significantly higher, when compared with that of group CTRL2. The parameters already described in other cancer models proved to be insufficient. For the CRC model, we considered assessing the abdominal temperature, priapism, and sudden increase in the BW

Assessing the virulence potential of different Listeria monocytogenes clonal complexes with Galleria mellonella larvae model

Listeria monocytogenes is a highly diverse species, exhibiting differential virulence potential within strains from different clonal complexes (CCs). Hypervirulent CCs strains tend to be associated with higher frequency in clinical cases and severe outcomes, while hypovirulent CCs are characterized by a reduced level of virulence and are often associated with food-related contamination. Recently, researchers have employed Galleria mellonella larvae as an in vivo model to characterize these variable virulence patterns among Listeria strains. Although it has only been utilized once to study CC-related virulence thus, there is still uncertainty about its relevance as an in vivo model. Infection studies with G. mellonella larvae were performed to evaluate the virulence potential of 16 Lm strains from CC1, CC2, CC4, CC6, CC388, CC87, CC9 and CC121. Hence, the survival rate and health index scores of larvae were used to quantify the virulence capacity of this pathogen. Results obtained indicate that: the CC2 strain exhibited a hypovirulent phenotype in the larvae with the highest survival rate and health index scores, followed by two strains from CC1 and CC6. In contrast, another CC6 strain exhibited reduced larvae survival rates, followed by the CC4 strain. Furthermore, strains from CC9, which is considered hypovirulent, caused around 47% mortality (Figure 1). Our findings revealed clear variations in virulence patterns that were previously determined with other in vitro and in vivo models. Moreover, it was observed a strain-dependent intra-clonal complex virulence difference in the infection of G. mellonella larvae. Additionally, by eliminating the dependence of L. monocytogenes strains on the inlA gene for host cell invasion, it was observed that hypovirulent clones demonstrated an infection potential equal to or greater than that of hypervirulent strains. Hence, there are still virulence markers that need to be characterized to improve the genotypic distinction of these CCs.This work was supported by National Funds from FCT - Fundação para a Ciência e a Tecnologia through project GenoPhenoTraits4Persitence - Genomic and phenotypic traits contributing to persistence of Listeria monocytogenes in food processing environment (PTDC/BAAAGR/4194/2021).info:eu-repo/semantics/publishedVersio

Care4Value:measuring value in health in integrated continuous care units

Objective: To develop a digital platform for optimizing data collection processes with medical scales and monitoring data for measuring value in health. Method: Using an investigative intervention methodology, a platform was developed including qualitative and quantitative approaches in three phases: focal groups were conducted by a multidisciplinary team of investigators and healthcare providers at the pilot study site, an Integrated Continuous Care Unit (UCCI); data from a sample of 21 UCCI users was analyzed as a pre-test to classify different levels of complexity; UCCI financial data and operational costs were collected and analyzed during the 21 users stay at the UCCI. The platform’s iteractive and incremental development allowed for the collection of as a form of improvement. Results: The platform includes three modules: a mobile application; a dashboard; and an import module. Data collected on the platform are centralized and shown on the dashboard. Data are collected using a mobile application and/or an import module to input data from existing medical systems. Conclusion: The mobile application is ready to be used by healthcare providers and caregivers. The dashboard shows users’ clinical follow-up and health gain data for monitoring.info:eu-repo/semantics/publishedVersio

Lee Index variation and glucose clearance rate in an animal model of obesity with animals supplemented with Ganodema lucidum

The consumption of diets high in sugars and saturated fat are associated with obesity and other comorbidities, as well as glucose intolerance1. Obesity can be influenced by the regular consumption of natural bioactive compounds like those found in Ganoderma lucidum mushroom (GL)2. The main objective of this work is to determine body mass variations (Lee Index) and serum glucose levels in animals fed with diets supplemented with three concentrations of an hydroethanolic extract of GL. The fruiting bodies of GL were provided by Bioreishi- Agricultura Bioliogica, Lda. Forty-eight male mice (C57BL/6) were acquired and divided into 5 groups: G1-Western Diet 0.2% Cholesterol (WD); G2-Western Control (WC); G3-WD+0.7%g/kg of G. lucidum; G4-WD+1.4%g/kg of G. lucidum; G5- WD+2.8%g/kg of G. lucidum. At 7th and 13th weeks of study, the animals were measured (nasoanal distance in cm) in order to calculate the Lee Index (cubicle root of the weight (g)/the nasoanal length (cm) x 1000). Obesity was defined by a Lee index>310. Glucose intolerance test was performed on 4 animals in each group. The animals were fasted overnight and in the early morning, a 50% glucose solution (2g/kg) was injected intraperitoneally. Blood samples were collected one hour before glucose (time zero) administration and 30, 60 and 120 minutes later. Serum glucose was determined with the OGCare equipment. Glucose concentration values at time zero were considered control values. All ethical issues were followed (approval nº 8776). The chemical composition of the extract was profiled by HPLC-DAD-ESI/MS. All data were analyzed using the GraphPad Prism® for Windows software (version 7.0). Ganoderic acid H and p-hydroxybenzoic acid were the main triterpenic and phenolic acids found in the extract, respectively. In respect to the Lee index, the values show that all animals in the experimental groups became obese. In both weeks, G5 showed the highest values (353.45 ± 12.43 and 351.77 ± 12.24 respectively). At week 7, G1 and G2 differed statistically (p<0,05) from G5. Although G1 and G2 have the lowest Lee values in both weeks, they are the only ones that increase from week 7 to week 13, in contrast to the groups supplemented with GL. Regarding the glucose intolerance test, recorded glucose values at 30 minutes after the injection were increased in all groups, returning to normal values two hours later. At 13th week, the glucose values were increased in all groups in the 30 and 60 minutes after the intraperitoneal injection. At the end of two hours, the values decreased, but did not return to normal values in all the groups. Although animals in all experimental groups remained obese, animals supplemented with GL decreased their Lee Index. At 7th week the animals showed a normal glucose clearance, but in the last week of the study glucose values did not return to the values initially recorded after two hours, showing that the animals were not able to maintain the glucose clearance rate.This work was supported by VALORIZEBYPRODUCTS Project, reference n.º029152; CIMO (UIDB/00690/2020); Project MicoCoating (PDR2020-101-031472); and L. Barros thanks the national funding by FCT, P.I., through the institutional scientific employment program-contract. No conflict of interest was declared.info:eu-repo/semantics/publishedVersio

Ganoderma lucidum in an animal model of obesity: preliminary results

Obesity is an emerging health problem worldwide. Hypercaloric or hyperlipidemic diets have been used as models of obesity induction in laboratory animals. Obesity can be influenced by regular consumption of natural bioactive compounds. Mushrooms, such as Ganoderma lucidum (GL), have been used in the human diet since ancient times and include a wide variety of biomolecules with medicinal properties. The main objective of this work was to study the effects of G. lucidum in an animal model of obesity.info:eu-repo/semantics/publishedVersio