Obtenção de mimetismo em restauração de dente posterior através da técnica de estratificação com resinas compostas e corantes: Relato de caso / Obtaining mimicry in posterior tooth restoration through the technique of stratification with composite resins and tinted flowable composite: Case report

O objetivo do estudo foi relatar, através de um caso clínico, a realização de um tratamento restaurador usando resinas compostas e corantes, a partir da técnica de estratificação, visando mimetizar as características naturais de um dente posterior. Paciente com 32 anos, do gênero feminino, queixava-se de fratura de uma restauração. Após a constatação na fratura no dente 47, foi realizada a seleção de cor (A2) e a restauração foi removida. Realizou-se profilaxia da cavidade, aplicação de um sistema adesivo autocondicionante de 2 passos e fotoativação por 10 segundos. Na etapa restauradora, foi inserida uma camada de resina composta fluida, na parede pulpar, e a dentina foi mimetizada com 2 incrementos. A resina de esmalte cromtático foi aplicada e realizou-se a delimitação do perímetro das 4 cúspides. O corante ocre foi aplicado no fundo do sulco central e o branco na vertente das cúspides, e por fim, foi aplicada a resina composta de esmalte acromático, restabelecendo as características de textura. Todos os incrementos de resina foram foativados individualmente por 40º segundos. Posteriormente, foi realizado o ajuste oclusal e o acabamento e polimento da restauração. Concluiu-se que a técnica restauradora incremental, utilizando resinas compostas com diferentes graus de translucidez e opacidade associado a corantes é eficiente para mimetizar restaurações em dente posterior

Plan gallego de hospitalización a domicilio. Estrategia HADO 2019-2023

Documento estratéxico que pretende potenciar e consolidar a hospitalización a domicilio como un modelo asistencial do Servizo Galego de Saúde e garantir o seu desenvolvemento nos próximos seis anos, establecendo criterios homoxéneos de atención coa finalidade de normalizar os modelos asistenciais, carteira de servizos e fluxos de traballo para asegurar una asistencia sanitaria de calidadeDocumento estratégico que pretende potenciar y consolidar la hospitalización a domicilio como un modelo asistencial del Servicio Gallego de Salud y garantizar su desarrollo en los próximos seis años, estableciendo criterios homogéneos de atención con la finalidad de normalizar los modelos asistenciales, cartera de servicios y flujos de trabajo para asegurar una asistencia sanitaria de calida

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

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

Conocimientos y prácticas en sexualidad en gestantes y madres adolescentes de una IPS de primer nivel

INTRODUCCIÓN: Existe una preocupación relacionada con las estrategias implementadas para la educación sexual de los adolescentes, puesto que, a pesar de ser una problemática ampliamente estudiada, se continúa evidenciando un aumento en las tasas de gestantes adolescentes. OBJETIVO: Determinar conocimientos y prácticas en sexualidad de las gestantes y madres adolescentes de una institución de primer nivel de atención de Barranquilla en el periodo 2018-2019. MATERIAL Y MÉTODOS: Estudio cuantitativo, descriptivo transversal realizado en una IPS de Barranquilla. Se seleccionó una muestra de 237 gestantes y madres adolescentes, se analizaron variables como conocimientos, prácticas en salud sexual. Para el análisis estadístico se utilizó el programa SPSS versión 23 siendo tabulados, organizados, interpretados y analizados por frecuencia absoluta y porcentual. RESULTADOS: La edad predominante con un 47,3% oscilo entre 15 y 19 años. El 64,1% no relacionan el coito con el sexo, el 47,7% manifiesta que la Postday es un método anticonceptivo, y el 42,2% no sabe cómo se transmiten las infecciones de transmisión sexual. El 66,2% refieren que no utilizaron método anticonceptivo en su primera relación y un 8,9% no recuerda si lo usó. CONCLUSIONES: Los resultados obtenidos guardan una estrecha relación con las estadísticas nacionales en aspectos relacionados a la edad, la escolaridad y otros factores comunes relacionados con el embarazo a temprana edad. Lo que permite afirmar que la problemática del embarazo en adolescentes afecta a las diferentes regiones del país en proporciones similares

La nanocelulosa: Una estructura producida por la naturaleza

Las tecnologías disruptivas dan cuenta del poder que tiene la innovación para transformar las industrias, mejorar la calidad de vida y salvaguardar el planeta. Entre estas tecnologías, la nanotecnología está siendo aplicada en numerosos campos e impactando no solo distintas industrias sino también la vida cotidiana, al hacer cada vez más concreto el ideal de una materia programable, adaptativa y evolutiva, que será el recurso para el diseño y la implementación de soluciones a los grandes problemas que debe afrontar la sociedad del actual siglo. Nanotecnología: Fundamentos y aplicaciones, más que explicar contenidos teóricos, busca hacer posible que el lector se acerque al sentido del diseño y la manipulación de la materia a nivel de átomos o moléculas. A tal fin, la obra abarca un amplio haz de temas y variantes, como la obtención y la caracterización de nanomateriales; la aplicación en-áreas como el medio ambiente, la salud, la energética; la industria textil y la agroin- dustria; los aspectos fundamentales de regulación y normatividad, y los elementos y riesgos de salud ocupacional fue se deben considerar cuando se hace uso de esta tecnología, junto con consideraciones éticas. Esta obra está pensada tanto para académicos interesados o especializados en la materia (profesores, investigadores y estudiantes) como para industriales y personal del nivel técnico que se desempeñan en áreas de aplicación actual y futura de la nanotecnología.Fil: Zuluaga Gallego, Robin Octavio. Universidad Pontificia Bolivariana.; ColombiaFil: Serpa Guerra, Angélica María. Universidad Pontificia Bolivariana.; ColombiaFil: Velez Acosta, Lina María. Universidad Pontificia Bolivariana.; ColombiaFil: Gómez Hoyos, Catalina. Universidad Pontificia Bolivariana.; Colombia. Universidad de Buenos Aires. Facultad de Ingeniería. Departamento de Construcciones y Estructuras. Laboratorio de Materiales y Estructuras; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Castro Herazo, Cristina Isabel. Universidad Pontificia Bolivariana.; ColombiaFil: Casas Botero, Ana Elisa. Universidad Pontificia Bolivariana.; ColombiaFil: Osorio Delgado, Marlon Andrés. Universidad Pontificia Bolivariana.; ColombiaFil: Velázquez Cock, Jorge. Universidad Pontificia Bolivariana.; ColombiaFil: Torres Taborda, Mabel Milena. Universidad Pontificia Bolivariana.; ColombiaFil: Gañán Rojo, Piedad Felisinda. Universidad Pontificia Bolivariana.; ColombiaFil: Marin Quintero, Diana Catalina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; ArgentinaFil: Stefani, Pablo Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; Argentin